The history of trauma in psychiatry

The accidental separation of PTSD and the dissociative disorders, based on the unfortunate fact that the PTSD and the dissociative disorder workgroups of the DSM-III never met to compare data, and the lack of knowledge within the workgroups of existing research connecting these disorders, will continue in the DSM-IV. That separation, however, is slowly being eroded by a solid body of research that shows that these conditions rarely occur independently. Thus, contemporary research is beginning to show that the original concept of "hysteria," formulated 150 years ago to capture a group of patients who have complex psychological and somatic problems and whose problems often elude intervention from the medical and psychological professions, is alive and well among patients on the verge of the twenty-first century. Although the DSM process has attempted to create cleaner diagnostic categories, 100 years of research on traumatized patients consistently shows that these patients defy easy classification, and that they seem to have symptoms that represent somatic, social, symbolic, and intrapsychic adaptations to having experienced overwhelming terror. Thus, what the DSM split when it abolished hysteria as a diagnosis, has once again been found to constitute a syndrome, a conglomeration of symptoms, first defined by Briquet and Janet more than 100 years ago, which is the result of severe and prolonged interpersonal abuse, usually starting in childhood. One hundred years of research has shown us that patients often cannot remember and, instead, re-enact their dramas. The professions ministering to these patients have had similar problems with remembering the past, and thrice in this century have forgotten the hard-earned lessons from our patients. It is not likely that these amnesias and dissociations will be a thing of the past; they are likely to continue as long as physicians and psychologists are faced, helplessly, with man's inhumanity to man.