The Reality Of Trauma

IHAVE BEEN ASKED TO ADDRESS the reality of trauma. I think there is no doubt that there are events and occurrences in an individual's life that may be considered traumatic. However, just as the diagnosis of stress requires the concept of strain, there is no way to consider what is psychically traumatic only by observation from the outside. The word trauma, of course, is borrowed from physical medicine, in which the integrity of the body, the bones, the skin, is disrupted by an external impact. We are pretty sure, to a degree, that impacts beyond certain limits will invariably create traumatic effects on the body. In a similar vein, Freud (1893–1895) postulated that experiences in life, especially those of immature organisms or involving out-of-phase excitement, such as gross sexual arousal in children, could be overwhelming to the psyche. In fact, his earliest formulations include the idea that the essential feature of trauma entailed the condition that the psyche is flooded by stimuli, the consequences of which were disorganizing effects on cognition, irritability, psychological confusion, disruption of such physiologic cycles as sleep, etc.

Cooper (1986) recently described extreme trauma in a similar vein: "A psychological event which abruptly overwhelms the ego's capacity to provide a minimal sense of safety and integrative intactness" (p. 44). Many of these extreme disorganizations of patterned behavior are included in the current DSM III-IV definition of PTSD. On the other hand, memories of the eliciting events might be forgotten via the imposition of repression or in a vertical split by dissociation.

Those ideas were not strikingly different from what was already known in early postindustrial France and Austria. There had been an increase in reports and legal claims of psychic trauma as the consequence of accidents on the newly introduced railroads. Thus, the new transportation system may be said to have given rise to new disorders. What