The New Historical Trauma Studies

March 11, 2009

Recent decades have seen an outpouring of publications about psychological trauma. With its formal diagnostic category of posttraumatic stress disorder (PTSD), Western psychiatric medicine has led the way in opening up this field of study. Many other disciplines of inquiry, including sociology, anthropology, legal studies, and literary studies, also have contributed their distinctive approaches and methodologies to the subject. Most recently, professional historians in Britain, Germany, Austria, Australia, Canada, and the United States have researched the origins of PTSD to great effect. These “new historical trauma studies” draw heavily on pioneering medical research from earlier places and periods. In addition, empirical findings from and analytical insights into humanity’s troubled, traumatic past provide ideas, observations, and insights that may be useful for mental health practitioners today.

Recent decades have seen an outpouring of publications about psychological trauma. With its formal diagnostic category of posttraumatic stress disorder (PTSD), Western psychiatric medicine has led the way in opening up this field of study. Many other disciplines of inquiry, including sociology, anthropology, legal studies, and literary studies, also have contributed their distinctive approaches and methodologies to the subject. Most recently, professional historians in Britain, Germany, Austria, Australia, Canada, and the United States have researched the origins of PTSD to great effect. These “new historical trauma studies” draw heavily on pioneering medical research from earlier places and periods. In addition, empirical findings from and analytical insights into humanity’s troubled, traumatic past provide ideas, observations, and insights that may be useful for mental health practitioners today.

As early as 1981, historically informed physicians set out the general historical trajectory of medical investigations of psychotraumatology-from mid-Victorian investigations of “railway spine” (PTSD-like symptoms in passengers involved in railroad accidents) to contemporary debates over workers’ compensation for on-the-job injuries.1,2 Likewise, scholars with specialized interests had trawled medical-historical records to find cases of PTSD-like symptoms that followed acutely stressful, natural or man-made environmental experiences.3-6 What the newer historical trauma studies offer, however, is extensive insight into collective catastrophic experiences that are archivally researched and intricately reconstructed within the cultural and chronological contexts that shaped the traumatic experiences of contemporaries at the time.

World War I

Academically trained historians have recently brought the particularizing power of historical scholarship to bear on the well-known phenomenon of “shell shock” in World War I.7-13 The best-known diagnostic precursor of PTSD, shell shock encompassed a flood of neuropsychiatric symptoms that emerged in almost epidemic numbers among officers and infantry on both sides of the conflict. Studies about this condition drew on the discovery that modern industrialized warfare (which uses machine guns, motorized tanks, long-distance artillery, mustard gas and other chemical weapons, and barbed wire), with its unprecedented, long-distance killing power, was uniquely destructive of human psychic defenses. This was particularly true for soldiers who were involved in lengthy operations that were interspersed with long periods of immobility.14 In psychiatric and military history, the “Great War” brought the advent of modern PTSD as we know it.

New works greatly enlarge on this earlier insight by examining cases in different combatant countries and the specific hospital facilities that employed diverse therapeutic modalities.7-9 There were great divergences in how cases of shell shock were viewed and treated from country to country, depending on the outcome of the war, the location of the fighting, the social class of soldier-victims, the dominant religious ideology, cultural attitudes toward health and sickness, and prevalent norms of masculinity.11,15 Recent works also highlight how “neuropsychiatric servicemen” were regarded on the home front. The array of social and cultural determinants of the nature of traumatic experience operated simultaneously in affected individuals, their consulting caregivers, their families, the community, and the state.

Not the least surprising discovery is the tremendous range of experiences that provoked neurotic breakdowns during and after World War I-the physical threat of injury and death, fear of live burial, the rigors of training, observation of the death of comrades, the prolonged anticipation of fighting, hand-to-hand combat, the burial of dead soldiers, physical disease, the anxiety of immobility, material deprivation, moral disgust at killing, the anxiety of readjusting to civilian life, and the guilt of survival.7-9 This diversity of past traumatogenic events makes the very notion of trauma relative. The emerging historical record, like contemporary clinical science, eschews the possibility of a clear quantitative characterization of trauma, which is defined by a given intensity of suffering. Rather, historical trauma has emerged as the subjective experiencing and remembering of war-related events in the mind of an individual or in the life of a community.11

The central subjectivity of historical trauma also comes through in a related topic of study. Shell shock did not end in 1918 with the armistice. Over the next decade and a half, France, Germany, Austria, Italy, Britain, and the United States struggled to formulate effective governmental policies and treatment regimens for their psychologically maimed veterans. In European nations with the highest rates of mortality and injury, soldiers’ cemeteries, war monuments, and memorial services, as well as the ubiquitous sight of injured veterans (where tens of thousands of amputees damaged by artillery shrapnel were treated) became part of the visual landscape of postwar Europe. Scores of novels, poems, memoirs, diaries, films, paintings, etchings, sculptures, and photographs of the war and its human toll constantly reminded post-1918 Europeans of the momentous calamity. (The psychological war “invalids” who populate the novels of D. H. Lawrence and Virginia Woolf may be the best-known expressions of this cultural phenomenon to English-language readers.) Likewise, the sight of the emasculated war neurotic, who connoted effeminacy, homosexuality, and sexual impotence, haunted artistic and autobiographical accounts of the war.

The new historical trauma studies suggest that in a real sense the first “culture of trauma” did not form in America following the Vietnam War, as it has been argued.16 Instead, it arose in interwar Europe, especially in Weimar, Germany, which not only lost more soldiers than any other combatant country (more than 2 million dead, mostly young adult males) but also had to accept a humiliating war defeat and a vindictive peace treaty.17-19

The US Civil War

Scholars have been exploring other aspects of the past as well. Recent studies of World War II extend the extensive literatures on shell shock, the Vietnam War, the Balkan Wars, and the Iraq wars to the 1940s.20,21 Much more surprising, however, have been historical studies of trauma and the US Civil War. The key exploration has been Eric T. Dean Jr’s Shook Over Hell: Post-Traumatic Stress, Vietnam, and the Civil War,22 which was followed by a cluster of other texts.23-28 Because the Civil War occurred on the eve of modern technologized warfare, it had seemed outside the purview of the history of trauma. But the findings of Dean and others have established that military and industrial modernity are not absolute preconditions for widespread psychological trauma.

Culling hospital records, the letters of physicians, and soldiers’ diaries, as well as accounts of wartime insanity, “battlefield anxiety,” malingering, self-wounding, vagabondage, and suicide, scholars have found clear expressions of acute, war-induced mental and nervous suffering among Civil War soldiers and veterans. The symptom profiles described by members of the protopsychiatric community in the court files, local newspapers, and medical records bear considerable resemblance to the posttraumatic psychopathologies of a century later and include severe and persistent psychological problems, such as anxiety, depression, and flashbacks. These were often accompanied by suicide, alcoholism, and domestic violence. Patient diaries unearthed by Dean,22 which often stretch across many years, are particularly moving.

One Confederate soldier recalled the scene at Gettysburg of thousands of his comrades “about to face death and the awful shock of battle.” Another Union soldier, Pvt. Wilbur Fisk, registered in a letter dated May 9, 1864, “the terrible nervous exhaustion of fighting.” Officers were not exempt from these experiences. The future Supreme Court Justice Oliver Wendell Holmes Jr was a member of the 20th Massachusetts Regiment, which had engaged in much hand-to-hand fighting after the autumn of 1861, and Holmes himself was wounded 3 times. Near his breaking point on June 24, 1864, a young Holmes, wrote from the killing fields of northern Virginia to his parents back home: “These last few days have been very bad. Many a man has gone crazy since this campaign begun [sic] from the terrible pressures on mind and body… I hope to pull through but I don’t know. Doubt demoralizes me as it does any nervous man. I cannot now endure the labors and hardships of the line.”29

Interestingly, the most common diagnosis assigned to patients at this time was “nostalgia,” a nontechnical term that can be traced back to the Napoleonic Wars. A kind of acute homesickness, nostalgia encompassed a variety of symptoms-from memory disorders and disorientation to a pathological longing to return home.30 This “diagnosis” was most often applied to younger soldiers from agrarian America, many of whom had never traveled beyond their own state or township before the outbreak of hostilities.

In the Civil War era, doctors, victims, and their families lacked the all-important concept of psychosomatic causation and a workable diagnostic vocabulary to comprehend these symptoms or the knowledge to treat them. The specter of a loss of willpower-that quintessential Victorian faculty reinforced by fears of unmanliness-further complicated the situation.28 As a consequence, those affected were considered to be a social problem and as such have largely been lost to medical history until 20th-century American wars attuned a later generation of observers to their existence.

New studies focus on male and female trauma

Historians’ recent documentations about trauma in wartime situations have necessarily focused on male psychiatric victims. One benefit of this is its elucidation of male sex as an operative factor in psychiatric history, which is a welcome counterbalance to the customary overemphasis on the past “female maladies” of hysteria and neurasthenia.11,28 But what role do women play in the new studies of historical trauma?

To date, the most powerful application of trauma theory to women’s history may be a brilliant doctoral dissertation by lawyer-historian Lisa Cardyn. Following closely on 2 densely documented articles, in 2003 Cardyn completed a 500-page dissertation at Yale University, “Sexualized Racism/Gendered Violence: Trauma and the Body Politic in the Reconstruction South.”31-34 Following the Civil War, former Confederate white supremacists founded numerous terrorist organizations, of which the Klu Klux Klan was the most notorious. These organizations sought to reverse the progressive goals of the Emancipation Proclamation. Cardyn discovered the sexualized character of countless acts of violence that were inflicted by these groups on freed African Americans and at times on their white allies. Klan sexual violence included stripping, whipping, gang rape, lynching, genital torture and mutilation, and the castration of women and men. Sexual trauma, both its threat and practice, became a widespread facet of terror and intimidation that was intended to prevent the attainment of legally mandated equality in the post–Civil War South.

If studies about wartime nervous and mental suffering foreshadow our own notion of military PTSD, Cardyn’s research casts forward to current studies about sexual and domestic abuse. Perhaps because readers are prepared for the violence that war entails, Cardyn’s cases, set in the civilian, rural world, are even more chilling than those of shell-shocked soldiers.

Cardyn also noted in her dissertation that pervasively sexualized terrorism was used 150 years ago not as a side effect of other organized mass violence but in a conscious effort to maintain a regime of race, gender, and power. The threat and practice of inflicting sexual trauma became a crucial, time-tested instrument of racial oppression. Cardyn also showed that these activities drew on extensive precedents in the white antebellum South. She pointed out troubling parallels between systematic sexual traumatization in the racialized world of late 19th-century America and in the horrific campaigns of ethnic and religious cleansing in late 20th-century Bosnia.

The individual and collective experience of sexual traumatization was of little interest to people at the time, including the medical profession. One result is rampant omissions in the historical record that scholars today, who are operating under dramatically altered political circumstances, are trying to reconstruct. The full extent of the suffering involved in these historical episodes will almost certainly never be known.

Conclusion

In the first decade of the 21st century, “psychotraumatology” is no longer simply a subspecialty of psychiatry. When researchers in many disciplines (eg, sciences, social sciences, and humanities) converge simultaneously on a new subject, deep metacultural forces are almost certainly at work, regardless of whether these subterranean forces are apparent at the time. Psychological trauma appears to be one of these general cultural forces. In a post-9/11 world, there is little likelihood that interest in the subject will wane in the near future. In humanity’s ongoing attempt to study, process, and master its painful pasts, historians, too, are playing a part.

References:

References

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