Childhood Trauma and the Mentally Ill Parent: Reconciling Moral and Medical Conceptions of “What Really Happened”

Jason Thompson’s “Imaginative reworking” of “an internal narrative about past trauma” has clearly served its purpose. Thompson was able to forgive his abusive mother and “return to life” after a bout of suicidal depression.

Effectiveness is surely what matters most when it comes to any form of therapy, but it is not always all that matters. When the therapy involves reconstructing (however imaginatively) childhood trauma, conformity to fact is important in some cases although irrelevant, and perhaps even impossible, in other cases. Did the hurtful behavior begin at age four and a half or five? Was the behavior the result of autonomous choice or mental illness? Getting the answer to the first question right seems far less important than getting the answer to the second question right (or at least not wrong). Indeed, I agree with Christian Perring’s suggestion (2010) that getting the answer to the second question right may have fueled Thompson’s preoccupation with discovering the “Truth of What Really Happened.”

Thompson does not seem to attribute his mother’s hurtful behavior to autonomous choice— at least not explicitly. He seems more inclined to attribute it to mental illness, to a “damaged psyche.” As he explains, “There was an objective dimension to the suffering my mother experienced and its transmission into my life” (2010, 250). Nevertheless, there is a subtle tension in Thompson’s characterizations of his mother’s troubles. In some cases, these are described in moral terms; elsewhere, they are described in medical terms. There is a tension here only because we do not generally regard attitudes and behaviors resulting from illness as suitable phenomena for characterization in moral language. Moral characterization suggests moral agency and thus amenability to blame—but how can we blame someone for attitudes and behaviors stemming from illness? To do so would only be to add insult to injury. A man commits suicide over family and financial pressures. Was his suicide the act of a cowardly man or a mentally ill man? To opt for the former characterization is to suggest (but not entail) the presence of moral agency; to opt for the latter characterization is to suggest the absence (or diminution) of such agency.

My aim in this brief commentary is four-fold. After spelling out the aforementioned tension, I attempt to resolve it. I then note the limitations of the proposed resolution, after which I comment on their significance.

Let’s begin by looking more closely at the tension in question. Thompson sometimes characterizes his mother’s troubles in moral terms. She is “abusive” and “spiteful”; she offers a “curt reproof” in response to his mediocre exam grades, over which he is visibly distraught. Instead of consoling Thompson, she “leaves him” in his room, alone. At other times, Thompson characterizes his mother’s troubles in medical terms. She suffers from a “mental illness,” she has a “disorder” that becomes “florid” during his adolescence. She has a “damaged psyche.” The tension here is a pragmatic (or rhetorical) one, rather than a semantic (or logical) one. As noted above, to characterize attitudinal or behavioral traits in moral terms is to suggest (but not entail) the presence of moral agency; to attribute a medical etiology to such traits is to suggest the absence of such agency.

Perhaps the tension can be resolved by disambiguating the notion of “moral” traits. “Deeply” moral traits might be defined as those for which the subject is (to some degree) morally responsible; “superficially” moral traits might be defined as those that can be characterized, accurately and literally, in moral language. Although deep morality entails superficial morality, superficial morality does not entail deep morality. The Alzheimer’s patient is “rude” to her caring husband; the schizophrenic patient is “hostile to” and “unduly suspicious of” his own mother; the autistic patient feels “no compassion for” his terminally ill friend. Yet none of these patients are morally responsible for their decidedly antisocial attitudes and behaviors. For those traits are the product, not of autonomous agency, but of...