Review: The PTSD Workbook by Mary Beth Williams

The PTSD Workbook by Mary Beth Williams (second edition) is an interactive journey through trauma recovery backed up by science and personal wisdom. It largely conforms to other works about trauma I have read, especially Judith Herman’s ideas about the three phases of trauma recovery.

I was super excited to dive in and do all of the activities. However, the workbook quickly lost my trust, though I continued to read through it in the hopes of gleaning some sort of wisdom. This is a very good workbook that I believe could help many people– with one small revision.

On page 25, there is an exercise about “My Trauma-Related Beliefs.” Readers are invited to think and write about the subconscious beliefs that trauma has given them and explore how true they are. The first example is “I believe I am a victim and that my troubles are the fault of others.” Readers are invited to think about whether that belief has determined their course of action in the past, with the assumption that they will work on revising it once they have had it pointed out. In this example, it’s a failure of personal responsibility to say that all of your troubles are someone else’s fault, even if people never deserve to be traumatized.

The second example is where I have an issue. The belief reads: “I believe that I can’t do things– that I am physically or emotionally incapable of doing them.” To give Williams the benefit of the doubt, I can see how learned helplessness could be a real problem that some people have and need to learn how to deal with. However, it continues in parentheses: “By the way, be aware that ‘I can’t’ generally means ‘I won’t’ or ‘I don’t want to.’ ‘I can’t‘ is really a statement of refusal.”

What?!

Psychological disabilities are real, just like physical ones. If someone can’t walk, they can’t walk. If someone can’t grocery shop, for example, they can’t grocery shop.

Let’s take the grocery shopping example further. Obviously, the person in question with a psychological disability (like PTSD) COULD go through the physical motions of going to the grocery store. Some people in wheelchairs CAN walk. However, the health consequences associated with completing that action will often make it not worth it. A wheelchair user, who can walk under very specific circumstances and/or for short times, would still suffer if you took their wheelchair away. They may be in severe pain or fall and injure themselves. Likewise, someone who “can’t” go to the grocery store may know that they will have a panic attack or exhaust themselves if they do, which are both examples of significant suffering that makes the activity not worthwhile. Just because they are technically capable of doing something that someone without a disability could do, it doesn’t mean that it would be good or healthy for them to do it.

You may have heard of “spoons,” or “spoon theory.” It’s not a metaphor that I love, since I prefer more common-sense units like “batteries” or “spell slots,” but it’s worth mentioning since it’s spawned an entire subculture. “Spoons” are the measurement of energy or ability a physically or psychologically disabled person has. While they’re not usually easily measurable in exact numbers, a “spoonie” who uses the spoon theory to talk about their illness may start out the day with a finite number of “spoons.” Each activity, depending on how challenging it is to complete, depletes (or sometimes replenishes) spoons. For example, taking a shower might be lots of spoons for someone, while a healthy person would barely notice the amount of energy it takes. A spoonie who is completely exhausted and needs to rest is said to be “out of spoons.” Pushing past this limit, while sometimes possible, tends to result in longer recovery times and lots of suffering.

Part of the implication in the workbook was that people often decide they “can’t” do things just because they don’t want to do them. I can understand why people feel this to be true. There are a few reasons for this.

One, people with disabilities often have to choose carefully what activities have room in their lives due to limited ability or spoons. They may prioritize beloved hobbies or time with family and friends over, for example, doing the dishes, because they can’t do both. This can look like they’re making excuses because they don’t want to do something. In reality, they are trying to take care of themselves by making sure their lives include meaningful activities.

Secondly, unpleasant activities often take more spoons just BECAUSE they are unpleasant. It’s like feeling sleepy during and/or after a boring meeting– the properties of the event or activity make it harder to deal with. It’s not laziness or oppositionality or babying ourselves– it’s a genuine result of symptoms that everyone with a disability understands, but those who don’t have one might not.

When dealing with disabled people (either others or yourself) please understand that disability really does mean that there are some things a person can’t do.

Note: there is a lot of ableism surrounding physical disabilities as well as psychological ones. It just isn’t true that physical disabilities are as widely understood as many psychological disability activists believe. I don’t mean to imply that anything else is the case through my comparisons, but I do feel that often physical disabilities are easier for people to imagine and empathize with than psychological ones.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s