Assignment: Conscious Awareness
If the person can effectively integrate the trauma into conscious awareness and organize it as a part of the past (as unpleasant as the event may be), then homeostasis returns, the problem is coped with, and the individual continues to travel life’s rocky road. If the event is not effectively integrated and is sub- merged from awareness, then the probability is high that the initiating stressor will continue to assail the person and become chronic PTSD. It may also dis- appear from conscious awareness and reemerge in a variety of symptomatic forms months or years after the event. When such crisis events are caused by the reemergence of the original unresolved stressor, they fall into the category of delayed PTSD (American Psy- chiatric Association, 2013).
PTSD is a newborn compared with the other crises we will examine, at least in regard to achieving official designation. In 1980, PTSD found its way int the third edition of the American Psychiatric Associa- tion’s (1980) Diagnostic and Statistical Manual of Mental Disorders (DSM-III) as a classifiable and valid mental disorder. However, the antecedents of what has been designated as PTSD first came to the attention of the medical establishment in the late 19th and early 20th centuries.
Two events serve as benchmarks in the history of PTSD. First, with the advent of rail transportation and subsequent train wrecks, physicians and early psychiatrists began to encounter in accident survivor’s trauma with no identifiable physical basis. Railway accident survivors of this type became so numerous that a medical term, railway spine, became an accepted diagnosis. In psychological parlance, the synonymous term compensation neurosis came into use for invalidism suffered and compensated by insurers as a result of such accidents (Trimble, 1985, pp. 7–10).
Concomitantly, Sigmund Freud formulated the concept of hysterical neurosis to describe trauma cases of young Victorian women with whom he was working. He documented symptoms of warded-off ideas, denial, repression, emotional avoidance, com- pulsive repetition of trauma-related behavior, and recurrent attacks of trauma-related emotional sen- sations (Breuer & Freud, 1895/1955). However, what Freud found and reported on the pervasive childhood sexual abuse of these women as the traumatic root of their hysteria was anathema to a puritanical Victo- rian society, and he was forced to disavow and then reject his findings (Herman, 1997, pp. 13–17).
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