A summarised history of trauma and dissociation from Charcot to 1990

Authored by Henry Strick van Linschoten

The idea of trauma has been adopted from medicine: a Greek word used by Hippocrates in its medical and common-sense meaning of physical injury. It was fundamental in the early theory of Freud, who first used it in 1893 and continued to use it throughout the 1890s. Freud adopted this term from Charcot (1885/1887/1889) and Janet (1889) in the metaphorical sense of psychic trauma. Psychoanalysis focused initially on the understanding and treatment of hysteria (Breuer & Freud, 1895/1955), and in the 1890s took environmental or external interpersonal trauma (such as by child sexual abuse) to be the main cause of hysteria. Laplanche & Pontalis (1967/1973) give a description of the place of trauma in Freud’s psychoanalysis. After Freud, Ferenczi (1930, 1931, 1933/1949) was the major theoretician who developed the trauma concept and linked it with childhood abuse and dissociation in a way which forms the basis of contemporary theory.

Trauma can be divided into various categories, caused by:

• natural events
• child abuse
• attacks (often criminal) by one person on another in a civilian context
• military, terrorist, war or war-related activity

The history of trauma is punctuated by developments in these areas, and has led to greater interest in the psychic consequences of trauma, development of the nomenclature and new ideas about treatment.

PTSD and war 

Every major war leaves a large number of traumatised people behind, whether civilian and military victims, their relatives, or soldiers traumatised by the violence that they have inflicted or witnessed, well documented after the US Civil War, the First and Second World Wars, the Vietnam War and the Iraq wars. After the Vietnam War the term Post-traumatic Stress Disorder (PTSD) was introduced, and in 1980 PTSD was incorporated into DSM-III, where it continued with some modifications until DSM-5. DSM-5 has introduced the theoretical innovation that PTSD, together with other stress-based disorders, is separated from the anxiety disorders, and has received its own chapter organised around the aetiological basis of trauma and stress.

There are similarities between PTSD and what was called ‘soldier’s heart’ or ‘irritable heart’ from the American Civil War until the middle of the 20th century (Wood, 1941) or, after the First World War, ‘shell shock’. C.S. Myers (1916, 1940), a British psychologist, made major contributions to its understanding which were consistent with Pierre Janet’s ideas about dissociation, and which have fed directly into Dr Onno van der Hart’s theories about Dissociative Identity Disorder (van der Hart et al., 2006).

An early book bridging these periods is Krystal (1968), with a major focus on PTSD in Holocaust survivors. A further influence on contemporary thinking about trauma by Van der Kolk, Psychological Trauma (1986)has been widespread and a great deal of information, both general and historical, is also contained in Judith Herman’s Trauma and Recovery (1992).

Dissociation 

In the second half of the 19th century in France, the term dissociation was used to describe two phenomena: altered states of consciousness in hypnosis, and the mechanism of hysteria. This usage was associated especially with Charcot (1885/1887/1889), with whom Freud studied, and was developed further by Janet (1889, 1893/1901 and passim).

Breuer & Freud (1895/1955) made extensive use of the concept, although in the 1890s they had begun to prefer different terms such as ‘splitting’ and ‘conversion’. The concept remained central in the early thinking of Freud until around 1900, when it was replaced by the theory of repression to explain how certain representations are kept unconscious.

Ferenczi used the phrase ‘splitting of the personality’ repeatedly in the major series of lectures he gave in the period from 1927 until 1933, shortly before his death (Ferenczi 1928/1994, 1930, 1931, 1933/1949).

Fairbairn (1929/1994) wrote his thesis on dissociation in 1929, and wrote again about dissociation during the Second World War (Fairbairn 1941/1952, 1944/1952) but was one of the last major theoreticians to devote substantial attention to this topic for a number of decades.

Outside Freudian psychoanalysis, Jung wrote frequently about dissociation as an important phenomenon between 1920 and 1960 (e.g. 1921, 1954/1969).

There was a major gap in thinking about dissociation from 1940 to the 1970s, apart from an interest in ‘war neuroses’ and the continued attention paid to hysteria, sometimes specified as ‘conversion’ or ‘dissociative hysteria’. One exception to this trend was expressed in the work of Rycroft (1962).

The modern period of thinking about dissociation has been strongly influenced by three pioneers, all of whom published influential books in the 1980s: Richard Kluft (1985; Kluft & Fine, 1993), Frank Putnam (1989) and Colin Ross (1989). This renewed interest in the 1970s was more centred on incest, child sexual abuse and other forms of abuse (e.g. Finkelhor, 1979; Herman, 1981), the effect of which was then connected with PTSD caused by military action. Dissociation was described as the major mechanism explaining the impact of abuse and trauma on the psyche and personality (Herman, 1992).

NOTE: The closely linked topic of hysteria also has an extensive history that is not detailed here. Hysteria has fed through into the theories of what is now called personality disorder, especially borderline, histrionic and anti-social.

Popular interest 

Professional interest in dissociation has long been paralleled by popular interest, especially in articles and books based on individual case histories. In France, Charcot (1885/1887/1889) gave public displays of hysterical women in the Salpêtrière. In the USA Morton Prince published in 1906 the story of Christine Beauchamp. This trend was strengthened by the general psychoanalytic interest in case histories. Recent examples are the stories of ‘Eve’, published (Thigpen & Cleckley, 1957) and turned into a film in 1957, and of ‘Sibyl’ (Schreiber, 1973). This trend has increased and there have been countless publications since then.

A recommended source for further reading on the history of dissociation is van der Hart & Dorahy (2009).

Bibliography 

Breuer, J. & Freud, S. (1895/1955). Studies on hysteria. In S. Freud, The Standard Edition of the Complete Psychological Works of Sigmund Freud: Volume II. London: Vintage/The Hogarth Press.

Charcot, J.-M. (1885/1887/1889). Clinical Lectures on Certain Diseases of the Nervous System. London: The New Sydenham Society.

Fairbairn, W.R.D. (1929/1994). Dissociation and repression. In E.F. Birtles & D.E. Scharff (Eds.), From Instinct to Self: Selected Papers of W.R.D. Fairbairn: Vol. II Applications and Early Contributions. Northvale, NJ: Jason Aronson, Inc.

Fairbairn, W.R.D. (1941/1952). A revised psychopathology of the psychoses and psychoneuroses. In Psychoanalytic Studies of the Personality. Hove: Brunner-Routledge.

Fairbairn, W.R.D. (1944/1952). Endopsychic structure considered in terms of object-relationships. In Psychoanalytic Studies of the Personality. Hove: Brunner-Routledge.

Ferenczi, S. (1928/1994). The problem of the termination of the analysis. In Final Contributions to the Problems and Methods of Psycho-Analysis. London: Karnac.

Ferenczi, S. (1930). The principle of relaxation and neocatharsis. International Journal of Psycho-Analysis. 11: 428-443.

Ferenczi, S. (1931). Child-analysis in the analysis of adults. International Journal of Psycho-Analysis, 12: 468-482.

Ferenczi, S. (1933/1949). Confusion of tongues between adults and the child. (The Language of Tenderness and of Passion). International Journal of Psycho-Analysis, 30: 225-230.

Finkelhor, D. (1979). Sexually Victimized Children. New York: The Free Press.

Herman, J.L. (1981). Father-Daughter Incest. Cambridge, MA: Harvard University Press.

Herman, J. (1992). Trauma and Recovery: From Domestic Abuse to Political Terror. New York: Basic Books.

Janet, P. (1889). L’Automatisme psychologique. Paris: Felix Alcan/L’Harmattan.

Janet, P. (1893/1901). The Mental State of Hystericals. New York: G.P. Putnam’s Sons.

Jung, C.G. (1921). Psychological Types. Princeton, NJ: Bollingen and Princeton University Press.

Jung, C.G. (1954/1969). On the nature of the psyche. In The Collected Works: Volume Eight: The Structure and Dynamics of the Psyche (2nd ed.). London: Routledge.

Kluft, R.P. (Ed.) (1985). Childhood Antecedents of Multiple Personality. Washington, DC: American Psychiatric Press, Inc.

Kluft, R.P. & Fine, C.G. (Eds.) (1993). Clinical Perspectives on Multiple Personality Disorder. Washington, DC: American Psychiatric Press.

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Myers, C.S. (1940). Shell Shock in France. 1914-1918: Based on a War Diary. Cambridge: Cambridge University Press.

Prince, M.H. (1906). The Dissociation of a Personality. New York: Longmans, Green & Co.

Putnam, F.W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press.

Ross, C.A. (1989). Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment. New York: Wiley.

Rycroft, C. (1962). Beyond the reality principle. International Journal of Psychoanalysis 43: 388-394.

Schreiber, F.R. (1973). Sybil: The True Story of a Woman Possessed by Sixteen Separate Personalities. Washington, DC: Henry Regnery.

Thigpen, C.H. & Cleckley, H.M. (1957). The Three Faces of Eve. London: Secker & Warburg.

van der Hart, O., Nijenhuis, E.R.S. & Steele, K. (2006). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. New York: W.W. Norton & Company.

van der Hart, O. & Dorahy, M.J. (2009). History of the concept of dissociation. In P.F. Dell & J.A. O’Neil (Eds.) (2009). Dissociation and the Dissociative Disorders: DSM-V and beyond. New York: Routledge.

van der Kolk, B. (1986). Psychological Trauma. Washington, DC: American Psychiatric Press, Inc.

Wood, P. (1941). Da Costa’s Syndrome (or Effort Syndrome). British Medical Journal, 1(4194): 767-772.