TRAUMATOLOGY AND POSTTRAUMATIC STRESS DISORDER: A HISTORIC OVERVIEW The two main categories of traumatic experience are public trauma and private trauma. Public trauma refers to traumatic events that occur in the public sector and are visible to and recognized by others. These events include natural disasters or other “acts of God,” war, traffic accidents, terrorist attacks, and the like. Common to these experiences is that the traumatic event is seen and accepted as reality by the general public. No question arises concerning whether the earthquake occurred, the veteran was exposed to sniper fire, or the two cars collided. There are witnesses and, often, pictures or live footage of the events. from growing up in addictive and dysfunctional family systems; and childhood physical, sexual, and emotional abuse. Typically, in private trauma there are no witnesses, and it is often the perpetrator’s word against the victim’s word (van der Kolk, 2014). Often the victim bears the added burden of invisible wounds and the experience of having the disclosure of the abuse or maltreatment met by disbelief from caretakers and professionals. These experiences add an additional layer of trauma to the
events—that of entrapment (the sense of feeling tricked or duped by the disbelief of family or caretakers and denial of the events by the offenders) and what is known as “learned helplessness.”
This is in contrast to private trauma, which includes domestic violence; rape; neglect traumas; medical traumas; the fallout Helplessness and Resilience In the 1960s, Martin Seligman carried out a research study on the concept of learned helplessness (Seligman & Maier, 1967). The researchers caged dogs and subjected them to an electric shock, while thwarting their ability to escape. (This study would not be permitted today due to better controls on animal cruelty in experimentation.) After a number of trials, the dogs had learned that escape from the noxious stimulus was not possible and they stopped trying to avoid the shock, seemingly resigned to their discomfort or pain. At this point, Seligman released the dogs from their confinement, allowing them the option of escaping the shock stimulus. He found that, initially, all of the dogs continued to suffer the shock and did not even try to escape because of the extent of their conditioned response. After several subsequent trials, some of the dogs did relearn that escape was an option and were able to avoid the shock. Others, however, never regained their capacity to avoid the pain and trauma of the shock and remained in place even when shocked. This rather gruesome experiment illustrates the accommodation to trauma that can occur in the face of a perception that no viable alternative option exists. Although this experiment is often offered as an example of learned helplessness (e.g., some dogs never acted in self-protection after the option became available), it is crucial that attention be placed on the dogs that did relearn to avoid pain and trauma because it is that ability to relearn a temporarily lost capacity that informs treatment orientations and helps to offer hope to those who suffer. The second group of dogs presents an example of the positive counterpoint to learned helplessness by illuminating the concept of resilience. When humans do not cause traumatic events, it is much easier to bear witness and offer aid to the victims. However, when humans do perpetrate traumatic acts against other human beings, the observer is forced to confront the capacity for evil in the world (Herman, 1992). Often, the witnesses, bystanders, or receivers of the disclosure are, in effect, asked to make the excruciating decision of whether to believe the victims. The perpetrators usually do everything in their power to preserve secrecy. In cases in which they are more credible and articulate than their victims, The History of Understanding Trauma Many people believe that the current understanding of trauma began with so-called combat neurosis or shell shock in veterans of World War I. The earliest roots, however, predate this time, extending back to the mid-1890s in the work of Pierre Janet and the early work of Sigmund Freud and Joseph Breuer. All three men, independently, expanded on the French neurologist Jean Martin Charcot’s (1887/1889) study of hysteria. They concluded that hysteria was the result of the psychological trauma that followed after enduring unbearable experiences. They determined that responses to unbearable traumatic events produced altered states of consciousness, which then led to hysterical symptoms (Herman, 1992). Janet (1889) stated in his doctoral thesis that there was a connection between trauma and various forms of psychological distress. At this time, Janet called it “dissociation,” whereas Freud and Breuer called it “double consciousness” (Breuer & Freud, 1893–1895/1962). Janet stated
they are more easily believed. Thus, the victims of private abuse or trauma are often left to suffer in silence and isolation (Herman, 1992). Despite the human capacity for resilience, public and private trauma can overwhelm the victims’ coping capacities, possibly resulting in acute or chronic maladaptive responses. Some psychological adaptations are useful for short-term coping; however, if they persist or become generalized to people, places, and things not related to the immediate traumatic events, they can become maladaptive and later interfere significantly with a person’s life. It is important to note that the majority of individuals who have been exposed to trauma do not necessarily go on to develop posttraumatic stress disorder (PTSD) because the human capacity for healing and resilience emerges, much as an individual heals from a physical wound. Persons with compromised immune systems may need additional supports or medical interventions to heal from relatively simple injuries, but the majority will heal on their own. This is the same for psychological healing. People with a strong premorbid constitution can heal on their own, with natural supports from their communities and families, and may not go on to develop a posttrauma syndrome. Individuals who are exposed to complex multiple traumas, or those who have a history of previous traumatic life events that have not yet been addressed or resolved, are the individuals more likely to experience complications, that is, to develop PTSD. (This situation will be discussed in further detail later in the course.) Both public and private trauma can interfere with the psychological, social, and biological balance of the individual (van der Kolk, 2014). The memories of one past event, or a series of events, may severely compromise an individual’s ability to live life fully in the present. A cornerstone of treatment is to help these individuals become able to internalize the concept of “that was then, and this is now” and have the memory of past trauma be truly a memory in the past instead of hijacking their present capacity for joy, connection, and fulfillment in life. that unintegrated and unexpressed vehement emotions are “split off (dissociated) from consciousness” (1919/1925, Volume I, p. 661) and that affected people are “unable to make the recital which we call narrative memory, and yet they remain confronted by [the] problem situation” (Janet, 1919/1925, as quoted in van der Kolk et al., 1996, p. 52). These analysts “also discovered that hysterical symptoms could be alleviated when the traumatic memories, as well as the intense feelings that accompanied them, were recovered and put into words” (Herman, 1992, p. 12). This understanding of the nature of traumatic memory later became the basis in part for modern- day trauma treatment (Herman, 1992). Indeed, the “talking cure,” the term used in a paper on Anna O. (Breuer & Freud, 1893–1895/1962) refers to what is known today as standard talk therapy.
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