Human history has been written in blood and suffering. It is only by small victories of the heart and spirit that we have endured, and through which we can but hope to prevail. If we as a species are to survive and evolve, it is necessary to find new ink, one composed of love, compassion, and understanding, and held in a crucible of forgiveness.
The above paragraph was inspired by a quote I read from Bessel van der Kolk, one of the true giants in the field of psychological trauma. I have had the benefit over the years of attending many of his workshops, trainings and lectures. At one point, I became concerned I was starting to sound like him, I so admired the work he was doing.
In 2010, the Congress of the United States named June 27th PTSD awareness day. Later, in 2014, the United States Senate designated all of June as National PTSD Awareness month. The appearance of the diagnosis of PTSD (posttraumatic stress disorder) marked a turning point in the history of psychiatry by acknowledging an external traumatic stressor as the cause of a psychological condition. Over my career as a psychologist I have been witness to the historic unfolding of PTSD’s life.
In 1980, as a newly minted master’s in clinical psychology, I got my first professional job in a state institution for the developmentally disabled. One summer day, I, along with other members of the psychology staff, attended a roll out workshop in Columbus, Ohio on the newly published DSM-III (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders). The workshop instructor was Robert Spitzer, a major architect of the modern system of psychiatric classification. Earlier in his career, Spitzer had been responsible for getting the diagnosis of homosexuality removed from the DSM II and no longer considered a mental disorder. He is considered one of the great psychiatrists of the 20th Century for his many innovations and leadership that helped to greatly humanize the mental health field.
Early in my career, as a doctoral student in clinical psychology, I worked as a student intern in a rape counseling center at a major level I urban hospital in Detroit. It was the early 1980’s and the diagnosis of Rape Trauma Syndrome had just been proposed by professors Ann Burgess and Larry Holmstrom which addressed a unique form of PTSD which women experienced from the effects of being raped. There was a great sense of empowerment that came from the societal acknowledgment of the impact of horrific events which created psychological symptoms that were being commonly observed in groups of people who shared similar traumas. Trauma that had historically been suppressed was now seeing the light of day, where real healing could begin. (I was thrilled later in my career to be able to meet Burgess and consult with her on a proposed research project.)
As a doctoral student, I worked on an admissions unit for what had one time been the largest psychiatric hospital in the world. It was the mid 1980s and many older psychiatrists were not receptive to the new diagnosis of PTSD, preferring instead to cling to such tried-and-true diagnoses as schizophrenia and manic depression while dismissing discussions of traumatic stressors.
I created waves by documenting trauma and linking these stressors to the psychiatric conditions that were presenting on the regional admission unit for an urban area fraught with violence. The effects of exposure to extreme violence was largely psychiatrically ignored at that time. Younger clinicians may not appreciate the reality of the mental health field just 30 to 40 years ago, where thousands of people were routinely held in state run psychiatric hospitals. I was told by older historians of the hospital that in years past when a patient was admitted, part of the intake was to measure their height which would be useful for coffin requirements should they die. There was a time when few people admitted ever left, except by death. The expectation was that patients would only sink deeper and deeper into insanity and madness with little hope of recovery.
Advances made in psychiatric medications are often given top credit for elimination of such hospitals, however I believe better clinical understanding of the impact of trauma and informed psychotherapeutic interventions administered in a timely manner have prevented many people from developing more serious mental health problems such as psychosis. In my opinion, psychosis is often born from a deep sense of isolation combined with biochemical imbalances often brought on by extreme traumatic stress. Our collective mental health consciousness has indeed risen over the past 30 years.
As a newly licensed PhD clinical psychologist in the late 1980s, I worked in a level one trauma hospital to create a center for preventing and treating psychological trauma. There was a gap that needed to be bridged between the physical trauma the hospital was famed for treating and the psychological effects of those injuries. Once again, there seemed to be difficulty by the establishment in acknowledging the effects of trauma that could not be viewed on an MRI, CT scan or x-ray. The battle to promote better recovery for survivors of trauma now continues for me in private practice treating survivors of motor vehicle crashes. I have come to view the effects of motor vehicle accidents which claimed the lives of over 40,000 people in the United States last year and resulted in hundreds of thousands of physical injuries as a unique form of PTSD, which I call Vehicular Trauma Syndrome (VTS). VTS involves both psychological and physical components, particularly related to the effects of brain injuries and chronic pain resulting from physical injuries. Perhaps one day we will have a national Vehicular Trauma Syndrome awareness day, to acknowledge the battlefield we all face every day on our roadways. Perhaps such national awareness would prompt more people to drive safely by engaging in education and training that helps them alter and defend against high risk driving behaviors.
There is clearly a call to action here, given the fact that in the United States in one year there are 40,000 auto related fatalities when compared to the 58,220 documented fatalities of US soldiers that resulted during the entire 20-year span of the Vietnam conflict. In an earlier blog, I wrote about how I believe we have become numb as a society to the death toll from auto accidents in a sort of collective PTSD around the horror. There are efforts underway by many organizations and employers to reduce the number of accidents, but there needs to be a much greater orchestrated action on a national level. The World Health Organization and the United Nations has called the third Sunday of every November the World Day of Remembrance for road traffic victims and their families. Started by the British road crash victim charity, RoadPeace, in 1993, and adopted by the United Nations General Assembly in 2005, World Day shines an international spotlight on road injury and prevention issues. Indeed, this form of trauma is a world pandemic. According to the World Health Organization there were 1.25 million road traffic deaths globally in 2013.