Coping in plain sight: Work as a local response to event-related emotional distress in contemporary U.S. society

Why trauma and event-related emotional distress is always “local” distress

DSM-IV attempts to identify types of trauma and event-related emotional distress by severity of traumatic or emotional reaction and also by the type of event triggering a traumatic or severe emotional response. For example, a reaction that can be diagnosed as posttraumatic stress disorder (PTSD) needs to be both intense, involving strong feelings of fear, helplessness, or horror, and long lasting, persisting for at least a month after the triggering event. A reaction that lasts less than a month or that involves less intense levels of subjective fear or helplessness, would be diagnosed as something other than PTSD, for example, an “adjustment disorder” of some kind. But DSM-IV also implies that some triggering events are much more likely than others to result in severe trauma or emotional distress. For example, it notes that personal experience of events that involve actual or threatened death or serious physical injury to self or other, especially when human caused, such as military combat, physical assault, kidnapping, hostage taking, torture, or incarceration are more likely to result in severe trauma than less intense threats, threats that are not directly and personally experienced, or those that are not human caused, such as natural disasters.

The DSM-IV strongly implies, then, that the most severe traumatic and emotional reactions are a direct result of the most severe triggering events (as defined by the DSM-IV) and that this relationship will hold across persons and social and cultural contexts. But note that both empirically and logically, the two means for identifying or suspecting trauma and severe emotional distress might not always align so neatly: that is, people sometimes have very intense and long-lasting reactions to events that are not life threatening per se, such as prolonged emotional abuse or deprivation, severe discrimination, or indirect and second-hand exposure to accidents and natural disasters. And conversely, people are sometimes extremely resilient in the face of even life-threatening events. It is exactly this kind of misalignment between the external forces impinging on people and their actual consequences for people that led the anthropologist and psychoanalyst George Devereux to observe:

It is one of the main faults of psychiatric thinking that it considers only the absolute intensity of the stress-producing impact [of impinging forces] and forgets that the individual may have valuable resources at his disposal for resisting and overcoming the impact he has experienced. In other words, an ordinary rifle bullet can penetrate the thick skin of a tiger and kill him, but it will only bounce off the back of a crocodile. (Devereux, 1980, p. 9)

Devereux gives several ethnographic and historical examples to illustrate this variability in response to stressful situations. He suggests, for example, that an Athenian mother was probably more traumatized and distressed than a Spartan mother by the loss of a son in battle because “the latter was conditioned by her culture to take pride and comfort in sacrificing a son to the city-state” (Devereux, 1980, p. 9). But while the loss of a son in battle might have been expected and even celebrated by Spartan parents, it might still be traumatic or severely distressing, according to Devereux, were they to lose more than one or several sons in battle or if they were to lose their one and only son. These latter losses, though culturally expected, might carry an emotional intensity that could overwhelm whatever comfort or buffering the culture could provide. Culturally anticipated stresses might also become overwhelming or traumatic for people when they are unable to utilize whatever buffering resources the culture might provide. According to Devereux, this can come about because one is too young to have learned how to use a buffering resource properly or because one is denied access to a buffering resource, either because of one’s age, gender, social class, religion, ethnicity, etc. A young Spartan boy who lost an older brother in battle was probably less likely to find solace in his brother’s sacrifice for the city-state than were his parents, and any survivor whose deceased son or relative was denied, for whatever reasons, the honor of claiming a legitimate sacrifice in battle would likely have suffered much more than those whose sons could.

Devereux also mentions that very atypical, idiosyncratic problems or stressors may or may not lead to trauma or severe emotional distress, depending on the availability of buffering resources. For example, he notes that the Turkish warrior, Tamerlane, was able to become “the sovereign of his people and leader of an immense military empire” (Devereux, 1980, p. 10) despite being lame from a severe leg wound because in Eurasian steppe culture, great exploits were accomplished on horseback, not on foot. He did not have to walk or run to become a great warrior and leader of soldiers. The opposite was the case for the North American Crow warrior, Takes-the-Pipe, however. Because of a severe limp, he “could not set out on foot and return astride a horse he had stolen from the enemy” and because of this, he did not qualify to become a chief. Takes-a-Pipe reacted to this stressful situation, apparently, by “becoming a Crazy-Dog-Wishes-to-Die” (Devereux, 1980, p. 10).

Devereux’s main point here, and the one I want to underscore for the purposes of this article, is that what is experienced as stressful and/or traumatic is culturally and individually variable, depending on how much one is exposed not only to physical threat and harm, but also to assaults on or erosions of one’s identity, honor, self-esteem, dignity, etc., and that it matters greatly how these threats or assaults are conceptualized and given meaning (or not). Because vulnerability to stressors is so directly linked to cultural meanings and buffering resources, all severe and traumatic reactions must necessarily be “local” reactions, with both their expression and their healing being entangled with local cultural meanings as well—a finding now supported by many studies in contemporary cultural psychiatry (e.g., Dwyer & Santikarma, 2007; Hinton, 2007; Hinton, Hinton, Pich, Loeum, & Pollack, 2009; Hollan, 2009; Kirmayer, 2007, 2009).

The use of cultural resources to express and cope with emotional distress

Although Devereux was an early pioneer in the study of how culture is implicated in the experience and expression of emotional distress, anthropologists such as Melford Spiro (1972, 1987) and Gananath Obeyesekere (1981, 1990) have developed these ideas further. I focus on Spiro and Obeyesekere here because while there a number of anthropologists who have examined how communities identify and respond to relatively severe mental illness and psychiatric disorders of various kinds once they have already arisen and developed (Biehl, 2005; Good & Subandi, 2004; Jenkins, 2004; Luhrmann, 2008), Spiro and Obeyesekere, like Devereux, were more interested in how cultures weave emotion, both pleasant and unpleasant, into the basic fabric of social life, often normalizing or containing emotional distress in nonstigmatized ways. Spiro, for example, has argued that emotional distress is only likely to gain open, unmediated expression when the distress is idiosyncratic enough that no readily available cultural resources exist to contain it, when the distress is more typical but when the readily available buffering resources have been inadequately taught or learned (see the discussion above), or when the distress is more typical, but because of rapid social or cultural change, the cultural resources once available to contain and/or ameliorate the distress are no longer available (Spiro, 1987, p. 159).

But Spiro is particularly intrigued by instances in which cultural resources are available to help cope with distress. With regard to them, he distinguishes between cases in which the resources available merely help to express, contain, or disguise the distress from those in which the cultural resources actually help to ameliorate or resolve distress (Spiro, 1972, p. 599). But in either of these cases, Spiro notes how emotional distress might actually be used to motivate the performance of culturally valued roles and behaviors, rather than disrupt or interfere with them (Spiro, 1972, 1987). His classic example of this is how Buddhist monasteries may allow certain troubled individuals to escape the pressures and expectations of everyday life in a way that in turn, provides the community with highly valued religious services of various kinds.

Obeyesekere has also examined the ways in which cultural resources may be used to help cope with personal distress, through a process that he refers to as the “work of culture” (1981, 1990). He uses the concept of “work” to suggest that the expression and/or transformation of personal distress into nonstigmatized culturally communicable forms, though potentially therapeutic, may take considerable effort and time to achieve, and that such efforts may as easily fail as succeed. This process unfolds in two, primary ways. In “objectification,” there is a relatively close match between the distress that a person needs or wishes to express and preexisting, readily available roles or institutions that enable that conventionalized emotional expression and containment. It may take time to learn the role or the culturally valued behavior appropriately, but once learned, the emotional distress is readily sublimated, as when a person consumed with guilt learns to enact culturally valued, conventionalized forms of penance. In “subjectification,” however, there is not a good match between emotional distress and preexisting cultural roles or behavior, and a person, usually nonconsciously, begins to manipulate the existing cultural resources so as to achieve a better match. To return to the example immediately above, if a person consumed with guilt does not find existing forms of conventionalized penance either satisfying or ameliorative, he or she may attempt to manipulate the existing forms into something more ameliorative or might attempt to introduce some new form of penance into the existing cultural repertoire, thereby changing the culture along the way.

Both Spiro and Obeyesekere suggest, then, that the extent to which cultural resources disguise, contain, and/or help resolve and heal emotional distress depends upon how they are being used by various individuals. The same cultural resource that might help one person at one point in time contain or even heal psychiatric distress, may merely conceal it or even exacerbate it for another (see Hollan, 2004). And these usages for any given individual can and do change over time: a resource that is being used adaptively at one point in time may be used defensively and maladaptively at another time and vice versa. This accords well with the insightful clinical observations of Rousseau and Measham (2007, pp. 289–290) that recovery from trauma and severe emotional distress is always a complex, nonlinear process that involves multiple and contradictory meanings. As they note,

Research has shown that people who undergo trauma may continue to be able to function despite experiencing symptoms that wax and wane over a long period, depending on internal and external environmental factors [including work] … During this time, the traumatic experience continues to transform the individual. It is clinically naïve to expect that, following catastrophic trauma, health will be manifested either by an enduring absence of symptoms or by a return to a previous state. Instead, the effect of psychic trauma may be to transform the person, who is also continuing on a developmental trajectory. The manifestation of symptoms is one aspect of the metamorphosis to a new state of equilibrium. (Rousseau & Measham, 2007, p. 280)

Emotional distress among middle-class Americans in a southern California psychotherapeutic practice

For over twenty years now, I have maintained a small, part-time research psychotherapy and psychoanalytic practice in southern California. My clientele has consisted primarily of middle-class students and working people, of a variety of races and ethnicities, who could afford a relatively low fee for consultation, since even those with health insurance usually did not have psychotherapy coverage—a situation all too typical in the contemporary U.S. in an age of biological psychiatry. Most of the people with whom I have worked come in complaining of problems with depression, anxiety, or both, and many of them have tried psychiatric medication before consulting me, only to discover that they were still suffering or unhappy. I believe this clientele is fairly typical of psychotherapeutic practices throughout the contemporary U.S.: people who have the means to try talk therapy even if their insurance companies do not pay for it, and people who either want to avoid taking psychiatric medications or those who have taken or take them, but remain unhappy with the results. It is also typical, I believe, in that behind the initial presenting complaints and diagnoses of depression, anxiety, adjustment disorder, etc., one often finds stories of grave family turmoil and distress.

What is the relevance of a practice like this for an examination of local responses to trauma? It depends on what we mean by “trauma.” Although most of my clients would not fit the formal DSM-IV criteria for PTSD, especially its implicit linkage of feelings of fear and hopelessness to actual experiences of physical harm or the threat of bodily injury, some of them do report intense feelings of fear, hopelessness, anxiety, or numbness, often related to growing up in very troubled family situations. These feelings are sometimes profound enough and persistent enough to severely impair family and social functioning. Devereux’s (1980) definition of trauma, with its emphasis on the culturally and individually variable consequences of stressful situations, rather than on the nature of the stress itself, becomes relevant here. While few of my clients have suffered actual physical abuse while growing up, some have suffered severe emotional threats of one kind or another, such as actual or threatened abandonment or neglect, becoming the target of someone’s extreme rage or anger, becoming the focus of ridicule or humiliation, threats of physical harm, and both emotional and sexual seductions of various kinds. Such experiences have had very severe emotional consequences for some of my clients, even without the threat of physical or bodily harm per se. Indeed, the relative cultural invisibility of these kinds of emotional troubles can magnify their negative consequences in some ways, since the sufferers’ pleas for help or understanding can more easily be ignored or dismissed as untruthful or exaggerated. Negative consequences can also be magnified because such emotional troubles so violate the U.S. middle-class expectation promoted by governments, schools, and the media that homes and families should be loving, protective, and supportive, not harmful and damaging. The unexpected and unprepared for nature of intrafamilial threats, neglect, and emotional troubles, their cultural atypicality and their undermining of basic social trust, certainly make them “traumatic” for some individuals, at least in Devereux’s sense of that term. And so it is in this more restricted sense that I think some of my clientele can help shed light on how local cultures and communities respond to emotional distress and trauma.

I want to acknowledge immediately, however, that acts of family neglect or mistreatment in a place like the U.S. are much more difficult to verify and document than are acts of communal violence or natural disaster, for the reasons of privacy and cultural invisibility I note above, and psychotherapists or analysts too often hear only one side of family histories that turn out to be extremely complex and difficult to characterize. And of course clients’ own psychiatric illnesses may be at the root of much family turmoil and miscommunication. For that reason, the cases I discuss below are ones for which we have some evidence that the client is reacting to an actual event or situation within the family, such as the death of a sibling or the erratic behavior of a parent who has been diagnosed with a severe mental illness. The cases I discuss, then, are analogous to other cases of event- or situation-related severe stress or trauma in that something unbidden and unanticipated “happens” to a person that makes them feel emotionally overwhelmed or damaged in some way.

Work as a coping strategy

While many of my clients have suffered intense emotional distress for weeks, months, or even years at a time, most have been able to keep working or attending school despite their difficulties. I have been amazed at times at how a variety of white-collar workers (physicians, lawyers, teachers, technicians, managers) have been able to maintain demanding positions of responsibility and leadership while at the same time suffering such symptoms as extreme anxiety or depression, interpersonal sensitivity, paranoia, ragefulness, insomnia, and/or family discord, while students, at all levels of education, have been able to complete exams, term papers, and higher degrees with many of the same debilitating symptoms. While economic necessity certainly explains some of this tenacity and steadfastness, middle-class Americans’ entanglements with work, its meaning and significance for them, goes far beyond the economic, I believe. Indeed, it is these extra-economic meanings and motivations that would undermine any suggestion that such people do not actually suffer that much merely because they continue to work. To the contrary, it is the value and meaning placed on work in middle-class American culture that makes it such an important coping resource for people, perhaps especially when inner sources of strength, value, or esteem have been undermined or damaged by abusive or neglectful relationships.

The concept and meaning of “work” in the U.S. or anywhere else is, of course, complex, and I do not attempt an exhaustive analysis of it in this short article. Rather, in the cases I present below, ¹ I illustrate some of the meanings and usages of work for middle-class Americans as they attempt to recover from damaging histories or situations of various kinds. For many of my clientele, gainful work bestows a profound sense of personal and social value that Max Weber (1958) would have recognized, though absent the religious connotations that he connected to the Protestant work ethic and to the rise of Western capitalism. Like many other people in the U.S., my clients, whether male or female, usually identify themselves as “teachers,” “lawyers,” “managers,” “technicians,” or “students” before claiming any other identification for themselves (such as parent, child, sibling, gardener, reader of fiction, etc.), an indication of how central work is to a person’s sense of identity, belonging, and value in middle-class U.S. culture. The loss of work and a work-related sense of identity might itself be considered a “trauma” in American culture, and has certainly deeply affected some of the people with whom I have worked over the years.

Since the rise of bureaucratized capitalism and industrialism in the U.S. and throughout the West more generally, “work” as a meaningful and economically significant activity has been set apart, conceptually and often physically and pragmatically, from domestic, leisure, educational, and other day-to-day activities, and yet it is generally considered to be a mundane and “ordinary” aspect of life, in Das’ (2007) use of that term. But as Das argues, these ordinary, everyday aspects of life can be very important in helping a person regain a sense of life and well-being in the aftermath of disturbing or traumatic events. By reclaiming normal, everyday activities, including, in the contemporary U.S., work, one learns how to “pick up the pieces [of one’s life] and find out how and whether to go on in this very place of devastation” (Cavell, 1994, as cited in Das, 2007, p. 6). One signals to oneself and to others that one will not be defined by the devastating events, that one has the strength and self-possession to carry on and live life. Das refers to these attempts to get on with everyday life as a “descent into the ordinary,” and she argues that they are often even more important to recovery than more culturally or religiously conspicuous attempts to overtly heal or reconcile. While I think Das may exaggerate this point, since many people who eventually seek out special healing contexts do so only because their earlier attempts to reclaim everyday activities have not worked out, I do strongly agree with her that the reclaiming of “normal,” “ordinary,” everyday routines and practices in the aftermath of distressing events can be an extremely important coping strategy or activity for people, and oftentimes the only type of coping or recovery strategy they ever attempt to enact.

One of the issues I focus on in the cases below is how a person is actually using work to cope with emotional distress. As Spiro (1972, 1987) and Obeyesekere (1981, 1990) have suggested, the very same cultural resource that might help resolve or ameliorate distress in one case, might merely disguise it or acerbate it in another. In particular, I will be focusing on the extent to which the type of work engaged in at the time of consultation articulates with the person’s underlying sense of emotional distress and damage, and whether and to what extent such articulation helps initiate the kind of complex, nonlinear, uneven, back-and-forth recovery process that Rousseau and Measham (2007) have described or leads away from or inhibits it. While Spiro and Obeyesekere both occasionally theorized about how people use various cultural resources to articulate with the kind of universal “drives” and “instincts” posited by classical psychoanalysis, I deliberately remain at a higher, less speculative, more experience-near level of analysis (Hollan, 2001). I focus on how work does or does not articulate with a type of contingently situated emotional stress that a person can readily identify and talk about.

I also examine the extent to which work does or does not help a person reclaim a sense of control and mastery over themselves, other people, and life in general, the painful and disorienting loss of which is often one of the primary consequences of severe emotional distress and trauma, in the U.S. or anywhere else. In theory, work in middle-class American culture should help a person reclaim a sense of control, since at least some white-collar jobs have publicly articulated duties and responsibilities that help keep relationships relatively open, fair, and respectful, and which can empower workers with a sense of initiative and responsibility. The rules of performance are relatively clear and unambiguous, and if one performs well, one will not be subject to the mistreatment or neglect one has suffered in the privacy of one’s own family. But the flip side of this is that when work does turn sour, for almost any reason, it can have dire consequences for coping or recovery, since it is a reminder of how even the most “safe” people and places can become dangerous and unsafe at times.

Of course the field of occupational and community psychiatry (e.g., Bond et al., 2001; Harvey & Henderson, 2009; McQuistion, Sowers, Ranz, & Maus Feldman, 2012; McReynolds, 2002; Thornicroft, Szmukler, & Mueser, 2011) has long promoted the importance and value of work and community involvement for recovery from mental illness. But that field has focused primarily upon those who have already been diagnosed with major mental illnesses of various kinds and who have experienced extended periods of disablement or unemployment. Indeed, one of its primary concerns has been to help such people get the vocational and life skills training they need to find and hold a job and to get back into the community—often, ironically, at the stigmatizing expense of indirectly broadcasting to the community that a psychiatric illness has been diagnosed and that help in living has been needed. The people I discuss below have been much more fortunate that most of those who come to the attention of occupational psychiatry. They have not yet suffered the stigma that often comes with being diagnosed with a major mental illness, and they have not yet been disabled or unemployed for extended periods of time. Indeed, because they have had the privilege of choosing their own careers, work has for the most part been an enabling activity in their lives, not a potential source of overwhelming stress and humiliation. Like many of the people Spiro and Obeyesekere have discussed, their status and position in society still enable them to use cultural resources, including work, to cope with or camouflage emotional distress in a way that is generally nonstigmatizing and adaptive. And this is one of the points I am attempting to make in this article: that important aspects of the work of coping and recovery from emotional distress and trauma goes on in mundane, everyday contexts, “woven around trauma” (Rosseau & Measham, 2007, p. 286), outside the scope of clinics or official healing ceremonies, whether religious or secular.

I turn now to my three clinical vignettes. Although I agree completely with Rousseau and Measham’s (2007) contention that recovery from severe emotional distress and trauma is always an uneven, back-and-forth, developmental process, I focus below on those aspects of the back-and-forth that were most prominent in each case at the time of consultation.

Case 1: Work as evasion of distress

Robert is a divorced man in his 40s who works in a computer-related field. He is an intensely shy and anxious man who fears most social interaction, and apart from his work, lives almost entirely in solitude. He relates his fear of others to having grown up with a mentally ill mother, who was occasionally hospitalized for her psychotic breakdowns, and a rigid, demanding, angry father, both of whom drank and gambled, often leaving him at home alone to wonder whether they would ever return for him. Although Robert comes across as a shy, withdrawn person, he has much pent-up anger about how things have turned out for him, which came out in private against his ex-wife—one of the reasons she sought a divorce from him—and which surfaces in occasional outbursts with his colleagues at work.

For his entire adult life, Robert has used work to escape the unhappiness he experienced growing up with his parents. He choose a major in college that was based on mathematics and logic, a field that always made complete sense to him, he says, unlike the emotional world of parents and family home. It was also a field in high demand, which enabled him to find work quickly, establish his own household, and further remove himself from his parents’ direct control and overt influence—though he remains very closely intertwined with them. Because he quickly became acknowledged as an expert in his own highly technical field, work gave him a sense of self-esteem and normalcy that allowed him to escape, at least at moments, the fear he had growing up that he was profoundly “broken” and forever doomed to be an alienated outsider.

It is evident that work has played a very significant role in Robert’s life, and that without it, he very likely would be in much worse shape psychologically and socially than he is today. Work literally serves as a life preserver for him, keeping him afloat and out of the maelstrom of his family’s unhappiness. And yet work has not “cured” his depression and anxiety, and in some ways, has allowed him to evade coming to terms with them. I have already mentioned that Robert is enamored of his work for its precision and clarity: something either works or it doesn’t work, it is either logical or illogical. This aspect of work is highly seductive for him, giving him a sense of mastery and control that he has in no other part of his life. Indeed, he is so taken with this aspect of his work, and so avoidant of other aspects of his life, most of which he associates in a negative way to the memory of his parents or other unhappiness, that he has become the classic “workaholic,” spending far more hours at work than do his colleagues, and even sleeping overnight in his office at times. Work is at once, then, the safe harbor that nurtures his sense of safety, control, and normalcy, but also the hideout to which he can escape when he is feeling overwhelmed by his own negative memories and emotions and by the illogic and emotionalism of other people.

For the most part, this is a coping strategy that keeps his family misery well contained and out of mind. But when he does occasionally get into a conflict at work, his experience of these troubles is often eerily reminiscent of how he remembers and experienced conflicts with his parents, even to the point of sometimes dreaming that is back at home and being attacked by them or other menacing, parent-like figures. When this happens, the illusion of safety and control that the workplace provides him is punctured, and he very quickly returns to feeling helpless and hopeless, as he did growing up.

Case 2: Work as cover-up of distress

While Robert has received solace, recognition, and financial reward from his work, people at work and elsewhere likely still perceive him as a troubled person, given his avoidance and extreme privacy. Ted, on the other hand, is very likely perceived as the intelligent, successful, and “conventional” information analyst he appears to be. Invariably polite, respectful, and well dressed; he has a reputation for being a meticulous and conscientious worker who garners high praise for his dedication and collegiality. Most of his friends, family, and colleagues would probably be quite shocked to discover that he has been going to prostitutes for years. ²

Ted’s involvement in sadomasochistic sexual practices is complicated, to say the least, and I do not have space here to review all the hypotheses about it that he and I have discussed over the years. But it now seems clear to us, in line with Robert Stoller’s work (1975), that it very likely reenacts aspects of his early family experience, which was dominated by the erratic and scary behavior of his father—a man who was eventually diagnosed with a major mental disorder. Ted’s father drank heavily at times, and during these binges, he would break furniture and windows, and occasionally demand that the whole family accompany him as he drove around the town drunk, accosting other drivers and pedestrians along the way. Ted remembers trying to hide in his room during many of these binges, once even urinating in the closet in order to remain hidden and out of harm’s way. Eventually he developed a strong conviction that it was only a matter of time before his father would shoot and kill the whole family and then commit suicide.

Ted’s highly choreographed play-acting with prostitutes resonates deeply with the emotional residues and memories of such early family life, especially the danger, the humiliation, and the sense of unworthiness and powerlessness. All of this fused with masturbation, one of the few, if highly secretive, activities of his youth that brought him pleasure and self-soothing.

Like Robert, Ted secretly feels marked and forever damaged by his early family life. And like Robert, his job and the praise he receives for it makes him feel at least a bit more “normal” and adjusted. But a critical aspect of work for Ted, and his very conventional way of enacting it, is that it allows him to conceal and misdirect attention from his life with prostitutes. In this sense, he uses work to cover over his distress, rather than to deny and evade it, as does Robert, or to work though it and resolve it. Indeed, it is in fact work that allows Ted to continue with his secret life, by giving him the means to pay for it and by eliminating suspicions about where he is spending his time and with whom.

Case 3: Work in the service of healing

Lisa, unlike Robert and Ted, grew up in an upper middle-class family and neighborhood, and she has enjoyed many of the social benefits that go along with such relative wealth, including an outstanding education and a network of politically and economically well-connected friends and associates. She is also different in that neither of her parents was ever diagnosed with a major mental disorder or suffered from an alcohol or drug problem, and neither actively and unmistakably mistreated or neglected her. But her family did suffer the death of her younger brother when she was quite young, which left them all bereft, indeed “traumatized,” for many years to come. Lisa reports that her father became severely depressed in the aftermath of her brother’s death, and that her mother withdrew into work. Neither parent, it seems, had the wherewithal to help Lisa and the other children understand or mourn their brother’s loss. Rather they both avoided talking about his death and grew distant and apart from one another, her mother eventually becoming involved with another man, which in turn, created much turmoil and stress within the family. Lisa is convinced that her own preoccupation with mortality and a sense of hopelessness about relationships and the future grows out of this unresolved grief and loss within her family.

Lisa has experienced psychotic-like moments when she thought that the very language she was using with others and others were using with her was beginning to fragment and fall apart, but for the most part, her relationship anxiety and her preoccupation with death remain well hidden. Although she is private and relatively reclusive, she has a wicked wit and sense of humor so that when she is with people, she is often remembered as being the funny, entertaining one—an image she finds extremely ironic and misleading of whom she experiences herself to be.

Like Robert, Lisa feels a special affinity for her work, teaching, not because it somehow counteracts her family’s preoccupation with death and loss, but rather because her subject of study allows her to actively investigate and contemplate the nature of human attachments and what becomes of them in a variety of circumstances. She has used her discipline and the freedom it affords her to focus especially on how relationships become broken—through death, loss, accident, betrayal, illness, etc.—and the fate of those who experience such losses. Unlike Robert and Ted, Lisa does not use work to evade or conceal her distress, but rather to lead her into the heart of it—although at enough of an aesthetic and psychological distance that she is not overwhelmed or retraumatized by it (Scheff, 1979). Through her work, she imaginatively reengages with the central experience of her life, the unexpected death and traumatic loss of her brother, and experiments with new ways of framing and understanding this loss and its significance for her and her ability to form attachments in the future. In turn, she uses her own experience of loss to animate her teaching and to make her subject come alive and relevant to her students, for which she has received several awards. Although she still struggles to feel safe within relationships and to develop a sense of optimism about them, she nevertheless persists in her attempts to develop and maintain them.

Lisa’s use of work approximates what Spiro would refer to as the enactment of a “culturally constituted defense mechanism” (1972, 1987) because it allows her to work through her fear of loss and mortality and in a way that is highly valued by her family and community. Robert and Ted also have work that is highly valued, but at the time of consultation, they had been unable to use it in an ameliorative, healing way. What is ironic about Lisa’s case is that it is evident that her fears and preoccupations are actually motivating her impassioned performance of the teaching role, and that without those concerns, she might not be the highly acclaimed and respected teacher that she is. It is just this irony that Spiro argued is typical of culturally constituted defenses (1972, 1987) and which distinguishes them from cultural performances that are more positively motivated or that do not result in relief of suffering.

Discussion

DSM-IV gives the strong impression that the most severe types of emotional distress and trauma can be anticipated in the wake of specific types of triggering events, in particular, those involving actual or threatened death or serious injury to self or other, and that this relationship between triggering events and trauma will hold across persons and social and cultural contexts. In contrast, I have argued, following George Devereux, that traumatic reactions are always relative to the cultural context in which they emerge because the meanings and experience of the stressful events that precipitate them are always filtered through cultural expectations, buffers, and defenses. For example, threats of physical assault or injury are probably more or less traumatic for people depending on whether they are anticipated, whether they can be easily or readily defended against, whether the victims of such assaults are stigmatized or considered worthy of empathy and respect, etc.

Using this broader, more culturally sensitive definition of emotional distress and “trauma,” I have suggested that some of the clientele in my research psychotherapeutic and psychoanalytic practice in southern California are relevant to a discussion of how cultures and communities cope with severe distress and trauma because some of them have been gravely harmed by emotional threats or neglect within their own families of origin. Such experiences, always shameful and humiliating, sometimes become “traumatic” for people because they so violate the middle-class expectation that families ideally should be loving and protective, not hurtful and damaging, and because both the actual acts of mistreatment and neglect and their harmful consequences for victims so often remain hidden by notions of family privacy. This cultural invisibility can magnify the negative consequences for some victims, since their pleas for help or understanding can easily be thought untruthful or exaggerated.

If culture is a key variable in determining whether people experience certain stressful situations as traumatic or not, it also greatly influences how people cope with severe distress once experienced. Devereux, Spiro, and Obeyesekere, among others, have all examined the various ways in which cultural resources mediate the expression, containment, and/or amelioration of trauma and other forms of emotional distress. All have suggested that if distress is truly idiosyncratic or culturally atypical and unexpected, then communities are unlikely to have cultural resources available that specifically target the distress as a site of healing or consolation. On the other hand, if the distress is more culturally anticipated, then such targeted resources are more likely to be available, as well as other less targeted, more mundane resources that may nevertheless be used by people to help contain or ameliorate distress. While much of Spiro and Obeyesekere’s work has examined cultural resources such as religious beliefs and healing ceremonies that are specifically intended to provide relief and solace for people, I have instead, following Das (2007), focused on how middle-class Americans can use a mundane activity such as work to cope with severe distress.

Work is a central component of many middle-class Americans’ sense of identity, and it is for this very reason that it is potentially such an important coping strategy, because it allows people to maintain a sense and appearance of normalcy and adjustment even when inners sources of strength, value, or esteem have been damaged by harmful relationships. Of course work is also important financially for sufferers, since it may provide them with the insurance or money necessary to go to a physician or therapist for help, but the coping benefits of work go far beyond this. I have shown how people can use work in a variety of nuanced ways to help cope with distress. Robert uses the logic and precision of his work to directly counteract and master the sense of chaos and uncertainty he experienced with his parents growing up. Work gives him the sense that at least some part of his life is controllable and manageable. Indeed, the appeal of work in this regard is so strong that he spends most of his waking hours and consciousness on work-related activities, which not coincidentally, also allows him to divert attention from the aspects of his life that feel out of control and overwhelming. In Robert’s case, work is a double-edged sword: while it gives him a sense of immediate relief from the misery of his family life, it actually interferes with his ability to confront that misery and resolve it.

Ted, on the other hand, uses work not to avoid or deny painful, embarrassing aspects of his private life, but rather to conceal them. His very conscientious and conventional performance of a white-collar job enables him to choreograph without suspicion complex and expensive interactions with prostitutes, interactions that seem to reenact aspects of the danger, humiliation, and powerlessness he experienced growing up with an abusive, unstable, hard-drinking father. These sessions with prostitutes are themselves likely an attempt at mastery of the fear and insecurity that besieges him, but ones that put him in constant danger of being caught, punished, and humiliated—perhaps yet another echo and reenactment of early family life. As in the case with Robert, work enables Ted to feel somewhat normal despite the damage and brokenness he experiences within himself, but not so normal as to keep him from reenacting that damage in the secrecy of his private life.

Lisa’s case stands in contrast to that of both Robert’s and Ted’s because it demonstrates how work can be used to work through and ameliorate severe distress rather than merely contain or conceal it. The sudden and unexpected death of Lisa’s brother in her childhood and the subsequent turmoil that loss caused in her family, left Lisa with a sense of hopelessness about intimate relationships and a preoccupation with mortality. Yet her work as a teacher has enabled her to engage with her preoccupations in a way that is productive and helpful to her, her students, and to the community at large. Her personal distress is not only ameliorated and given significance by her work, but it is the driving motivational force behind her impassioned enactment of a highly valued job.

I have entitled this article, “Coping in Plain Sight,” because I want to draw attention to a type of emotional distress and “trauma” that usually remains hidden by cultural camouflage. Domestic emotional mistreatment and neglect do not leave overt scars on the body, as do war wounds or other types of physical assault, but depending on the cultural context, they can be just as damaging and result in many of the same types of psychiatric distress—depression, anxiety, nightmares, numbness, and social and familial dysfunction. (As I discussed above, I speak here only of cases for which we have some “objective” evidence that mistreatment has occurred.) Indeed, from a cultural point of view, they are sometimes even more damaging because in the U.S. and in many other places, the victims of domestic mistreatment are rarely valorized, and in many cases, their complaints dismissed as exaggerated or unbelievable. This lack of recognition and sympathy only intensifies the stigma and negative consequences of domestic mistreatment. In the U.S., people with these invisible wounds are often told to stop crying, buck up, and get on with their lives. And what is astonishing is the number of walking wounded who actually do exactly that.

And this is where work as a coping strategy comes into play. Although work in the U.S. is valorized as an end in itself, something that apart from financial gain, is thought to bestow meaning, value, and purpose to a person’s life, it can and is used in the subtle ways I have described in this article to enable people to express, contain, or ameliorate emotional distress that might otherwise be quite crippling. And all of this occurs in plain sight, outside of the clinic or church or other culturally marked site of healing or solace, in everyday contexts of living. Though rendered nearly invisible by its apparent ordinariness and normality, this use of everyday, mundane culture to cope with grave distress occurs in all societies (Das, 2007) and is certainly worthy of much more attention and study.