History, EpidEmiology, trEatmEnt Psychological trauma: a historical perspective

During the 1970s a paradigm shift occurred in the way that psychological trauma was conceived and managed. Until then, it was argued that individuals without a family history of mental illness or other evidence of predisposition, if exposed to a traumatic event, might develop acute psychological distress, but would then go on to recover naturally with no long-term effects, rather like a self-healing wound. The discovery of a so-called ‘delayed stress syndrome’ during the Vietnam War seemed to show that healthy soldiers subjected to stress could suffer chronic, adverse effects that were not apparent at the time of their exposure. The terrifying event, until then regarded merely as a trigger, assumed a crucial importance in the genesis and description of psychiatric breakdown. This new concept of psychological trauma also saw the retreat into obscurity of ‘secondary gain’, the attention and rewards that a patient received as a consequence of suffering from a recognized disorder. Before the 1970s anyone who broke down and suffered long-term effects was considered constitutionally vulnerable or the product of a degenerate family; in either case, responsibility lay with the individual. Not everything, however, was attributed to pre-exposure predisposition – since it was also considered that ‘secondary gain’, which was often but not exclusively financial, could inhibit the process of recovery. After the admission of post-traumatic stress disorder (PTSD) to DSM-III in 1980,1 causation was attached to the event itself and individual sufferers were largely absolved from blame or responsibility. The