The symptom is never the root; the victim is never random
Some victims of abuse are also victims before and beyond the abuse.
"The ever-popular victim-perpetrator split does not always fit in any neat way to the lives of people with PTSD, or PD."
Many times, symptoms in mental illness manifest precisely because some nontrivial deficit or deficiency exists at a timeline that preceded the symptom and at a level that superseded it in causal significance. This is one of the reasons why only treating a readily visible symptom may not bring permanent relief to the patient nor secure them from relapse or future recurrence. It's also why we can sometimes correctly estimate prognosis and maintain professional humility about expected treatment outcomes.
Jonathan Shedler is fond of asserting that the surface problems or the apparent presenting complaints a client brings into therapy are rarely the core problems that eventually need to be addressed. This makes a lot of sense the moment one makes the distinction between cause (risk factors) and effect (symptoms).
In discourse fora among mental health practitioners, it's almost a taboo to make any reference to predisposing factors (the 'why' behind the 'what' as it were) when certain class of mental health issues are the focus of discussion (this is a less common error of thinking among academics, though they have their own faults as well).
Examples of such topics hostile to the 'why' query are; domestic abuse, sexual abuse, bullying, PTSD, etc. Most people (professional and lay alike) tend to focus on the moral injustice these experiences entail to the exclusion of predisposing factors. They believe that the "wickedness" or "irresponsibility" of the perpetrator is a necessary and sufficient explanation for the event and its pathological outcomes. The client is just an unfortunate victim (which is a sentiment with a strong iota of truth). But when you consider that most perpetrators of physical, emotional, and sexual injuries are highly discriminative when it comes to their potential target, then we begin to realize that a victim profile exists at some knowable and classifiable level. And there’s often a dynamically powerful force of attraction that is invariably switched on when a potential abuser walks into the living frame of a potential victim.
A bully, a rapist, or a domestic tyrant perhaps has more insights (however perversely deployed) into the psychology of their victims than many clinically-oriented psychologists. Besides, as a psychotherapist seeing a victim, you can do absolutely nothing about the "wickedness" or "irresponsibility" of a perpetrator (that’s more a job for outside the therapy space), but you can do a lot about fortifying the victim with psychological and socioemotional tools to make them less vulnerable.
There are some individuals who have never suffered any kind of direct intimate abuse but still carry about and operate with the internal schema of a victim. Should such individuals eventually fall prey to an unfortunate experience, many mental health professionals would be quick to make sense of the subject’s symptomatic expressions almost exclusively in the light of the adverse event. They conveniently fail to enquire into the premorbid functioning of this doubly victimized subject.
Again, Jonathan Shedler is fond of saying that it's not the job of a professional psychotherapist to perpetually coddle the sensibilities of their clients. The truth is, if a therapist fails to address the question: why this victim and not that? Why this perpetrator and not that? Why these ensuing symptoms and not those? You'd have utterly failed your client in actually fortifying them against the very high risk of relapse or repeat of such traumatic event.
Some people at risk of relational abuse are actually self-aware enough to recognize their at-risk status and their predilection to attract precisely the abusive type. Here is Stella Tsantekidou expressing this awareness in a recent substack piece:
I get triggered when people talk about Boris, his personality and love life. I have never met him in person, but from the gossip and the rumours and the way he speaks and writes, I recognise the type viscerally. It is the type of man I inevitably attract and the type I am infuriatingly, inexorably, attracted to…. The type I am talking about is not the posh twat, though, as we have extensively covered in this blog, that demographic looms large in my past. I am talking about men who are ambitious, intelligent, extroverted, energetic, with addictive personalities that make them love variety and chasing shiny things. Reddit calls them narcissists. I call them my evil male versions.
Notice the author’s undertone of frustration with this fastidious personality tendency but also a morbidly humorous acceptance of her lot. This is a very good example of things we can’t change about ourselves but which awareness makes significantly less costly and much easier to accept and negotiate.
The only instance I know where it'll be correct to not look at individual-level factors is in cases of mass trauma/disaster where everyone was affected. But even in these cases, one will still need to identify unique protective-vulnerable elements that variate the expression of post-trauma symptoms both in degree and quantity.
It's not the job of a knowledgeable professional to pander to the sentiments and sensitivities of the lay public. When there's no longer any line of demarcation between professional and common opinions, it's a strong sign of dilute currency.