A History of the Study of Trauma

History of the study of trauma

 

“The study of psychological trauma has a curious history – one of episodic amnesia. Periods of active investigation have alternated with periods of oblivion.” (Herman, 1992)

 

“It is a deplorable fact that each investigator who undertakes to study these conditions [trauma] considers it his sacred obligation to start from scratch and work at the problem as if no one had done anything with it before.” Kardiner & Spiegel (1947)

 

It helps in our understanding of trauma to have a sense of the history of its study, and so what follows is a brief resumé of this history, for which I am indebted to the American professor of psychiatry at Harvard University, Judith Herman, and her book Trauma and Recovery (1992) and to an essay by Bessel van der Kolk, Professor of Psychiatry at Boston University and Medical Director of the Trauma Centre of the JRI, Massachusetts, entitled A History of Trauma in Psychiatry (2007a).

 

It is the fate of trauma, and its very nature, to be over-looked, ignored, forgotten, by-passed and side-lined. The natural human survival response is to put as much energy as necessary into avoiding such terrifying and overwhelming feelings and re-lived experiences; and as much as this is a natural response to personal experience, it seems, too, to have been the response to the research and study of trauma by professionals.

 

In her book, Trauma and Recovery (1992), Herman opens with a chapter she calls ‘A Forgotten History’, in which she sets out a record of the study of trauma. She divides this history into three phases over the last hundred or so years, each separated by periods of time where trauma was forgotten, “periods of oblivion” (ibid.). Like personal trauma, where often we will only address it when the symptoms have become too much for us to manage, in effect when we have no choice, the phases of trauma study came about only because circumstances forced it to attention. Because the study of trauma is done by people who are likely themselves to be managing their own trauma, their approach to the study of trauma is always shadowed by ambivalence, unconscious dissociation and deflection. Why study something that perhaps at the time is not asking to be studied, and as well is likely to take one into rough personal waters? It’s not a consciously thought through response, but a spontaneous, ‘life-preserving’ reaction.[1]

 

The three episodes[2] of trauma study over the last hundred years that Herman cites are:

 

·      The study of the diagnosis known as ‘hysteria’ by the followers and students of the 19th Century French neurologist Jean-Martin Charcot, which included Sigmund Freud, Pierre Janet, Joseph Breuer and many others.

·      The study of shell shock or combat neurosis, which began during the First World War in England, revived again after the Second World War with the Holocaust, and reached a peak during and after the Vietnam War.

·      The growing awareness in the 1980s and 1990s of domestic violence, the high incidence of violence, neglect, rape and emotional and sexual abuse within the privacy of the home.

 

‘Hysteria’ and Early Trauma Study

 

“As early as 1859, the French psychiatrist Briquet (1859) elucidated an association between childhood histories of trauma and symptoms of ‘hysteria’, such as somatization, intense emotional reactions, dissociation and fugue states ... Sexual abuse of children was well documented during the second half of the 19th century in France by researchers such as Tardieu (1878), a professor of forensic medicine.”

(van der Kolk, 2007a)

 

Deeply engaged as I am in the subject of trauma, from my present-day perspective it seems quite extraordinary that science and the discipline of psychotherapy have so successfully avoided for the most part dealing with trauma,[3] particularly in light of the quote from van der Kolk above. And yet, when we look at the roots of psychotherapy, the psychoanalytic tradition based primarily on Freudian principles, we can see that the whole endeavour was founded to a large extent on an avoidance of trauma. Most psychotherapies, and all the great innovators within the broad realm of psychotherapy, whatever their philosophy and values, were rooted in Freud’s ideas, and their work was based on Freudian principles, that essentially from the beginning tended to avoid the issue of trauma.

 

The diagnosis of ‘hysteria’[4] originated over two thousand years ago in Greece, and stayed for the most part during that time as “a disease proper to women and originating in the uterus” (Herman, 1992). In the early stages of the development of psychotherapy ‘hysteria’ was understood by Freud and others to be the somatic symptoms that “represented disguised representations of intensely distressing events which had been banished from memory.” (ibid.). Breuer and Freud, “in an immortal summation, wrote that ‘hysterics suffer mainly from reminiscences’” (ibid.). Both of these statements could easily be current statements about trauma, except that, happily, we don’t use the term ‘hysteric’ any more.

 

It is demonstrative of the tensions involved, and the need for a supportive social and political context for difficult phenomena to be tolerated, that when Freud presented his paper entitled ‘The Aetiology of Hysteria’ (Freud, 1896) to his colleagues in Vienna in 1896, it caused such a stir, and was so challenging of the current ethics and perceptions of society, that just one year later it seems he quietly began to recant and move away from his published conclusions. Since many see it as a key point in understanding the modern history of psychotherapy and the study of trauma, I will discuss it briefly.

 

In his paper Freud presented the thesis that “at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psychoanalysis in spite of the intervening decades.” (Freud, 1896, 1962).

 

It is indicative of how important Freud thought this paper by a quote from him after his presentation: “I [have] shown them the solution to a more than two-thousand-year-old problem”, referring to the hazy diagnosis of hysteria that had been in place for that long. This paper was based on twenty cases from Freud’s practice. As Herman states: “A century later, this paper still rivals contemporary clinical descriptions of the effects of childhood sexual abuse”; I would agree.

 

Despite the brilliance and importance of this paper, just one year later Freud withdrew his support of it. Jeffrey Masson, in his book, Assault on Truth (1984), offers a careful exploration of this paper, and the reasons behind Freud’s eventual retraction. The assertion of Freud’s paper was shocking and provocative at the time: that hysterical neurosis (trauma) symptomatology in adult life was founded on severe childhood trauma through inappropriate sexual activity, predominantly perpetrated by adult family members or other caretakers of the child (servants and nannies). It was founded on Freud’s work with a number of clients who told him terrible stories of what we would now call sexual abuse and harassment (including violence) at the hands of prominent adults. It is hard for us looking from the 21st century to understand the impact of this assertion at the time. Most psychiatrists’ client base then was the middle-class bourgeoisie, and most psychiatrists were from this same class. To contemplate such a phenomenon amongst their own educated class was intolerable. One reaction by a colleague to his presentation was: “It sounds like a scientific fairy tale.” (Krafft-Ebing, in Masson, 1984).

 

Freud was ostracised by his peers and colleagues for his paper, and in a letter to his friend, Wilhelm Fleiss, wrote: “I am as isolated as you could wish me to be: the word has been given out to abandon me, and a void is forming around me.” A year later he retracted his support of his paper privately, and over the subsequent years increasingly publicly. In his Autobiographical Study twenty-nine years later, he wrote: “I was at last obliged to recognise that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up.” (Freud, 1922). According to van der Kolk:

 

“... the relationship between actual childhood trauma and the development of psychopathology was henceforth ignored. In Freud’s view, it was not the actual memories of childhood trauma that were split off from consciousness, but rather the unacceptable sexual and aggressive wishes of the child . . . Real life trauma was ignored in favour of fantasy.” (van der Kolk, 2007a)

 

In fact, the knowledge of the prevalence of childhood sexual abuse was not new at the time. As van der Kolk says in the quote at the beginning of this section, the work of the French forensic scientist, Auguste Ambrose Tardieu was revealing through his work on dead children that sexual and physical violence to children was rife. Tardieu documented his findings in a publication in 1857,[5] and Freud, studying in Paris at the time, was very likely, along with his contemporaries, to have witnessed Tardieu’s work and read his publication (Masson, 1984).

 

Additionally, in fairness to Freud, it is worth adding something more about the context at the time (1880s). There was already occurring fierce debate amongst the students and followers of the famed neurologist, Jean-Martin Charcot, at the Salpêtrière Hospital (with whom Freud also studied), as to the veracity or not of accounts of child sexual abuse; whether patients’ accounts of their childhood abuse were real or a false memory, what Charcot termed a “hystero-traumatic auto-suggestion” (van der Kolk, 2007a). Freud was not alone in preferring to think in terms of “simulation and suggestibility” (ibid.) and fantasised imaginings, rather than the reality of the traumatic acts recounted. However, since the basics of all psychotherapy come from Freud’s work, and the legend of Freud as the predominant author of psychological understanding still dominates much thinking and study today, it does not seem unfair to focus on his contribution to the years of subsequent avoidance of this truth.

 

The result has had far reaching effects for psychoanalysis and the whole of psychotherapy, and for the study of trauma. In effect Freud’s withdrawal of his support for the idea that his clients were speaking the truth when they told him tales of sexual abuse and violence, set him and the development of psychoanalysis on a course of valuing the internal imagined, fantasy and dream world of the client, which the analyst or therapist could interpret for the client, over the external possibility of real traumatic events; in effect an avoidance of the reality of trauma. It also turned the child from victim of adult oppression and seduction into the fantasy seducer who could not be trusted, and the abusive parent/adult from perpetrator of violence on the child into the innocent and maligned victim of the child’s subversive perpetrator fantasies and seductive nature.

 

This idea combined well with ideas about child-rearing that dominated at the time, many of which still persist to this day, what the Polish psychologist and renegade psychoanalyst, Alice Miller, explored under the term ‘poisonous pedagogy’[6] (Miller, 1987). ‘Poisonous pedagogy’ was based on the idea that the child had to be controlled and disciplined by generally what we would see today as “mental cruelty” (ibid.), but also physical cruelty, at times to the extent of torture. The notion was of punishment by the parent as being for the child’s own good,[7] with parents always being right and the notion that “every act of cruelty [by the parents], whether conscious or unconscious, is an expression of their love” (ibid.). In Germany particularly, at the time (late 19th century and early 20th century) these views were immensely popular and there was a flourishing literature on the topic of such brutal child- rearing techniques.[8]

 

This theme was repeated later when, in the 1980s, as clients again began to tell their therapists about their childhood traumas of sexual and violent abuse, the idea of ‘false memory’ took hold, which held that the memories of sexual abuse of a client were fabrications. (See below section on Sexual and Domestic Abuse) This was one of the sorriest episodes of our coming to terms with trauma, and a betrayal of the abused similar to that of Freud and his colleagues.

 

So, psychoanalysis and psychotherapy were set along a path of mistrust of the client’s ability to tell the truth. Everything the client said was to do with her sexual fantasies rather than the truth, which in light of the fact that the majority of the clients were women (although not all), set even more firmly the notion inherent in the age-old diagnosis of hysteria that women were malingerers and couldn’t be trusted. Freud’s female patients’ disclosures of very real and agonising sexual trauma were interpreted back to them as their sexual fantasy desires for their fathers, and the Freudian tradition, indeed to an extent the whole of psychotherapy, subsequently took this as its underpinnings. One can only wonder at the potential for gross and tragic re-traumatisation this has incurred in patients over the last hundred years in the therapy room as a result.

 

From the perspective of the study of trauma, all of this can be seen as an example of a collective unconscious avoidance of trauma, and in a sense from this moment trauma entered one of its periods of oblivion. Herman again: “Out of the ruins of the traumatic theory of hysteria, Freud created psychoanalysis”, and what was lost was the good and careful study of trauma that was needed. Was the whole of the psychoanalytic tradition in fact born out of an unconscious survival tactic on the part of these pioneer analysts in order to protect themselves from their own buried and unconscious trauma experiences? If the therapist remained the interpreter of the client’s truth, then this ‘truth’ could be the therapist’s safety net, protecting him from his own terrifying unresolved trauma.

Interestingly the current work of the psychoanalyst, Allan Schore,[9] (a forerunner in the work of linking psychotherapy with the findings of the neurosciences), is founded on the open empathic relationship between therapist and client. This means that the ‘analyst’ attends to his or her own emotional process whilst in relationship with the client, thereby, it would seem, potentially bringing the therapist’s unresolved trauma more into the therapeutic framework.[10]

 

A further footnote to this account is the fact that Freud’s great friend in later life, Sándor Ferenczi,[11] resurrected the issue of childhood trauma in a paper presented in 1932. Ferenczi became convinced that accounts of early sexual trauma given him by his clients were real rather than the fantasy wishes of Freud’s theory. Ferenczi’s paper on the topic was called ‘Confusion of Tongues between Adults and the Child’,[12] and in it he went further than Freud’s original paper and implicitly criticised the current developments of Freud’s theories. Ferenczi, for whom Freud was a father figure to look up to and revere, and from whom he always hoped to find support of his work, in fact received no support from Freud, and died not having retracted his devastating ideas, isolated and criticised by his colleagues and peers (Masson, 1984). His paper is very readable and immensely relevant today, as it should have been then. Here is an extract from Ferenczi’s diary showing that it wasn’t only the victims of abuse who were talking to him in analysis, but the perpetrators as well:

 

“The obvious objection [to the thesis], that we are dealing with sexual fantasies of the child [as opposed to reality] ... that is, with hysterical lies, unfortunately is weakened by the multitude of confessions of this kind, on the part of patients in analysis, to assaults on children.”

(From Ferenczi’s diaries, translated by Masson, in Masson, 1984.)

 

When I first got involved in psychotherapy in the 1970s and trained in the late 1980s, the general atmosphere of therapy was in fact quite persecutory towards the client, with a “pervasive subculture ... of the client being troublesome, resistant, defensive, stubborn, blind and manipulative” (Broughton, 2013). From my present perspective I would say this attitude is potentially extremely re-traumatising. There was a persecutory element in how what are known as transference and projection in therapeutic language were used, and may still be used. Many times did I hear, amongst my fellow trainees as we all endeavoured to learn from our trainers, someone accuse another of projecting unwanted psychological ‘stuff’. These accusations always felt persecutory to me, as if I, as the ‘projector’ was not okay and should feel shame and guilt, which I did. This is subtle, but nevertheless has been a strong feature of the psychotherapeutic discipline.

 

There are two further points that I would like to make about this historical account: one is that the focus on the accounts of sexual abuse at that time, as important as they were, tended to deflect from other forms of childhood abuse, i.e., non-sexual violence, and emotional and physical neglect. Of course, any form of inappropriate and/or non-consensual sexual activity is a violence whether to a child or adult, but it would seem that the idea of adult (parent)/child sexual activity was so horrific that violence and neglect as a traumatic stimulus on its own were for the most part missed. The second point I want to highlight is that if we hadn’t deflected away from these topics, and moved away from traumatic reality as a central issue, it is possible that we could have come to understand the much earlier trauma of the attachment phase of the infant’s life, the ‘symbiotic trauma’ that Ruppert named, much sooner than we have (Ruppert, 2011). If the reality of traumatic events had been more within the domain of psychoanalysis than it was in the 1950s, it is likely that John Bowlby’s work would have been much more oriented around the traumatic nature of very early attachment than it was.

 

War Trauma and the Trauma of Militarism

 

“... man is not by nature a killer.” (Grossman, 2009)

 

Perhaps more than anyone else, the military have always known about trauma, but their relationship with it is complex. They have probably had a more consistent interest in it than any other section of society (Grossman, 2009, Shay, 1994, 2002). They have always had to grapple with the issue of how to get human beings to kill a member of their own species. No other species wilfully kills its own kind without severe provocation or under the pressure of evolutionary and ecological considerations, and even then, will usually try all kinds of submissive and avoiding behaviours in order not to do so. Some animals, such as the male lion, when taking over the pride of another male who has died, may kill and eat the young of the previous male in the interests of evolutionary supremacy and survival, to make sure that the female’s offspring have his genes rather than those of his predecessor. It is true that some of our human history of intra species violence has also at times had as its pressure securing or defending ecological security, but not all, and, as we shall see, even so there is an inhibition to killing our own kind. Interestingly the one species that we do know sometimes makes seemingly gratuitous attacks on another group of its own kind is the chimpanzee, perhaps not coincidentally the closest species to humans.

 

In addition to grappling with this issue of creating conditions in which humans will come to kill each other, the military have also always had to be concerned with how to keep personnel on the field in the face of the effects of their experiences in combat, i.e., when traumatised by their military experiences. In footnote 15 above we saw that in parallel with Breuer and Freud’s explorations of hysteria, there was a study of trauma from the neurological and organic (physical) perspective, which, according to Bessel van der Kolk was particularly appealing to the military:

 

“When issues of cowardice and shirking are raised, ascribing post traumatic symptoms to organic problems offers an honourable solution: The soldier preserves his self-respect, the doctor stays within his professional role and does not have to get involved in disciplinary actions, and military authorities do not have to explain psychological breakdowns in previously brave soldiers.” (van der Kolk, 2007a)

 

In other words, symptoms that should be ascribed to trauma could be deemed as physical symptoms which allowed the military to avoid the sticky issue of the psychological damage of combat.

 

The military have a vested interest in two things: not talking about trauma, ignoring and trying to diminish its effects and consequences, but also in conditioning people to kill, which to an extent must involve traumatising them. It requires a degree of dissociation to be able to harm another, and traumatised people are always to an extent dissociated. As we discuss trauma further in this book (Broughton, 2013), it will become clear that the less severely traumatised person is able to see others clearly in a way that provides a strong prohibition to harming them. It seems worth proposing then, that it is the traumatised person who, because their dissociation confuses their clarity of perception, can cause trauma to another. They do not see clearly the humanity of the other. For the military this creates a very delicate, even impossible, balancing act. The training of combatants to kill must involve some degree of traumatisation, which produces the level of dissociation necessary to be able to perform their function.[13] At the same time, the traumatised combatant is also likely to be a troublesome liability for those in command.

 

In his book, On Killing: The Psychological Cost of Learning to Kill in War and Society (Grossman, 2009), the military psychologist Lt Col Dave Grossman devotes considerable space to gathered statistics and opinions of many authorities on war over the last hundred years or so of the ‘firing rates’ of soldiers in war; that is the number of combat soldiers who actually do or do not shoot to kill in a combat situation; the number who shoot to miss – above the head for example – or who find other ways of avoiding killing. Here is a quote, for example, from a Second World War veteran:

 

“Squad leaders and platoon sergeants had to move up and down the firing line kicking men to get them to fire. We felt like we were doing good to get two or three men out of a squad to fire” (ibid.)

 

It is a relief to have someone from the military tell us that we have an innate resistance to killing another human being. At the same time, we have faced two troubling developments in our recent war-making: one is that the military understood that in order to get combatants to kill, the training needed to involve the production of a degree of dissociation in their soldiers. In the period after the Second World War, through the Vietnam War and into the Iraq War, increasingly this was done by the cultivation of hatred.[14] From there combatants are continually re-traumatised when on duty, their level of dissociation increasing each time.

 

A shocking statistic recently in the news (Los Angeles Times, April 2012) was that 110,000 active-duty US Army troops in Iraq took antidepressants in 2011. It has also been reported that such medication is commonly issued as a preventative aid – in my view to avoid combat soldiers becoming vulnerable to the debilitating effects of traumatisation by inducing a pharmacological pre-trauma dissociation.

 

A recent television programme on the BBC entitled “Are you Good or Evil?” in part looked at modern military training policy in the US, which now understands that killing is contrary to the human moral instinct. So military training now has two elements: a learned embodied reactive ability to kill, aimed to work alongside the natural human moral instinct to only kill in order to “protect and defend life”. They realised after the devastating aftermath of the Vietnam War and the Iraq debacle that training combat soldiers to hate in order to get them to kill has awful, irrevocable consequences. It killed their instinctive human morality, causing the absolutely shocking behaviours of combatants towards Iraqi captives that emerged in our news during the occupation of Iraq after the fall of Saddam Hussein, and the subsequent inability of combatants to reintegrate into society.

 

The second development is war at a distance, which began with distance bombardment and has become the more sophisticated computer room war, where unmanned drones and other remote military equipment are operated from a computer room thousands of miles away. No longer does one have to face the person one is about to kill; more and more war becomes like a computer game, dissociated from reality.

 

The history of the Diagnostic & Statistical Manual of Mental Disorders (currently the DSM-V), which is the American Psychiatric Association’s manual of diagnosis and categorisation of mental illness, in widespread use in the western world, has a military background. Originally the manual evolved from a census in 1840 that used a single category: idiocy/insanity (Wikipedia). At the time of the Second World War the American Military involved psychiatrists in the selection, processing, assessment and treatment of soldiers, and from this a team headed up by military psychiatrists developed a classification scheme called Medical 203 in 1943, and in 1952 the first DSM – DSM-I – evolved directly from this military document. The military were so in need of a means of assessing psychological conditions that they were the forerunners to what is now the psychiatric profession’s established manual.

 

The Holocaust of the Second World War, probably the most known, but of course not the only, genocidal event of the 20th century, set in train its own particular study of trauma. This, followed by the Korean and Vietnam Wars, more than ever before brought war trauma and the trauma of persecution and victimisation to the forefront of our attention. In the social atmosphere in the latter part of the 20th century more people developed a sense of a right to their emotional life, to the exploration and expression of their emotional selves, as therapeutic resources became commonplace and a ‘grin and bear it’ attitude was no longer so much valued. This, along with the unprecedented number of servicemen who came home after Vietnam severely traumatised and found no good way of integrating back into society, made the reality of combat trauma harder to avoid. A society that had hoisted its flag in America (and to an extent in the broader western world) to the American dream, didn’t want to know about the darker lives and experiences of these war-scarred men and women. This created an intolerable tension, and combat trauma was very much back on the agenda.

 

Sexual and Domestic Abuse and Violence

 

“The late nineteenth-century studies of ‘hysteria’ foundered on the question of sexual trauma. At the time ... there was no awareness that violence [was] a routine part of women’s sexual and domestic lives. Freud glimpsed this truth and retreated in horror.” (Herman, 1991)

 

“The acceptance of psychoanalytic theory went hand in hand with a total lack of research on the effects of real traumatic events on children’s lives. From 1895 until very recently, no studies were conducted on the effects of childhood sexual trauma.” (van der Kolk, 2007a)

 

“About 50,000 names are etched into the Vietnam War Memorial. If we made a memorial to children who have been sexually abused, it would be more than 1300 times the size of the Vietnam memorial. If we included other forms of child abuse it would be more than 7,500 times its size… These are souls lost in a betrayal and wounding that is so deep that most are unable to heal and reconnect with self, others and God.” (Whitfield, 1995)

 

In the late 1960s and early 1970s gradually the reality of many women’s lives started to come to the surface. The dominant male trauma was war trauma (of course it was not only men, but predominantly men who suffered from war trauma), whereas the predominant female trauma was the hidden, private and shameful life of the home, where domestic sexual, emotional and physical violence played out, often on a daily basis:

 

“The cherished value of privacy created a powerful barrier to consciousness and rendered women’s reality practically invisible ... Women were silenced by fear and shame, and the silence of women gave license to every form of sexual and domestic exploitation.” (Herman, 1992)

 

A colleague of mine, who was a young social worker in London in the 1970s, tells me that domestic violence and sexual abuse were the most common issues that she had to deal with every day. The level of dysfunctionality that she witnessed and attempted to work with in families at that time was completely horrifying. And the level of her superiors’ dissociation from the horror and devastation of what she was having to deal with was evidenced by the fact that, at the age of twenty-two, she was required to work with large families on her own, with limited and variable supervision, families with histories of extreme violence and dysfunctional, aberrant, and often psychotic, behaviour. Social workers in London in the 1970s knew the trauma of domestic violence and sexual abuse very well, and were up against the terrible effects every single day.

 

At the same time in the privacy of the psychotherapy room and ‘consciousness-raising’ groups of the 1970s, slowly women started to try and understand their experiences, to put a name to them, and speak out; but the cost was often high in terms of their financial status, their safety and that of their children. The first widely known women’s refuge in the UK opened in 1971 in London, called Chiswick Women’s Aid; and in the USA Haven House opened in California in 1964. At the same time as women were dealing with current issues of domestic violence, they also started to speak out about childhood experiences of sexual violence and abuse at the hands of parents or other family members.

 

Many were not believed, and the emergence of so-called ‘false-memory syndrome’ (never an actual official designation) was one of the most appalling phases of trauma avoidance when applied to the disclosures that women were making.[15] To be sure, in the confusion of the client – and of the therapist as she or he tried to comprehend and make sense of what it was they were hearing – there may well have been false assumptions, but think for a moment of the potential re-traumatisation of the woman who finally gains the courage to share her confused and disoriented fragments of memory, then to be accused of purposely falsifying these memories. We are back to the frightening and self-denying origins of psychotherapy. And many therapists, to be sure probably confused and overwhelmed themselves by what they were hearing and having to manage, came under fire as having put these ideas into the heads of their clients. I grew up as a psychotherapist in the late 1980s and early 1990s and I remember clearly the confusion and stomach-churning nausea I felt the first time a client told me about the abuse she had experienced as a child. I remember how hard I found it to believe, even at the same time being convinced that it was true, and I remember how much every fibre in my body wanted to avoid it.

 

Today

During the 1990s there was an increasing interest in trauma, reflected in the proliferation of literature on the topic by writers such as Judith Herman, Babette Rothschild, Peter Levine, Charles Whitfield, Donald Kalsched. Sandra Wieland, Jonathan Shay, Bessel van der Kolk, Leonore Terr and Kaethe Weingarten amongst many others. Broadly the approaches to understanding trauma fall into the following categories: understanding shock and trauma (Herman and Weingarten), Post Traumatic Stress Disorder (PTSD) and the bio-physiology of trauma (Rothschild, Scaer, Etherington, Levine, Ogden, Siegel, Minton & Pain, Friedman, Kean, Naparstek, Resick, van der Kolk, McFarlane and Wesaeth), childhood sexual abuse (Wieland, Whitfield, Cloitre, Cohen & Koenen), combat trauma (Shay), the neurology of trauma (Stein & Kendall), the transgenerational aspect of trauma (Auerhahn & Laub, Danieli, Fromm), the formation of psychological dissociative structures (van der Hart, Nijelhuisen, and Steele).

 

There has always been a difficulty in the psychotherapy tradition of evaluating the effectiveness of what we do, and since there has never been a scientific method that could usefully perform this evaluation, psychotherapy has always kept itself somewhat distanced from other sciences. The basis of psychotherapy is personal experience, and it was only by subjective experience reports that we could make any judgement of what was and what was not effective. This is decidedly unscientific. In the 1950s the English psychoanalyst John Bowlby shocked many of his colleagues, and invoked criticism from some, by his interest in other sciences, particularly the science of ethology and the work of Konrad Lorenz.[16] Bowlby regarded many of his contemporary psychoanalysts, particularly the leaders of the movement in the time following Freud’s death, Anna Freud (Freud’s daughter) and Melanie Klein and their followers, as “hopelessly unscientific” (Holmes, 1993). According to Holmes “Both [Klein and Anna Freud] argued from intuition and authority, rather than subjecting their claims to empirical testing.”

 

The absence of any useful means of assessing the efficacy of psychotherapy later led many in the 1970s and 1980s to focus on Behavioural Therapy, which aimed to change behaviour. Subsequently in the late 1980s and the 1990s Cognitive Behavioural Therapy (CBT) became popular, based on the assumption that “negative feelings are caused by irrational thoughts and beliefs; therapy aims at changing beliefs.” (Shedler in Schore, 2012). Both of these methods in their own way were deemed to be scientifically proven effective; however, the results were generally short term (as far as I can ascertain there were no studies of long-term outcomes), and neither discipline had any particular focus or understanding of the real dynamics of trauma. Alongside this the Humanistic tradition continued to work with emotion and relationship, and increasingly with trauma.

 

However, the emergence of the neurosciences in the late 1990s also stimulated an intense focus on child development, and the potential for trauma of attachment and early childhood, combining this with a focus on PTSD (Post Traumatic Stress Disorder). The prominent writers of the early 21st century coming from a synthesis of neurobiology and psychotherapy include Dan Siegel and Pat Ogden (Sensorimotor Psychotherapy), Bessel van der Kolk et al (Traumatic Stress), Allan Schore (Affect Regulation Therapy), and Ian McGilchrist, whose seminal book, The Master and his Emissary, provides an adventurous account of the evolution of our brain structures and function, and the effects on us.

 

Allan Schore in his latest book, The Science of the Art of Psychotherapy, proposes that the neurosciences finally do offer clear evidence of the effectiveness of psychotherapy, and that this will prompt a paradigm shift in the profession’s approach from a cognitive, verbal, conscious and behavioural emphasis to an emotional, non-verbal, unconscious and relational emphasis.

 

As a final word on the topic of this chequered history of trauma studies I will quote Bessel van der Kolk on the history of psychiatry’s relationship with trauma:

 

“People have always been aware that exposure to overwhelming terror can lead to troubling memories, arousal and avoidance: this has been a central theme in literature from the time of Homer (Alford, 1992; Shay, 1994) to the present (Caruth, 1995). However, psychiatry, as a profession, has had a troubled relationship with the idea that reality can profoundly and permanently alter people’s psychology and biology. Psychiatry has periodically suffered from marked amnesias, in which well-established knowledge was abruptly forgotten, and the psychological impact of overwhelming experiences [were] ascribed to constitutional or intrapsychic factors alone. Mirroring the intrusions, confusion, and disbelief of victims whose lives are suddenly shattered by traumatic experiences, the psychiatric profession periodically has been fascinated by trauma, followed by stubborn disbelief about the relevance of our patients’ stories.”

(van der Kolk, 2007) (my emphasis)

 

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REFERENCES

Broughton, V. (2013). The Heart of Things: Understanding Trauma. Green Balloon Publishing, UK.

Freud, S. (1962) The Aetiology of Hysteria (1896), in Standard Edition, Volume 3, translated by J. Strachey. Hogarth Press, London.

Freud, S. (1922). Beyond the Pleasure Principle, in Sigmund Freud: Beyond the Pleasure Principle and  Other Writings (2003). Penguin, USA.

Grossman, D. (2009). On Killing: The Psychological Cost of Learning to Kill in War and Society. E-Rights/E-Read, New York, USA.

Herman, J. L.  (1992). Trauma and Recovery: The aftermath of Violence from Domestic Abuse to Political Terror. Basic Books, New York.

Holmes, J. (1993). John Bowlby & Attachment Theory. Routledge, London.

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