Kai An Chee

When Nightmare is Real: Trauma in Childhood and Adolescence

Feb. 14, 2017
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Judith Herman, in her volume Trauma and Recovery, paints a holistic picture of the

physiological and psychological effects of trauma on the individual. She creates an incredibly

informed sense of how trauma and its diagnoses came to be what they are today; beginning from

the time of Charcot, Freud, and Janet, she takes readers on a journey from hysteria to todays

post-traumatic stress disorder. In addition, Hermans lens is, without a doubt, feminist, and she

sheds remarkable light on battered and raped women. Her perspective informs the data

presented, framing it in a way that allows the readers to better understand these women not only

as statistics or case studies, but as real people. Her book, which centers on three main categories

of victimsbattered and raped women, war victims, and childrenis complete and technical in

its scope but personal in its approach. While Hermans work sheds light on many controversial

subjects within the realm of trauma studies, one of these is her conceptualization of Complex

Trauma Disorder.

In describing Complex Trauma Disorder, Herman begins by noting that it is usually

people who, unaffected by trauma themselves, are given the responsibility of diagnosing or

understanding those who have been through a traumatic event. She acknowledges that, for those

who do not know, social judgement of chronically traumatized people therefore tends to be

extremely harsh (84). To those who do not understand, the range of emotions that the

traumatized person exhibitswhich range from helpless and passive to angry and frustratedis

seen as cause for annoyance and condemnation. Herman also makes the point that, from the

perspective of an observer, the responses of the traumatized person seem almost reversible:
observers who have never experienced prolonged terror and who have no understanding of

coercive methods of control presume that they would show greater courage and resistance than

the victim in similar circumstances (84). The behavior of the victim is blamed on the character

of the victim. Perhaps one of Hermans most insightful comments is when she asserts that what

is surprising is the enormous effort to explain male behavior by examining characteristics of

women (84). Despite the fact that most women who enter into a harmful relationship are no

more psychopathic than those who do not, researchers continue to search the characteristics of

the women rather than looking directly at the actions of the perpetrators.

Building upon this, Herman goes on to describe multiple incidences of misdiagnosis due

to a caricatured view of who the abused person is. In response to this misdiagnosis, male

psychoanalysis of the mid-190s created a new disorder for review: masochistic personality

disorder. Described as someone who remains in relationships in which others exploit, abuse, or

take advantage of him or her, despite opportunities to alter the situation (85), this disorder was

greatly contested by womens rights groups. Herman herself was one of the participants to

formally argue this disorder, and felt that she was met with bland denial (85). Eventually,

masochistic personality disorder was eventually renamed self-defeating personality

disorderit is now part of an appendix, unseen and unknown by the majority of practitioners.

Hermans example of the masochistic personality disorder - self-defeating personality

disorder debacle goes to show both blatant prejudice as well as a lack of appropriate diagnoses

for victims of highly traumatic situations. While the anxieties, fears, and panics of trauma

survivors are often grouped under the same umbrellas as anxiety disorders, Herman argues that

they are very different. She states that the somatic symptoms of survivors are not the same as
ordinary psychosomatic disorders. Their depression is notordinary depression. And the

degradation of their identity and relational life is not the same as ordinary personality

disorder (86). By trying to place trauma survivors into categories previously established for

other disorders, only partial understandingand thus, only partial recoveryis achieved.

Herman argues that none of these categories speaks to the depth of what these trauma victims

experienceeven post-traumatic stress disorder does not capture the full experience of all

trauma survivors. The existing diagnostic criteria for [these disorders], Herman argues, are

derived mainly from survivors of circumscribed traumatic events (86). For survivors of long-

term, repetitive trauma, however, this diagnosis is shallow and vague. In contrast to survivors of

short-term trauma, prolonged abuse causes characteristic personality changes, including

deformations of relatedness and identity (86). Being exposed to repeated trauma for a long

period of time has more of an impact on an individuals sense of self and the world around them.

The concept of captivity, furthermore, arises as one that needs a far deeper diagnosis than simple

Post-Traumatic Stress Disorder. The physical and emotional isolation attached to such an

experienceespecially when occurring over months or even yearsis deeply damaging not only

emotionally and psychologically, but also physically. Herman calls this diagnosis Complex

Post-Traumatic Stress Disorder. By viewing trauma as a spectrum rather than a single and

simple diagnosis, she believes that we will be able to have a deeper understanding of experiences

that are anything but black and white.

Complex Post-Traumatic Stress Disorder has implications for those affected by childhood

abuse as well. These victims have a higher risk of being harmed by both themselves and other

people, and can potentially develop issues with personality and relationships. Indeed, most
patients in the psychiatric care system have endured long-term, repeated childhood abuse

50-60% of psychiatric inpatients and 40-60% of outpatients report childhood histories of

physical or sexual abuse or both (88). Survivors of prolonged child abuse show higher base

levels of distress, insomnia, sexual dysfunction, dissociation, anger, suicidality, self-mutilation,

drug addiction, and alcoholism (88). Relationally, these victims are unable to be intimate with

others, are excessive with their expression of care to others, and continue to allow themselves to

be victimized. Herman, here, makes an insightful pointthat due to the huge amount of

symptoms experienced by victims of prolonged child abuse, their diagnoses are often fragmented

and widespread. The medical system becomes almost a second abuser: caregivers victimize the

patience, and the destructiveness of inappropriate diagnoses puts the patient through another

level of abuse. Such patients are often diagnosed with somatization disorder, borderline

personality disorder, and multiple personality disorderdisorders with vague yet overlapping

symptoms. These diagnoses, while accounting for some of the symptoms experienced by

victims, do not attack the root of the problem: the trauma experienced in childhood. The

necessity for a diagnosis of Complex Post-Traumatic Stress Disorder makes itself all the more

clear in this instance, and an understanding of how childhood trauma can result in a myriad of

serious symptoms can make or break an effective treatment.

Given Hermans assertions and arguments, I do believe that an added diagnosis of C-

PTSD would be beneficial to those whose experience surpasses a simple diagnosis of PTSD.

Despite often following a pattern, trauma comes in many shapes and formsit is only right that

a wider diagnosis be available for potentially endless amounts of symptom combinations and

responses to the abuse. The fact that there is not currently a distinction between simple PTSD
and C-PTSD is greatly troubling; studies have shown that trauma, especially during childhood,

has an unbelievable amount of dangerous repercussions for the individual. The existence of only

a single diagnosis asserts that all forms of trauma fall within a single diagnosis; this is absolutely

not the case. The level and duration of trauma, no doubt, plays a huge part in how the

individuals mental and physical state will be changed. Especially for instances of captivity in

which the victims can be kept in isolation and abused for months or even years, I believe that a

diagnosis of C-PTSD would help these individuals find treatment that is productive and

appropriate. The expanded scope of symptoms in C-PTSD would, furthermore, lessen

misdiagnoses. While I do believe in the addition of C-PTSD, potential problems do arise. A

diagnosis with a wider scope of symptoms could conversely cause the misdiagnosis of

individuals with borderline or multiple personality disorder; it would be imperative to find about

about trauma that may be repressed before providing a diagnosis. I truly believe that adding this

diagnosis would not only make treatment more effective, but it would also target the root of the

problem, thus providing a sense of support and validation to those who have had these

experiences.