Chapter 3 - Stairway to Heaven

In the third chapter, Stairway to Heaven, Perry recounts working with some of the children who had been released from the Branch Davidian compound in Waco in the early 1990s. Having myself been born in 1991, this event is just outside the scope of my memory – though I do vaguely recall hearing news stories and conversations between the adults in my life, especially in the late 1990s when the incident was officially investigated, and piecing together some aspects of the story in the years after. I've never revisited this piece of history, until now. For those of you who, like me, would appreciate some additional background on the incident, please watch the following short clip.

 

It's interesting to watch this brief summary of the events of the Waco Siege from the perspective of a reporter or historian rather than reading about them from the perspective of a clinician. In watching this clip, and bearing in mind Perry's own perspective on the events and the work he was doing at the time, and knowing that he is somewhere in the background, on the sidelines, gathering information and helping to treat the twenty or so children that were released, I can't help but wonder if things could have ended differently.

In any case, his work with the children from the compound was eery and ominous, but fascinating to read about. It's an incredibly rare opportunity indeed, from a clinical perspective, to work with such a specific set of symptoms and outlandish environmental pressures. As awful as the whole experience must have been, I must admit that I would have found it intriguing to observe and learn about them. I'm struck by all of the behaviors that Perry describes – sorting themselves into groups along gender lines, reacting angrily to Perry when he violates this norm, assigning leaders, etc. – but the ones that stand out the most vividly to me include their reaction to the helicopter which flew over the cottage and the response of one little girl, a four-year-old, who, upon examining the bolt action on a toy rifle, said – with “disgust,” Perry notes – “this isn't even real.”

I'm inclined, in light of the nature of this chapter, to wonder about the gray areas of culture and belief as they relate to human behavior, particularly in a clinical sense, and the implications of the (western) clinical practice of psychopathologization across religious and cultural lines. I'm reminded of certain syndromes discussed in the DSM-5 which are regarded as culture-bound: specifically, khyâl cap in Cambodian culture, kufungisisa in Shona culture, and taijin kyoufushou in Japanese culture, among others. We know that culture shapes human experience, and that in the context of cultural norms certain behaviors that might otherwise be called clinically significant – such as hearing voices – are considered acceptable experiences; but we also know that there are physiological and neurobiological commonalities among humans, irrespective of culture, and that the human brain responds to trauma in highly specific and predictable ways. As clinicians, how do we treat the symptoms of trauma while respecting the culture or belief systems which, in some cases – like the Branch Davidians – originates that trauma? With regard to the Davidians specifically, is it important to respect their religious/cultural practices, even if those practices actively produce trauma? Why or why not?

I think it is important to remember that we, as clinicians, operate from a uniquely western set of metaphysical assumptions, and that psychopathology and morality are relative, and that these facts influence and even determine the way we approach the treatment of trauma, but - even though perception is key when it comes to what may or may not traumatize a given individual - trauma itself finds its basis in neurobiology, which does not respect the constructs of culture or religion.