Distressed But Not Helpless
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Both woody and Wharne provided insightful commentary on my view that survivors of trauma have a duty to repair any impaired natural powers caused by symptoms of trauma by seeking empirically informed treatment. While Woody agrees with the main aspects of my view, they disagree with the motivation for seeking treatment. Woody argues that the “helplessness” caused by symptoms of post-traumatic stress disorder (PTSD) should motivate survivors to pursue treatment. I disagree with this characterization and will discuss my concerns in the first part of this reply.
Wharne contends that the symptoms of PTSD should be characterized as understandable responses to trauma rather than deviations from normal experience. We should seek to understand why the survivor of trauma is experiencing these symptoms rather than coldly excising the perceived aberrations. While I agree that we cannot simply remove symptoms of trauma like cancerous tumors, I maintain that these symptoms must be treated in order to reduce distress. I will discuss and respond to Wharne’s concerns in the second part of this reply.
Woody and Helplessness
Woody describes the experience of trauma as “overwhelming,” creating the feeling of being “derealized,” a sense “loss of agency,” and overall rendering the survivor “helpless.” Woody argues that the helplessness created by trauma provides sufficient impetus for a survivor to seek treatment. Woody rightfully attributes some of these sensations to flashbacks or reexperiencing the traumatic event, a symptom of PTSD listed in the DSM-5 (American Psychiatric Association, 2013). Other symptoms like intrusive memories, nightmares, memory loss associated with the traumatic event, and “feelings of detachment or estrangement from others” (American Psychiatric Association, 2013) can all further contribute to feelings of helplessness. However, while the symptoms of trauma may create feelings of helplessness, these sensations do not render the individual helpless and in many cases does not motivate the survivor to seek treatment.
The fictional Sandra from the original article, for instance, is not rendered helpless by her symptoms. Sandra experiences many of the symptoms of trauma that can generate a feeling of helplessness and I conclude that these symptoms “impair Sandra’s ability to respond appropriately to morally-relevant reasons and stimuli.” While this impairment is severe, I also argue that Sandra is able to seek treatment for these symptoms and “repair the relevant faculties.” Survivors feel the impact of the symptoms of trauma but are still capable of seeking treatment. Woody does not [End Page 165] dispute this, but argues that feelings of helplessness lead survivors to seek treatment. As it turns out, survivors of trauma choose to seek or not seek treatment based on a variety of reasons, including symptom severity (Gavrilovic, Schützwohl, Fazel, & Priebe, 2005). Yet not all survivors who feel “helpless” seek treatment.
As I discussed above, feelings of helplessness can be created by a number of trauma symptoms yet only 53% to 33% of survivors seek treatment (Roberts, Gilman, Breslau, Breslau, & Koenen, 2011). Survivors of trauma do not seek treatment for a variety of reasons (Kantor, Knefel, & Lueger-Schuster, 2017). A metanalysis found that survivors of trauma did not seek treatment because they were not well-informed about mental health, they experienced difficulties accessing services, they worried about stigma and shame, they could not afford treatment, amidst other reasons (Kantor et al., 2017). While symptom severity may motivate some survivors to seek treatment (Gavrilovic et al., 2005), we cannot ignore that one-half of all survivors will not seek treatment despite feelings of helplessness.
This is why it is important to motivate the duty to seek treatment through Kantian natural powers rather than through the symptoms of trauma alone. No matter how a survivor perceives their symptoms, as long as they impair their moral faculties they have a duty to seek treatment. The individual does not need to feel helpless and helplessness need not motivate the individual to seek treatment.
Furthermore, we might worry that someone who is helpless cannot be subject to certain kinds of obligations. Seeking treatment can be an emotionally and practically difficult process. It seems excessively onerous to require someone who is helpless to seek out and participate in this process. My Kantian account stipulates...
