The History of Trauma

The study of ‘trauma’ throughout history

“Although human beings have been experiencing trauma for thousands of years, it is only in the last ten years that it has begun to receive widespread professional and public attention.”
Peter Levine, 1997

For as long as humans have lived, humans have suffered as a result of tragedy, violence, or loss. For most of our history, the memory of this anguish could only be found in novels, art, and poetry, as there was no formal clinical language to describe or categorize such psychological and emotional suffering. The words trauma and psychological were not paired until the very late 19th century, when they started to find their way into the pages of medical books. And it would take almost another century for the term psychological trauma to make its journey into the vocabulary of the general population.

Throughout the last 150 years, the study of trauma has gone through periods of oblivion and expansion. The concept itself has branched out extensively, creating a family of related terms, theories, and treatments that map the ways painful experiences wound us.

The study of trauma is shaped by history

Periods of active investigation have alternated with periods of oblivion. Repeatedly in the past century, similar lines of inquiry have been taken up and abruptly abandoned, only to be rediscovered much later […] The fate of this field of knowledge depends upon the fate of the same political movement that has inspired and sustained it over the last century.
Judith Herman, 1992

The study of trauma is intertwined with the historic context of its time. In the Western world, the story begins in late 19th-century Europe, where scientists were trying to understand why patients manifested serious symptoms in the absence of physical injuries. These symptoms appeared after railway accidents, which had increased since the Industrial Revolution, or after returning from combat, which was becoming increasingly terrifying and destructive due to technological advancements. Meanwhile in France, a growing movement toward a secular democracy fueled scientific curiosity about hysteria, a mysterious condition whose cause and cure were unknown.

The 1880s and 1890s laid the foundations for the study of psychological trauma. Somewhere in the late 19th century, the concept of trauma went through a pivotal transformation. Long used to describe physical injuries, the term ‘trauma’ was expanded to also refer to a type of harm that had gone unnamed: the psychological and emotional impact of painful and terrifying events.

Each of the global wars in the 20th century was a turning point in the study of trauma. During World War I, mysterious post-war symptoms were observed and named shell shock. During World War II, military psychiatrists sought to destigmatize such conditions with the hope of finding a treatment so soldiers could return to war. However, it was only many years later, in the late 70s and 80s, that research on trauma reached its peak, with many of the studies being done on veterans of the Vietnam War.

For decades, trauma carried a stigma: post-traumatic symptoms were seen as signs of weakness or madness, not as psychological wounds that needed healing. It was not until 1980 that this perception shifted, when PTSD was included in the DSM-III, legitimizing the condition as a mental health reality. This pivotal recognition opened the door for other traumatic experiences to be acknowledged: child abuse, sexual abuse, domestic violence, generational trauma… Slowly, painful experiences that had gone unnamed, understudied, and untreated for years started to be recognized.

In the late 80s and early 90s, most people didn’t know what the word trauma meant, except if we were talking about veterans or rape survivors. The idea that child abuse and domestic violence are traumatic came much later. So in 1990, it was hard to convince people that clients were suffering the effects of traumatic experiences […] In those days, in the world of psychiatry and psychoanalysis, the belief was that being sexually abused by a parent was not traumatic. It was just distressing. So it was a whole revolution to try to convince the mental health field that actually, sexual and physical abuse were traumatic for children.

Dr. Janina Fisher

In the 2000s, research on trauma has only increased, creating new terms, definitions, and therapies. To understand what we mean by ‘trauma’ today, we need to trace the word itself, following it backward through history to discover why it emerged when it did and how our understanding of it has evolved over time.

Timeline of the terminology and study of trauma

Ancient Greece (5th century BCE) — La palabra trauma comes from the Greek word τραῦμα meaning ‘wound’ or ‘injury’. The term was used to refer to physical injuries, wounds, and bodily harm.
1650s-1690s — La palabra trauma is documented in English medical terminology as referring to physical wounds, injuries, or bodily harm caused by an external force.
1867 — After a series of train crashes in Great Britain, many victims reported inexplicable symptoms such as memory loss, neck and back pain, headaches, fatigue, irritability, insomnia… Doctors could not understand what caused them because there was no visible physical damage that could provide an explanation. But one surgeon, John Eric Erichsen, created a name for this mysterious disorder: railway spine. Erichsen did not associate the disorder with a psychological cause; he theorized that it resulted from a physical injury to the spinal cord, too small to be visible or measurable.
1883 — English Surgeon Herbert William Page was one of the first to bring forward the idea that railway spine had a psychological origin. He believed the overwhelming fear from the accident affected the brain and the central nervous system, creating those mysterious symptoms, which he called general nervous shock.
1862-1893 — Neurologist Jean-Martin Charcot studied hysteria at the Salpêtrière hospital, where pioneering psychologists such as Pierre Janet, William James, and Sigmund Freud made pilgrimage. Charcot argued there were psychological factors behind hysteria during a time when the medical community believed that either there was a physiological explanation for the disorder or patients were malingering their symptoms.
“Charcot focused on the symptoms of hysteria that resembled neurological damage: motor paralyses, sensory losses, convulsions, and amnesias. By 1880, he had demonstrated that these symptoms were psychological, since they could be artificially induced and relieved through the use of hypnosis.” Judith Herman, 1992
1889 — After studying the symptoms of railway and industrial accident victims, German-Jewish neurologist Hermann Oppenheim named the syndrome traumatic neurosis and attributed the symptoms to undetectable organic changes in the brain. Just like Erichsen, Oppenheim faced political backlash and was accused of enabling fraudulent disability claims. This was not the case for Charcot, who maintained popularity and whose studies on male victims of railway accidents demonstrated that hysteria was not solely a woman’s ailment.
1890s — Charcot’s students were eager to find the cause of hysteria and began talking with patients about their lives, rather than just observing symptoms.
“By the mid 1890s, Janet in France and Freud, with his collaborator Joseph Breuer, in Vienna had arrived independently at strikingly similar formulations: hysteria was a condition caused by psychological trauma” Judith Herman, 1992
1915 — During World War I (1914-1918), Charles Myers observed in soldiers symptoms that could indicate brain injuries (such as fatigue, memory loss, hyperarousal) but without any actual head wounds. He called this shell shock because he believed the reverberations from exploding artillery shells were causing invisible brain damage. Even if the suffering of soldiers was evident, the traditional idea that they should glory in war and show no sign of weakness prevailed, shaming and devaluing soldier patients as “inferior”, “coward”, or “lazy”.
“The majority of physicians remained indifferent to the psychic suffering of the shell-schoked soldier, who was widely accused of malingeneering. But a small and increasingly influential minority recognized the psychogenic nature of the war neuroses.” Ruth Leys, 2000
1940s — In World War II (1939-1945), the shell shock diagnosis was replaced by Combat Stress Reaction, also known as combat neurosis or battle fatigue. Military psychiatrists tried to decrease the stigma and find an effective treatment quickly, so soldiers could return to the battlefield.
1952 — The American Psychiatric Association (APA) included the diagnosis of Gross Stress Reaction in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I) for people who had symptoms related to traumatic events such as natural disasters or war. This disorder was omitted in the 2nd edition of the DSM in 1968.
1962 — Pediatrician C. Henry Kempe and his colleagues published The Battered-Child Syndrome, the first recognition of child physical abuse in the medical community.
1966 — The concept of intergenerational trauma was introduced in the psychiatric literature when researchers observed the high rates of psychological distress experienced by the children of Holocaust survivors.
1970s — The efforts of anti-war veterans of the Vietnam War (1955–1975) to raise awareness on the traumatic experiences of war provided impetus for psychological research.
1970s — Inspired by the feminist movement, the psychological effects of rape and domestic violence began to be studied by women.
1972-1974 — In 1972, Ann Burgess, a psychiatric nurse, and Lynda Holmstrom, a sociologist, started to study the psychological effects of rape. In 1974, they gave a name to the pattern they observed in the patients they interviewed and counseled: Rape Trauma Syndrome. Their study drew attention to the striking similarities between the experiences of soldiers returning from war and of rape survivors.
1976 — Sociologist Kai Erikson was one of the first to introduce the term collective trauma after studying the aftermath of the Buffalo Creek coalmine flood in 1972.
1980s — Social worker Maria Yellow Horse Brave Heart studied the effects of historical trauma on Native Americans.
1980 — The term Post-Traumatic Stress Disorder (PTSD) is introduced for the first time in the DSM-III. The creation of this diagnosis legitimized that traumatic experiences can lead to psychological symptoms. This shift destigmatized trauma and opened the door to developing treatments for trauma.
“Only after 1980, when the efforts of combat veterans had legitimated the concept of post-traumatic stress disorder, did it become clear that the psychological syndrome seen in survivors of rape, domestic battery, and incest was essentially the same as the syndrome seen in survivors of war.” Judith Herman, 1992
1970s-1990s — Growing research links trauma to the nervous system. In 1915, Walter Cannon coined the term fight or flight to describe a universal survival mechanism: when faced with a threat, the sympathetic nervous system mobilizes energy and prepares the body for action or escape. Years later, a third stress response was identified: freeze. Throughout the 70s and 90s, some psychologists started to explore the connection between trauma and the nervous system more deeply. Their work shed light on the role of the body in experiencing and recovering from trauma.
“Trauma was a complete mystery to me when I first began working with it. My first major breakthrough in understanding came quite unexpectedly in 1969 when I was asked to see a woman, Nancy, who was suffering from intense panic attacks. (…) In our first session, as I naively, and with the best of intentions, attempted to help her relax, she went into a full-blown anxiety attack. She appeared paralyzed and unable to breathe. Her heart was pounding wildly, and then seemed to almost stop.” Peter Levine, 1997
1991 — Psychiatrist Lenore Terr publishes a paper proposing two fundamental trauma types: Type I trauma: Single-incident, unexpected, sudden trauma (e.g., accidents, natural disasters) and Type II trauma: Prolonged or repeated trauma (e.g., psychological abuse, domestic violence).
1992 — Psychiatrist Judith Herman proposes a new diagnosis: Complex-PTSD. Herman observed that prolonged, repeated interpersonal trauma leads to more complex symptoms than single-event trauma.
“The syndrome that follows upon prolonged, repeated trauma needs its own name. I propose to call it “Complex Post-Traumatic Stress Disorder.” The responses to trauma are best understood as a spectrum of conditions rather than as a single disorder”. Judith Herman, 1992
1995 — The term Post-Traumatic Growth was coined by psychologists Tedeschi and Calhoun to describe the transformative positive outcomes after traumatic experiences.
1995-1998 — The first large study of the consequences of childhood trauma was published in 1998. The Adverse Childhood Experiences Study (ACEs) lists 10 categories of potentially traumatic events that can happen between birth and the age of 17. The study revealed a powerful “dose-response” relationship: greater exposure to multiple childhood traumas predicts higher rates of adult addiction, disease, suicide, and early death. These results legitimize the cumulative effect of trauma. The ACE study was the first one to look beyond physical abuse and include emotional and sexual abuse, as well as other potentially traumatic experiences, such as a loss of a parent, or living with a caregiver who is dealing with mental illness, addiction, or prison time.
2001 — Harris and Fallot introduced the concept of trauma-informed care (TIC), where they propose a shift from viewing social or behavioral issues as problems (“What is wrong with you?”) to seeing them as signs of potential trauma requiring supportive care (“What happened to you?”).
2013 — Pete Walker proposed a “4F framework” that includes a fourth stress response: Fawning. Walker explains how children who grew up in dysfunctional families tend to gravitate towards one stress response, creating a fixed defense mechanism that once protected them but often becomes limiting and counterproductive in adulthood.
“A fight response is triggered when a person suddenly responds aggressively to something threatening. A flight response is triggered when a person responds to a perceived threat by fleeing, or symbolically, by launching into hyperactivity. A freeze response is triggered when a person, realizing resistance is futile, gives up, numbs out into dissociation and/or collapses as if accepting the inevitability of being hurt.A fawn response is triggered when a person responds to threat by trying to be pleasing or helpful in order to appease and forestall an attacker” Pete Walker, 2013
2000s — Progress in trauma research only adds more nuance to the concept of trauma. Psychologists observed that not everyone who is exposed to a traumatic event (as described in the DSM) develops PTSD, while others develop post-traumatic symptoms from experiences that don’t count as “traumatic events” according to those same standards. This leads to a new understanding of trauma: a traumatic event is one that overwhelms the nervous system’s natural capacity to cope. This reveals an important distinction: the word trauma can be used to refer to the event (“to experience a traumatic event”) or its impact (“to have trauma”). When we use trauma to describe the psychological impact of an event, we are returning to the original meaning of the Greek word: wound.
2010s–2020s — Terms like “Big T” and “little t” become a popular way of differentiating between traumatic events that meet the clinical criteria for PTSD (Big T) and distressing events that don’t meet the clinical threshold for PTSD (small t) but still cause significant emotional distress, such as bullying, divorce, emotional neglect, or loss.
2018 — The World Health Organization officially recognizes Complex PTSD as a separate diagnosis in the International Classification of Diseases (ICD-11), advancing what Herman proposed in 1992.
2010-2020s — The study of childhood and interpersonal trauma continues. Lines of research that had started in the late 20th century are carried forward and receive more attention than ever before, such as collective and generational trauma. New areas of investigation also begin to study trauma’s intersections with health, addiction, racism, neurodiversity, queerness… This expansion of research brings the concept of trauma to all corners of mental health, and not long after, to the general public.

Recognition comes after

The study of trauma has always been propelled by the wish to bring healing to survivors of accidents, war, sexual abuse, as well as women (gender violence), children and adolescents (childhood trauma), racialized people (racial trauma), survivors of natural disasters or social tragedies (collective trauma), oppressed or persecuted groups (historic trauma) and the descendants of those who have been traumatized: their children (intergenerational trauma) and grandchildren and subsequent generations (transgenerational trauma).

If we look closely at the timeline, we see how multiple lines of trauma research received attention and recognition many years after they were initially proposed. The very concept of psychological trauma emerged in the 1880s, but the emerging field of psychiatry lost interest in it, and it was not a focus of research or therapy during the first half of the 20th century.

From the perspective of today, it seems very plausible that railway spine and shell shock were cases of PTSD. Yet, the idea that one could develop psychological symptoms even if the body bore no injuries was inconceivable during those days. The main consensus was that such symptoms could only be attributable to a root cause in the body. This was still the prevailing view during World War I, even though soldiers were manifesting post-war symptoms that could not be explained by a physical cause.

The documented evidence of the devastating consequences of war, concentration camps, and rape did not succeed in sparking widespread interest in trauma. It was only when anti-war veterans, healthcare workers, and activists made efforts to raise awareness of the post-war suffering of veterans of the Vietnam War that PTSD was officially recognised in 1980.

The pattern of delayed recognition of psychological trauma despite early evidence is a recurrent one. The consequences of child physical abuse were already documented in 1962, but research on childhood trauma didn’t receive attention until the 1990s. The impact of social tragedies on targeted groups was observed in Holocaust survivors in the 1960s and in indigenous people in the 1980s, but historic and generational trauma remained understudied topics until the 2010s.

With more awareness of a particular type of pain comes a name. And for that suffering to be understood and taken seriously, there needs to be a social context to support it. Nowadays, almost every psychologist understands that fighting in a war, being sexually abused, or being hit as a child are potentially traumatic experiences, and the scars they leave reveal not a flaw in the person, but what needs healing. But there was a time, only a few decades ago, when men were shamed for showing signs of distress after combat, hitting a child was seen as parenting, and women who went through gender or sexual violence were blamed, disbelieved, or saw their experiences minimized. We have come a long way since then, but we can still see remnants of these ways of thinking today.

Seeing how concepts that seem so evident now were once unheard-of makes me wonder if there are traumas we are blind to now. Is there something that needs a name and doesn’t have one? And which of the many terms, theories, and treatments that have emerged in the last twenty years will prevail? How will the timeline look in 2050 or in 2100? The field of trauma has never received more attention than it does now, but I’ll leave the task of writing our current history for the future. Just like doctors in the late 19th and early 20th century could not understand the entirety of what they were observing, it won’t be until several decades have passed that we will know the meaning of what we’re seeing and experiencing now.