The political and sociological events and movements that I mentioned in my previous posts provided an acknowledgement of the hidden epidemic of child abuse and its link to posttraumatic and dissociative symptoms. Another such event was the Vietnam War. Despite the unpopularity of that conflict with much of the American people, it could not be denied that many of the young men who returned from battle were changed forever. As a result, the concepts of posttraumatic stress disorder (PTSD)(formerly known as “shell shock” or “war neurosis” during previous wars) were further elucidated and defined.1
“Rap Groups” for returning Vietnam vets provided an outlet for vets to talk out their war experiences. From those experiences, psychiatrists formulated 27 of the most common symptoms of traumatic neuroses. From that point on, a classification symptom was developed which resulted in the presentation of the American Psychiatric Association’s inclusion of PTSD in the DSM III in 1980.
Another major movement to support the study of trauma and dissociation resulted from the rise of modern feminism in the 1960s and 1970s.2 The psychological syndrome seen in survivors of rape, domestic battery, and incest was essentially the same as the syndrome seen in survivors of war. Diagnostic criteria included alternating patterns of reliving/re-experiencing and numbing/denial of the trauma, along with chronic physiological hyperarousal.
A hallmark of the diagnosis was the difficulty that many traumatized individuals experienced in integrating the emotions associated with the overwhelming nature of the traumatization. Such disparate defensive operations as dissociation, somatization, and fixation on the trauma, including patterns of amnesia and hypermnesia (the condition of having an unusually vivid or precise memory), were identified and incorporated within the diagnosis of PTSD from the start. The common denominator of psychological trauma is a feeling of intense fear, helplessness, loss of control, and threat of annihilation.
Studies of PTSD and dissociation in the 1980s blossomed with new evidence of the psychological and physiological effects of trauma. The International Society for the Study of Dissociation (ISSD) and the International Society for the Study of Traumatic Stress (ISTSS) were founded in the mid-1980s, and helped to organize efforts to study trauma and treatment of traumatic sequelae. The diagnosis of Multiple Personality Disorder (MPD) became an official diagnosis of the American Psychiatric Association and was listed in the DSM III in 1980 in large part because the size of the field of trauma and dissociation had expanded a great deal.
The DSM III defined Multiple Personality Disorder as “the existence within the individual of two or more distinct personalities, each of which is dominant at a particular time. Each individual personality is complex and integrated with its own unique behavior patterns and social relationships.” The defining feature and the core of this disorder is that certain aspects of the person’s identity become detached or dissociated. For this reason, the name of the disorder was changed in the DSM IV form MPD to DID (Dissociative Identity Disorder) in 1994.
Elizabeth Loftus, a research professor wrote: “According to Freud, people often push unacceptable, anxiety-provoking thoughts and impulses into their unconscious so as to avoid confronting them directly. This psychological defense mechanism is called repression.
Thus, a young woman who is sexually attracted to her father may try to repress her disturbing incestuous desires. But her behavior may indicate that these feelings are not completely forgotten. The woman may pause or fumble for words when discussing certain things about her father, and she may show other signs of anxiety such as sweating or blushing.”3
A year later Loftus wrote, “A leading interpretation of these results is that memory traces consolidate with the passage of time, and that a critical incident can disrupt the process of consolidation. Other interpretations are also possible: for example, that the critical incident affects retrieval, rather than storage, of information in memory. These experiments provide support for the theory that exposure to mentally shocking events can cause retrograde amnesia for other events that occur a short period of time earlier… A promising explanation for these memory deficits is that mental shock disrupts the lingering processing necessary for full storage of information in memory. Our results showed that impairment in memory occurred not only for an item seen immediately prior to the critical incident, but also for items occurring nearly 2 minutes earlier. Although this may seem to challenge the consolidation explanation, it can be accounted for by assuming that there are two consolidation processes, one for short-term traces and another for long-term traces. Presumably, exposure to violence disrupts not only short-term consolidation but also long-term consolidation.”4
It is important to remember what she wrote because she makes a complete about face when she discusses trauma and repression with the media years later. For now we need to focus on the almost 100 years of documentation about dissociation, memory, amnesia, and multiple personalities both by the psychiatric and military communities.
1 “Conversion Disorders,” by Edwin A. Weinstein M.D., War Psychiatry, Office of the Surgeon General, Borden Institute, Walter Reed Army Medical Center, Washington, D.C. 1995.
2 “Mental Health: A Report of the Surgeon General,” U.S. Department of Health and Human Services, 1999
3 Wortman, C. and Loftus, E. Psychology. (1981) Alfred A. Knopf: New York, p. 203.
4 “Mental shock can produce retrograde amnesia,” Loftus, E. and Burns, T. (1982) Memory & Cognition, 10 (4), 318-323.