The Myth of SanityDivided Consciousness and the Promise of Awarenessby Martha Stout, Ph.D.PREFACEThe idea of earning a doctoral degree, which later turned into a lifelong career in the psychology of trauma, was first suggested to me by my father's mother, who was born a quarter of a century before women had the rightto vote, in the backwoods of North Carolina. She was a woman of great faith and strength-with more than a few radical opinions for her time-and she endured much during her nearly eighty years on this earth. Yet when the endcame, she willingly relinquished her life.To be more precise, I could say that my grandmother willed her own death. Lying in a hospital bed, being attended for minor cardiac difficulties ina heart relatively strong for a woman her age, she informed her nurse one night, simply, that she would go to God before morning. The nurse, I am told,kindly reassured her she was not so ill as all that, and that she should notthink such thoughts. My grandmother died that night, inexplicably, of congestive heart failure.When she died, I was a junior in college, and it was there that I learned the implications of congestive heart failure. Voodoo victims die that way,victims of their own strength of belief, and other mammals, swimming against the tide for too long, let death come, and die of exploding hearts, beforethe water has a chance to drown them. Having decided it is time, one simplydies.As a therapist, I see trauma survivors, and in the course of my profession I have heard the life stories of dozens and hundreds of people who have survived childhood and adult circumstances of unrelenting horror. The vague whisper I heard through knowing my grandmother, that life was not always so gentle as my childhood, has become a frank cacophony of excruciating human histories.And now it is my trauma patients who seem the oldest souls in the world, though some of them are quite young people. They are proud human spiritswho seem ancient and ageless at the same time. Over the years, I have seenbrighter passions in their eyes than in the eyes of any priest or guru. I have heard more wisdom from their mouths than I have read in any book. And,ironically I suppose, I have at times experienced a more profound and cente
red stillness in their presence than in the company of people whose histories and memories have been far less scarred.My patients come from both genders, and all walks of life. Some are simple. Others possess intellects as brilliant and faceted as diamonds. Most are somewhere in between. They come to my office bearing a wide variety of diagnoses currently in medical vogue: depression, manic-depressive disorder,panic disorder, anorexia nervosa, alcoholism, borderline personality disorder, paranoia. Their stories are seemingly diverse. Some have survived earthquakes. One, when she was two years old, watched from inside the basket someone had hidden her in, as her Cambodian parents and nine sisters and brothers were shot to death by invading soldiers. Many others have survived chronic childhood incest. And still others are adult survivors of other kindsof childhood-long abuse, physical and psychological.But I have learned that they all have one thing in common. Underlying the various forms of heartrending pain and diverse complaints with which theycome to therapy is the same fundamental question--Shall I choose to die, orshall I choose to live? They come to therapy to help themselves answer thatquestion, and I will get nowhere if I try to answer the question for them, or even delay its consideration. The rest of therapy never begins for a survivor of trauma until that ruthlessly basic question has been answered.I cannot resolve the life-or-death question for my patients, and I shouldconfess that I do not even approach the practice of psychotherapy with the premise about suicide that is widely held to be self-evident. Many say it is necessarily our job to insure that no individual be allowed to carry out a decision to die, that it is our job to prevent-this no matter what the measure takento prevent it, be that measure manipulative, legal, even legally violent. ButI do not believe, nor can I be persuaded, that some form of psychological distortion underlies absolutely all acts of suicide. I do believe that, at least in some cases, a decision to die could be just that, a decision. This seems obvious and simple enough to me.And I have come to accept that a person can consciously or unconsciously terminate biological existence in a variety of ways, most of them not preventable by me or anyone else, regardless of ideology. For example, my grandmother decided to die when she did, or that is my belief anyway. Having knownFleeta Florence Stout, I am not surprised she was capable of that. What impresses me is that for eighty years she chose to live-not just to not die, but to live-passionately, consciously, full of faith, despite all the hardships and sorrows of her time here.Moreover, I have learned through my work that most people need look back only a generation or two, if at all, to find survivors in their own families-individuals who have somehow found the strength and the faith to go onliving-and that the nearness of trauma, and of survival's impossible choice
s, has powerful and unexplored implications for the human family as a whole.The survivors I see in my practice have known undistilled fear, have seenhow nakedly terrifying life can be, and in many cases have seen how starklyugly their fellow human beings can be. Listening to their stories, no one atall could be surprised that they consider the possibility of not going on. Ina struggle with the power of their past experiences, even the biological imperative to survive is puny.No. Their choosing to die would not be surprising. What is so extraordinaryabout these people is that they choose to live-not just to not die, not just to survive, but to live.Why this choice gets made, and how it gets put into practice, are two of themost interesting personal, psychological, and philosophical questions I can conceive of. And one of the greatest privileges of my life has been to know the people who are my patients, to be able to sit with them, to be a part of their lives for a while, and with grateful and undisguised self-interest, to listen. For I have become convinced that these courageous people, in winning their struggles, must learn things about genuine living, and about genuine sanity, that the rest of us have never even imagined.ACKNOWLEDGMENTSFirst, I would like to thank my friend and brilliant colleague, Carol Kauf fman, on whose patio this book was invented one sunny Memorial Day, and who has seen me all the way through to the end. Without cease and without complaint, she has provided motivation, note-perfect advice, and the priceless favor of her expert commentary. And I would like to thank (a million times thank!) my heaven-sent agent, Susan Lee Cohen, whose wisdom, balance,and loveliness of spirit inaugurated the project and kept it alive.Thanks to the gifted Beena Kamlani, for her integrity, for her beautifuland meticulous editing, and for that uncanny guiding voice in my head, andto Carole DeSanti, for recognizing the manuscript in the first place, and for her relentless advocacy of the book at Viking. My gratitude also to Alexandra Babanskyj, and to Jaime Wolf.For having helped me in their various crucial ways to complete the book, I would like to thank Jane Delgado (an inspiration even now), Paul Horovitz, Deborah Horvitz, Judith Jordan, Howard Kielley, Martin: Seligman, David Stein, and Len Thomas.And I would like to thank my patients, every single one of them.
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