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The Harmony of Illusions

The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder

Allan Young
Copyright Date: 1995
Pages: 328
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  • Book Info
    The Harmony of Illusions
    Book Description:

    As far back as we know, there have been individuals incapacitated by memories that have filled them with sadness and remorse, fright and horror, or a sense of irreparable loss. Only recently, however, have people tormented with such recollections been diagnosed as suffering from "post-traumatic stress disorder." Here Allan Young traces this malady, particularly as it is suffered by Vietnam veterans, to its beginnings in the emergence of ideas about the unconscious mind and to earlier manifestations of traumatic memory like shell shock or traumatic hysteria. In Young's view, PTSD is not a timeless or universal phenomenon newly discovered. Rather, it is a "harmony of illusions," a cultural product gradually put together by the practices, technologies, and narratives with which it is diagnosed, studied, and treated and by the various interests, institutions, and moral arguments mobilizing these efforts.

    This book is part history and part ethnography, and it includes a detailed account of everyday life in the treatment of Vietnam veterans with PTSD. To illustrate his points, Young presents a number of fascinating transcripts of the group therapy and diagnostic sessions that he observed firsthand over a period of two years. Through his comments and the transcripts themselves, the reader becomes familiar with the individual hospital personnel and clients and their struggle to make sense of life after a tragic war. One observes that everyone on the unit is heavily invested in the PTSD diagnosis: boundaries between therapist and patient are as unclear as were the distinctions between victim and victimizer in the jungles of Southeast Asia.

    eISBN: 978-1-4008-2193-8
    Subjects: Psychology, General Science

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-2)
  4. Introduction
    (pp. 3-10)

    As far back as we know, people have been tormented by memories that filled them with feelings of sadness and remorse, the sense of irreparable loss, and sensations of fright and horror. During the nineteenth century, a new kind of painful memory emerged. It was unlike the memories of earlier times in that it originated in a previously unidentified psychological state, called “traumatic,” and was linked to previously unknown kinds of forgetting, called “repression” and “dissociation.”

    The new memory is best known today in connection with a psychiatric malady, post-traumatic stress disorder (PTSD). PTSD was adopted by the American Psychiatric...


    • One Making Traumatic Memory
      (pp. 13-42)

      A century ago, a new kind of memory was born, at the intersection of two streams of scientific inquiry: somatic and psychological. The somatic stream dates from the 1860s and the discovery of a previously unidentified kind of assault, called “nervous shock.” The psychological stream begins earlier, in the 1790s, and leads to the discovery of a previously unidentified kind of forgetting, called “repression” and “dissociation.” By the 1890s, nervous shock and repression/dissociation have been conjoined to producethe traumatic memory, the subject of the present study.

      This chapter is divided into three parts. The first provides a history of...

    • Two World War I
      (pp. 43-86)

      The “Rivers” who is mentioned in this passage is W.H.R. Rivers, a temporary captain in the Royal Army Medical Corps (RAMC) serving as a psychiatrist at the Craiglockhart Military Hospital, near Edinburgh. Over the preceding two decades, Rivers had established an international reputation as an ethnographer and a pioneer researcher on nerve regeneration. It is Rivers the anthropologist who is best remembered today—Rivers the member of the Cambridge Expedition to the Torres Straits (1898), the originator of the “genealogical method” of investigating kin relations and terminologies (1900), and the author of a classic ethnography of South Asia,The Todas...


    • Three The DSM-III Revolution
      (pp. 89-117)

      A flurry of publications on traumatic neuroses followed the armistice in 1918. Over the next two decades, however, these disorders attracted little attention, until in 1941, just prior to American entry into the Second World War, a monograph titledThe Traumatic Neuroses of Warwas published under the auspices of the National Research Council, a private American foundation (Kardiner 1941; Kardiner and Siegel 1947). This book, by Abram Kardiner, is the first systematic account of the symptomatology and psychodynamics of the war neuroses published in the United States. It is now routinely cited as a landmark in the history of...

    • Four The Architecture of Traumatic Time
      (pp. 118-142)

      Post-traumatic stress disorder is part of amonotheticsystem of classification. Within this system, each classification (disorder) is identified with a list of criterial features that are individually necessary and collectively sufficient for including or excluding a case from the classification. A case that overlaps the boundaries between classifications is handled in two ways. Either the patient is given concurrent diagnoses—the case is diagnosed as belonging to both categories XandY—or the patient is said to have a “mixed disorder,” which includes features of two different disorders, such as schizo-affective disorder.

      DSM-IIIincluded one entry, schizotypal personality...


    • Five The Technology of Diagnosis
      (pp. 145-175)

      This chapter describes a series of diagnostic sessions conducted during 1986 and 1987 at a Veterans Administration psychiatric facility, the National Center for the Treatment of Post-Traumatic Stress Disorder (a pseudonym), specializing in the diagnosis and treatment of war-related PTSD. The center’s origins and operations are described in some detail in chapter 6.

      The veterans who come to be diagnosed at the center are drawn from two main sources. Approximately two-thirds of the men are referred from other VA psychiatric units, usually alcohol and drug abuse inpatient units, acute psychiatry inpatient units, and mental hygiene outpatient units. About a third...

    • Six Everyday Life in a Psychiatric Unit
      (pp. 176-223)

      PTSD is treated with both pharmacotherapy and psychotherapy. The most commonly prescribed medicines are antidepressants and minor and major tranquilizers, and they are used mainly against conditions that co-occur with PTSD: depression, generalized anxiety, and alcohol and chemical substance abuse (Silver 1990:36; Solomon et al. 1992:634). Although pharmacotherapy is less often used for symptoms specific to PTSD, several drugs have been found to have a modulating effect on intrusive phenomena, such as nightmares and dream recollections, and symptoms of autonomic nervous system arousal, such as irritability, aggressive outbursts, exaggerated startle response, and hypervigilance. Sedatives are also given to patients who...

    • Seven Talking about PTSD
      (pp. 224-263)

      In Alfred Hitchcock’s film,Spellbound(1944), Gregory Peck plays the victim of a traumatic neurosis similar to PTSD. He is tormented by a memory he cannot recall but is certain that it concerns an act of terrible violence. He also suffers from a mysterious phobic horror of objects decorated with parallel lines. By the film’s end, it is discovered that the phobia mirrors a visual element of his traumatic experience, which involved attempted homicide and accidental death on a downhill ski slope. Like many of the patients who speak on the following pages, the Gregory Peck character is chronically angry...

    • Eight The Biology of Traumatic Memory
      (pp. 264-286)

      The birth of PTSD followed a historical transformation in psychiatric knowledge making. Out of these changes emerged an invigorated psychiatric science that identified progress with the accumulation of facts by means of testable hypotheses: “Hypotheses prove themselves superior … by surviving strenuous attempts at disconfirmation. Science advances by the replacement of falsified theories by yet to be falsified ones” (Wallace 1988:140). Psychiatric writers associate “testability” with Karl Popper’s epistemology of falsificationism (Faust and Miner 1986). There are important differences between Popperian falsificationism and knowledge making in psychiatric science, though, and I will use the term “fallibilism” when I refer to...

  8. Conclusion
    (pp. 287-290)

    In 1994, the American Psychiatric Association published a fourth edition of its official nosology. The new manual,DSM-IV, perpetuates the Kraepelinian framework established byDSM-III. Disorders are generally represented as monothetic categories, each one bounded by a distinctive list of criterial features. The manual’s most obvious departure from the previous editions is rhetorical and concerns the definition of its eponymic subject, “mental disorders.” InDSM-IIIandDSM-III-R, the term is defined in a way that includes all of the factions and orientations that were then represented in the American Psychiatric Association:

    [E]ach of the mental disorders is conceptualized as a...

  9. Notes
    (pp. 291-298)
  10. Works Cited
    (pp. 299-320)
  11. Index
    (pp. 321-327)