Trauma

Lucy Bond, Stef Craps

• Éditeur: Routledge
• Année: 2019
• ISBN:
  9781134106615
• Édition: 1
• Sujet: Historia
• Sous-sujet: Historia del mundo

Trauma has become a catchword of our time and a central category in contemporary theory and criticism. In this illuminating and accessible volume, Lucy Bond and Stef Craps:

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• provide an account of the history of the concept of trauma from the late nineteenth century to the present day

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• examine debates around the term in their historical and cultural contexts

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• trace the origins and growth of literary trauma theory

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• introduce the reader to key thinkers in the field

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• explore important issues and tensions in the study of trauma as a cultural phenomenon

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• outline and assess recent critiques and revisions of cultural trauma research

Trauma is an essential guide to a rich and vibrant area of literary and cultural inquiry.

1

THE HISTORY OF TRAUMA

Critics have often connected the origins of the trauma paradigm to the onset of Western modernity. As Roger Luckhurst contends, ‘trauma is a concept that can only emerge within modernity, … as an effect of the rise, in the nineteenth century, of the technical and statistical society that can generate, multiply and quantify the “shocks” of modern life’ (2008: 19). The growing interest in nervous disorders in the mid-to-late nineteenth century can be directly traced to a number of related social, economic, political, and technological developments that contributed to a massive transformation of everyday life. The sheer scale and speed with which Western nations modernized produced a widespread sense of insecurity, as ‘the excesses of mechanized work, travel, and warfare’, along with increasingly ‘unstable social and cultural systems’, converged to reveal the modern world as ‘an open, mass, secular, dynamic, heterogeneous, capitalist, and liberal-democratic culture with all its confusions, complexities, and incoherences’ (Micale 2001: 139). Throughout Europe and America, growing public and professional fascination with nervous disorders was linked to sweeping changes in socio-cultural worldviews, catalysed by the rise of empire; the spread of socialism, feminism, anarchism, and secularism; and processes of urbanization, industrialization, technologization, and democratization.

The emergence of the trauma paradigm was thus ‘simultaneously responsive to and constitutive of “modernity”’ (Micale and Lerner 2001: 22). Two contemporaneous developments brought trauma to the forefront of public consciousness in the late nineteenth century: first, significant advancements in the mental sciences repositioned nervous disorders as the product of psychical, rather than physical, causes; second, the increasing mechanization of industrial society transformed conventional modes of travel, labour, warfare, and leisure. As Mark Micale and Paul Lerner contend, nineteenth-century Europe ‘saw the growth of technological modernity parallel to the formation of the first organized and systematized means for studying its consequences on the human psyche’, and these ‘two developments occurred in a … self-reinforcing manner; together they gave birth to the medical and cultural engagement with mental trauma’ (2001: 11).

Emphasizing the link between processes of historical change and developments in scientific knowledge, this chapter positions psychiatric accounts of trauma in relation to the advent of ‘concurrent modernities’ (Micale 2001: 139), stretching from the mid-nineteenth to the late twentieth centuries. Conceptions of trauma vary dramatically from nation to nation, decade to decade, and clinician to clinician, making it necessary to consider attitudes towards nervous disorders within the specific historical, cultural, and institutional contexts of their emergence. Since the mid-nineteenth century, understandings of trauma have remained consistently in flux, shifting in response to the varied approaches of mental health professionals (neurocognitive, psychiatric, psychodynamic, etc.), who have differed significantly over which groups or individuals (in classed, raced, and gendered terms) might prove more predisposed to nervous disorders of one kind or another, and which mode of clinical treatment might prove most appropriate to the recovery of these patients (hypnosis, medication, electric shocks, psychotherapy, etc.). The terminology in which trauma has been couched has also proven remarkably fluid, and the label has functioned as an umbrella for a number of different but related pathologies (including, in the nineteenth century, hysteria, railway spine, traumatic neurosis, and neurasthenia, and, more recently, shell-shock, war neurosis, combat fatigue, PTSD, and Gulf War Syndrome) whose visibility has waxed and waned according to disciplinary fashions and political necessity.

Such developments reveal how changing socio-political norms and values inflect conceptualization of nervous and mental disorders. Because clinical understandings of trauma are at least partially socially constructed, what counts as trauma in one context may not be recognized as such in another. Approaches to trauma are culturally and historically contingent, respondent to both the changing environments that give rise to them and the cultural, scientific, legal, and political power structures that allow them to exist. Interrogating such ambiguities, this chapter examines conceptions of trauma in different clinical, cultural, and historical contexts. The first section foregrounds the relationship between trauma and the new technologies of modernity, focusing particularly on John Erichsen’s work on railway spine in the UK and Hermann Oppenheim’s theories of traumatic neuroses from industrial accidents in Germany in the mid-to-late nineteenth century. The second section examines the origins of hysteria in the research of three seminal figures in early psychiatric practice: Jean-Martin Charcot, Pierre Janet, and Sigmund Freud. The third section explores the intimate connection between trauma and warfare that was forged during the First World War, looking at different approaches to the psychiatric treatment of soldiers in Germany, Italy, the UK, and the US. The fourth part of the chapter examines the emergence of a master paradigm of trauma, post-traumatic stress disorder (PTSD), in America in the aftermath of the Vietnam War, and the final part considers the evolution of a broader trauma culture at the end of the twentieth century.

THE PUZZLE OF RAILWAY SPINE AND THE PERILS OF INDUSTRIALIZATION

The nineteenth century brought human life into ever more intimate contact with technology. Central to this process was the development of an expansive network of railways across the Western world, which, from 1830 onwards, transformed the experience of time and space. As Christian Wolmar notes, ‘[t]raveling by train was an utterly novel experience’ (2007: 43) that ‘demonstrated how the Industrial Revolution was accelerating the rate of social change. Indeed, the railways were the greatest product of the Revolution, and its major driver’ (2007: 54). However, alongside the undoubted advantages of faster and more reliable travel, the expansion of the railways exposed Victorians to new forms of risk. As Ralph Harrington argues, from the 1840s to the 1860s, the growing number of casualties resulting from railway accidents created ‘a uniquely sensational and public demonstration of the price which [technology] demanded—violence, destruction, terror, and trauma’, embodying and symbolizing ‘many of the age’s apprehensions about progress, technological development, and modernity’ (2001: 31).

Public anxiety about the dangers of railway travel was fed by the media coverage of lawsuits brought against train operators for failing to protect their passengers. In 1864, parliamentary legislation made British railway companies liable for the health and safety of their clients. It was from this juridical context that the earliest accounts of trauma emerged. Medico-legal professionals initially struggled to comprehend a category of injuries whose long-term consequences appeared as much psychological as physical. As the number of compensation claims rose, debates about the authenticity of the largely invisible psychical damage sustained in accidents focused on the phenomenon of ‘railway spine’, a condition first classified in Erichsen’s pioneering lectures. In 1866, Erichsen published a paper entitled ‘On Railway and Other Injuries of the Nervous System’ in which he analysed the forms of nervous damage associated with spinal injuries from railway collisions. Throughout the 1870s, Erichsen’s work gave rise to an increasing number of studies examining railway spine, most notably the research of Herbert Page. In 1883, Page published a paper on ‘Injuries of the Spine and Spinal Cord without Apparent Mechanical Lesion’, followed, in 1891, by his monograph Railway Injuries: With Special Reference to Those of the Back and Nervous System, in which he argued that the psychological effects of railway accidents such as fear and shock were in and of themselves capable of inducing enduring psychical damage, regardless of whether or not the patient had sustained a physical wound in the collision.

This revolutionary claim paved the way for subsequent conceptions of traumatic neuroses divorced from any physical injury. In so doing, the study of railway spine firmly linked the technological advancements of modernity to new and unprecedented forms of nervous disorder. The debates of this period prefigured and introduced many of the complexities that have since shadowed changing conceptualizations of trauma. As Luckhurst argues:

Railway spine names a conjuncture of body and machine, the violent collision of technological modernity and human agency. This inaugural version of trauma is also intrinsically modern because it is, from the first, a medico-legal problem, which is to say that it is defined in and through the institutions and discourses marking the rise of the professional society in the nineteenth century. Rival experts would henceforth seek to define the protean signs of trauma in their specific disciplinary languages, partly recognizing that the very act of definition contributed to the mobility of symptoms.

(2008: 24)

However, although it was certainly key to establishing the terms of early discourses surrounding trauma, the case of railway spine was not unique in revealing the complex relationship between the lived experience of modernity and the disparate forms of psychological injury to which modern subjects were exposed.

British debates over railway spine found a continental equivalent in controversies surrounding the establishment of the German welfare state. As in Britain, the mid-nineteenth century was a time of intense change in Germany, as an unprecedented population boom, the emergence of wage labour, the spread of unemployment and poverty, and the mass exodus of the rural working class to rapidly expanding cities transformed the social fabric. Conservatives perceived these developments as a threat to traditional German culture and values; wary that the growing social democratic movement would give rise to a revolutionary working-class politics, officials oversaw the creation of a prototypical welfare state designed to pacify workers while protecting the status quo. Organized around the administration of social insurance, this nascent welfare state had the dual benefit of reinforcing conventional patterns of power and governance while appearing to serve the interests of ‘ordinary’ citizens. As Greg Eghigian comments, ‘insurance appeared to offer a particularly attractive way of fulfilling the professed aims of late nineteenth century social policy’ (2001: 97), emphasizing ‘the bourgeois and domestic virtues of order, thrift, prudence, far-sightedness, family life, frugality, orderliness, responsibility, contribution, labor, industriousness, and economy all at once’ (2001: 98). The years 1840–1880 saw an enormous rise in the popularity of private life-insurance schemes, followed from 1883 to 1891 by the introduction of a compulsory national state-run general workers’ insurance, ‘deliberately placed in the industrial setting of capital-labor antagonism’ in order to ‘ensure social harmony and productivity’ (2001: 99).

Over the course of the late nineteenth century, German medico-legal professionals developed a lexicon of trauma that facilitated the administration of compensation cases relating to industrial accidents. This emerging vocabulary resonated strongly with innovative discourses in clinical practice. As we have seen in the case of the UK, the mid-nineteenth century saw an explosion of interest in the mental sciences across Western Europe, which was manifested in Germany by a growing fascination with traumatic neurosis. Nowhere was this interest exemplified more clearly than in the work of Oppenheim. Like Erichsen before him, from 1883 to 1888 Oppenheim engaged in a study of principally male, working-class individuals who had been involved in railway and industrial accidents. In 1889, he published his findings in a monograph featuring the case histories of forty-one subjects. Oppenheim attributed traumatic neuroses to the presence of paralysing physical lesions in the brain and nervous system (as we will see, this theory was also expounded by Charcot in Paris, with whom Oppenheim corresponded closely). However, he argued that these physical injuries were only partially responsible for subsequent nervous disorders, suggesting that, in instances of traumatization resulting from industrial accidents, ‘[a]n important—and in many cases the major role—is played by the psyche: terror, emotional shock’ (qtd in Lerner 2001: 178). This meant that even in cases where no visible physical injury was evident, it would be perfectly possible for the patient to suffer long-term psychological damage from the intense psychical shock of the accident.

Oppenheim’s career was dogged by controversy. As his theory of trauma was ‘swept up into large controversies about social insurance and its purportedly pathological effects’ (Lerner 2001: 159), the physician was held personally responsible for ‘a perceived epidemic of “pension neuroses”’ (2001: 150). In the same year that Oppenheim published his monograph, Germany’s Imperial Insurance Office recognized traumatic neurosis as a compensable injury in workplace lawsuits. However, as with lawsuits relating to railway spine in the UK, claimants often struggled to prove the authenticity of their claim to the satisfaction of insurers, who were predictably reluctant to acknowledge invisible injuries. The alleged suggestibility of the traumatized mind was exploitatively evoked by insurance companies to construct these cases as ‘little more than a wave of mass malingering’, ‘intimately linked to what was believed to be a prevailing tendency among laborers to avoid work’ (Eghigian 2001: 106).

Over the next three decades, arguments over claims relating to traumatic neuroses became increasingly litigious, as workers denied recompense took insurers to court to appeal their decisions. In turn, opponents of accident insurance law contended that the 1889 ruling risked actively producing traumatic neuroses by encouraging a pathological desire for pensions in a work-shy labour force. The effect, allegedly, was to sap the productivity of the German nation by rewarding laziness, generating, in the words of prominent psychiatrist Alfred Hoche, a ‘people’s epidemic’ so grave that it constituted ‘a cancer on the organism of [the] whole working class’ (qtd in Lerner 2001: 150). From the 1890s onwards, the German medical community began to abandon Oppenheim’s conception of traumatic neuroses in favour of a return to the older notion of hysteria, which will be discussed in more detail in the following section. This suited the economic interests of Germany’s insurers and employers, for whom a diagnosis of hysteria was preferable to the label of traumatic neurosis. While traumatic neurosis was considered potentially incurable (opening the employer to indefinite pension payments), hysteria was understood as a temporary response to overwhelming stimuli, which might be overcome through treatment, facilitating the patient’s return to work. The preference for hysteria over traumatic neurosis thus appeared financially, socially, and medically expedient, and the resulting backlash against Oppenheim was to have dramatic effects both for his professional reputation and for the way in which mental and nervous disorders were viewed and treated in Germany over the coming decades.

THE ORIGINS OF HYSTERIA

As the work of Erichsen and Oppenheim reveals, the late nineteenth century saw a paradigm shift in the mental sciences, which transformed medical attitudes towards nervous disorders. Instead of perceiving such diseases to be rooted in physiological causes, practitioners working within neuropathology, psychiatry, and the new discipline of psychoanalysis began to conceive of the existence of pathologies that might be purely or at least predominantly psychological in nature. While successive generations of mental health practitioners have revised and revisited this work, many of the foundational concepts that inform the study of trauma can be traced back to Charcot, Janet, and Freud. Although there are significant discrepancies in their accounts, these individuals remain highly influential in shaping the field of trauma studies into the twentieth and twenty-first centuries.

Charcot has been described as ‘the foremost neurologist of late nineteenth century France’ (Kushner 2009: 11). As one of his most prominent students, Joseph Babinski (whose work will be examined later in this chapter), remarked, ‘to take away from neurology all the discoveries made by Charcot would be to render it unrecognizable’ (qtd in Tan and Shigaki 2007: 383). Stationed at the Salpêtrière Hospital in Paris for thirty-three years, Charcot developed a groundbreaking system for the classification of nervous diseases. From 1878 to 1893, he embarked upon a detailed examination of traumatic neuroses to understand how and why relatively minor physical injuries could cause disabling psychical effects. While his findings would divide the fields of psychiatry and psychoanalysis, this project provided some of Charcot’s most important legacies for the study of nervous disorders.

Although Charcot’s research encompassed a wide range of illnesses, from multiple sclerosis to Parkinson’s disease, it was his work on hysteria that proved most significant for the new disciplines of psychiatry and psychoanalysis. In line with the prevailing bias of French neurology in the nineteenth century, Charcot believed that hysterical symptoms emerged when an individual with a hereditary predisposition to nervous collapse was faced with an unexpected external shock. While defective tendencies could remain latent in the patient for decades, he argued, the triggering of hysterical symptoms (which might include amnesia, hallucinations, emotional disturbance, or delusions) was reliant on two causal factors: ‘an unlocated physical functional lesion, the result of a physical trauma’ and the ‘psychological effects of fright and dissociation’ (Fletcher 2013: 7).

Charcot’s early investigations of hysteria were based on the study of female patients, whom he often put on display at his theatrical Tuesday lectures. In these lectures, he used live demonstrations to illustrate his clinical findings. Where previous generations of physicians had perceived hysterics, overwhelmingly identified as female, to be malingerers, Charcot contended that hysteria was a disease of the will that revealed unconscious thoughts and desires. He believed that such phenomena were best treated through a process of hypnotic suggestion, which would allow the patient to play out their fears and dreams in a ‘safe’ therapeutic environment. In his later practice, Charcot turned his attention to the victims of industrial and railway accidents. This move was revolutionary in terms of shifting established preconceptions about the identity of hysterics. While hysterics had previously been pictured in gendered and classed terms (as bored, affluent women), in focusing upon male, working-class patients in...

Table des matières

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• Series editor’s preface
• Introduction: Not even past
• 1. The history of trauma
• 2. Words for wounds
• 3. Trauma theories
• 4. The future of trauma
• Conclusion: The limits of trauma
• Glossary
• Bibliography
• Index