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Psychiatrists and psychologists taking care of emotionally disturbed individuals have always been faced with a problem that modern neuroscience has come to elucidate so well—that the affective power of people's passions arises from subcortical systems that are not under their conscious control. Starting with Charcot, amplified by Janet, and built into a formal discipline by Freud, the clarification of those unconscious forces traditionally was the unique territory of psychiatry. We have long wrestled with the painful reality of how little capacity reasoning has to affect the intense emotions and urges that often follow exposure to extreme experiences. Much of the history of psychiatry consists of the exploration of a variety of methods to tame the power of subcortical processes that had their roots in experiences that overwhelmed people's psychological and biological coping mechanisms. Only during the last few decades have the neurosciences started to contribute vast new perspectives to the nature of those subcortical processes and offer a rationale for new treatment methods.
From time to time, psychic trauma has been a central organizing paradigm to clarify people's seemingly infinite capacity to react to current situations with the irrelevant responses that inflict dreadful suffering on themselves and others. However, rather like traumatized patients who alternate between intrusive reliving and numbed denial, psychiatry, as a profession, has been periodically fascinated by trauma, alternating with a stubborn dismissal of the relevance of the reality our patients' experiences. During those times of denial, the symptoms that previously were understood as a “fixation on the trauma” tended to be ascribed to genetic weaknesses, manipulations, or secondary gain.
The relationship between soma and psyche, particularly as it related to the traumatic origins of “hysteria,” was central to psychiatric inquiry