In 2017, Stephanie Foo was slapped with a complex PTSD diagnosis. She was dumbfounded.
Foo, a successful podcast producer on shows like This American Life, had heard of PTSD – the disorder associated in popular culture with war veterans who witnessed death, or had guns held to their heads. She knew those afflicted were frequently revisited by traumatic memories, often in flashbacks playing before their eyes.
Complex PTSD was supposed to be worse: while PTSD is generally caused by singular traumatic events, complex PTSD survivors have usually been exposed to trauma repeatedly, sometimes over years, making it hard to isolate triggers and move past them.
Foo had somehow relegated her own trauma to the back drawers of her mind. She had become accustomed to rushing through the details of her abuse, as if reading from a grocery list: she was physically abused as a child; regularly told she was stupid, unwanted, ugly and fat; exposed to deathly car trips during which her father told her he was going to kill them both; and was abandoned by both parents as a teenager, left with no money to survive on frozen meals.
The abuse settled into her psyche, making it hard for her to accept love from anyone. She was prone to outbursts and over-reliant on validation, especially at work. She was miserable for a long time, but didn’t know why.
In her new book, What My Bones Know: A Memoir of Healing from Complex Trauma, she grapples with the aftermath of her diagnosis and tries to provide a roadmap to help others heal.
Poppy Noor: Before we start this interview, I should tell you I also have a complex PTSD diagnosis. When I found out, I thought it was the most damning thing in the whole world, because I heard it was basically incurable. I felt very alone. But since I started reading your book, I’ve had people come up to me in public and ask me about it, or give me a knowing nod. Do you think complex PTSD might be more prevalent than we realize?
Stephanie Foo: I think it’s under-diagnosed simply because people don’t know about it. It’s not in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the US. But also, there’s this idea that, well, “I didn’t have a gun in my head in Afghanistan. So how could I have PTSD?”
But one in six people have an ACE score [an indicator of a level of childhood trauma that could cause serious health repercussions] over six. That’s like 50 million people. So I think it’s a big thing.
A lot of your book is about the erasure of trauma. For example, when kids are doing well at school, we assume they can’t be traumatized. We also ignore immigrant trauma, because it’s an uncomfortable stain for the US – and it’s an uncomfortable burden for a lot of immigrants trying to assimilate.
I have friends who start teaching at all-Asian schools and they’re delighted by the Asian kids who are just so studious, so excited about learning and so hardcore about getting good grades. That’s comfortable, right? Why would you want to further investigate, to see whether [the reason] all these students want to have perfect grades and freak out otherwise, is because they’re being abused at home? Capitalism and academic success have buried trauma.
It’s also about the value we ascribe to work. I remember saying to my therapist once that I was worried I wasn’t good at writing. And she said, and what if you’re not? Does that make you an unworthy person? I was so confused. I was thinking, what does anyone else judge themselves by?
It’s like we have to earn love as if it is a commodity.
You struggle with your diagnosis throughout the book. A lot of the scientific literature says people with complex PTSD are damaged and hard to fix. But you acknowledge the strength that can come with trauma. I thought that idea was incredibly healing.
I kept seeing these TikToks where people say stuff like: “Am I careful at my job, or was I abused as a child?” It just seemed to be creating this binary or this pathology: I’m a perfectionist, or a multitasker, or a people-pleaser - I guess it’s because I was abused. Not every aspect of your trauma makes you a toxic person. So you’re a people-pleaser – okay, you’re charming. Is that really so bad? You can learn to draw healthier boundaries, so you can people-please while not making yourself feel bad. But you don’t need to pathologize it.
What you’re saying is, not all of it needs to be fixed just because it came from trauma.
I had a lot of grit throughout my life that made me work really hard. For a long time, I was really resentful and angry, especially after my diagnosis, because work wound up being a symptom. It was workaholism – I was working to avoid confronting my trauma.
What I’ve come to learn is that I have to change the voice in my head. It used to be if I wasn’t working, the voice would say, “You’re lazy, you’re a piece of shit, you’re not trying hard enough, because you’re a bad person.” Now, I’ve been able to change it to, “This is something you really care about, get stoked, you have the work ethic and the skills this trauma has built you over time. And now you can use all of that!”
I don’t know if I’m necessarily grateful, because of all the other stuff that it comes with. But I’m happy with the way that I’m able to use it. The important thing in healing is being able to hold the nuance of it.
Why do so many books speak about trauma in that way, like everything is a symptom that needs to be fixed?
The way we view trauma in this country is deeply broken. Because if you have complex PTSD, you’re probably going to have some deep feelings of shame and self-loathing. And if you are just diagnosing people by saying, “here are all the things that are wrong with you, you’re pathologically broken”, those people are not going to be able to heal.
We need to say: “You’re not neurotypical. But there are advantages and disadvantages. Let’s explore how you can have better coping mechanisms for some of the disadvantages that you might be experiencing.”
Speaking of how we talk about trauma – the word itself seems to be having a moment. As you said, it’s everywhere on TikTok, people are using words like “triggered” colloquially – do you think the way that we’re talking about it is a good thing?
Everyone has trauma, or will have trauma. Suffering is life and loss is part of life; you’re going to lose people and you’re going to be miserable. If we understand that, then we can normalize it more. I think it’s weird that if someone says, “I’m dead!”, people are like, “That’s really disrespectful to dead people.” Of course some people are gonna misuse it. Some people are gonna make jokes - I make jokes all the time. I’m always like, “I’m triggered!” Life is funny. It doesn’t have to be that serious all the fucking time. That’s a part of normalization. And I think normalization is a good thing.
In your book you explore how many people are in denial about the trauma within their own communities, or their own families. Why are you so keen for people to talk about it?
I think that one of the reasons why I wasn’t able to heal for so long is because I buried it. I was like, look at me, I’m on [the podcast] This American Life. How could somebody on This American Life have trauma? It’s ridiculous in retrospect. You can’t heal without acknowledgment. We have to normalize therapy – not just, like, talk therapy or psychotherapy. We have to normalize different generations of Americans working through trauma.
At the end of the book you start talking about trauma survivors as having “superpowers”. I wasn’t used to reading about it in that way, and it made me feel better – because I spend so much time trying to “outpace” my trauma. That was a useful way of reframing it for me. What do you hope that this book will do for other people?
I don’t want people to have that hopelessness upon diagnosis. I wanted to counter some of the prevailing narratives put out by scientists and doctors who don’t have complex PTSD, and clearly don’t know what it’s like. I would love for teachers, particularly in immigrant communities, to take child abuse more seriously. And to understand that just because you’re not seeing it doesn’t mean it’s not there.
I would just love for complex PTSD to be normalized – like depression, or anxiety, or bipolar disorder. Get it in the goddamn DSM. That is very important.
I also want people to know there are superpowers associated with complex PTSD. You have to tell people they are going to be okay. I’m not so naive and vain as to think that this book can change all of these very big systemic things. But if that changes some of these things a little bit, I will be very happy.
• What My Bones Know: A Memoir of Healing from Complex Trauma, is out now. This interview was condensed and edited for clarity
