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Introduction to Trauma, a Capacious Social Concept
The word âtraumaâ originates from the Greek trauma, meaning âwoundâ. It first appeared in English in the 1690s as a medical term denoting a physical wound. It was not until the late nineteenth century that âtraumaâ came to connote a âpsychic wound, [an] unpleasant experience which causes abnormal stressâ.1 Todayâs expanded meaning still rests on âwoundâ.
The experience of serious trauma impacts and often shatters our understandings and assumptions about the world and our place in it. Some trauma survivors experience lasting, if not permanent, psychological and physiological distress, influencing behaviour, feelings, and functioning. For most of human history, people who sought to understand and heal from such traumas looked to religious or spiritual practices or supportive connections with others. But by the late nineteenth century, the work of the French doctor Pierre Janet conceptualised much about psychological trauma as it is understood today, viewing âthe trauma response basically as a disorder of memory which interfered with effective actionâ, and making âthe first attempt to create a systematic, phase-oriented treatment of post-traumatic stressâ.2 Freud, according to psychoanalyst Peter Loewenberg, was soon to define âtraumaâ as âan experience that, within a short period of time, presents the mind with an increase of stimulus too powerful to be dealt with or worked off in the normal wayâ.3
Trauma first became a major psychiatric concern during World War I.4 Troops on all sides of the conflict experienced wide-ranging neuropsychiatric symptoms, termed âshell shockâ, even those without any physical injuries.5 Psychological wounds were linked to physical wounds.6 After World War I it was generally understood that traumatised individuals required psychiatric or medical intervention.7 Nonetheless, in spite of so many sufferers, for a time scientific study of psychological trauma and development of healing or recovery methods was intermittent at best. World War II and the Korean War brought another wave of the study of trauma when soldiers returned home with now-familiar symptoms.8 By the 1960s and 1970s different survivor populations were raising awareness of psychological trauma. The feminist movement led to the identification of the âsyndromesâ of rape trauma and battered women. Toward the end of the Vietnam War in 1975, a âpost-Vietnam syndromeâ was proposed, referring primarily to soldiersâ trauma symptoms.
Finally, in 1980, the clinical diagnosis, post-traumatic stress disorder (PTSD), was formally acknowledged by inclusion in the American Psychiatric Associationâs Diagnostic and Statistical Manual of Mental Disorders (known as the DSM). Acceptance of the concept promised momentous change in the understanding of much human suffering. As the National Center for PTSDâs website puts it, âthe significant change ushered in by the PTSD concept was ⌠that the etiological agent was outside the individual (i.e., a traumatic event) rather than an inherent individual weakness (i.e., a traumatic neurosis)â.9
Overall, thereafter, the existence of PTSD and the understanding that its cause was outside the individual came to be recognised in the United States and internationally. Psychiatrist Judith Hermanâs classic work, Trauma and Recovery, published in 1992, became the first to link two populations of individuals, soldiers returning from Vietnam and sexually abused women, each with a high percentage of trauma. She found that the existence of trauma or traumatic events and the internal state of being traumatised in both groups was more widespread than had previously been acknowledged. As mental health professionals absorbed her message, advances in understanding psychological trauma and processes for recovery followed. Soon afterwards, the idea took hold that whole societies or groups could be similarly affected.
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This chapter and the next respectively emphasise individual trauma, the third collective trauma. The three chapters provide the foundation of the trauma-informed perspective that shapes the historical narratives and analyses in the rest of the book. But although this bookâs focus is more on peoples than on individuals, it also offers brief portrayals of a number of individuals who are emblematic of their entire people or a significant segment among them as they cope with traumatic challenges in their societies. Some captured and influenced the public mood, if not their peopleâs collective psyche and actions.
I.PTSD AND TRAUMA: CLINICAL AND POPULAR USES
Today both âtraumaâ and âPTSDâ are capacious social concepts in common use with somewhat varying but overlapping meanings. Strictly speaking, PTSD denotes a clinical diagnosis. The American Psychiatric Association specifies PTSDâs meaning and application through a periodic process in which a group of experts reexamines, and sometimes redefines, mental disorders and publishes them in the DSM. (The 2013 fifth edition of this volume, commonly referred to as the DSM-5a, remains current,10 but at the time of writing, a cohort of international mental health clinicians is at work redefining PTSD.)
PTSD is the best-known trauma-specific diagnosis in the current DSM and is applied when a person manifests one or another specified set of reactions or symptoms. Thus, having some of the symptoms of PTSD does not mean a person has PTSD. Indeed, many individuals who experience traumatic events and have symptoms may not be clinically diagnosable with PTSD because their symptoms fail to meet one or another set of DSM symptoms for assignment of the diagnosis. Nonetheless, most who go through terrible events are traumatised to some degree. On the other hand, researchers estimate that many more individuals would be diagnosed with PTSD or trauma, but never seek treatment and thus never receive this diagnosis.11
Since âPTSDâ is widely if loosely used outside clinical contexts as well, PTSD, the clinical diagnosis, cannot be fully conflated with the popular use of PTSD â or with trauma. All in all psychological trauma is a much broader category than clinical PTSD.
II.TRAUMA
Trauma refers to events or ongoing conditions that âcreate harm or threat of harmâ12 and cause intense physical and psychological stress reactions or symptoms. Trauma disrupts individualsâ major biological systems for coping with stress,13 overwhelming the ability to manage or make sense of the experience. Thus, in their foundational handbook on trauma therapy, psychiatrists John Briere and Catherine Scott wrote that âan event is traumatic if it is extremely upsetting, at least temporarily overwhelms the individualâs internal resources, and produces lasting psychological symptomsâ.14 Similarly, Loewenberg distinguishes the core objective from the subjective elements of traumatic experience: âThe external stimulus is too powerful to be mediated by the normal adaptive coping mechanisms; the person is overwhelmed and helplessâ.15
At the same time, the word âtraumaâ and its offshoots such as âtraumaticâ elude precise distinction between objective events and subjective experience. Does âtraumaâ refer to the objective stressor event, the victimâs subjective experience of the stressor, and/or the victimâs subjective symptoms that arise in response to the stressor? It is used for them all. As noted, when I began writing this book, I thought I could use âtraumaâ and its related terms to refer to either subjective or objective experience, not to both. I attempted to use âtraumatic eventâ to refer to the objective event and âtraumatisedâ or âbeing traumatisedâ to refer to the condition of having one or more of many possible symptoms after the event. But I found that the distinctions among the family of words just didnât hold consistently.
Clarification is complicated because individuals exposed to the same traumatic events often respond differently. Some people are little traumatised by events that seriously traumatise others. All manifest a wide range of reactions or symptoms. And assessing whether or how much an individual or group is traumatised depends on the criteria used. In this book, âtraumaâ refers to both objectively and subjectively known experience, and at times to both simultaneously.
III.TYPES OF TRAUMATIC EVENTS
Because traumatic events and traumatic situations come about by accident, nature, or are inflicted by humans, deliberately or not, a very wide range of types of events and situations may be so identified. They include physical and verbal abuse, aeroplane/train/automobile accidents, death, discrimination, fires, life-threatening or debilitating illness, isolation, losses of many kinds, material and psychological, including of reputation, status, or regard, mugging, rape and sexual assault, starvation, and torture. This book is centrally about humanly caused events and situations imposed without concern for those affected or with deliberate malintent â discrimination, massacres, genocide, ethnic cleansing, enslavement, and starvation â that often led to complex if not traumatising situations. Traumas are also âacts of omission ⌠(such as neglect or abandonment) where the absence or withdrawal of certain resources may create a threat to [human] survival or well-beingâ.16 Witnessing others experiencing trauma or discovering a victim is another category of events that are often traumatic.17
Much trauma literature conveys the impression that all traumatic experiences are events in the sense that there is a clear beginning and end, and that survivors cope with their aftermath. Increasingly, however, awareness is growing that there are situations of protracted wounding and of continuous, ever-present facts of life.18 Thus, ethnic cleansing, large fires and floods, genocide, terrorist attacks, and war, all entailing vast collective hurts and losses, are generally understood as traumatic collective events. In contrast, conditions of ongoing discrimination, impoverishment and environmental degradation make for collectively traumatic situations.
In writing about trauma, neuroscientists Joseph LeDoux and Daniel Pine refer to âthreatsâ, not âeventsâ.19 Are threats of trauma âeventsâ? âThreatsâ ordinarily denotes not the possibility, but the occurrence, of events. But even if what is threatened does not materialise, being threatened may nonetheless be traumatising. Receiving threatening phone calls from dangerous persons or living under constant threat of arbitrary arrest, torture, or death are likely to be traumatising. Another example is that of the threat of a whole social classâs loss of superior status. In 2018 a study found that Trump voters were âmotivated by ⌠fears of waning power and status in a changing countryâ.20 The recent book by political scientists Steven Levitsky and Daniel Ziblatt, How Democracies Die, recognises that white Republican menâs fears are leading them to do anything to keep their social status and possession of societyâs powerful positions.21...