PTSD: A new trauma paradigm

Post-traumatic stress disorder, immediately punctuated into the pithy acronym PTSD, emerged in 1980 with its inclusion as a new diagnostic category in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-III). Rarely has a disorder felt so definitively coined in a particular place and time, although this apparent definitiveness covers over a much more complicated history and present of trauma and its vicissitudes. The new diagnostic category has had a profound impact not just in psychiatry but also in culture at large, with the result that PTSD is a multiple and complex object that is enacted in a variety of discourses, practices, and institutional spaces. Although PTSD first emerged as a diagnostic category and as part of a classification system within the clinical context of the institution and discourses of American psychiatry, historicizing the category reveals continuities and discontinuities between PTSD and other historical trauma paradigms. The prehistory of PTSD provides a genealogical framework for analyzing the contemporary deployment of the term in clinical, critical, political, and cultural domains. As well as being a historically defined category, however, PTSD is also an illness performative that brings into being new subjectivities and sites of diagnosis and treatment, clinical and otherwise. Illness narratives can be read as symptomatic texts of our time in at least two respects: as texts that literally describe symptoms (and struggle with finding a form to describe the affective and physical experience of symptoms), and as texts that describe illness as an event that goes beyond any particular individual’s experience and account of it, reflecting wider cultural categories, including race, gender, class, and sexuality. Any treatments of PTSD, therefore, will extend transversally to include not only clinical methods for healing the devastating biopsychosocial effects of trauma but also critical methods for analyzing PTSD as symptom and sign of a changing politics of trauma in the present. It is also necessary to consider PTSD’s representability, not to give the question of representation the last word, but rather as a gesture meant to keep open the question of how we treat trauma.