The DSM-III Revolution
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 titled The Traumatic Neuroses of War was 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 the posttraumatic disorders (e.g., Herman 1992: 23–26, 28), and it is a source of the symptom list for post-traumatic stress disorder in the current psychiatric nosology.
Abram Kardiner had been briefly psychoanalyzed by Freud in the early 1920s. Once back in the United States, he worked as a psychiatrist in a Veterans Hospital from 1922 to 1925. (Like W.H.R. Rivers, Kardiner was attracted to anthropology; he played an important part in the “culture and personality” school that flourished in American cultural anthropology from the 1930s to the 1950s.) Kardiner's starting point in The Traumatic Neuroses of War is Freud's argument that traumatic events coincide with breaches in the barrier that protects the brain against external stimuli. Freud described the symptom formation that follows these events as defensive; it functions to preserve the ego. (See the discussion of Freud in chapter 2.) Kardiner, on the other hand, claimed that the symptomatic reaction is a form of adaptation. It is an effort to eliminate or control painful and anxiety-inducing changes that have been produced by the trauma in the organism's external and internal environments. The kind of adaptation that occurs in a particular case will depend on the individual's psychological resources and his relations to his primary social group (Kardiner 1941:141). This is called an “environmental” or “reactive” view of psychiatric problems, and it was widely accepted in American psychiatry (and anthropology) during this period.
In Kardiner's account, traumatic events create levels of excitation that the organism is incapable of mastering, and a severe blow is dealt to the