International Trauma Studies Program

Patricia Cohen
New York Times
Saturday, 8 May 1999
Arts & Ideas/Cultural Desk

As Soeren Buus Jensen got ready to give a seminar at New York University on treating the shaken Kosovars arriving at Fort Dix, he recalled the chaos of the Bosnian refugee camps where he worked four years ago.

Mr. Jensen, the chairman of psychiatry at Copenhagen University Hospital and the World Health Organization's former coordinator for mental health, had been frustrated by how difficult it as to help terrorized survivors cope with their trauma.

''I came to New York to learn how it was done here,'' he said, ''but that turned upside down.'' There was no program in the city. So he and Jack Saul, a clinical psychologist, decided to create one. Last year they inaugurated the International Trauma Studies Program at New York University. Mr. Saul says it is designed for professionals and is one of the first in the United States to combine academic research on trauma with mental health programs developed in wartime.

From the cycle of violence in the Balkans to the string of teen-age killing sprees at high schools, trauma has become nearly as commonplace as the weather on the evening news. It has rippled through boardrooms and bedrooms, emergency rooms and courtrooms across the United States. Nearly everywhere, it seems, except the university classroom.

Although many skeptics question whether the effects of trauma are genuine, some specialists in the field complain that American universities have been slow to contribute to the recent flood of advances in the study and treatment of trauma.

Traditionally the domain of psychology, trauma has more recently grabbed the attention of nurses, social workers, neurobiologists, public health workers, medical researchers and others. Yet universities, the specialists say, have often failed to knit together these disciplines and create comprehensive study and research programs.

That may be changing. The experience of clinicians who work with sexually abused children, disaster survivors, refugees and the like has begun to make colleges rethink their approach. At the same time advances in neurobiology are showing that trauma can affect the body much more than had been thought. Brain imaging and medical research have shown that trauma leaves scars on the brain and central nervous system and that it can alter the immune system, cripple learning and shorten life span. The findings may transform the way trauma is taught, understood and treated. ''Academe is being overtaken by what is happening in the real world,'' says Charles Figley, director of the Traumatology Institute at Florida State University. ''Now there is a critical mass of scholarly and professional work in trauma studies, and a critical mass of students who demand this. That's exactly how new fields start.''

This month Florida State is reviewing a proposal to become the first school in the country to offer a graduate degree in trauma studies. Mr. Figley said, ''It's almost like the university is finally coming around.''

Other colleges are experimenting as well. The University of South Dakota now offers a degree in disaster psychology. The program, approved four months ago by the state's Board of Regents, is aimed at psychology students who want to specialize in research and in responding to catastrophes like hurricanes and earthquakes. The University of Illinois at Chicago has just established a fellowship in refugee mental health for psychiatry residents. It also sponsors monthly trauma studies workshop for professionals, scholars and survivors to talk about the latest developments, and Yale has as well.

''This field is exploding; it's taken off,'' said Judith Herman, a clinical professor of psychiatry at Harvard Medical School.

Trauma is not a new idea. Writers as far back as Homer wrote of it. But the recognition of trauma as a specific disorder appropriate for scientific scrutiny is barely 100 years old.

As Ms. Herman explains in her classic book, ''Trauma and Recovery,'' the understanding of trauma has been shaped as much by social attitudes and politics as by medical research. Without a political movement to support the scientific investigation, trauma research sank out of sight.

The 19th-century French neurologist Jean-Martin Charcot was the first to study hysteria, rescuing it from the domain of demons and witches and claiming it for science. Sigmund Freud, Josef Breuer and Pierre Janet, who all attended Charcot's famous Barnum-and-Baileyesque lectures, built on the idea that hysteria was the result of traumatic experiences. These breakthroughs were followed by one of the frequent episodes of historical amnesia on the subject, and it disappeared until World War I resuscitated it. Traumatic reactions were considered a sign of deep character flaws. Shell-shocked soldiers were often described as ''moral invalids'' and threatened with court-martial. The British psychiatrist Lewis Yealland tried to shame and punish traumatized soldiers back to health. Hour after hour he applied electric shocks to the vocal cords of those who had lost their ability to speak. As the antiwar movement in Britain grew, so did a more compassionate approach based on psychoanalytic principles.

Breakthroughs in trauma research often come from outside the classroom. Bosnian refugees reaching safety in Muslim-controlled city in 1994

Similarly, Vietnam veterans who joined the antiwar movement argued that comrades who were haunted by nightmares and flashbacks, rage and panic were not weak-willed cowards but suffered from the severe aftershocks of combat. Bessel A. van der Kolk, who runs one of the country's largest trauma clinics, in Brookline, Mass., remembers treating veterans after the war. Even in 1978, he said, ''there was not a single book in the Boston Veterans Administration library on war neurosis.''

It was only a political alliance between Vietnam veterans and feminists (who brought the trauma of rape victims and battered wives into the open) that eventually compelled the scientific establishment to take notice. In 1980 post-traumatic stress disorder was included in the official manual of mental disorders published by the American Psychiatric Association.

Trauma isn't simply a more extreme version of everyday stress. You can't just snap out it. Exposure to terrifying events can overwhelm and break down the body's natural system of self-defense. Traumatic memories continually bulldoze their way into the present. Research shows these may be stored in a different part of the brain than regular memories, says Mr. van der Kolk, who is also a psychiatry professor at Boston University.

Trauma leaves its mark on the brain in other ways as well, he adds. Researchers examining Vietnam veterans who had severe symptoms found that the hippocampus, a part of the brain associated with memory, had significantly shrunk in size. Another study found that women with histories of chronic sexual abuse had more immunological disorders than other women. Most recently a large study in California found that people who were exposed to traumatic events as children were much more likely to develop lung disease, obesity, diabetes, heart disease, cancer and drug and alcohol addictions. Yet even now, Mr. van der Kolk says, major institutions ''have resisted looking at how reality shapes biology.''

Trauma's sprawling character has made it difficult for universities to swallow. ''It doesn't fit into existing structure,'' said Mr. Figley, a Vietnam veteran whose antiwar activities got him interested in the field. ''That's why universities have been slow to move into this.''

With the field less than 20 years old, many questions about trauma remain unanswered. How does it affect the ability to learn? How does it cripple a child's development? Does trauma cause other mental disorders? Physical diseases? Is psychoanalysis an outdated approach for dealing with mass trauma?

Both university professors and clinicians believe no single discipline has the answers. ''Psychoanalysis was never intended to be all things,'' explained Stevan M. Weine, an associate professor of psychiatry at the University of Illinois who has worked with Bosnian refugees. One thing it certainly was never to be was a public health effort to address the social suffering of genocide survivors. Mental health work with survivors was influenced far less by psychoanalysis and more by the social psychiatry and the community mental health movement.''

As with women's studies and black studies programs in their early stages, intellectual breakthroughs have often come from outside the classroom. For instance, clinicians working with severely abused children developed techniques to deal with traumatic memories. In Bosnia, Ms. Herman said, it became clear that ''the SWAT team approach, the 'let's everybody get in a circle to talk about their rape,' is not the way to go.''

Counselors have to use the community and existing social networks, she said. It was crucial that the Muslim clergy stood with the women who were raped and said they should not be shamed or shunned.

It may take years before comprehensive trauma programs are woven into the academic mainstream, said Mr. Saul, who also teaches in the psychiatry department of New York University School of Medicine. Still, Ms. Herman contends that there has been a lot of cross-fertilization between fieldwork and university research. It's just that ''sometimes academics don't understand how deeply dependent they are on the grass-roots activists and how indebted the whole field is to them.''

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