Trauma A Potted History

The word ‘trauma’ or ‘traumatic’ is often used to describe, jokingly, the slightest upset or inconvenience a person encounters in Life. Everything in life can be described as ‘traumatic’. Or if it was narrowly avoided, could otherwise have resulted in a person feeling ‘traumatised’. Though the word seems ever present today, the concept of ‘trauma’ as a presenting problem is a very recent development.

Trauma wasn’t considered ‘a thing’ (in today’s parlance) until the middle of last century. Before then, the idea of trauma or traumatic experiences were dismissed or overlooked, and people who experienced trauma were expected to simply “get over it” and move on. Trauma today is regarded as one of top five presenting problems a person can suffer. It dramatically increases the risk for seven out of 10 of the leading causes of death in the United States. It affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. People who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy (CDC and Kaiser Permanente 2019).

While addiction has a long history dating back to ancient times (Carl Fisher 2022), the recognition of trauma as a significant presenting problem requiring attention and treatment has only emerged in the last century. It is important to examine how this recognition has evolved in order to better understand and address the impact of trauma on individuals.

The recognition of trauma as a discrete psychological disorder can be traced back to the work of neurologist W.H.R. Rivers early 20th century. During World War I, many soldiers experienced what was then known as “shell shock” during combat, a condition characterised by all the classic symptoms of trauma we understand today.

These include:

1. Physical symptoms, such as headaches, dizziness, and tremors.
2. Emotional symptoms, such as anxiety, depression, and irritability.
3. Cognitive symptoms, such as memory problems, difficulty concentrating, and confusion.
4. Behavioural symptoms, such as insomnia, nightmares, and avoidance of associated places or activities.
5. Hyper-vigilance, or being on constant alert for potential danger.
6. Flashbacks, or re-experiencing the traumatic event in one’s mind.
7. Dissociation, or feeling disconnected from one’s surroundings or emotions.

The first study to examine trauma outside a military context was the work of the psychiatrist Eric Lindemann. He studied the survivors of a tragic nightclub fire in Boston in 1942 and found survivors experienced a range of psychological symptoms, including guilt, anger, and depression, and he coined the term “grief work” to describe the process of coming to terms with traumatic loss.

But aside from Lindemann’s work, research on trauma largely continued to focus on its effect of combat on military personnel through to the Falklands, Iraq and Afghanistan. The professional focus was on a person’s their symptoms with especial regard for their speed and ability to ‘recover’ and either rotate back to combat or to return home and reintegrate into normal life.

But the yellow ribbon return of veterans jarred with their contention that their minds we’re still in Vietnam (demonstrated by their throwing medals over the White House fence) focused attention on what was becoming defined as ‘trauma’.

During the 1960’s and early 70’s an increasing number of psychiatrists maintained people experience events which they find ‘traumatic’ and the psychological effects of these traumatic incidences play out in ways which are identical to those found in combat veterans. These events can be ‘shock trauma ‘ such as accidents, assaults or natural disasters. ‘Developmental’ and ‘relational’ trauma such as child abuse. And “intergenerational trauma” a terms used to describe the ways in which trauma can be transmitted across generations, both through biological and cultural means.

‘Simultaneously the women’s liberation movement testified to the hidden everyday crimes of battery and incest’. (Herman 2023). As a consequence the definition and importance of recognizing the widespread impact of trauma was completely overhauled. And the pursuit of a more comprehensive and compassionate approach to trauma treatment and prevention addresses begun.

During the 1970’s and 1980’s the field of psychology began to pay more attention to the effects of childhood trauma, such as physical and sexual abuse within families. Trauma also began to enter popular awareness through several popular books and the rise of cable television.

This was due in part to the feminist movement and the work of researchers such as Judith Herman, who published “Trauma and Recovery” which was regarded as ‘one of the most important psychiatric works to be published since Freud’ (New York Times 1992) Herman ‘s research on sexual abuse laid out a simple thesis: trauma can occur not only in the blind terror of combat, but quietly, within the four walls of a house, at the hands of a trusted person.

The Jungian analyst Marion Woodman explored the role of trauma particularly in the form of emotional and psychological wounds, and their ability to manifest in the body and psyche to have a significant impact on an individual’s life and relationships (The Ravaged Bridegroom,1990). Woodman believed this process could involve working with dreams, symbols, and archetypes, as well as exploring the body and its somatic experiences.

The ways in which trauma could be unconsciously stored within the body was explored and further popularised by Woodman’s contemporary, Dr. van der Kolk. Van der Kolk emphasised that traumatic experiences are not just events that happen to us, but are also experiences that get stored in our bodies and affect our ability to regulate emotions, process information, and form healthy relationships with others. His book “The Body Keeps the Score” which addressed the ways in which a person’s unconscious may address trauma and rapidly gained popular audience and is largely responsible for the way in which we think about trauma today. (His book appeared on the New York Times best seller list for 232 weeks).

In terms of clinical research, the American physicians Dr. Vincent Felitti and Dr. Robert Anda are credited for their seminal work during the 1990’s on the link between childhood trauma and adverse health outcomes in adulthood. The Adverse Childhood Experiences (ACE) study, still represents one of the largest investigations ever conducted on the relationship between childhood trauma and health outcomes. It involved over 17,000 participants and confirmed that individuals who experienced childhood trauma, such as abuse, neglect, or household dysfunction, had a significantly higher risk of developing a range of negative health outcomes later in life, including chronic diseases, mental health disorders, and substance abuse.

From a clinical perspective the diagnosis of post-traumatic stress disorder (PTSD) first appeared in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1980. This entry in the DSM catalysed the debate on what ‘counted” as trauma. In 1994 the editors of the DSM expanded the definition of PTSD, dropping the requirement that the traumatic event be “outside the range of usual human experience.” Dr. Herman and Dr. van der Kolk began lobbying for the inclusion of complex PTSD, the result of recurring or long-term traumatic events this has yet to be accepted.

Since the mid-1990s, the editors of the DSM have consistently opposed further expanding the definition of PTSD. The original definition was intentionally strict, meant to avoid the possibility that ALL mental disorders are simply caused by trauma. The concern was that while stress contributes to most psychiatric problems PTSD diagnoses could be made quickly and carelessly, without pursuing underlying mental disorders, such as anxiety and depression.

The complexity of diagnosing and understanding and treating trauma led to what became known as the memory wars of the 1990’s The “memory wars” were a heated debate that took place in the 1990s within the field of psychology and psychotherapy regarding the validity of recovered memories of traumatic events, particularly memories of childhood sexual abuse.

On one side of the debate were therapists and advocates who believed that people could repress traumatic memories and recover them later in life, often through therapy. They argued these recovered memories were valid and should be taken seriously, even if they surfaced years after the event took place.

On the other side were sceptics who believed memories could be distorted or false, particularly if they were recovered through techniques like hypnosis or guided imagery. They argued false memories could be created by well-meaning therapists or by the influence of popular culture. The debate was often polarised and emotional, with both sides accusing the other of ignoring evidence or engaging in unethical practices. The rise of cable TV also played a significant role in shaping public perception of the debate, with sensational stories and TV shows like Oprah Winfrey’s covering the issue.

By 2000, the ‘memory wars’ led to a greater awareness of the complexity of memory and the potential for both accuracy and inaccuracy. The professional response was a more cautious response by therapists working with traumatic memories focusing called “trauma-informed therapy.”

Trauma-informed therapy is based on a number of key principles, including safety, trustworthiness, choice, collaboration, and empowerment. It emphasises the importance of creating a safe and supportive environment in which individuals can explore their experiences and feelings at their own pace, and in which they have agency and control over the therapeutic process.

During 2010, the ‘decade of the brain’ provided neurobiological evidence for the way in which the people respond to life threatening situations and helped to clarify some of the issues around ‘false memories’. Advances in neuro-imaging technologies (CAT and fMRI scans) and neurobiological research helped to shed light on the physiological and neurological underpinnings of trauma and related disorders. For example, researchers have identified specific areas of the brain that are activated. ‘light up’, in response to perceived threats, as well as changes in brain structure and function that can occur as a result of trauma.

Today ‘trauma’ is recognised as a significant presenting problem the cause of which has several psychological and physical roots. A traumatic experience can leave a person consciously ‘lost for words’ while their body reacts in ways which can feel alarmingly out of control. Present day understanding of trauma draws from the latest clinical and neurobiological research and successful treatment usually combines an approach that has a psychological and physical aspect.

The polyvagal theory was put into practice by clinicians such as Deb Dana who developed a range of trauma informed interventions based upon it for example “Rhythm and Resilience,”

The work of Dr. Gabor Maté is known for his work on (especially intergenerational trauma) and its relationship to addiction. In his book “In the Realm of Hungry Ghosts” Maté explores the connections between trauma and addiction. He suggests substance abuse is often a coping mechanism for individuals who have experienced trauma and are struggling with emotional pain and distress.

Dr. Dan Siegel work on trauma has contributed to a growing understanding of the impact of trauma on the brain and the importance of building healthy relationships and promoting neural integration in promoting healing and recovery.

Peter Levine is a psychologist and body-oriented therapist who is known for his work on the treatment of trauma. Through’ Somatic Experiencing’ Levine suggests that traumatic experiences can become “stuck” in the body and lead to chronic patterns of tension, anxiety, and other physical symptoms. “Waking the Tiger.”

The acknowledgment of trauma has led to the pursuit of a more comprehensive and compassionate approach to trauma treatment and prevention. Trauma-focused therapies, such as cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), and somatic experiencing (SE), aim to help individuals recover from the effects of trauma. Trauma-informed care approaches have also been developed to help organizations and individuals understand how trauma can affect individuals and how to create safe and supportive environments.

Overall, the recognition of trauma as a significant issue has come a long way, and it is essential that we continue to acknowledge and address trauma to help individuals recover and lead healthy and fulfilling lives