Traumatic

Traumatic (pronounced traw-mat-ik (U), truh-mat-ik or trou-mat-ik (both non-U))

(1) In clinical medicine, of, relating to, or produced by a trauma or injury (listed by some dictionaries as dated but still in general use).

(2) In medicine, adapted to the cure of wounds; vulnerary (archaic).

(3) A psychologically painful or disturbing reaction to an event.

1650–1660: From the French traumatique, from the Late Latin traumaticum from traumaticus, from the Ancient Greek τραυματικός (traumatikós) (of or pertaining to wounds, the construct being traumat- (the stem of τραῦμα (traûma) (wound, damage) + -ikos (-ic) (the suffix used to forms adjectives from nouns).  Now familiar in the diagnoses post traumatic stress disorder (PTSD) & post traumatic stress syndrome (PTSS), it was first used in a psychological sense in 1889.  Traumatic is an adjective & noun and traumatically is an adverb; the noun plural is traumatics.

PTSD, PTSS and the DSM

Exposure to trauma has been a part experience which long pre-dates the evolution of humans and has thus always been part of the human condition, the archeological record, literature of many traditions and the medical record all replete with examples, Shakespeare's Henry IV often cited by the profession as one who would fulfill the diagnostic criteria of post traumatic stress disorder (PTSD).  Long understood and discussed under a variety of labels (famously as shell-shock during World War I (1914-1918)), it was in 1980 the American Psychiatric Association (APA) added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III).  The entry was expected but wasn’t at the time without controversy but it’s now part of the diagnostic orthodoxy (though perhaps over-used and even something of a fashionable term among the general population) and the consensus seems to be that PTSD filled a gap in psychiatric theory and practice.  In a sense that acceptance has been revolutionary in that the most significant innovation in 1980 was the criterion the causative agent (the traumatic event) lay outside the individual rather than there being an inherent individual weakness (a traumatic neurosis).

However, in the DSM-III, the bar was set higher than today’s understanding and a traumatic event was conceptualized as something catastrophic which was beyond the usual range of human experience and thus able to be extremely stressful.  The original diagnostic criteria envisaged events such as war, torture, rape, natural disasters explosions, airplane crashes, and automobile accidents as being able to induce PTSD whereas reactions to the habitual vicissitudes of life (relationship breakdowns, rejection, illness, financial losses et) were mere "ordinary stressors" and would be characterized as adjustment disorders.  The inference to draw from the DSM-III clearly was most individuals have the ability to cope with “ordinary stress” and their capacities would be overcome only when confronted by an extraordinarily traumatic stressor.  The DSM-III diagnostic criteria were revised in DSM-III-R (1987), DSM-IV (1994), and DSM-IV-TR (2000), at least partly in response to the emerging evidence that condition is relatively common even in stable societies while in post-conflict regions it needed to be regarded as endemic.  The DSM-IV Diagnostic criteria included a history of exposure to a traumatic event and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms; also added were the DSM’s usual definitional parameters which stipulated (1) the duration of symptoms and (2) that the symptoms must cause significant distress or functional impairment.

#freckles: Freckles can be a traumatic experience.

The changes in the DSM-5 (2013) reflected the wealth of research and case studies published since 1980, correcting the earlier impression that PTSD could be thought a fear-based anxiety disorder and PTSD ceased to be categorized as an anxiety disorder, instead listed in the new category of Trauma- and Stressor-Related Disorders, the critical definitional point of which is that the onset of every disorder has been preceded by exposure to a traumatic or otherwise adverse environmental event.  It required (1) exposure to a catastrophic event involving actual or threatened death or injury or (2) a threat to the physical integrity of one’s self or others (including sexual violence) or (3) some indirect exposure including learning about the violent or accidental death or perpetration of sexual violence to a loved one (reflecting the understanding in the laws of personal injury tort and concepts such as nervous shock).  Something more remote such as the depiction of events in imagery or description was not considered a traumatic event although the repeated, indirect exposure (typically by first responders to disasters) to gruesome and horrific sight can be considered traumatic.  Another clinically significant change in the DSM-5 was that symptoms must have their onset (or a noticeable exacerbation) associated with the traumatic event.  Sub-types were also created.  No longer an anxiety disorder but now reclassified as a trauma and stressor-related disorder, established was the (1) dissociative sub-type which included individuals who meet the PTSD criteria but also exhibit either depersonalization or derealization (respectively alterations in the perception of one's self and the world) and (2) the pre-school subtype (children of six years and younger) which has fewer symptoms and a less demanding form of interviewing along with lower symptom thresholds to meet full PTSD criteria.

When the revised DSM-5-TR was released early in 2022, despite earlier speculation, the condition referred to as complex posttraumatic stress disorder (CPTSD) wasn’t included as a separate item, the explanation essentially that the existing diagnostic criteria and treatment regimes for PSTD were still appropriate in almost all cases treated by some as CPTSD, the implication presumably that this remains an instance of a spectrum condition.  That didn’t please all clinicians and even before DSM-5-TR was released papers had been published which focused especially on instances of CPTSD be associated with events of childhood (children often having no control over the adverse conditions and experiences of their lives) and there was also the observation that PTSD is still conceptualized as a fear-based disorder, whereas CPTSD is conceptualized as a broader clinical disorder that characterizes the impact of trauma on emotion regulation, identity and interpersonal domains.

Still, the DSM is never a static document and the committee has much to consider.  There is now the notion of post-traumatic stress syndrome (PTSS) which occurs within the thirty-day technical threshold the DSM establishes for PTSD, clinicians noting PTSS often goes unrecognized until a diagnosis of PTSD is made.  There is also the notion of generational trauma said to afflicting children exposed repeatedly to the gloomy future under climate change and inter-generational trauma Screening tools such as the PTSS-14 have proven reliable in identifying people with PTSS who are at risk of developing PTSD. Through early recognition, providers may be able to intervene, thus alleviating or reducing the effects of a traumatic experience.  Long discussed also has been the effect on mental health induced by a disconnection from nature but there was no name for the malaise until Professor Glenn Albrecht (b 1953; one-time Professor of Sustainability at Murdoch University (Western Australia) and now honorary fellow in the School of Geosciences of the University of Sydney) coined psychoterratic, part of his lexicon which includes ecoagnosy (environmental ignorance or indifference to ecology and solastalgia (the psychic pain of climate change and missing a home transforming before one’s eyes).  The committee may find its agenda growing.

Saved by a “traumatic” transmission

In the 1960s, “the ocean was wide and Detroit far away” from Melbourne which is why Holden was authorized to design and built its own V8 rather than follow the more obviously logical approach of manufacturing a version of Chevrolet’s fully-developed small-block V8.  The argument was the Chevrolet unit wouldn’t fit under the hood of Holden's new (HK) range which was sort of true in that there wasn’t room for both engine and all ancillaries like air-conditioning, power brakes and power steering although it would have been easier and cheaper to redesign the ancillaries rather than embark on a whole new engine programme but this was the 1960s and General Motors (GM) was in a position to be indulgent.  As it was, Holden’s V8 wasn’t ready in time for the release of the HK in 1968 so the company was anyway forced in the interim to use 307 cubic inch (5.0 litre) and 327 (5.3) Chevrolet V8s, buyers able to enjoy things like power steering or disk brakes but not both.

The "Tasman Bridge" 1974 Holden Monaro GTS (308 V8 Tri-matic).  The HQ coupés were Holden's finest design. 

Also under development was a new three-speed automatic transmission to replace the legendarily robust but outdated two-speed Powerglide.  It was based on a unit designed by GM’s European operation in Strasbourg and known usually as the Turbo-Hydramatic 180 (TH180; later re-named 3L30-C & 3L30-E) although, despite the name, it lacked the Powerglide-like robustness which made the earlier (1964) Turbo-Hydramatic 400 (TH400) famous.  Holden called its version the Tri-matic and, like the early versions of the TH180 used in Europe, there were reliability problems although in Australia things were worse because the six and eight cylinder engines used there subjected the components to higher torque loadings than were typical in Europe.  Before long, the Tri-matic picked up the nickname “trau-matic” and in the darkest days it wasn’t unknown for cars to receive more than one replacement transmission and some even availed themselves of their dealer’s offer to retrofit the faithful Powerglide.  The Tri-matics’s problems were eventually resolved and it became a reliable unit, even behind the 308 cubic inch (5.0 litre) Holden V8 (although no attempt was ever made to mate it with the 350 cubic inch (5.7 litre) Chevrolet V8 Holden offered as an option until 1974).

Whatever its troubled history, the “trau-matic” did on one occasion prove a lifesaver.  In the early evening of 5 January 1975, the bulk carrier Lake Illawarra, while heading up Hobart's Derwent River, collided with the pylons of the Tasman Bridge which caused a 420 foot (128 m) section of the roadway to collapse onto the ship and into the river, killing twelve (seven of the ship's crew and five occupants of the four cars which tumbled 130 feet (40 m) into the water.  Two cars were left dangling precariously at the end of the severed structure and it emerged later that the 1974 Holden Monaro was saved from the edge only because it was fitted with a Tri-natic gearbox.  Because the casing sat lower than that used by the manual gearbox, it dug into to road surface, the effect enough to halt progress.

The tragedy had a strange political coda the next day when, at a press conference in The Hague in the Netherlands, the Australian prime-minister (Gough Whitlam, 1911-2014; Australian prime-minister 1972-1975) was asked about the event and instead of responding with an expression of sympathy he answered:

I sent a cable to Mr Reece, the Premier of Tasmania, I suppose twelve hours ago and I received a message of thanks from him.  Now you have the text I think.  I expect there will be an inquiry into how such a ludicrous happening took place.  It's beyond my imagination how any competent person could steer a ship into the pylons of a bridge.  But I have to restrain myself because I would expect the person responsible for such an act would find himself before a criminal jury. There is no possibility of a government guarding against mad or incompetent captains of ships or pilots of aircraft.

Mr Whitlam’s government had at the time been suffering in the polls, the economy was slowing and ten days earlier Cyclone Tracy had devastated the city of Darwin.  The matter didn’t go to trial but a court of marine inquiry found the captain had not handled the ship in a proper and seamanlike manner, ordering his certificate be suspended for six months.

Aftermath:  Hobart clinical psychologist Sabina Lane has for decades treated patients still traumatized by the bridge’s collapse in 1975.  Their condition is gephyrophobia (pronounced jeff-i-ro-fo-bia) which describes those with an intense fear of driving over a bridge (which in the most severe cases can manifest at the mere thought or anticipation of it), sometimes inducing panic attacks.   Ms Lane said she had in the last quarter century treated some seven patients who suffered from gephyrophobia trigged by the trauma associated with the tragedy, their symptoms ranging from “...someone who gets anxious about it all the way to someone who would turn into complete hysterics."  Some, she added, were unable “…even to look at a photo of the Tasman Bridge.”  She noted the collapse remains “still quite clear in everybody's mind, and that's perhaps heightened by the fact that we stop traffic when we have a large boat passing beneath it."  Her treatment regime attempts to break the fear into manageable steps, having patients sketch the bridge or study photographs before approaching the structure and finally driving over it.