PTSD, Traumatic Memory and the Lessons of History

Allan Young
Departments of Social Studies of Medicine and Psychiatry
McGill University

1. PSYCHIATRY, CULTURE AND HISTORY

Culture and psychiatry: DSM-IV, Appendix I
Culture of psychiatry: taken-for-granted knowledge
PTSD and the indispensable traumatic memory
Why history counts

2. VARIETIES OF PSEUDO-HISTORY

Misdiagnosing the Past
A Manichaean History of PTSD
Example: Judith Herman in Trauma and Recovery
Science is a Self-Correcting Process
The epistemic cultures of medical science

3. LESSONS FROM HISTORY

Post-combat Symptom Clusters
Boer War to the Gulf War
Cluster 1: debility syndrome without psychological or cognitive symptoms
Cluster 2: somatic syndrome focused on the heart
Cluster 3: neuropsychiatric syndrome
Symptoms remain constant over time; change = how they are reported and interpreted.
Memory is not a consistent feature or focus of Cluster 3.
Vulnerability
The epidemiological puzzle
Diathesis versus character/personality: e.g., traumatic hysteria vs. traumatic neurasthenia (WHR Rivers)
"Traumatic Memory" and "Traumatic Time"
Traumatic time: event - memory - syndrome
Varieties of memory: iconic, attributed, belated, factitious, fictitious
Malleability and multiplicity
The Consequences of Diagnosis
Inter-war debates in Great Britain and Germany: cutting the Gordian knot

4. DSM-III AND FREUD'S TRAUMATIC NEUROSIS

PTSD Falls into the Psychoneurosis Cluster
The distinctiveness of PTSD: A and B criteria
Freud's Traumatic Neurosis
A + B + polymorphous adaptation to anxiety
DSM-III'S Kraepelinian Mission
Purging American psychiatry of its neurosis; the history of an exception

5. FORWARD INTO THE PAST: 1995-2002

Remembering and Forgetting the Varieties of Traumatic Memory
Ref. Southwick et al. 1997
Rediscovering Vulnerability
From normality to abnormality
Diathesis: from Charcot to hypocorticolism, the diminished hippocampus, SNS reactivity
Neuroticism

6. HOW TO IGNORE HISTORY

The "looping effect" in the clinic
The "prototype effect"
The moral and clinical consequences of skepticism
Neuroticism as a "risk factor"

7. HAS BIOLOGICAL PSYCHIATRY OUTFLANKED THE MEMORY PROBLEM?