Early Foundations (Janet and Freud): The origins of psychotraumatology trace back to the late 19th and early 20th centuries. French psychologist Pierre Janet was among the first to describe how overwhelming experiences can cause dissociation – a splitting of conscious awareness – and to outline a phased treatment approach for trauma survivors^15. Around the same time, Sigmund Freud acknowledged traumatic memories in his early work on hysteria, though he later shifted focus away from actual trauma to internal fantasies. Janet’s observations of “fixed subconscious ideas” forming after trauma presaged our modern understanding that traumatic experiences can leave indelible unconscious imprints on the mind and body. However, much of this early work was largely forgotten during the mid-20th-century dominance of psychoanalysis, which tended to attribute symptoms to intrapsychic conflicts rather than real events.
Trauma and War (Shell Shock to PTSD): It was chiefly the world wars that reawakened interest in trauma. In World War I, soldiers suffered “shell shock,” exhibiting tremors, flashbacks, and paralysis with no physical cause. Though often met with misunderstanding or labeled cowardice, these cases forced recognition of traumatic neurosis. In World War II, terms like “combat fatigue” or “battle stress” described similar phenomena. Psychiatrists like Abram Kardiner in the 1940s noted that war trauma produced a “physioneurosis” – a persistent mobilization of the body’s fear response. Yet after the wars ended, attention to trauma again waned. It was only after the Vietnam War that a concerted push by veterans and clinicians led to the formal inclusion of Post-Traumatic Stress Disorder (PTSD) in the DSM-III in 1980. This legitimized psychological trauma as a clinical syndrome, incorporating symptoms like re-experiencing, avoidance, and hyperarousal. The diagnosis of PTSD was historically significant, but it centered initially on a Criterion A traumatic event (a life-threatening incident outside the range of usual experience). This event-focused definition would later be critiqued as too narrow.
Evolution of the Field (1980s–1990s): The 1980s and 1990s saw an explosion of trauma research and the birth of psychotraumatology as a distinct field. Clinicians like Judith Herman and Bessel van der Kolk built upon Janet’s insights, emphasizing that trauma survivors often oscillate between numbed detachment and intense intrusion. Herman’s influential book Trauma and Recovery (1992) traced a lineage from Janet’s 19th-century ideas to modern treatment, and she proposed a stage-wise model for trauma therapy (Safety, Remembrance and Mourning, Reconnection)^15. Herman also coined “Complex PTSD” to describe survivors of prolonged, repeated trauma (such as childhood abuse or captivity) who exhibit broader disturbances in self-regulation and identity beyond standard PTSD. Around the same time, Lenore Terr distinguished Type I trauma (single-incident trauma) from Type II trauma (chronic/repetitive trauma), observing that single events tend to produce clearer memories and classic PTSD symptoms, whereas prolonged trauma leads to denial, emotional numbing, and dissociation^4. These developments expanded the field’s understanding that not all trauma is one-size-fits-all.
Changing Concepts of Trauma: A critical conceptual shift during this period was recognizing that the event itself does not define trauma, but rather the individual’s internal response and the imprint left on the mind and body. Pioneering researchers began to argue that trauma’s essence lies in what the nervous system holds onto after an overwhelming event. As physician Gabor Maté succinctly put it, “Trauma is not what happens to you, but what happens inside you as a result of what happens to you.”^1 This marked a departure from viewing trauma simply as an external event (e.g., war, disaster) toward understanding trauma as a psychobiological process within the person. In the same vein, psychologist Peter Levine asserted, “Trauma is in the nervous system, not in the event,” emphasizing that two people can undergo the same event. Still, one might be traumatized if their body remains locked in a fight-or-flight state^2. Thus, trauma came to be seen less as an objective occurrence and more as a subjective experience of helplessness that becomes biologically encoded.
Clinicians also critiqued the simplistic dichotomy of “Big T” versus “little t” trauma. Traditionally, “Big T” referred to major catastrophes (e.g., violent assault, combat), and “little t” to more minor, more personal losses or stresses. However, by the 2000s, experts noted this distinction can be misleading – so-called more minor traumas (like emotional abuse or neglect) can have cumulative, insidious effects just as severe as a single horrific event^4. Trauma experts observed that what makes an experience traumatic is not its categorical label but the degree of threat, fear, and helplessness it evokes and the person’s inability to process it. In fact, chronic “little t” traumas (for instance, ongoing childhood emotional neglect) can erode a person’s sense of safety over time, leading to complex posttraumatic symptoms that were often overlooked when focusing only on “Big T” events^4. This evolving perspective underscored that trauma exists on a continuum, and all forms of trauma deserve attention and care, not just obvious life-threatening incidents.
Expert Warnings and New Directions: By the early 2000s, leading trauma specialists began warning that standard therapy approaches like cognitive-behavioral therapy (CBT) and exposure therapy need significant adaptation for trauma work. Dr. Bessel van der Kolk, a prominent figure in psychotraumatology, voiced concern that forcing patients to repeatedly relive their trauma (as in prolonged exposure therapy) without sufficient attention to bodily safety can backfire. “The VA seems surprised by how many veterans drop out of prolonged exposure; likely it is re-traumatizing them,” van der Kolk noted, explaining that “blasting people with the memories” may desensitize but does not necessarily lead to proper integration of the trauma^3. He emphasized that traumatic stress is rooted in the emotional brain and body areas not easily reached by talk and reasoning alone, and thus “has little to do with cognition.”^3 Likewise, Gabor Maté has advised that focusing only on symptoms or using confrontational methods can risk “re-wounding” survivors by ignoring the deeper needs underlying their trauma. These critiques spurred the development of more body-centered and compassion-focused modalities (e.g., somatic therapies, EMDR, yoga) as alternatives or complements to pure exposure techniques.
A Holistic View of Trauma: By the 2010s, the field widely recognized that trauma is a multifaceted phenomenon affecting mind, brain, and body. The consensus became that trauma is not defined by the magnitude of the event but by its psychological and neurobiological impact on the individual^4. A minor incident can be deeply traumatizing if it overwhelms one’s coping resources, especially if it occurs in childhood when the brain is developing. Conversely, even horrendous events might not leave lasting trauma in someone with adequate support and adaptive processing. This holistic view integrates the early insights of Janet (that trauma splits and overwhelms the psyche) with modern neuroscience (showing trauma changes brain circuitry) and the lived realities of survivors (for whom trauma is an enduring emotional and somatic imprint). Trauma is now understood as an experience that “lives on” in the body and subconscious until it can be processed and integrated.
Case Illustrations: For example, one combat veteran of the Iraq War might return home with classic PTSD, plagued by nightmares of an IED blast, hypervigilant to loud noises, emotionally numb with his family. His trauma was a single, life-threatening “Big T” event, and he re-experiences it vividly against his will. In contrast, a survivor of childhood abuse may not have one specific memory but rather a diffuse trauma history (“little t” events repeated) leading to chronic shame, relationship difficulties, and periodic dissociative episodes. She might not connect her adult depression and chronic pain to her childhood trauma, since the trauma was pervasive and normalized when she was young. These two cases differ, yet both individuals carry unresolved trauma that shapes their lives. Such examples call on psychotherapists to be trauma-informed – to recognize the many faces of trauma and adjust treatment accordingly.
The history of psychotraumatology teaches us that trauma has long been under-recognized, sometimes even by our own profession. Only in recent decades have we come to appreciate the true prevalence of trauma and its profound consequences. Studies show most of the population is exposed to at least one traumatic event in their lifetime, and perhaps 10–20% will develop lasting PTSD symptoms^38. Yet, many clinicians until recently received minimal training in treating trauma. The field’s evolution – from Janet’s early breakthroughs, through years of neglect, to the current rich body of knowledge – implores modern therapists to carry this legacy forward. Psychotraumatology is now a mature discipline providing crucial insights and tools. It urges psychotherapists and clinical psychologists to approach clients with a trauma-informed lens, understanding symptoms not as random pathology but often as adaptive responses to harm. In practice, this means screening for trauma history, creating safety, and tailoring therapy to gently address traumatic memories stored in the mind and body.
The bottom line is a moral and professional imperative: trauma is ubiquitous, and its survivors deserve competent, compassionate care. As van der Kolk famously said, “The single most important issue for traumatized people is to find a sense of safety in their own bodies.” Psychotherapists must rise to this challenge. By learning from the history of psychotraumatology – its early missteps and recent advances – we can avoid retraumatizing those we seek to help and instead guide them toward genuine healing. The field’s pioneers have given us a roadmap; it is now up to today’s practitioners to heed it. In the sections that follow, we delve into the neurobiology of trauma, the comprehensive body of knowledge that has emerged, the types of trauma and their treatment implications, and the phased model of trauma therapy that has become the gold standard. This framework will equip clinicians with an academic yet humane foundation to practice as effective psychotraumatologists in the modern era.