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The history of trauma

2020-03-18

 

One of the things that caught my eye while reading Van der Kolk's book was the title of the first chapter: The Rediscovery of Trauma. In it, he discusses how PTSD first received official recognition in the aftermath of the Vietnam war. However the story then goes back a hundred years to the work of Sigmund Freud. Its an interesting story, worth relating here.

 

In 1885 Freud studied under Jean-Martin Charcot, the Paris based 'father of neurology'. Charcot taught other distinguished physicians such as William James and Pierre Janet. Together they were studying the causes of what was then known as hysteria. Hysteria was a term used most commonly for women, who would exhibit antisocial behaviors like emotional outbursts, muteness, convulsions and memory loss (if you have seen the 2014 film The Homesman you'll understand).

 

Charcot, although he studied methodically, believed that hysteria was caused by weak nerves, and was inherited. It was Janet who to his credit started his clinical work with the foundation of actually listening to his patients. Often for hours and days at a time. Janet came to understand and name the now important concepts of dissociation and the subconsious.

 

"Janet coined the term 'dissociation' to describe the splitting off and isolation of memory imprints that he saw in his patients. He was also prescient about the heavy cost of keeping these traumatic memories at bay. He later wrote that when patients dissociate their traumatic experience, they become 'attached to an insurmountable obstacle'. [U]nable to integrate their traumatic memories, they seem to lose their capacity to assimilate new experiences. It is... as if their personality has stopped at a certain point, and cannot enlarge any more by the assimilation of new elements." Van der Kolk, Chapter 11.

 

By the mid 1890s Janet in France and Freud in Vienna had arrived independently at the same conclusion, that hysteria was a condition caused by psychological trauma.

 

While Janet's work is largely unrecognized today, it was to be Freud who came into the limelight. Back in Vienna with his colleague Joseph Breuer, he advanced his ideas that hysteria was rooted in traumatic experience. When they published their 1896 paper called 'The Aetiology of Hysteria', it said in essence that hysteria was caused by premature sexual experience, and which came to be known as his 'Seduction theory'. Here the story gets a little murky, but Van der Kolk considers the view of Judith Herman (one of the founders of modern Psychotherapy), which is this:

 

"Both Janet and Freud recognized that the somatic symptoms of hysteria represented disguised representations of intensely distressing events which had been banished from memory... By the mid 1890s these investigators had 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. This method of treatment became the basis of modern psychotherapy." Herman (1992), Trauma and Recovery, Chapter 1.

 

Again it was to be Freud that followed this trail into the realm of sexuality. He listened closely to his female patients and...

 

"What he heard was appalling. Repeatedly his patients told him of sexual assault, abuse, and incest... By 1896... in a report on eighteen case studies, he made a dramatic claim: I therefore put forward 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... A century later, this paper still rivals contemporary clinical descriptions of the effects of childhood sexual abuse. It is a brilliant, compassionate, eloquently argued, closely reasoned document."   Herman (1992)

 

Except, unfortunately, soon afterwards he changed his mind. Based on my reading of the literature, it seems the conclusion was politically unpopular and lead to his being professionally ostracized .

 

"Within a year, Freud had privately repudiated the traumatic theory of the origins of hysteria. His correspondence makes clear that he was increasingly troubled by the radical social implications of his hypothesis. Hysteria was so common among women that if his patients stories were true, and if his theory were correct, he would be forced to conclude that what he called perverted acts against children were endemic, not only among the proletariat of Paris, where he had first studied hysteria, but also among the respectable bourgeois families of Vienna, where he had established his practice." Herman (1992) Chapter 1.

 

The details of his fear of peer censure are still being debated today, but either way the outcome was without doubt unfortunate, because as a result, he moved on to his dubious ideas about the role of infantile desire, fantasy and the oedipus complex, and it would be many decades later before the subject would again get the attention it deserves from the science of psychology.

 

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