Returning Vietnam veterans.
When Bessel van der Kolk was at the Veteran’s Administration (VA) in 1978, he was one of many clinicians fascinated by the complaints of returning Vietnam veterans. At the time, there was no definition of trauma related to combat, rape, involvement in fatal accidents — none whatsoever. When van der Kolk submitted a grant to do research on trauma symptoms it was denied. “It has never been shown that PTSD is relevant to the mission of the Veterans Administration” the VA stated flatly. (The quote is taken from Mary Sykes Wylie’s excellent profile of van der Kolk and his work “The Limits of Talk” — which you can find here.)
Van der Kolk is well versed in the limitations of defining trauma in terms of diagnostic category. He helped write the definition. Post-Traumatic Stress Disorder (PTSD) first appeared in the Diagnostic Statical Manual III (DSM-III) in 1980. So what’s so important about a diagnosis? Without one you will not get treatment, or your treatment will not get reimbursed.
The current DSM-IV description begins “…exposure to an extreme traumatic stressor involving direct personal experience of an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, seriuos harm, or threat of death or injury experienced by a family member or other close associate.” But at its core, the kernel of the diagnosis is not so much the experience itself as the feeling of helplessness that it arouses in the victim. Another trauma expert, Judith Herman, M.D., describes this in Trauma and Recovery, as “its power to inspire helplessness and terror.” Continue reading “What is Trauma?”