I originally titled the article, "I Wrote This For My Own Good" and submitted it for publication with the Trauma Informed Care Network (TICN) Utah e-newsletter in June 2018. I sought and obtained permission from the presenter, David Prescott, and the TICN founder, Kristan Warnick, before posting here.
On April 3, 2018, I had the pleasure of hearing David Prescott speak at the 5th Annual Utah Sexual Violence Conference hosted by the Utah Coalition Against Sexual Assault. Prescott’s first presentation was “6 Strategies for Improving Your Working Alliance Skills” and his keynote speech was titled, “Where There’s Hope: What We’ve Learned About Treating People Who Have Abused.” Here is an historical perspective of the development of the Post Traumatic Stress Disorder (PTSD) diagnosis, of interest to those who study and treat trauma. It is based on the notes I took during Prescott’s presentations. http://www.davidprescott.net/
Original discussion around trauma came from railroad accidents of affluent businessmen, and was referred to as “train sickness.” The concept of trauma was next applied to returning combat veterans and named “shell shock,” ”battle fatigue,” and “the thousand yard stare.” Posttraumatic stress disorder was not fitted for children who did not meet the symptom criteria, but whose lives are train wrecks.
The irony of the trauma industry is that the Veteran’s Affairs and Child Welfare budgets do not and have never matched what these organizations claim they are addressing. As with many groupthink errors, a distracting analogy was offered, that if PTSD was a means to pathologize the individual, how much better would it be to pathologize groups of people? Thus was born complex PTSD.
Complex PTSD allows clinicians and organizations to diagnose a wider swath of the population. The need for services is justified and the context that creates the disturbance is not part of the picture. The crucial role of choice, options and decision-making by the individual is removed. More recently, the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM5) published by the American Psychiatric Association, has shifted to Disorders of Extreme Stress Not Otherwise Specified. Whatever the label, qualifier or diffusing descriptor, PTSD is a diagnosis of white male privilege, more male than white.
As per the suggestion of David Prescott, I conducted a Google search on “developmental trauma disorder not otherwise specified” and the first scholarly article that showed was this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032083/. I learned that the Veterans Health Administration lobbied in part to omit this disorder in the DSM5 because there was only enough funding and money flow to research PTSD and not a new diagnosis. David Prescott told his audience that two leading traumatologists, Julian Ford and Bessel van der Kolk, verified this to him.
The history of trauma diagnosing is important for trauma treatment. Humans can help each other and have been helping each other regardless of their formal training and specialty. The Trauma Informed Care Network of Utah (ticn.org) is one such example. To be truly trauma informed, we can conceptualize trauma based on what the person went through rather than what is the matter with them. That means that prevention involves avoiding foreseeable traumas (e.g., don’t go into combat); treatment involves training society at large to be curious about how childhood and emotional experiences get in the body; and recovery involves a lifestyle of noticing and investigating each experience by staying in the present moment (i.e., mindfulness) and seeing what happens next. Any response that returns power and choice to the individual will foster recovery.
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