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Until the middle of the nineteenth century, the word trauma was used primarily to designate physiological injury emanating from an external event. Beginning in the 1860s, however, the term acquired additional significance when survivors and witnesses of industrial accidents began to show symptoms of trauma in the absence of any observable physical injury. These symptoms typically included mutism, amnesia, tics, paralysis, recurrent nightmares, and, in some extreme cases, psychic dissociation. Observing a pattern that linked exposure to an overwhelming event with forms of mental disorder, doctors coined the term traumatic neurosis.

One of the most remarked-upon features of this neurosis was the incapacity of the victim to recall the event that precipitated it, coupled with a simultaneous sensation of its recurrence in the present. For this reason, trauma quickly became understood not merely as a psychic injury but also as a wound in the memory. It therefore demanded particular techniques of memory recovery, which ranged over the century from hypnosis to narcotic therapies.

Freud and His Followers

The crisis of memory was variously understood as a function of repression and/or nonsymbolic apprehension of an event. In Austrian Sigmund Freud’s (1856-1939) later writings, trauma was conceived as the result of extreme psychic excitement, in which the mind’s consciousness— which he analogized as a protective shield—was traversed by overwhelming stimuli, which were then registered in a different part of the mind, namely its unconsciousness. Precisely because the traumatic event had never become an object of consciousness, Freud theorized, it was unavailable for narration, objective reflection, and the analytic distance of the kind that would secure the subject against its frightening effects. For this reason, treatment focused on the method of abreaction, an induced revival of the event in which a subject, working with the therapist, would be able to render it conscious. The abreaction was also intended to produce a discharge, which then relieved the patient of a crippling, nervous energy.

Whether the efficacy of the treatment lay in the revival and cognitive apprehension and contextualization of the event or in the simple emotional relief obtained from the process was a matter of some controversy. Some argued that any event, even a false or confabulated one, could serve the purpose of treatment if its recall relieved patients of their symptoms. In the 1980s and 1990s, debates about the dubious validity of the “recovered memories” used in cases of alleged satanic or mass sexual abuse in the United States can be traced to this history of confabulation, coupled with the centrality of hypnosis in the treatment of trauma. Freud and his followers nonetheless insisted that the purpose of treatment was an intellectual reconciliation with the truth of experience, and hence the cathartic function of abreaction was played down in favor of a synthetic narrative or “talking cure.”

Freud and his followers developed their theories and treatments largely in response to two kinds of phenomena, namely female hysteria (initially believed by Freud to be caused by sexual seduction of the girl) and “war neuroses.” In both cases, charges of dissimulation (fakery) were often leveled against sufferers, and it was for this reason that Freud argued so fervently against the therapeutic deployment of fiction.

During wartime, the possibility of dissimulated illness acquired additional salience because soldiers who manifested acute forms of traumatic neurosis were relieved of their military duties. It was, in fact, the proliferation of cases of war neuroses (or “shell shock”) that led to the burgeoning study of trauma in the early twentieth century. The centrality of war in the development of trauma theory has continued unabated since then.

Post-World War II Developments

Since World War II (1939-1945), two major developments have affected trauma theory: the experience of mass or collective trauma, especially that associated with the Nazi death camps, and the recognition of delayed developments of traumatic symptoms, or post-traumatic stress disorder (PTSD). In the first instance, individual experience has become paradigmatic of a general historical condition, and a person’s incapacity to represent traumatic events has been translated into a suspicion of historical narratives that claim to represent the truth of collective violence. In the second, a historically verifiable event has been used to liberate individuals for recognition, treatment, and material compensation.

In some cases, events of mass suffering—such as the Holocaust, the atomic bombing of Hiroshima and Nagasaki, the Middle Passage of slavery, or the rape camps of Bosnia—are deemed uniquely unrepresentable. This is an argument of scale, but an ethico-political injunction emanates from it, prohibiting or restricting efforts to represent such horrors on the grounds that their actuality would be betrayed or diminished in the process. In some versions of this argument, the question of scale is either linked to or substituted with one of structure, according to which all representation is deemed inadequate or incommensurate with actual historical events (Caruth 1996). For proponents of this position, the purpose of historical narration is the communication of traumatic effects to others—secondary witnesses and historical heirs—a process that is said to facilitate identification between those who have survived and those who have not. This argument has been widely criticized, however, because it fails to differentiate between those who suffered or witnessed events firsthand and those whose encounters with trauma were mediated by narratives of others who suffered them in actuality.

The question of PTSD has attracted similarly widespread debate. Observing that the syndrome was recognized only through advocacy on behalf of U.S. military veterans (PTSD was added to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association in 1980), some have suggested that presentation of symptoms and prevalence rates are influenced by the possibility of compensation for injuries. Moreover, as the authority of PTSD and American psychiatry has assumed international dimensions, new questions have arisen about the cross-cultural validity of the concept of trauma. In Vietnam, for example, there is considerable resistance to the idea of veterans suffering from PTSD. In Japan the diagnosis was rarely made prior to the Kobe earthquake of 1995, despite the country’s long experience of acute postwar ailments.

Two factors explain the differential diagnosis of PTSD on a global scale, one cultural, the other politico-economic. First, there are many culturally distinct vocabularies and methodologies for identifying and treating shock and its psychosomatic aftermath. In some Buddhist societies of Southeast Asia, a sudden fright or accident is said to cause a dissociation of the person’s spiritual being and requires rituals that call back or rebind dislodged spiritual essences. In parts of Africa and in aboriginal America, shock may be adduced as a causal factor in some illnesses and is often said to precipitate birth crises. It may be treated with combinations of naturopathic and ritual methods.

Second, the widespread recognition of shock as a source of injury and the prevalence of ideas of dissociation that accompany vernacular knowledge about shock resonate strongly with Western medical concepts of trauma, though Western medicine increasingly attributes the disturbing symptoms of PTSD to chemical transformations of the brain, especially in the hippocampus, amygdala, and cerebral cortex. The diagnosis of PTSD, however conceived, has nonetheless been promoted by international humanitarian organizations as a mechanism for obtaining financial resources and mental health services for populations—displaced by war and natural disaster—that would otherwise lack them. Invoking PTSD as a basis for claiming human rights is not without risks, however. The inherent focus on traumatic events in its diagnosis (which requires that the symptoms of hyperarousal and/or withdrawal be linked to an originating event) often displaces concern for the structural sources of long-term social and psychic suffering, including that caused by homelessness, poverty, unemployment, or long-term political oppression. Moreover, the proliferating tendency to invoke trauma as a synonym for unpleasant experiences in popular media and public discourse threatens to dissipate the term’s medical as well as its ethico-political force. Beyond the risks that it is subject to both trivialization and economic utilitarianism, however, most theorists agree that trauma is a phenomenon whose increasing occurrence is inextricably tied to the industrialization of war and the massifications of modernity.

Bibliography:

Antze, Paul, and Michael Lambek, eds. 1996. Tense Past: Cultural Essays in Trauma and Memory. New York: Routledge. Bracken, Patrick J., and Celia Petty, eds. 1998. Rethinking the Trauma of War. London: Free Association.
Breslau, Joshua. 2004. Introd. to Cultures of Trauma: Anthropological Views of Posttraumatic Stress Disorder in International Health. Spec. issue, Culture, Medicine, and Psychiatry 28 (2): 113–126.
Caruth, Cathy, ed. 1995. Trauma: Explorations in Memory. Baltimore, MD: Johns Hopkins University Press.
Caruth, Cathy. 1996. Unclaimed Experience: Trauma, Narrative, and History. Baltimore, MD: Johns Hopkins University Press. Ferenczi, Sándor. 1988. The Clinical Diary of Sándor Ferenczi, ed. Judith Dupont. Trans. Michael Balint and Nicola Zarday Jackson. Cambridge, MA: Harvard University Press.
Freud, Sigmund. 1955a. Beyond the Pleasure Principle. In Vol. 18 of The Standard Edition of the Complete Psychological Works of Sigmund Freud. Trans. and ed. James Strachey. London: Hogarth Press. (Orig. pub. 1920.)
Freud, Sigmund. 1955b. Introd. to Psycho-Analysis and the War Neuroses. In Vol. 17 of The Standard Edition of the Complete Psychological Works of Sigmund Freud. Trans. and ed. James Strachey. London: Hogarth Press. (Orig. pub. 1919.)
Kardiner, Abram. 1941. The Traumatic Neuroses of War. Washington, DC: National Research Council.
Laplanche, Jean. 1976. Life and Death in Psychoanalysis. Trans. Jeffrey Mehlman. Baltimore, MD: Johns Hopkins University Press.
Leys, Ruth. 2000. Trauma: A Genealogy. Chicago: University of Chicago Press.
Young, Allan. 1995. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton, NJ: Princeton University Press.