Interview: Does Complex Trauma Exist? A “Long View” Based on Science and Service in the Trauma Field

Abstract

I’m very happy to share some thoughts about this topic. For a long time I have been following the professional dialogue about posttraumatic stress disorder (PTSD), psychological trauma, domestic violence, interpersonal violence, and then the emergence of a condition called complex trauma. I believe that one of the very first places that Judy Herman discussed complex trauma was in my living room in Brookline, as part of the Harvard Study Group on Trauma. That group comprised 25 to 30 people who consistently attended a monthly meeting in Boston, starting in the mid-1980s and continuing until my sabbatical year in 1993 when, for a variety of reasons, it never picked up again. This group gathered people who were doing some of the foundational work on psychological trauma. It included colleagues in Boston at many of the key academic and clinical institutions, some who were visiting Boston for one reason or another, and some whom we would invite from elsewhere in the country to talk with our group about concepts of psychological trauma. Over time the people who comprised the Harvard Study Group on Trauma and those who presented to that group emerged as some of the leading figures in the field, including some who defined key concepts related to psychological trauma. Initially, the group met at the home of Henry Murray’s1 wife (Nina). Their home was in the shadows of Harvard’s William James Hall–a particularly wonderful place to have a conversation about a disorder that was not well-accepted by mainstream psychology and psychiatry. Bessel van der Kolk also hosted the group at times in his beautiful South End row house. One evening Judy Herman spoke about her concerns about the issues of PTSD and the very different patient population she was seeing at the Victims of Violence program at Cambridge Hospital. Her take on it was that many of the people who were given diagnoses of personality disorders were really people who suffered considerable domestic violence, child physical abuse, child sexual abuse, and neglect in ongoing ways. The nature of the distinction was that these were ongoing psychological traumas–ongoing oppression, ongoing stress associated with living in abusive situations, whether it was the spouse, or the parents, or the uncle, or whomever. It was this ongoing nature of it, the sense that “there is no safety,” “no place where anything is safe,” that I think led her to think a bit differently about what conventionally was called personality disorders (borderline being one, but not the only one). She gave birth to the notion of complex trauma and it received a great deal of attention from lots of people at the time who were seeing patients with this same set of problems. I would characterize the patients being discussed as those with dysregulated emotion, cognition, and behavior. The common thread was the existence of this background of ongoing, abusive environments. Interestingly, the syndrome