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Most people think of trauma as a “mental” problem, even as a “brain disorder.” However, trauma is something that also happens in the body. We become scared stiff or, alternately, we collapse, overwhelmed and defeated with helpless dread. Either way, trauma defeats life.
The state of being scared stiff has been portrayed in the various great cultural mythologies. There is, of course, the Gorgon Medusa who turns her victims to stone by exposing them to her own wide-eyed terrified gaze. In the Old Testament, Lot’s wife is turned into a pillar of salt as a punishment for witnessing the terrifying destruction of Sodom and Gomorrah. If these myths seem too remote, we need only look at children throughout the world playing “statue.” How many countless generations of kids have used this game to help them master the primordial terror (often lurking in their dreams) of being scared stiff? To these stories we can add our contemporary myth of the “disease” that psychiatry has named posttraumatic stress disorder or PTSD. Indeed, when compared with historical mythologies, modern science has certain advantages and disadvantages in accurately comprehending the universal human experience of terror, horror, injury and loss.
The indigenous peoples throughout South America and Mesoamerica have long understood both the nature of fear and the essence of trauma. What’s more, they seemed to know how to transform it through their shamanic healing rituals. After colonization by the Spanish and Portuguese, the indigenous peoples borrowed their word _susto_ to describe what happens in trauma. Susto translates graphically as “fright paralysis” and as “soul loss.” Anyone who has suffered a trauma knows, first, paralyzing fright, followed by the bereft feeling of losing your way in the world, of being severed from your very soul.
When we hear the term _fright paralysis,_ we may think of a startled deer, stunned motionless by oncoming headlights. Humans react similarly to trauma: thus Nancy, her startled face wide-eyed and frozen in fear. The ancient Greeks also identified trauma as being paralyzing and corporeal. Zeus and Pan were invoked to instill terror and paralysis in the enemy during times of war. Both had the capacity to “freeze” the body and induce “_pan_-ic.” And in the great Homeric epics, the Iliad and the Odyssey, trauma was portrayed as ruthlessly destructive to self and families.
By the time of the American Civil War—when young men were suddenly exposed to their comrades being blown into pieces by cannon fire; to the noise and terror of chaos; and to stinking, rotting corpses far beyond anything they were prepared for—the term used to describe traumatic post-combat breakdown was _soldier’s heart._* [NOTE: This descriptive term was probably borrowed from the Swiss in the mid-1600s, where it was also called nostalgia (Heimweh)—and yes, the armies of the “neutral” Swiss cantons were at each other’s throats for centuries! END NOTE.] This name conveyed both the anxious, arrhythmic heart, pounding in sleepless terror, as well as the heartbreak of war, the killing of brothers by brothers. Another term from the Civil War era was _nostalgia,_ perhaps a reference to the unending weeping and inability to remain oriented to the present and go on with life.
Shortly before World War I, Emil Kraepelin, in an early diagnostic system published around 1909, called such stress breakdown “fright neurosis.” After Freud, he recognized trauma as a condition arising from an overwhelming stress. Freud had defined trauma as “a breach in the protective barrier against stimulation [(over)stimulation—my addition], leading to feelings of overwhelming helplessness.” Kraepelin’s definition was largely lost in the nomenclature of trauma, yet it recognized the central aspect of fright—although the word “neurosis” has pejorative associations.
In the wake of World War I, combat trauma was reincarnated as _shell shock,_ simple, honest and direct. This bluntly descriptive phrase almost resounds like the maddening explosions of shells, shattering the stunned and trapped men into shaking, urinating and defecating uncontrollably in the cold, wet trenches. Like susto, this raw descriptive term had nothing distancing, dispassionate or disinfected about it.
However, by World War II, any real reference to soldiers’ suffering was stripped of dignity and neutered to _battle fatigue_ or _war neurosis._ The first term suggested that if a soldier heeded Grandma’s advice and took a good long rest, all would be just fine. This dismissive minimizing was especially insulting, and even ironic, given a suffering soldier’s profoundly disturbed capacity for restorative sleep. Even more demeaning was the pejorative use of the word _neurosis,_ implying that a soldier’s “shell shock” was somehow due to a “character defect” or a nagging personal weakness—perhaps an “Oedipal complex”—rather than to one’s entirely appropriate terror of exploding shells or stark grief for fallen comrades and the horror of men killing men. These newer monikers separated civilians, families and doctors from the jagged reality of the soldiers’ profound suffering.
In the aftermath of the Korean War, all remaining poignancy was excised from the next generation of war trauma terminology. The term used here for combat trauma, _operational exhaustion_ (which was resurrected as _combat operational exhaustion_ for the Iraq war), certainly had nothing gritty or real in respect to the horrors of war. It was an objectified term, more applicable to a laptop computer of today when left on too long and needing a reboot.
Finally, the current terminology, derived largely from the experiences of the Vietnam War, is _posttraumatic stress disorder._ As PTSD, the universal phenomenon of terror and paralysis—in which the nervous system has been strained to the breaking point, leaving body, psyche and soul shattered—is now fully sanitized as a medical “disorder.” With its own convenient acronym, and serving the dispassionate nature of science, the archetypal response to carnage has now been artificially severed from its ravaging origins. Where it was once aptly conveyed by the terms _fright paralysis_ and _shell shock,_ it is now simply a disorder, an objectified collection of concrete and measurable symptoms; a diagnosis amenable to vested research protocols, detached insurance companies and behavioral treatment strategies. While this nomenclature provides objective scientific legitimacy to the soldiers’ very real suffering, it also safely separates doctor from patient. The “healthy” (“protected”) doctor treats the “ill” patient. This approach disempowers and marginalizes the sufferer, adding to his or her sense of alienation and despair. Less noticed is the likely burnout in the unprotected healer, who has been artificially hoisted onto a precarious pedestal as false prophet.
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