Troubles in Traumatology

(Can J Psychiatry 2005;50:815-816) No area within psychiatry has expanded as much as traumatology-the study of the causes and treatment of posttraumatic stress disorder (PTSD). Despite its phenomenal growth, traumatology has been wracked with controversy (1,2). From the beginning, critics of the PTSD diagnosis wondered whether its advocates had discovered a disease entity in nature or whether they had cobbled together a cluster of symptoms shared with other syndromes and then traced its etiology to the unpopular war in Vietnam (3). Was PTSD discovered by clinical scientists or created by them? Several years later, the National Vietnam Veterans Readjustment (NVVRS) study reported that 30.9% of all men who had served in that war-cooks and clerks as well as infantrymenhad developed PTSD and that another 22.5% had developed partial, subclinical PTSD (4, p 63). That over one-half of all who served developed at least the subclinical form of the dis ease should have been surprising, especially because only 15% of those who served in Vietnam were in combat units (5, I 209). The NVVRS suggested a hidden epidemic of untreated PTSD among Vietnam veterans, and funds poured into Department of Veterans Affairs (DVA) hospitals to cope with the problem. However, few seemed to notice that the NVVRS reported that twice as many men developed PTSD as were assigned to combat units. The mystery behind the discrepancy in numbers of those with the disease and of those in combat remains unsolved today. Meanwhile, beginning in the 1980s, the notion that many adults harboured repressed (or dissociated) memories of their childhood sexual abuse (CSA) began to spread. Although architects of the PTSD diagnosis emphasized that traumatic events were remembered all too well, other traumatologists argued that the mind can protect itself by banishing horrific memories from awareness. Therapists began interpreting diverse symptoms as signs of inaccessible memories of trauma and began to use hypnosis and other methods to unlock and detoxify the supposed dissociated memories that were silently poisoning the mental health of victims. The movement to help survivors recall these allegedly repressed memories resulted in the worst catastrophe to befall the mental health field since the lobotomy era. Therapy designed to recovered alleged repressed memories of trauma was based on misunderstandings of how memory works. The 2 articles in this issue were written to help counteract these misunderstandings. The first covers a multitude of errors that continue to plague the literature on trauma (6). Clinical theorists endorsing the concept of traumatic dissociative amnesia often misunderstand the very studies they cite in support of this alleged phenomenon. They often misinterpret diverse memory impairments as if they indicated an inability to remember the trauma itself. The second article reviews evidence that people can come to believe they experienced emotionally intense events that never happened (7). It refutes the claims that people can only develop false memories of trivial events devoid of emotional significance and that memories of trauma are invariably accurate. This article is cowritten by Elizabeth F Loftus, one of the great figures in the history of psychology-a recent empirical study ranked her 58th in a list of the 99 most eminent psychologists of the 20th century (8). Like a tsunami that has yet to strike shore, the impact of the most serious controversy in traumatology has yet to be felt. It concerns the validity of self-reported trauma exposure in American war veterans receiving service-connected disability payments for PTSD. Burkett and Whitley's award-winning book Stolen Valor: How the Vietnam Generation Was Robbed of its Heroes and its History (9) alerted the field to the possibility that many individuals diagnosed with PTSD may never have been exposed to trauma in the first place. Mainstream traumatologists, however, have either ignored Stolen Valor or privately maligned the authors ' motives without substantively rebutting Burkett and Whitley's critique of the field. …