Treating Trauma: History of trauma CLASSIFICATION and current debate on the definition of trauma

Treating Trauma is a four-part series exploring how Kelli and I approach trauma treatment through different therapeutic lenses. Perhaps most interesting are the similarities in how these theories address the issue. Whether you are curious about starting trauma work or are simply interested in clinical theory, understanding how different models frame PTSD can be invaluable to how you treat yourself and others who may be struggling.

Series Highlights:

    •    Theoretical foundations of Trauma Therapy

    •    History and Current debate of “Trauma”

    •    Practical applications of Trauma therapy

    •    Grounding theory and the therapeutic relationship

History of trauma classification and current debate on the definition of trauma

"Trauma" isn't a new human experience, but its classification certainly is. For decades, we lacked a unified language for the soul-crushing aftermath of horror and its ongoing effects of the self.

The Evolution of the Label

Before 1980, the medical community viewed trauma through a fractured lens. In the American Civil War, it was "Da Costa’s Syndrome" or "Soldier’s Heart." During WWI, it was "Shell Shock"—initially thought to be physical brain damage caused by the percussion of exploding shells. By WWII, we called it "Battle Fatigue."

The common thread? These were seen as acute, temporary failures of willpower or short-term physical exhaustion. If you didn't "get over it," you were often viewed as having a pre-existing character flaw.

1980: The Turning Point

The sea change occurred in 1980 with the publication of the DSM-III. For the first time, PTSD was formally recognized as a distinct diagnosis. This wasn't just a win for semantics; it was a political and social revolution led largely by Vietnam War veterans and feminist advocates focusing on "Battered Woman Syndrome" and sexual assault.

By codifying PTSD, the psychological community finally admitted that an external event could fundamentally rewire a healthy brain. The "disorder" wasn't the person or their char; it was the lingering footprint of the event.

The 1980s & 90s: The Urgent Need for Treatment

Once we had the diagnosis, we faced a terrifying realization: we had no idea how to treat it effectively. The 1980s and 90s became a "Gold Rush" for clinical innovation because of three primary pressures:

The Vietnam Legacy: Hundreds of thousands of veterans were struggling with homelessness, substance abuse, and suicide. The "talk therapy" of the era—which often focused on childhood dynamics—was failing men who were reliving ambushes in their dreams.

The Recognition of "Civilian Trauma":Clinicians realized that the symptoms of a soldier were identical to those of a domestic violence survivor or a victim of a natural disaster. The scale of the need was massive.

The Biological Revolution: In the 90s, the "Decade of the Brain," neuroimaging showed that trauma physically altered the amygdala and hippocampus. We realized that since trauma was "stored" in the body and the nervous system, we needed more than just conversation

Current debate on the concept and definition of trauma.

The debate isn't just about symptoms; it’s an ontological struggle over whether trauma is an event, a biological injury, or a subjective interpretation of meaning.

1. The Shift: From Event to Wound

Etymologically, "trauma" means "wound." Historically, the field viewed trauma as an external, objective event—a "catastrophic stressor" outside the range of usual human experience. However, critics argue this event-based definition is flawed.

Philosophically, we now lean toward a response-based definition. If two people experience the same car accident and only one develops lasting psychological fragmentation, the "trauma" is not the accident itself, but the internal rupture of the self’s ability to integrate that experience. This moves trauma from the realm of physics into the realm of phenomenology.

2. PTSD vs. C-PTSD: The Structure of Suffering

The distinction between Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD) represents a major evolution in how we categorize human distress.

PTSD (The "Fear-Based" Model): Defined largely by the DSM-5, PTSD focuses on a single "Criterion A" event (e.g., a natural disaster or assault). The symptoms are primarily about threat-processing: flashbacks, hypervigilance, and avoidance. It treats the mind as a system that has been "shocked" by a moment in time.

Complex PTSD (The "Relational" Model):Formally recognized by the ICD-11, C-PTSD arises from prolonged, repeated exposure to trauma, often where escape is impossible (e.g., childhood neglect, domestic captivity).

The philosophical difference here is profound. While PTSD is about fearing the past, C-PTSD is about a dissolution of the self. C-PTSD adds "Disturbances in Self-Organization" (DSO) to the standard symptoms:

Emotional Dysregulation: An inability to soothe oneself.

Negative Self-Concept: Deep-seated beliefs of being "broken" or "worthless."

Relational Impairment: A fundamental inability to feel safe with others.

3. The Current Debates: Over-Pathologization?

You have probably witnessed the description of something as traumatic to be used for just about anything. The term is used to describe everything from systemic oppression to a difficult breakup. Here the expanding of the definition is heralded by some, and met with concern by others.

The Expansionist View: Proponents argue that broadening the definition validates the lived experience of marginalized groups whose suffering doesn't fit the "war zone" archetype of traditional PTSD.

The Essentialist View: Critics, such as philosopher Ian Hacking, worry about "looping effects." By labeling every negative experience as "trauma," we may inadvertently change how people perceive their own resilience, potentially "creating" kinds of people who view themselves as permanently damaged rather than temporarily distressed.

The tension becomes on one hand if everything is trauma, nothing is trauma. And on the other hand, if trauma is based on one’s experience that is an individuals response to a negative or painful experience. It is by definition subjective.

This is why therapy speak makes the most sense in therapy. Because the answer is always, “it depends.”

Summary

I ultimately believe that trauma is both a narrative crisis and a biological fact. When a traumatic event happens, it’s often too much to process. Whether that event was primarily social-emotional (even spiritual) or had a clear definable physical event.(to briefly digress, even the social emotional or spiritual event had a physical reality to it your brain and body experienced something in a particular way add a particular time in a particular space even if you can’t fully recall the details). I sometimes describe a traumatic event as getting a Truckload of emotional bricks dumped on top of you. Your brain is not able to lift and move all the weight. Good trauma therapy helps you take small chunks of the debris at a time and learn to lift with good form, so that you can become strong enough to move and re-organize the chaos you were exposed to into a meaningful narrative, that no longer fears the past.

If you’re interested in talking more about trauma treatment, please reach out below to schedule a consultation today!