Before Sigmund Freud founded psychoanalysis, he was a neurologist whose growing interest in psychiatry led him to study hysteria. “Hysteria” was a catch-all term for a number of symptoms, both physical and mental, believed to only affect women; the term itself derives from the Greek word for uterus. Women who were diagnosed with hysteria tended to faint, have trouble breathing, developed physical maladies with no organic cause, lost all interest in food or sex, were nervous, and were generally considered to be troublemakers. Hysteria had been an object of fascination since ancient Greece, and of the variety of treatments proposed to treat it, most failed to help.
Hypnosis was the treatment of choice in Freud’s day, but he soon deviated from that trend to develop his own method. Freud was one of the first practitioners to actually listen to patients with hysteria, and as he developed his “talking cure,” he was struck by the pervasiveness of childhood sexual trauma in his patients’ histories. In The Aetiology of Hysteria (1896), he proposed that “at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience.” This was an explosive assertion, and Freud soon began to backpedal. If his patients were to be believed, rape, molestation, and incest were not uncommon occurrences but instead happened at a depressing frequency. Freud found this to be unbelievable, so he slowly began to shift these reports of premature sexual experience to the realm of fantasy, giving birth to the Oedipus and Electra complexes and so forth.
The history of the psychological treatment of trauma is strewn with such false starts and missteps. When soldiers in World War I began to exhibit unfamiliar psychological symptoms, doctors initially believed they resulted from the concussive impact of exploding shells, hence “shell shock.” When this theory was disproven, those afflicted were seen as “moral invalids” not capable of handling the rigors of warfare. When the same phenomenon was observed in World War II, the military developed procedures to rapidly stabilize impacted soldiers and returned them to the front as quickly as possible. According to one report, 80 percent of American soldiers experiencing acute stress were returned to the front lines within a week, 30 percent of those to active combat units. It wasn’t until Vietnam that things began to change, and that was only because the Vietnam War went on for so long that veterans were able to return and talk about the horrors they had witnessed while the conflict was still ongoing, causing a public reckoning. At the same time, feminists were bringing to light the pervasiveness of sexual violence and reframing rape as a crime of power rather than of misdirected passion. It was these parallel efforts that actually spurred the creation of the diagnosis of post-traumatic stress disorder, which was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders in 1980.
These stories help illustrate the depth of a problem most people understand through their own lived experience: Trauma is uncomfortable to confront. Indeed, for most of human history we’ve done all we could to avoid it. Unfortunately, even after these misfires, mental health professionals like myself still haven’t quite corrected the problem. My graduate program in social work, for example, offered one class on the treatment of trauma, capped to only a handful of students. The DSM-V diagnosis of post-traumatic stress disorder remains flawed: The symptoms of PTSD better match an individual who experienced one traumatic incident rather than someone who has endured multiple traumatic events, and the number of criteria required to merit the diagnosis far exceeds that of most other mental disorders.
From time to time, events arise that force us to reconsider this legacy. The revelations of Harvey Weinstein’s years of unchecked predatory behavior is one of those times. Indeed, it has opened the floodgates to reveal a myriad of other such stories. It’s common to observe a snowball effect in the disclosure of trauma. The multiple disclosures made by Weinstein’s victims coupled with the fact that their accusations brought about some form of justice enabled others to come forward, and as the #MeToo phenomenon has demonstrated, this is not limited to celebrities.
It is in the face of such suffering that we are often most tempted to look away. Of course, this sort of intentional ignorance is precisely what enables predators to continue their abuse. As Judith Herman notes in Trauma and Recovery, “It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing.” Most of us can agree that we do not want to do this. We know that the prevalence rate of false reports of sexual assault is low. It’s actually extremely low, at about 2 percent. It’s far more common for sexual violence to simply go undisclosed; only about a third of all rapes are reported, and of those, only 2 percent result in a conviction.
So what should we do? It is easy to feel overwhelmed by the number of stories. Given the unfortunate prevalence of sexual trauma, most of us know several survivors. I suggest that we start by simply choosing to believe all survivors. As someone who works with trauma survivors daily, I cannot count the number of patients who were retraumatized when someone near them disbelieved their disclosure. Those who have not yet shared their private pain may very well be looking for an ally, and they will be watching how we speak about survivors of sexual assault to determine whether or not it is safe to open up.
If someone chooses to open up, just listen. If they get overwhelmed, take a break. It is human to want to try to make it better, whether that’s by trying to problem-solve the situation or relativize their pain (“well, at least he didn’t …”). Avoid these urges at all costs. It is enough to be present and to offer the occasional “I’m so sorry that happened to you.” Thank them for sharing their story with you. Suggest that they find a therapist, and if they are nervous or unsure, offer to accompany them to their first appointment.
Freud abandoned his initial findings regarding trauma because they were simply too much for him to bear. In later years, trauma survivors would be made to bear the blame of what happened to them, if their claims were believed at all. Society has made some progress since those times, but the temptation to look away remains. The Harvey Weinsteins and Louis C.K.s of the world depend upon us doing just that. We can do better—indeed, we know we must do better. The easiest place to start is by listening.