International Handbook of Clinical Hypnosis - E-Lib FK UWKS

HYPNOSIS, DISSOCIATION AND TRAUMA 145
usually remained emotional cripples much of their life because the premise was
they had been so neurologically damaged that there was no repairing them. This
turned out to be a mistake. So in World War II the term was changed to traumatic
neurosis, and the idea there was to treat people `within the sound of the guns'
Kardiner & Spiegel, 1947). This was a much better idea because it acknowledged
the reality of intense reaction but did not presume that you had to consolidate it by
pulling the soldiers away from their combat duties. Most were able to respond,
which was a major advance. However, with the development of the psychoanalytic
model there was more emphasis placed on early childhood development and less of
the effect of proximate trauma. Indeed much has been made of Freud's abandonment
of the trauma theory in the etiology of neuroses and the subsequent development
of a metapsychology which emphasized the role of unconscious fears and
wishes in developing symptoms rather than traumatic experiences. It came to be
believed that the reason people got PTSD was because of developmental dif®culties.
This point of view can be seen as a denial of the reality of trauma. Indeed the
idea that traumatic experience is less important than developmental history in the
etiology of PTSD is problematic because it ®ts into a common fantasy that we
control and therefore deserve whatever happens to us, thereby creating inappropriate
guilt for events over which we have no control. Such thinking allows one to
distance oneself from being in the category of potential victim. But this denies the
existential reality that we are all in the category of potential victim.
However, the psychoanalytic domination of traumatology was ended in 1944
when Eric Lindemann wrote his classic paper on the symptomatology and management
of acute grief Lindemann, 1944[94]). He described the now-familiar symptoms
of PTSD in his study of the aftermath of the Coconut Grove Night Club ®re,
in which hundreds of people were killed or badly wounded. He saw people who
were agitated, restless, pacing, experiencing a sense of unreality, somatic discomfort,
and intrusive recollections of the ®re. He classi®ed them into three groups:
a) people who had extreme symptoms: hyperactive, restless, unable to sleep, some
became psychotic; b) people who were acutely agitated and went through a very
dif®cult period of adjustment but then recovered; c) those who acted as through
nothing had happened. An example of this last group is a man whose wife had been
killed and the next day he went to work and said `well she would want me to go on
with things and I should just go on'. Lindemann found that people at either extreme
did the worst. The ones who were the most severely agitated did very badly. But the
ones on the other end of the symptom continuum, who pretended nothing had
happened, also did very badly. A number had committed suicide within several
years. Lindemann then describes how the principles of grief work as a means of
working through and beyond trauma, which means mourning what was lost. He
noted that it was necessary to decathect a loved one who had died before it was
possible to recathect to someone new. Grief work may also involve the loss of a
sense of personal invulnerability, or the loss of somatic function due to injury. This
conceptualization makes it understandable why some people who appear to be