Traumatic shock and electroshock: the difficult relationship between anatomic pathology and psychiatry in the early 20th century.

In the conviction that a look at the past can contribute to a better understanding of the present in the field of science too, we discuss here two aspects of the relationship between early 20th century anatomic pathology and psychiatry that have received very little attention, in Italy at least. There was much debate between these two disciplines throughout the 19th century, which began to lose momentum in the early years of the 20th, with the arrival on the scene of schizophrenia (a disease histologically sine materia) in all its epidemiological relevance.The First World War also contributed to the separation between psychiatry and pathology, which unfolded in the fruitless attempts to identify a histopathological justification for the psychological trauma known as shell shock. This condition was defined at the time as a "strange disorder" with very spectacular symptoms (memory loss, trembling, hallucinations, blindness with no apparent organic cause, dysesthesias, myoclonus, bizarre postures, hemiplegia, and more), that may have found neuropathological grounds only some hundred years later.Among the doctors with a passed involvement in the conflict, Ugo Cerletti, the inventor of electroshock treatment, focused on the problem of schizophrenia without abandoning his efforts to identify its organic factors: if inducing a controlled electric shock, just like an experimentally-induced epileptic seizure, seems to allay the psychotic symptoms and heal the patient, then what happens inside the brain? In seeking histological proof of the clinical effects of electroconvulsive therapy ("the destruction of the pathological synapses"), and attempting to isolate molecules (that he called acroagonins) he believed to be synthesized by neurons exposed to strong electric stimulation, Cerletti extended a hand towards anatomic pathology, and took the first steps towards a neurochemical perspective. However his dedication to finding a microscopic explanation for schizophrenia - in the name of a "somatist" approach that, some years earlier, the psychiatrist Enrico Morselli had labelled "histomania" - was unable to prevent psychiatry from moving further and further away from anatomic pathology.

Modalidades de respuesta frente a lo traumático: aportes de la segunda tópica freudiana / Method of response to traumatic: contributions of the second freudian topic

El siguiente artículo se inscribe en el Proyecto de Investigación UBACyT: “La clínica de la segunda tópica freudiana” Programación científica 2011-2014. Dentro del marco de dicha Investigación, este artículo indaga los distintos modos de respuesta frente a lo traumático teorizados por Freud. Para ello recorreremos las diversas conceptualizaciones freudianas de lo traumático, y fundamentalmente, destacaremos las modalidades de respuesta frente a lo traumático que están por fuera de la operatoria de la represión. Es decir, aquellas respuestas subjetivas que el aparato psíquico presenta en los momentos denominados tempranos, previos lógicamente al Edipo. Precisaremos los diferentes articuladores conceptuales y referentes clínicos que nos permitan ilustrar estas nociones. En primer lugar, situaremos los desarrollos freudianos respecto de la represión, el síntoma y el valor de las fantasías, y luego nos dedicaremos a ubicar los distintos modos de defensa que exceden la operación de la represión: los diques pulsionales, los dos destinos de pulsión previos a la represión, la compulsión de repetición y la angustia como contrainvestidura...

Development and psychometric properties of the resistance to trauma test (TRAUMA) / Desarrollo y propiedades psicométricas del Test de Resistencia al trauma (TRauma)

BACKGROUND: The Resistance to trauma Test: TRauma is an instrument designed to assess six dimensions involving personal strengths or resources that promote coping with difficult life situations. In addition, an overall score is obtained that is conceptually equivalent to the concept of resilience. The aim of this study was to analyze the psychometric properties and factorial structure of the TRauma in a sample of subjects affected by a traumatic event. METHOD: Participants were 222 people affected by a traumatic life event (36.5% males), with ages ranging between 18 and 71 years. RESULTS: Confirmatory factor analysis supports the theoretical internal structure proposed for the instrument. Moreover, the reliability coefficients of the six scales and the total score are both acceptable. CONCLUSIONS: Overall, the findings of this study support the use of the TRauma to measure factors of personal strengths and resilience. However, these results do not exhaust the validation process of the TRauma, and it is necessary to continue to seek empirical evidence

ANTECEDENTES: el «Test de Resistencia al trauma: TRauma» es un instrumento que pretende evaluar seis dimensiones que suponen fortalezas o recursos personales que favorecen el afrontamiento de situaciones vitales difíciles. También se obtiene una puntuación global que sería conceptualmente equivalente al concepto de resiliencia. El objetivo de este estudio es analizar las propiedades psicométricas y la estructura factorial del TRauma en una muestra de sujetos afectados por algún suceso traumático. MÉTODO: los participantes fueron 222 personas afectadas por algún suceso vital traumático (36,5% de varones), con edades comprendidas entre los 18 y los 71 años. RESULTADOS: el análisis factorial confirmatorio apoyaría la estructura interna propuesta teóricamente para el instrumento. Además, los coeficientes de fiabilidad tanto de las 6 escalas como de la puntuación total son aceptables. CONCLUSIONES: en conjunto, los hallazgos de este estudio avalan el uso del TRauma para medir factores de fortalezas personales y resiliencia. Sin embargo, estos resultados no agotan el proceso de validación del TRauma; es necesario seguir recabando evidencias empíricas

Peritraumatic distress: its relationship to posttraumatic stress and complicated grief symptoms in sudden death survivors.

Although sudden death has been linked to posttraumatic stress disorder (PTSD), its role in complicated grief (CG) and sudden death survivors is unknown. This questionnaire study investigated the role of peritraumatic distress in PTSD and CG symptoms in adults (n = 125) an average of 28.37 months (SD = 3.12) after a loved one's sudden death. The Peritraumatic Distress Inventory, Impact of Event Scale-Revised, and Inventory of Complicated Grief were administered to assess symptoms of peritraumatic distress, PTSD, and CG, respectively. Peritraumatic distress was the strongest correlate of both PTSD (ß = .42, p < .001) and CG (ß = .39, p < .001) symptoms, in a model containing current distress (Hopkins Symptom Checklist-21). Peritraumatic distress may be a key mechanism in the development of both PTSD and CG, therefore suddenly bereaved individuals reporting higher peritraumatic distress may be at risk of both adverse trauma and grief reactions.

A clínica social em situações extremas: o trauma na dimensão coletiva / Social clinic in extreme situations: the trauma in collective dimension

Este artigo tem o objetivo de descrever o traumático na clínica enquanto realidade psíquica epsicopatológica, suas dimensões subjetiva e social. A realidade psíquica de um sujeito enquanto asoma de traços deixados por suas experiências relacionais, que nos dirá sobre as consequênciaspatológicas ou não de um acontecimento potencialmente traumático: uma ruptura violenta na marchados eventos cotidianos e sociais. A compreensão psicanalítica do traumatismo lança luz sobre o fatode que ele não é constituído unicamente do choque provocado pelo agente exterior, mas tanto quantopelas possibilidades de reação da pessoa que o suporta. Esse é o fundamento do tratamentopsicoterápico do traumatismo. Estas aproximações de uma clínica em situações extremas partem dopressuposto de que não há uma natureza única do trauma nem das defesas mobilizadas em seuenfrentamento. O enfoque clínico do social nos mostra a importância da plasticidade cultural quandose participa com as equipes de intervenções locais e no desenho das estratégias a seremimplementadas. A clínica do sujeito nos revela que mesmo que o psiquismo estenda os meios deproteção e de autoproteção para se preservar dos traumas, sua reorganização tem um custo psíquicoque pode tanto favorecer quanto impedir o trabalho terapêutico (AU)

This article describes clinical treatment after traumatic situations, as being understood as psychic andpsychopathological events with subjective and social dimensions. The subject s psychic realityrepresented by the sum of the traces left by his or her relational experiences tells about theconsequences, pathological or otherwise, of a potentially traumatic event: a violent break in thecontinuity of the subject s everyday life. Psychoanalysis understands traumatism as consisting notonly by the shock caused by an outside agent but as also closely related to the individual s specificability to react. This would be the basis of the psychotherapeutic treatment of traumatism. Suchclinical approaches to extreme situations are based on the supposition that there would be a singlenature of neither the traumatic experiences nor the defenses mobilized to cope with them. The clinicalfocus of social realities shows the importance of cultural flexibility when participating in localintervention teams and designing strategies to be implemented. Clinical practice which is based on thesubject shows that even if the mental apparatus is able to expand its ability to protect itself by wardingoff traumas, the consequent reorganization has psychic costs that can either favor or block therapeuticwork (AU)

A clínica social em situações extremas: o trauma na dimensão coletiva / Social clinic in extreme situations: the trauma in collective dimension

Este artigo tem o objetivo de descrever o traumático na clínica enquanto realidade psíquica epsicopatológica, suas dimensões subjetiva e social. A realidade psíquica de um sujeito enquanto asoma de traços deixados por suas experiências relacionais, que nos dirá sobre as consequênciaspatológicas ou não de um acontecimento potencialmente traumático: uma ruptura violenta na marchados eventos cotidianos e sociais. A compreensão psicanalítica do traumatismo lança luz sobre o fatode que ele não é constituído unicamente do choque provocado pelo agente exterior, mas tanto quantopelas possibilidades de reação da pessoa que o suporta. Esse é o fundamento do tratamentopsicoterápico do traumatismo. Estas aproximações de uma clínica em situações extremas partem dopressuposto de que não há uma natureza única do trauma nem das defesas mobilizadas em seuenfrentamento. O enfoque clínico do social nos mostra a importância da plasticidade cultural quandose participa com as equipes de intervenções locais e no desenho das estratégias a seremimplementadas. A clínica do sujeito nos revela que mesmo que o psiquismo estenda os meios deproteção e de autoproteção para se preservar dos traumas, sua reorganização tem um custo psíquicoque pode tanto favorecer quanto impedir o trabalho terapêutico

This article describes clinical treatment after traumatic situations, as being understood as psychic andpsychopathological events with subjective and social dimensions. The subject s psychic realityrepresented by the sum of the traces left by his or her relational experiences tells about theconsequences, pathological or otherwise, of a potentially traumatic event: a violent break in thecontinuity of the subject s everyday life. Psychoanalysis understands traumatism as consisting notonly by the shock caused by an outside agent but as also closely related to the individual s specificability to react. This would be the basis of the psychotherapeutic treatment of traumatism. Suchclinical approaches to extreme situations are based on the supposition that there would be a singlenature of neither the traumatic experiences nor the defenses mobilized to cope with them. The clinicalfocus of social realities shows the importance of cultural flexibility when participating in localintervention teams and designing strategies to be implemented. Clinical practice which is based on thesubject shows that even if the mental apparatus is able to expand its ability to protect itself by wardingoff traumas, the consequent reorganization has psychic costs that can either favor or block therapeuticwork

Recalling war trauma of the Pacific War and the Japanese occupation in the oral history of Malaysia and Singapore.

The Pacific War and the Japanese Occupation were traumatic periods in the lives of people now over seventy years old in Malaysia and Singapore. This study traces why individuals interviewed for oral history of the Pacific War and the Japanese Occupation have often been able to tell stories of trauma without being overwhelmed by their reminiscences. It emphasizes that memories of traumatic experiences of the Pacific War and the Japanese Occupation in Malaysia and Singapore are mediated and eased by supportive social networks that are part of the interview subject's community. The individual's personal memories of traumatic war experiences are positioned in the context of the collective memory of the group and, thus, are made easier to recall. However, for individuals whose personal memories are at variance with the collective memory of the group they belong to, recalling traumatic experiences is more difficult and alienating as they do not have the support in their community. The act of recalling traumatic memories in the context of the collective memory of a group is particularly relevant in Malaysia and Singapore. These countries have a long history of being plural societies, where although the major ethnic groups -- the Malays, Chinese, and Indians -- have lived side by side peacefully, they have lived in culturally and socially separate worlds, not interacting much with the other groups. The self -- identity of many older people who lived through the Pacific War and the Japanese Occupation is inextricably bound up with their ethnicity. Oral history on war trauma strongly reflects these identities.

Traumatic Events and Tonic Immobility/

Tonic immobility is a basic defense strategy which has not been studied in depth in humans. Data suggest that it may be a relatively frequent phenomenon in victims of rape and sexual abuse, but its occurrence has not been systematically explored in other types of trauma. We carried out a retrospective study in a sample of 100 university students to establish whether tonic immobility varies depending on the nature of the worst trauma experienced, defined subjectively by each participant. Immobility was assessed using the Tonic Immobility Scale and traumas were assessed using the modified Traumatic Events Questionnaire. Seventy percent of the sample had experienced trauma of some kind. There were no significant differences in tonic immobility between different types of trauma (e.g., physical abuse, assault or aggression, serious accident), except that the mean tonic immobility score was significantly higher in the group with trauma due to physical/psychological or sexual abuse than in the group with trauma due to receiving news of the mutilation, serious injury, or violent or sudden death of a loved one. We conclude tentatively that tonic immobility may be typical not only of sexual traumas, but of other kinds of directly experienced traumas as well (AU)

La inmovilidad tónica es una estrategia defensiva básica que ha sido muy poco estudiada en seres humanos. Hay datos de que puede ser un fenómeno relativamente frecuente en víctimas de violación y abuso sexual, pero su ocurrencia no ha sido investigada de forma sistemática en otro tipo de traumas. Así pues, estudiamos retrospectivamente en una muestra de 100 estudiantes universitarios si la inmovilidad tónica varía en función del peor trauma experimentado, definido este según la valoración subjetiva de cada participante. La inmovilidad fue evaluada mediante la Escala deInmovilidad Tónica y los traumas mediante el Cuestionario de Eventos Traumáticos modificado. Un 70% de la muestra había experimentado algún trauma. No hubo diferencias significativas en inmovilidad tónica entre diferentes tipos de traumas (p.ej., maltrato, atraco o agresión, accidente grave), excepto que la media de inmovilidad tónica fue significativamente mayor en el grupo con trauma de maltrato físico/psicológico o abuso sexual que en el grupo con trauma subsecuente a noticias de mutilación, heridas graves o muerte violenta o inesperada de alguien cercano. Así pues, puede concluirse tentativamente que la inmovilidad tónica puede ser típica no sólo de traumas sexuales, sino también de otro tipo de traumas directamente experimentados (AU)

A Columbine study: giving voice, hearing meaning.

On a quiet spring morning, the 20th of April 1999, Columbine High School emerged from relative anonymity as a typical suburban high school and became internationally recognized as a symbol of school violence and tragic loss. As a parent whose child was in the school at the time of the attack, I struggled to make sense of the tragedy. I decided to conduct research into the experience as a way to learn lessons that might help others exposed to community-wide trauma in the future. Through modified oral history interviews of other Columbine parents in combination with other qualitative research strategies, I collected and studied stories of the events of that day and the years following. An unexpected by-product emerged from the study, for it seemed that I was not only learning about crisis response and trauma care but also offering a means for parents to gain comfort in reflecting on their own experience. This paper describes the distinct approach that I employed to create a gateway to understanding this experience. It does not explicate the findings of the Columbine study but instead explores the potential for positive outcomes for those who, by giving voice to their stories, can connect to a deeper appreciation for their own experience.

Oral history and Hurricane Katrina: reflections on shouts and silences.

In the immediate aftermath of Hurricane Katrina in August 2005, many oral historians throughout the nation began to consider the role their methodology could serve in documenting the storm and its aftermath. Interviewing so soon after such a traumatic event creates new considerations for oral history as an approach to recording experience. The problems and possibilities of oral history as such a moment initiated a vibrant discussion on H-Oralhist and at professional meetings in the fall of 2005. This article reflects on many of the topics raised in that dialogue, including issues of historical distance, objectivity, reflection, and emotional trauma. The piece also offers an early review of the work of the Center for Oral History and Cultural Heritage at the University of Southern Mississippi to document the impact of Hurricane Katrina in Mississippi.

Garimpando na fronteira psicanálise-literatura / Looking for precious stones on the psychoanalysis literature boundary

O trabalho toma por base alguns dos diversos enfoques que a questão dos traumas tem recebido na literatura psicanalítica, inclusive seus vínculos com a compulsão à repetição, narcisismo, perversões e transferências, além de outros. São destacados os paradoxos da traumatofilia, em função de suas origens e desdobramentos. Algumas contribuições das neurociências são acrescentadas a certas visões psicanalíticas do problema. São comentadas as dificuldades técnicas das análises destes casos e os possíveis limites da ação terapêutica, do lado do paciente e do analista. Alguns pontos são ilustrados com vinhetas clínicas.

Psicotrauma y estrés postraumático, su valoración como daño psicológico o moral dentro del proceso civil y penal / Psycho trauma and posttraumatic stress its valuation like psychological or moral damage within the civil and penal process

Nuestro objeto de estudio, abarca los Psicotraumas, sin importar su causa (accidente tránsito, riesgos laborales, delitos sexuales, ejercicio profesional, violencia doméstica, etc). Tampoco vamos a entrar a analizar las especificidades en las incidencias del stress postraumático: negatividad, ansiedad, agresividad, regresiones, conductas destructivas, disturbios del sueño, perdida de la autoestima, déficit de lenguaje, dismininución en las funciones intelectuales; sino que intentará buscar la reparación, imputándose el daño a la persona o personas que de alguna manera participarón en su producción. Junto a la resarcibilidad del daño patrimonial, se reconocerá además todos aquellos daños que afecten directamente el patrimonio (material o corporal) de una persona y a los cuales se le han llamado "daños morales" o bien "daños patrimoniales", como lo es el psicotrauma y el estrés postraumático. Palabras clave: Psicotrauma, resarcitorio, daño, material, corporal, daño moral, daño no patrimonial.

Psicotrauma en sobrevivientes de guerra en Guatemala / Psycho-trauma in survivors of war in Guatemala

Con el levantamiento militar del 13 de noviembre de 1960 se inició un conflicto armado interno entre grupos guerrilleros y las fuerzas armadas del gobierno que se desarrolló por 36 años y que finalizó con la firma de la paz el 29 de diciembre de 1996. La violencia de la guerra las políticas contrainsulgentes del Estado con sus secuelas de muerte, dolor, torturas, desapariciones forzadas, violaciones a los derechos humanos causaron graves daños a la población, principalmente de las áreas rurales. Aún es manifiesto el daño físico, psicológico y social en los sobrevivientes de esta prolongada guerra. Se realizó un estudio de tipo descriptivo para determinar la presencia de Trastorno de Estrés Post-traumático en 4 familiares de 8 víctimas fallecidas durante un ataque militar ocurrido en su comunidad a mediados de 1982, cuyos restos fueron exhumados por un equipo de trabajo de la Fundación de Antropología Forense de Guatemala. Palabras clave: Psicotrauma, guerra, conflicto armado, incursión militar, víctima, muerte, tortura, estrés agudo, trastorno de estrés postraumático.

Depresión y mala interpretación de los padres luego de una exposición traumática de la ansiedad del hijo / Depression and parental misperception of child anxiety following traumatic exposure

Este estudio examinó el rol parental ante eventos traumáticos sobre los niveles de ansiedad de sus hijos. Fueron incluidos 52 niños derivados a un tratamiento clínico debido a las dificultades por excesivo miedo o ansiedad, y uno de sus progenitores (generalmente la madre) de cada niño. La exposición parental a un evento traumático estaba asociada a un informe sobredimensionado que el progenitor hacía de la ansiedad del hijo. Además, se encontró que la depresión era un mediador parcial del informe sobredimensionado que hacía el padre de la ansiedad del hijo con posterioridad a una exposición traumática. Los hallazgos sugieren que tal vez sea necesario ser cautos al utilizar los informes de los padres que presentan depresión o que experimentaron una experiencia traumática o que padecen o padecieron ambas.(AU)

Depresión y mala interpretación de los padres luego de una exposición traumática de la ansiedad del hijo / Depression and parental misperception of child anxiety following traumatic exposure

Este estudio examinó el rol parental ante eventos traumáticos sobre los niveles de ansiedad de sus hijos. Fueron incluidos 52 niños derivados a un tratamiento clínico debido a las dificultades por excesivo miedo o ansiedad, y uno de sus progenitores (generalmente la madre) de cada niño. La exposición parental a un evento traumático estaba asociada a un informe sobredimensionado que el progenitor hacía de la ansiedad del hijo. Además, se encontró que la depresión era un mediador parcial del informe sobredimensionado que hacía el padre de la ansiedad del hijo con posterioridad a una exposición traumática. Los hallazgos sugieren que tal vez sea necesario ser cautos al utilizar los informes de los padres que presentan depresión o que experimentaron una experiencia traumática o que padecen o padecieron ambas.