منابع مقاله با موضوع trauma، an، not، symptoms

within an information-processing model in which, the person is initially assailed by the intrusive and emotionally disturbing memories of the trauma and tends to use avoidant strategies to ward off these distressing thoughts, images and feelings. Horowitz considered reactions to consist of alternating phases of intrusion and avoidance or ‘denial’ and that these symptom categories constituted the architecture of post-traumatic stress reactions. His model was adopted as the framework for the new concept of PTSD in the American Psychiatric Association’s third edition of the Diagnostic and Statistical Manuel of Mental Disorders(Joseph, Williams, and Yule, 7)
In his autobiographical essay in Mapping Trauma, Horowitz considers his contributions as theoretical, methodological, and empirical. His research findings looked back to improve theory. Part of the experience in defining PTSD involved the sequel of the Vietnam War. He explains about his experience as follows” While consulting at a VA hospital, I found that the staff usually did not know if a patient they discussed had been in Vietnam. Because the war was widely regarded as a terrible mistake, the veterans concealed their combat history. Also, the military doctors of the time believed, too hopefully, that the early treatment, optimistic return to duty, and rotations off combat duty would prevent the stress reaction seem so frequently in prior wars. Another VA consultant and I reported our prediction of delayed stress response syndromes after we sought out and found enduring post combat intrusive and avoidance symptoms. We projected rates of clinical-level stress response syndrome in combat veterans of more than one-quarter of returning military men and women. There was enormous resistance to our findings and predictions. Publications were delayed, for example. Nonetheless, studies of Vietnam veterans were finally conducted, with pressure from the U.S Congress, and our predictions proved correct (Mapping Trauma, 87-88).
2.5.3 Judith Herman (1942- )
Judith Herman calls the study of psychological trauma an episodic amnesia in which periods of active investigation have alternated with periods of oblivion. This is not the result of the ordinary changes in fashion that affect any intellectual pursuit, rather because to study in this field is to come face to face both with human vulnerability in the natural world and the capacity for evil in human nature. It is bearing witness to horrible events in which the bystander is forced to take sides in a conflict between victim and perpetrator. The victim asks the bystander to share the burden of pain; he demands action, engagement and remembering. On the contrary, all the perpetrator asks is do nothing, to see, to hear and speak no evil. He does everything to escape the accountability for his crimes, to promote forgetting.
The study of psychological trauma must constantly contend with this tendency to discredit the victims or to render them invisible. However it is not only the patients but also the investigators of post-traumatic conditions whose credibility are challenged. Investigators who follow the field too far beyond the bound of conventional belief are often subjected to isolation. Therefore the systematic study of psychological trauma depends on the support of a political movement powerful enough to legitimate an alliance between investigators and patients and to counteract the ordinary social processes of silencing and denial. The study of war or sexual trauma for example becomes legitimate only in a context that challenges the sacrifice of young men in war, or the subordination of women and children.
According to Herman over the past century, trauma emerged into public consciousness in three different periods, each time the investigation of it has flourished in affiliation with a political movement. The first was in the late nineteenth century in France when the study of hysteria grew out of the republican, anticlerical political movements. The second was after the First World War and specifically after the Vietnam War in England and the United States that the study on shell shock or combat neurosis emerged. Its political context was the collapse of cult of war and the growth of an antiwar movement. The last which surfaced into public consciousness in recent years, was sexual and domestic violence in a political context of feminist movement in Western Europe and North America. The synthesis of these three separate lines of investigation builds our contemporary understanding of psychological trauma (Herman, 7-9). Hyperarousal, Intrusion and Constriction: Symptoms of Trauma
According to Judith Herman the three main symptoms of post-traumatic stress disorder are categorized as “hyperarousal,’’ “intrusion,” and “constriction.” Hyperarousal is the persistent expectation of danger; intrusion is the indelible imprint of the traumatic moment and constriction is the numbing response of surrender.
In the first cardinal symptom of post-traumatic stress disorder, hyperarousal, the human system of self-preservation seems to go onto permanent alert after the experience; the person startles easily, reacts irritably and sleeps poorly. Studies have now shown that the psychological changes of this disorder are both extensive and enduring. Instead of a baseline level of alert, patients have an elevated baseline of arousal in which their bodies are always on the alert for danger. They have an extreme startle response to unexpected stimuli or one associated with the traumatic event as if they cat not tune out repetitive stimuli that other people find annoying; instead they response to it as though it were a new and dangerous surprise. This increase in arousal results in sleep disturbances since they persist during sleep. Therefore it takes longer for such people to fall asleep; they are more sensitive to noise and are awaken more frequently during the night.
Traumatized people relive the event long after it is past; they cannot resume the normal course of their lives since the trauma repeatedly interrupts as though time has stopped at the time of the incident. It has encoded in an abnormal form of memory which breaks into consciousness as flashbacks in waking states and as nightmares during sleep with all the vividness and emotional force of the original event. These memories are not encoded like the ordinary memories in a verbal linear narrative, they lack verbal narrative and context and are encoded in the form of sensations and images which gives the memory a heightened reality. Traumatized people relieve the moment of trauma not only in their thoughts and dreams but in their actions; they also re-create the moment of terror, reenact it with a fantasy of changing the outcome.
The third cardinal symptom of post-traumatic stress disorder is constriction or numbing in which the system of self-defense shuts down entirely. The person is completely powerless and any form of resistance is futile; the result is an escape not by action in the real world but by altering the state of consciousness. Analogous states are observed in animals, which sometimes freeze when they are attacked since situations of inescapable danger may evoke not only terror and rage, but also paradoxically, a state of detached calm in which terror, rage and pain resolve. These states are similar to hypnotic trance states, but while people usually enter hypnotic states under controlled circumstances and by choice, these states occur in an uncontrolled manner, without conscious choice. Therefore traumatized people may attempt to produce similar numbing effects by using alcohol or narcotics; something which appeared among soldiers in an attempt to remove their sense of helplessness and terror. This may be adaptive at the moment total helplessness, but becomes maladaptive once the danger is past; since these states keep the experience walled off from ordinary consciousness and prevents the integration for healing (Herman, 35-46) The Dialectic of Trauma
The d
lectic of trauma is self- perpetuating which is the result of two contradictory responses of intrusion and constriction. This opposing psychological state is perhaps the most characteristic feature of the post-traumatic syndromes since neither of these symptoms allow for integration of the traumatic event and the alternation between them might be understood as an attempt to find a satisfactory balance between the two, something that a traumatizes person lacks. He finds himself caught between the extremes of amnesia or of relieving the event, between floods of intense overwhelming feeling and arid states of no feeling at all. The instability produced by these periodic alternations intensifies the person’s sense of unpredictability and helplessness and the dialectic self-perpetuating.
In the course of time this dialectic goes under a gradual evolution. Initially the victim remains in a highly agitated state, alert for new threats, as the intrusive reliving of the traumatic event predominates. These symptoms emerge most prominently in the first few days or weeks following the event, in some cases they persist over a longer period, for example four to six years, then attenuate slowly over time. While these symptoms seem to fade over time, they can be revived by reminders of the original trauma years after the incident such as the nightmares and other intrusive symptoms suddenly recurred in a Second World War combat veteran after a delay of thirty years.
Numbing or constrictive symptoms come to predominate as intrusive symptoms diminish. The person may resume the outward forms of life, but the severing of events from their ordinary meanings persists as if the person is observing the events of daily life from a great distance. The sense of numbing and disconnection is temporarily broken by reliving of the moment of horror. Virginia Woolf depicts this moment of alienation and inner deadness of a traumatized person in her portrait of Septimus, a shell-shocked veteran. “He looked at people outside; happy they seemed, collecting in the middle of the street, shouting, laughing, and squabbling over nothing. But he could not taste, he could not feel” (qtd. in Herman, 49).
The force upon the traumatized person’s inner life and outer range of activity are negative symptoms that their significance lies in what is missing, they are not recognized and their origins in a traumatic event are often lost. With the passage of time as these negative symptoms become the most prominent feature of the disorder, the diagnosis becomes easy to overlook. Since these symptoms are so persistent and so wide-ranging, they may be mistaken for enduring characteristics of the victim’s personality; therefore the person with unrecognized disorder is condemned to a diminished life, tormented by memory and bounded by helplessness and fear. Many of them feel that a part of them has died; most wish that they were dead. The estimate of actual suicide following severe trauma is riddled with controversy. However some studies show that most of the men who were persistently suicidal had heavy combat exposure who suffered from unresolved guilt about their wartime experiences. Thus the threat of annihilation that defined the traumatic moment may pursue the survivor long after the danger has passed (47-50). Stages of Recovery: Safety, Remembrance and Mourning, Reconnection
The concept of recovery stages has emerged repeatedly from Janet’s classic work on hysteria to recent descriptions of work with combat trauma, dissociative disorders, and multiple personality disorders. The traumatic syndromes are complex disorders, and as they affect every aspect of human functioning, from biological to the social, they require complex and comprehensive treatment. In the course of a successful recovery, it should be possible to recognize a gradual shift from unpredictable

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