The history and politics of trauma theory

Once limited to the domain of psychology, the language and usage of the term trauma has become so widespread that Miller and Tougaw (2002, p. 1) claim that we are now in the “age of trauma”. Trauma-informed practices range from approaches to sexual and domestic violence, to mindfulness and yoga. While this proliferation of understanding about trauma and the way in which an individual's experiences of violence, abuse and neglect can impact their mental health is positive, we want to draw attention to the ways that the language of trauma can obscure the political and social causes of women’s mental distress as well as locate the solution to this distress as being within individual control.

Trauma theory has its roots in psychoanalytic theory, where as early as the 19th century women’s hysteria was seen as resulting from mental trauma (and the curse of female reproductive organs) (Ringel & Brandell, 2011). The solution to this hysteria was usually a hysterectomy, until neurologist Jean Martin Charcot, a French physician, argued that the cause of hysteria was psychological and due to traumatic events. He believed that women’s trauma could be alleviated through hypnotism, where he would help them to remember their trauma and consequently their symptoms would ease (Herman, 1992). Influenced by Charcot, Sigmund Freud also theorised that hypnosis could access traumatic childhood experiences and transform women’s hysteria. However he later suggested that women’s hysteria was not caused by external trauma, but that their recollections of rape and violence were actually inner fantasies and wishes (Haaken, 1998).

Trauma theory experienced a resurgence of interest after the two world wars, where it was applied to the distress experienced by returning soldiers (Courtois, 2004). The goal of trauma therapy, or what was also termed psychological first aid, at the time was to assist soldiers through their symptoms of distress, memory loss and lack of responsiveness in order to return them back to the frontline (Herman, 1992). Early trauma theorists would blame the soldiers' symptoms of trauma on their weak moral character, but Abram Kardiner (Kardiner, 1941) believed that these trauma symptoms were normal reactions to the horrors of war.

Alongside this understanding of combat trauma, the women’s movement in the 1970s started to recognise the private trauma of women’s lives and move this into the public consciousness. Feminists began to politicise rape, childhood sexual abuse and domestic violence as social problems that impacted women’s mental health. Trauma theory provided the language to describe the significant impacts of men’s violence on women and girls' lives, and was used by feminists in a way to locate these problems experienced by individual women within a wider sociopolitical context.

The inclusion of Post Traumatic Stress Disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 was was initially viewed by feminists as a positive acknowledgment of the psychological aftermath of men’s violence against women and girls (Burstow, 2005). Feminist therapists in the U.S. in particular embraced the diagnosis because they believed it legitimised the harm of violence against women, and it also meant that therapy for victims would be covered by insurance and that victims could sue for compensation (Burstow, 2005).

However, Burstow argues that the definition of PTSD is limiting as it reinforces that it is the victim’s reaction to a traumatic event that is abnormal and this reaction is consequently medicalised. For example, PTSD is diagnosed if a woman is psychologically traumatised for longer than one month after a traumatic event, like rape. The reason why the woman is still traumatised after this one month is seen as a symptom of either a psychological and/or a biological problem with the woman. The woman’s reaction to the traumatic event is then pathologised, something is wrong with her, and that something is not caused by the traumatic event itself (Burstow, 2005).

Wasco (2003) has raised concerns about PTSD and its application to victims of sexual violence. Wasco argues that the trauma paradigm and the diagnosis of PTSD can limit our understanding of the full range of victims’ experiences. Wasco highlights that the individualisation caused by the trauma model of understanding rape victims’ distress is limiting as it obscures the fact that it is not just the traumatic event that is harmful to victims. Often in the case of a sexual assault a woman may not necessarily be physically harmed, and she may not be fearful that she is going to die. This is different to the trauma that may be caused by a natural disaster or war, for example. Wasco asserts that sexual violence, and domestic violence are not events, or traumas, but rather occur on a continuum (see also Kelly, 1988). Rape and domestic violence should then be understood in the context of a social problem, thus occurring before and after the assault takes place. Wasco explains:

A broad understanding of the ‘process’ of rape would include victims’ strategies to survive the assault, their strategies (e.g. coping, disclosure, and help-seeking) to negotiate their post assault experiences, and society’s responses to the assault, which often absolve the perpetrator of blame (2003, p. 312).

Wasco also highlights that the most significant and devastating effects of sexual violence are not actually covered by the diagnosis of PTSD. These include depression, low self-esteem, shame, self-blame and damaged sense of worth (Wasco, 2003). Shame and self-blame have been noted as being one of the key reasons that victims of sexual violence do not seek help, which can in turn hinder recovery (Ullman, 1996).

Trauma theory has been condemned by some feminists as being entirely unhelpful to women (Gilfus, 1999). Gilfus suggests that there instead needs to be a shift in the way we understand rape victims’ experiences that places them in a feminist survivor-centred epistemology. This theory would legitimise survivors’ own knowledge of their world and their experiences. Gilfus argues that by constructing trauma as psychopathology, victims are left with little option but to limit their recovery to individualised solutions for what are actually social and political problems.

There are also concerns that trauma theory is now pulling us backwards into a biological understanding of the impacts of trauma (Tseris, 2013). Physical changes that are seen in the brains of traumatised populations have led to conclusions that trauma changes the brain. While there have been observations of differences in traumatised women’s brains to that of ‘normal’ brains, particularly in the amygdala, the hippocampus, and the medial frontal cortex (Nutt & Malizia, 2004) many of these results are experimental. Fine (2010), herself a neuroscientist, advises that there be extreme caution when drawing conclusions from brain structure to psychological function. Framing trauma as a biological problem risks further individualising and medicalising what is a sociopolitical issue, and relegating the solutions to trauma within the medical realm.

We want to emphasise that problematising trauma theory does not negate that it can be useful for victim-survivors in legitimising and making sense of the impacts of abuse on their lives. For practitioners and researchers, trauma-informed approaches provide a framework which can enable them to understand how trauma shapes victim-survivors lives, their behaviours and their decisions.

A way forward can be found in the work of Judith Herman, one of the most influential feminist theorists around trauma. Herman wrote in her groundbreaking book Trauma and Recovery (1992) that exposure to traumatic events can and does result in psychological harm, such as mental health symptoms, issues in self-regulation and alterations in self-perception. However, Herman emphasises that trauma therapy needs to include a recognition on the context in which this trauma occurs, and that we need to move beyond ‘fixing’ the symptoms of individual women to explore how we can challenge the patriarchal conditions that foster and perpetuate the violence and abuse that are at the root of these traumas. Herman writes that her understanding of trauma ‘‘owes its existence to the women’s liberation movement… a collective feminist project of reinventing the basic concepts of abnormal psychology’’ (p. ix) and it is important that this centering of feminist politics and ethics continue to be at the core of our understandings of trauma and its impacts.

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References

Burstow, B. (2005). A critique of posttraumatic stress disorder and the DSM. Journal of Humanistic Psychology, 45(4), 429-445.

Courtois, C. A. (2004). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 41, 412–425.

Fine, C. (2010). Delusions of gender. Icon Books.

Gilfus, M. E. (1999). The price of the ticket: A survivor-centered appraisal of trauma theory. Violence Against Women, 5(11), 1238-1257.

Haaken, J. (1998). The recovery of memory, fantasy, and desire in women’s trauma stories: Feminist approaches to sexual abuse and psychotherapy. Women, autobiography, theory: A reader, 352-361.

Herman, J. (1992). Trauma and recovery: The aftermath of violence—From domestic abuse to political terror. New York, NY: Basic Books.

Kardiner, A. (1941). The traumatic neuroses of war. National Academies.

Kelly, L. (1988) Surviving sexual violence. Polity Press.

Miller, N. K., & Tougaw, J. D. (Eds.). (2002). Extremities: Trauma, testimony, and community. University of Illinois Press.

Nutt, D. J. M., & Malizia, A. L. (2004). Structural and functional brain changes in posttraumatic stress disorder. Journal of Clinical Psychiatry, 65, 11–17.

Ringel, S., & Brandell, J. R. (Eds.). (2011). Trauma: Contemporary directions in theory, practice, and research. Sage.

Tseris, E. J. (2013). Trauma theory without feminism? Evaluating contemporary understandings of traumatized women. Affilia, 28(2), 153-164.

Ullman, S. E. (1996). Social reactions, coping strategies, and self‐blame attributions in adjustment to sexual assault. Psychology of women quarterly, 20(4), 505-526.

Wasco, S. M. (2003). Conceptualizing the harm done by rape: Applications of trauma theory to experiences of sexual assault. Trauma, Violence, & Abuse, 4(4), 309-322.