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Trauma constitutes a major category in both general and psychological medicine. As a clinical specialty, it covers general accidents, major injuries, fractures, and dislocations; and, as a psychiatric and psychotherapeutic diagnostic category, it covers immediate and long-term mental disorder relating to extreme events including physical injury, violent and sexual abuse, torture, war, natural disasters like earthquakes or floods, accidents, and the witnessing of extreme situations such as accidental death or murder.
Before Pinel's new nosology, introduced during the French Revolution, the physiological and psychological aspects of trauma were mutually conceptualized through a theory of lesions, whose effects were articulated through the Central Nervous System (Foucault, 1973, pp. 176-80). After Pinel, psychological trauma were increasingly separately classified as “neuroses,” or as diseases of the nerves and mind with no necessary founding lesion.
Nonetheless, strong diagnostic and conceptual links still remain today between physical and psychological trauma. This is particularly evident in accounts of the affective response to trauma, notably in the analysis of pain (van der Kolk, 1988; Pitman et al., 1990). It is difficult not only, for example, to isolate physical from psychological pain, but also, in the case of bodily injury, to separate the “traumatic pain” provoked by the original event, from the long-term pain that follows it.1 This is the main reason that, in contemporary terms, the interrelation between physical and psychological trauma is inevitably conceptualized as a complex and multiple process. There is both integral psychological processing of physical trauma, and physiological processing of