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Accepted Western guidelines for the treatment of trauma survivors who are diagnosed with Posttraumatic Stress Disorder (PTSD) demonstrate an emerging consensus with regard to treatment. All of the guidelines cite strong evidence for the inclusion of an exposure component to treatment. However, the accumulated evidence base for the treatment of patients with PTSD is drawn from trials that almost exclusively do not include refugees. The question this chapter explores is the advisability of using an exposure component to the treatment of refugees who have suffered traumatic experiences and who remain symptomatic. Do we have clear evidence that exposure techniques are necessary or even advisable to resolve the psychological difficulties that refugees experience? Based on a number of reasons, the authors suggest that in the first years of resettlement and adaptation, successful treatment should be focused on settlement issues. [ABSTRACT FROM AUTHOR]

The current interest in the psychiatric disorders of the Great War dates back to three innovative and very different studies of the 1970s: The Great War and Modern Memory by Paul Fussell, The Face of Battle by John Keegan, and Eric Leed's study of combat and identity No Man's Land. The focus of these studies was the personal experience of war, especially but not exclusively the Great War; the assumptions and understanding brought to it and, often, the damage and loss that result. A second group of studies emerged in the middle and late 1980s, including more specialized works on psychological medicine, feminist interpretation, as well as two extended pieces of research on the British experience. Snowball-like, the chapters presented in the final sections of Traumatic Pasts illustrate the development of comparative and postwar studies, although other issues, such as the experience of war neurotic ex-servicemen and the much wider theme of Great War psychological trauma as a pathology of modernity, are open to further exploration. The Great War and the British soldiers' experience of that war were the starting point for these developments, the studies of the 1970s particularly helped establish a framework within which more recent debates have taken place, and for that reason I want to review the British experience. [ABSTRACT FROM AUTHOR]

Late in the spring of 1871, a thirty-year-old seamstress was admitted to an eminent New York asylum in what her physicians termed an “acutely maniacal condition.” She had suffered terribly during the weeks prior to her commitment – emotionally erratic, unable to eat or sleep properly, she had grown increasingly weak and disconsolate. Moreover, her caretakers reported that she “was destructive of clothing, pulled her hair out, was noisy, incoherent, and violent; opposed care, wandered about, and was with difficulty controlled.” Having exhibited a certain nervous debility throughout her adult life, the young woman's affliction was, if not entirely explicable, at least familiar in its basic contours. Or so it seemed. On further examination, the asylum physicians discovered scarring and discoloration that extended over much of her body, the result, they soon learned, of habitual injections of morphine. Consistent with established practices, her doctors prescribed a daily dose of chloral to allay her addiction and placed her on an exacting program of bedrest and overfeeding devised to hasten her recovery. Observing this regimen, the woman grew stronger and seemingly more contented in the weeks and months that followed. By August, her menstrual cycle had resumed after a lengthy cessation, a sure sign of health from her physicians' point of view. Accompanying her period, however, was a swelling of the right breast so severe that adhesive straps were required to provide support and elevation. [ABSTRACT FROM AUTHOR]

In light of the catastrophes and cataclysms that have marked twentieth-century history, it is scarcely surprising that trauma has emerged as a highly visible and widely invoked concept. Having transcended its origins in clinical medicine to enter everyday culture and popular parlance, trauma has become a metaphor for the struggles and challenges of late twentieth-century life, a touchstone in a society seemingly obsessed with suffering and victimization. Simultaneously, the concept of trauma itself has inspired vigorous criticism, resulting in a series of highly publicized medical and legal controversies. Indeed, debates over the nature, “reality,” and significance of traumatic suffering have had enormous cultural resonance as we struggle to make sense of a ceaselessly violent and chaotic world. THE BACKGROUND OF HISTORICAL TRAUMA STUDIES As a category in psychological medicine, trauma was given official recognition by the American Psychiatric Association in 1980 in the form of Posttraumatic Stress Disorder (PTSD). The APA's authoritative Diagnostic and Statistical Manual of Mental Disorders, the psychiatric bible that names and classifies all nervous and mental disorders, granted post-traumatic psychological suffering the status of a discrete and independent diagnostic entity in its third edition. According to the 1980 definition, PTSD is precipitated by an event that would cause great distress to almost anyone; and with the revised 1987 edition came the added stipulation that such an event must lie “outside the range of usual human experience.” [ABSTRACT FROM AUTHOR]

Physicians have long believed that disturbing experiences arouse intense emotions that can cause illness and disease. Similarly, human behaviors that can be interpreted in the diagnostic language of our own time as post-traumatic pathology date back to classical times. The first medical instances of describing, labeling, and treating such behaviors appeared during the seventeenth century, when army doctors typically regarded the cases as an organic disease of an unknown nature, cowardice, or malingering. Traumatic neurosis as a distinct psychiatric category, however, with an independent diagnostic identity and psychological – or mixed somatic and psychological – origins emerged in Western Europe and North America only during the last third of the nineteenth century. The period 1870–1910 witnessed an unprecedented burst of creative psychological theorizing in Europe and the United States. This was the founding generation of modern psychology, psychiatry, and psychotherapy during which the sciences of the mind largely assumed the theoretical and professional forms in which we know them today. The observation and theorization of psychological trauma played no small part in this intellectual development. One of the first physicians of this period to explore systematically the idea of posttraumatic pathology and to write extensively about it – and who was a direct and demonstrable inspiration to medical traumatologists in the next generation – was the Parisian neuropsychiatrist Jean-Martin Charcot. THE BACKGROUND TO CHARCOT'S WORK ON TRAUMATIC NEUROSIS Charcot (1825–1893) studied trauma during the second half of his career, from the later 1870s through to his death in the early 1890s. [ABSTRACT FROM AUTHOR]