Even Freud’s original formulation of trauma had been troubled by a crucial indeterminacy: Did trauma come from something that occurred outside the individual’s psyche (say, an explosion or a railway accident) or inside it (a neurotic complex triggered by an external event)? Trauma, in other words, seemed to beg the central question: Does trauma happen when stress tips over some acute threshold, or are people traumatized because of some underlying vulnerability that makes trauma out of what, for someone else, might just be stress? Is trauma even a useful concept, scientifically?
Ultimately, the strength of the grassroots campaign for PTSD, coupled with the undeniable symptoms psychiatrists were seeing in veterans, forced the skeptics to cave. PTSD became an official diagnosis in the DSM-III. The central indeterminacy about what trauma actually is, however, continued unresolved.
In the ’80s and ’90s,” van der Kolk told me, repeating a line he’s fond of, “Boston was for trauma studies what Vienna was for music.” He had married Elisabeth “Betta” de Boer, a Dutch au pair who would become a social worker. Their first child, Hana, was born, then Nick. Every day, van der Kolk would bike from their brownstone in the South End to work at Massachusetts General, one of Harvard’s teaching hospitals. By the mid-1980s, a small but powerful coalition of psychiatric researchers was taking shape to steer what PTSD would mean. In Cambridge, Massachusetts, van der Kolk was the ringleader of this network. For more than ten years, the Harvard Trauma Study Group met every month, forming the first stronghold of what its enemies would later call “the traumatologists.”
In 1984, van der Kolk published his first trauma paper; it contained the seed from which all his future work would develop. In it, he argued that the nightmares veterans were having weren’t like normal nightmares: They came earlier in the sleep cycle and “were repetitive dreams that were usually exact replicas of actual combat events.” That is, unlike normal dreams, which fuse memories, wishes, and anxieties, PTSD nightmares are a literal replay of the traumatic event itself. At a biological level, van der Kolk would soon argue, this implied that trauma is physically seared into the nervous system, more like a scar than a story. This was a big claim. If it was true, it meant trauma could act as a kind of objective proof that something had happened. A person can lie, but the body cannot.
