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Abstract
The concept of complex trauma has been around for a long time and in 2018, it’s expected to become a new diagnosis in the International Classification of Diseases eleventh revision, ICD-11, the World Health Organisation, WHO, manual used formally in the NHS. Psychiatric diagnosis often does not sit well with psychoanalysis, which is at least as interested in unconscious phantasy as it is in symptoms. But as psychodynamically-trained practitioners in the NHS we need to engage with ICD-11 and apply our own understanding to service design so that patients have access to treatment which works for them. The service where I work (a secondary mental health team in the London borough of Lewisham) has already been receiving referrals for ‘complex trauma’ for some time, despite its not being formally classified. Patients so described are most often those with a history of childhood sexual abuse, and refugees with a history of brutality and torture. Differential diagnosis includes personality disorder since many have difficulties with interpersonal issues. In this paper I want to discuss how we might understand the new diagnosis of complex Post-traumatic Stress Disorder, PTSD, and its implications for treatment in the NHS.
Highlights
Freud and complex PTSD In her seminal study of PTSD in 1992, Trauma and Recovery, Judith Herman begins by exploring how psychoanalysis grew out of the study of complex trauma
In this paper I will argue that the new diagnosis of complex PTSD offers a window of opportunity for psychodynamic practitioners to build on these theoretical origins, by incorporating later theoretical developments in the psychodynamic field around attachment theory
I want to return to the critical writers cited above (Bracken, 2001; S ummerfield, 2001) who are concerned about the way in which psychological distress has been medicalised through the PTSD diagnosis, partly because important social and political dimensions of suffering may be ignored in individual treatment by clinical experts
Summary
Freud and complex PTSD In her seminal study of PTSD in 1992, Trauma and Recovery, Judith Herman begins by exploring how psychoanalysis grew out of the study of complex trauma. Patients experiencing these symptoms may not be helped by exposure-based therapies This leads me directly to the clinical problem which a new diagnosis of complex trauma was intended to address: that many clinicians such as Van der Kolk (2000) or Lab, who worked at the Traumatic Stress Clinic at the Maudsley Hospital in London, have found that treatments for which there is a statistical evidence base are not always successful in the ‘real world’ I want to return to the critical writers cited above (Bracken, 2001; S ummerfield, 2001) who are concerned about the way in which psychological distress has been medicalised through the PTSD diagnosis, partly because important social and political dimensions of suffering may be ignored in individual treatment by clinical experts Another negative consequence of the ‘medicalisation of distress’ may be a greater burden on the NHS, and increasingly complex presentations have been noted by some of the clinicians who bear this burden. These are the factors which led us to consider the role of groups and the possibilities of peer support in promoting recovery
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