Trauma Lecture 3

History of Trauma Psychology

Introduction

  • Speaker: Michael Pauldine, PhD

General Reactions to Readings

Queries for Discussion

  • General reactions to assigned readings

  • Reactions to Freud’s discovery and subsequent abandonment of the trauma-hysteria link

  • Treatment methodologies for hysterical patients, focusing on the vast majority of female patients

  • Sociopolitical influences surrounding Freud's theoretical reversal on trauma and hysteria

  • Societal motivations contributing to the tendency to forget or disinterest in trauma between significant movements

  • Observations about the prevalence of these tendencies in recent decades

  • Major events in the past 25 years that have resulted in renewed focus on trauma

  • Examination of whether the sociopolitical climate resisted the neglect of traumatic experiences and comparisons to past climates

Historical Context of Trauma

Ancient Accounts

  • Sumerian tablets, approximately 4,000 years old, document citizen reactions to the death of a king, including:

    • Sleep disturbances

    • Anxiety

  • Represents the first known account attributing such reactions to events rather than supernatural causes.

  • Greek epics, such as the Iliad and the Odyssey (circa late 8th or early 7th centuries BCE), depict:

    • Grief and sleep disturbances

    • Flashbacks related to combat experiences and loss

  • In 440 BCE, a Greek author noted chronic symptoms stemming from battle fright, illustrated by:

    • A soldier who became blinded after witnessing a killing, marking an early account connecting witnessing death to trauma reactions.

Modern Era

  • Researcher Judith Herman (1992) identifies three critical epochs of heightened attention toward trauma in the 20th century:

    1. Hysteria

    2. Combat neurosis during:

    • World War I

    • World War II

    • Vietnam War

    1. Recognition of sexual and domestic violence

  • Herman posits that periods between these movements often experienced collective forgetting, denial, and repression at both individual and societal levels.

    • Such dynamics benefit offenders by fostering secrecy and silence.

    • If secrecy collapses, survivors' credibility is attacked with narratives such as:

    • "It never happened"

    • "The survivor lies or exaggerates"

    • "The survivor is to blame"

    • "It’s the past, time to move on"

    • Perpetrators succeed if bystanders remain passive while survivors request acknowledgment of their pain.

  • Each of the three movements toward understanding trauma was accompanied by a political agenda that legitimized the advancement of trauma studies.

Examination of Hysteria

  • Hysteria was historically labeled an umbrella term, predominantly attributed to women, encompassing a range of psychological and behavioral issues during the 1800s and early 1900s.

    • Examples of conditions termed hysteria included:

    • Depression

    • Anxiety

    • Fainting

    • Paralysis

    • Emotional dysregulation

    • Initially believed to originate from physiological issues, possibly related to the uterus, or from malingering.

  • French neurologist Jean-Martin Charcot specialized in the study of hysteria

    • His work established a psychological basis for hysteria, rather than merely physiological.

    • Acknowledged that hysteria symptoms could also manifest in men, linking these symptoms to psychosocial histories, notably traumatic experiences.

  • Pierre Janet and Sigmund Freud, both influenced by Charcot's findings, elaborated on the relationship between trauma and hysteria.

    • Through listening to women with hysteria, they concluded that trauma caused altered states of consciousness.

    • Janet referred to this phenomenon as "dissociation."

    • By the late 1890s, it was established that recovery of traumatic memories and associated emotions could effectively treat hysteria.

    • Janet termed this approach "psychological analysis."

    • Freud labeled it "psycho-analysis."

    • Freud specifically connected hysteria to memories of childhood sexual abuse in The Aetiology of Hysteria (1896).

  • Within a year of publishing his trauma theory, Freud recanted it due to radical social implications.

    • Acknowledgment of the prevalence of trauma, particularly child sexual abuse among women, was socially unacceptable and politically charged amid the prevailing climate of civility and morality.

    • Freud eventually ceased taking patient accounts seriously, which marked a collaboration's end between physician and patient.

    • For decades, survivors' voices were silenced, and Freud’s theories became riddled with denial against women’s experiences.

    • Freud suggested that women fabricated or desired sexual abuse, reflecting antifeminist sentiments.

    • Although Janet retained the trauma theory, his contributions were largely overlooked.

    • One significant patient, "Anna O" (Bertha Pappenheim), emerged as a feminist leader and social worker.

Industrial Accidents and Trauma

  • Railway accidents led to the development of the concept termed "railway spine,"

    • Description of posttraumatic symptoms without accompanying physical injury, including:

    • Somatic complaints

    • Restlessness

    • Helplessness

    • Symptoms could appear weeks or months post-accident.

  • Medical opinions were divided:

    • Some concluded symptoms were psychological, induced by the trauma of the accident.

    • Others proposed that symptoms emerged from physical damage like microscopic abrasions or lesions caused during the event.

    • There were contrasting views about physiological causes vs. malingering.

Combat Neurosis

  • American Civil War (1861-1865):

    • Soldiers were treated for Da Costa’s syndrome, known as "soldier’s heart" characterized by:

    • Chest pains

    • Shortness of breath

    • Fatigue

    • Heart palpitations, with no physical explanation discerned.

  • World War I (1914-1918):

    • Soldiers who faced the war's terrors exhibited symptoms of hysteria such as:

    • Fatigue

    • Hyperarousal

    • Somatic complaints

    • Amnesia

    • Initially attributed to physical injuries from concussions or brain lesions (termed "shell shock") even though many soldiers reported no direct physical trauma.

    • Societal expectations of honor and valor led to perceptions that affected men were cowards or of poor moral fiber; some treatments were punitive.

    • More humane approaches emerged, advocating open discussions about war experiences as necessary for healing.

    • Despite varied treatment strategies, the overarching aim remained the return of soldiers to combat.

  • World War II (1939-1945):

    • There was a noticeable attempt to lift the stigma surrounding combat trauma; recognition arose that any soldier could experience stress reactions.

    • Stress reactions correlated with combat exposure severity; research explored protective factors that facilitated recovery.

    • Emotional bonds among soldiers were found beneficial, hence treatments prioritized minimizing separations from comrades.

    • Rapid interventions were mandated near front lines, yet post-combat or homecoming interventions remained limited.

    • Long-term trauma impacts, including those on Holocaust survivors, took roughly two decades to be examined.

    • Post-war narratives often suggested Jewish complicity in Holocaust atrocities, resulting in victim-blaming and pathologizing.

  • Vietnam War (1965-1973):

    • Marked the initiation of large-scale studies focusing on long-term psychological effects of combat, promoting advocacy for "post-Vietnam syndrome."

    • In the late 1970s, the Veterans Administration (VA) received legal mandates to provide psychological treatments based on self-help and peer counseling structures.

    • This period acted as a catalyst for research correlating combat exposure with PTSD symptoms, establishing a scientific framework.

    • Anti-war attitudes led to acknowledgment that psychological trauma could be a persistent outcome of warfare.

    • Diagnostic criteria for PTSD were officially established in the DSM-III by 1980.

Understanding of Sexual and Domestic Violence

  • The women’s liberation movement of the 1970s marked the first significant acknowledgment that prevalent posttraumatic reactions were frequently found among women in civilian life rather than exclusively among combat veterans.

    • The primary aim was consciousness-raising due to widespread, hidden abuses.

    • Notable increase in research about sexual assault that had been historically overlooked.

    • Participant-centered approaches with deep, personal interviews revived understanding of trauma experiences.

    • Findings highlighted the widespread nature of sexual violence against women and children, demonstrating:

    • Rape defined as a life-threatening event inciting fear of harm or death.

    • Symptoms such as:

      • Heightened startle response

      • Insomnia

      • Nausea

      • Nightmares

      • Dissociation, mirroring symptoms in combat veterans.

    • Rape redefined from being perceived as lustful to being understood as a violent act of control and subjugation.

    • This movement also sparked social initiatives responding to survivors, establishing crisis centers.

  • Initial emphasis focused on stranger-perpetrated rape, progressively redirecting attention to assaults by acquaintances, intimate partners, and spouses.

    • This understanding led to the term "rape trauma syndrome."

    • Subsequent investigations focused on domestic violence, coining the term "battered woman syndrome."

    • Recognition of symptoms shared by female and child survivors of assault began after the legitimacy of PTSD among veterans gained acceptance.

    • Judith Herman articulated, "Hysteria is the combat neurosis of the sex war" (Herman, 1992, p. 32).

The Importance of Power Dynamics

  • Quote from Brownmiller (1975) in Against Our Will: Men, Women, and Rape:

    • "Man’s discovery that his genitalia could serve as a weapon to generate fear must rank as one of the most important discoveries of prehistoric times, along with the use of fire and the first crude stone axe. From prehistoric times to the present, I believe, rape has played a critical function. It is nothing more or less than a conscious process of intimidation by which all men keep all women in a state of fear."

Contemporary Debates in Trauma Psychology

  • Distinction between PTSD and Complex PTSD (CPTSD):

    • Complex PTSD arises from prolonged or repeated trauma exposure, leading to differing psychological reactions.

    • This diagnosis was developed by Judith Herman in 1992.

  • Concept of Posttraumatic Growth:

    • Refers to positive and adaptive changes that occur following stressful and traumatic experiences, contributing to resilience and adaptability.

  • Discussion of Dissociative Identity Disorder (DID):

    • Debate remains active concerning the existence and validity of DID as a trauma response.

  • The "memory wars" regarding trauma:

    • Ongoing contention over the ability of trauma memories to be repressed and then retrieved later, impacting trauma assessment and therapy frameworks.