Bernard Hart (1879–1966) and his influence on British psychiatry

Bernard Hart was among the most eminent 20th-century British psychiatrists. Following medical qualification at University College Hospital, London, he trained in psychiatry, which included two years studying in Paris and Zurich. He was appointed as the first psychiatric consultant at University College Hospital, then spent some time in Liverpool, where he specialized in treating war neurosis. Early in his career, Hart was one of the first to introduce the ideas of Freud and Janet, and the importance of unconscious processes, to the British public. After the First World War, Hart returned to University College Hospital, where he remained until 1947, building up a flourishing department. Hart was appointed to numerous senior offices and directed the psychiatric section of the British Emergency Medical Services in the Second World War. Hart is believed to be the last psychiatrist to certify someone (John Amery) as being of sufficiently sound mind to die for treason.

Thalassa, "Confusion of the tongues", "The unwelcome child and his death-instinct": Sándor Ferenczi's unfolding model of trauma

In this article, I trace the evolution and unfolding meanings and use of Ferenczi's model of trauma as it appears in his work on sexual abuse, on war trauma, and on early neglect. Some are works of quite long gestation and some written and published in the context of immediate circumstances, for instance, his paper on war neurosis. Ferenczi's work is seen as an influence on the psychoanalytic study of somatic states, on early gaps in psychic structure and in early and adult trauma.

Post-traumatic Stress

The concept of trauma has been a central feature of psychiatry and psychology ever since a century ago, when a Viennese neurologist concluded that many of his young female patients with hysteria had experienced childhood sexual abuse. The concept of trauma soon was extended to adults, mainly soldiers. “Hysteria,” “shell shock,” “war neurosis”—it all became mutated in DSM-III’s radical revision of 1980 into “post-traumatic stress disorder” (PTSD). In this chapter, the diagnosis and treatment of post-traumatic stress are explored. DSM-based diagnoses are viewed as broad, and overly oriented toward comorbidity. Instead, PTSD-like symptoms occur as part of the typical stressors that trigger mood or psychotic states. True PTSD can occur with severe trauma, as in childhood sexual abuse or war trauma. Symptomatic treatment is seen to be questionable in benefit over risk, both for antipsychotics and for SRIs.

PTSD and the War of Words

Trauma-related symptoms among veterans of military engagement have been documented at least since the time of the ancient Greeks.1 Since the third edition of the Diagnostic and Statistical Manual in 1980, this condition has been known as posttraumatic stress disorder, but the name has changed repeatedly over the past century, including shell shock, war neurosis, and soldier’s heart. Using over 14 million articles in the digital archives of the New York Times, Associated Press, and Reuters, we quantify historical changes in trauma-related terminology over the past century. These data suggest that posttraumatic stress disorder has historically peaked in public awareness after the end of US military engagements, but denoted by a different name each time—a phenomenon that could impede clinical and scientific progress.