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t nightmares and lack of sleep six months after the incident, that how his sleep was still disturbed by recurrent memories and images: ‘it is strange to think how to this very day I cannot sleep a night without great terrors of fire, and this very night could not sleep till 2 in the morning through thoughts of fire’. (qtd. in Trauma and Life Stories, 3).He also referred to the sequel of the disaster for others, including attempted suicide (Charles R. Figley, 7).
Another testament has been left in Charles Dickens diaries. He was involved in a railway accident on June 9, 1865 which made him feel weak. He believes his state of mind and not feeling good is the result of the railway shaking; “I am not quite right within, but believe it to be an effect of the railway shaking”. He developed a phobia of railway traveling but summed up the sequel as: “I am curiously weak as if I were recovering from a long illness” (qtd. in Charles R. Figley, 7).
2.4.2 Railway Spine
Two important human activities led to an explosion of literature and interest in the concept of post- traumatic disorder, wartime experiences and development of workmen’s compensation acts in the late nineteenth century (Charles R. Figley, 7). The latter increased medical awareness of possible psychological and neurological effects of physical injuries, such as ‘railway spine’- a term coined to describe the experience of persistent severe back pain after train accidents, without any apparent injury to the back itself (Trauma and life Stories, 3).
In mid- nineteenth century, following an increase in invalidism reported after railway accidents in which the railway companies were seen as an easy target for compensation, physicians were called upon to examine potential litigants. John Eric Erichsen wrote an influential book entitled On Concussion of the Spinein 1882which made railway spine adiagnosis for the post-traumatic symptoms of passengers involved in railroad accidents. His little volume became a guide book to distinguish the dishonest plaintiffs who attempted to get a heavy verdict by dissimulation and imposture (Charles R. Figley, 7).
Not long, in 1885, a rebuttal of Erichsen’s ideas was published entitled Injuries of theSpine and Spinal Cord Without Apparent Mechanical Lesion by a surgeon to the London and North West Railway, Herbert Page. He used the term “nervous shock” as the subtitle of his book and considered it so common after railway collision. He also believed that the railway spine in the majority of the cases was psychological rather than an organic disorder. His views were supported by many but the central feature of many arguments was the extent which patients were malingering for personal gain, a subject that is a kernel found at the center of the whole issue of post-traumatic disorders in general(Charles R. Figley,7).
2.4.3 War
There has been a powerful social myth that heroes do not or should not have any problems; thus, it has been difficult for veterans to admit to themselves or to the others that they might be suffering from war zone experiences per se. The military view on acute psychiatric casualties until the 1980s was (1) temporary breakdown; (2) individual weakness; (3) poor leadership and weak unit cohesion. None of these perspectives let the possibility that war might be traumatic itself (Handbook of Post –Traumatic Therapy, 180). However, arguably the most important focus for the study of trauma from the mid-nineteenth to the mid-twentieth century was the soldier. The Crimean War (1854- 6) and the American Civil War (1861- 5) brought to the attention of doctors various stages of physical and mental exhaustion arising in soldiers exposed to combat (Trauma and life stories, 3).By the Second World War and specifically after Vietnam War further descriptions of post-traumatic stress reactions were provided by psychiatrists (Joseph, Williams, and Yule, 6). It was fifteen years after the withdrawing of U.S troops from Vietnam, that the United States conducted the National Vietnam Veterans Readjustment Study (NVVRS) that set out to determine shorter-and longer-term sequel of the war experience and other pre- and postwar factors (Handbook of Post –Traumatic Therapy, 180).
The effects of traumatic events on psychological health have been recognized under various names; most of these labels have been chosen in relation to combat, e.g., nervous shock, traumatic neurosis, anxiety neurosis, fight neuroses, and shellshock. Shell shock is perhaps the most well-known of these terms. Originally it referred to the belief that combat-related disorder was minute brain hemorrhages which resulted from the lodging of shrapnel in the brain during the explosions. But the observation that soldiers could develop shell shock even in the absence of explosions let to the belief that shell shock implied weakness of character with the consequence that many soldiers of the First World War, who today would be diagnosed as suffering from PTSD, were executed for cowardice on the part of military authorities (Joseph, Williams, and Yule, 6)
Frederick Walker Mott (1919) coined the term ‘’shell shock’’ and suggested that the condition was due to a physical lesion of the brain, brought about in some manner by carbon monoxide or changes in atmospheric pressure. It was Charles Samuel Myers (1940) with his research over 2000 cases of shell shock that divided the problem into shell concussion and shell shock. He believed that the term ‘’shell shock” was ill-chosen, since it could occur in soldiers not exposed to exploding missiles but subject to emotional stress, therefore the term gave rise to hysteria, neurasthenia, or even psychiatric illness(Charles R. Figley, 8)
Indeed, neurologist dealing with casualties in such wars accepted a psychological approach both to the etiology and treatment of these neuroses, and techniques such as suggestion or hypnosis, were widely used. Kardiner (1941) suggested that war only created one syndrome, and that this was essentially no different from traumatic neuroses in peacetime. For him, shell shock, battle neurosis, battle fatigue and combat exhaustion all meant the same thing. ‘’ they all refer to the common acquired disorder consequence on war stress.’’ Further, the suggestion that symptoms were interlinked with gain became readily ingrained in the literature (qtd. in Charles R. Figley, 8)
2.5 Trauma Theory: Influential Figures
2.5.1 Sigmund Freud (1856-1939)
From his earliest work on hysteria in the 1890s Freud identified and set about theorizing the possibility that certain intractable ‘illnesses’ might be more correctly described as states of psychic disturbance and disconnection, whose underlying causes could be traced back to traumatic experiences in the past.According to psychoanalysts, the traumatic effects of a shocking event or circumstance upon the psyche are manifested unconsciously in a range of bodily symptoms and disturbances, in neurotic behaviors, in nightmares and hallucinations and in amnesia. These can all be read as symbolic expressions of an experience which is difficult or impossible to make sense of (Trauma and life stories, 2)
In majority of the cases tracing the origin of the disease is impossible since the patient dislikes discussing about the experience. In fact he is unable to recollect it and often has no suspicion of the casual connection between the event and the pathological phenomenon. The connection is not so simple; there might be a ‘symbolic’ relation between them. The cause of the traumatic neurosis is not physical injury but the effect of fright- the psychological trauma. Any experience which calls up distressing affects such as fright and anxiety may operate as trauma and depends naturally enough on the susceptibility of the person affected. Based on their observations, the memories of such phenomena persist for a long time with astonishing freshness and with a whole of its affective coloring. These memories, however, unlike other memories of past liv
es, are not at the patient’s disposal.
In a close study of their hysterical patients, Breuer and Freud found out that each individual symptom of the disease disappeared in bringing to light the memory of the event and arousing its accompanying affect with the patient’s detailed description of it in words. The fading of a memory or the loosing of its affect depends on various factors. An energetic reaction to the event, voluntary or involuntary, from tears to acts of revenge, provokes an effect, which is the most important one. The affect remains attached to the memory, if the reaction is suppressed. If an injured person’s reaction to the trauma is adequate, for instance, revenge, the effect is cathartic; on the other hand, by giving utterance to a tormenting secret, e.g. a confession, an affect can be ‘abreacted’ effectively since language serves as a substitution for action. Any recollection retains its affective tone, if there is no reaction, whether in deeds or words. For instance certain memories of aetiological importance which dated back from fifteen to twenty-five years were found to be astonishingly intact and when returned acted with all the affective strength of new experiences.
These memories correspond to memories which have not been sufficiently abreacted. One of the main conditions under which the reaction to the trauma fails to occur are those cases in which the nature of the trauma excluded a reaction because social circumstances made a reaction impossible or because it was a question of things the patient wished to forget and therefore intentionally repressed, inhibited and suppressed from the conscious though. This is what leads them to speak of abnormal states of consciousness and to emphasize the fact that recollection of trauma is not to be found in the patient’s normal memory but in the memory when he is hypnotized. The splitting of the consciousness under the form of ‘double conscience’ is present in every hysterical case and a tendency to such dissociation, and the emergence of abnormal states of consciousness is the basic phenomenon of this neurosis.
They believe that their observations contribute nothing fresh but just throwing light on the contradiction that between the dictum ‘hysteria is a psychosis’ and the fact that people of clearest intellect, strongest will and greatest character may be found among hysterics. These characteristics are present in their waking state, but in their hypnoid states they are insane as ordinary people are in dreams. However, while the dream-psychoses have no effect on people’s waking state, the product of intruding hypnoid states into life of hysterics form the symptoms of their disorder (Breuer and Freud).
According to Judith Herman Freud was one of the first people to develop a post-traumatic paradigm. His original view of neurosis, the ‘seduction theory’, emphasized the role of actual sexual abuse in the development of later emotion disorders. Freud soon revised this theory because, it has been suggested, the emphasis on sexual abuse was not well received in Vienna and because he found it difficult to accept how widespread sexual abuse might be if his theory were correct. He revised his theoryto suggest that the memories of patientsseeking treatment may have been fantasies of such events (Joseph, Williams, and Yule, 1)
2.5.2 Mardi Horowitz (1934 – )
Mardi Horowitz is a Distinguished Professor of Psychiatry at UCSF. He has written 20 professional books and over 280 scientific articles in the fields of psychology, psychiatry, and psychoanalysis. He has provided forensic consultations in the fields of PTSD, stress, personality, and psychotherapy. In addition, he has provided consultation to the media and governmental agencies on these topics.
The diagnostic specification of PTSD was influenced by Horowitz’s work on the phenomenology of trauma-related reactions. Horowitz described reactions to trauma

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