The Recent Recognition of Trauma

It is important to understand the historical context: trauma has only recently been taken seriously as a legitimate focus of mental health treatment. For much of the history of psychiatry and psychology, the effects of trauma—particularly chronic, developmental trauma—were misdiagnosed and misunderstood. As Judith Herman (2015) observes in Trauma and Recovery, “The study of psychological trauma has a curious history—one of episodic amnesia. Periods of active investigation have alternated with periods of oblivion. Repeatedly in the past century, similar lines of inquiry have been taken up and abruptly abandoned, only to be rediscovered much later” (p. 7).

Before trauma-informed approaches gained recognition, women’s responses to abuse and violence were frequently pathologized as mood disorders, personality disorders, or character flaws. Herman notes that “the psychology of women has been consistently misunderstood. Women’s complaints about battering, rape, and incest have repeatedly been dismissed as hysterical, masochistic, or delusional” (2015, p. 28). As Pete Walker (2013) explains, “Many survivors of prolonged abuse are misdiagnosed as having Borderline Personality Disorder, Narcissistic Personality Disorder, or Bipolar Disorder, when they are actually suffering from Complex PTSD” (p. 13). The symptoms of trauma—hypervigilance, emotional dysregulation, dissociation, difficulty with relationships—were treated as intrinsic personality disorders rather than adaptive responses to chronic harm.

This historical misdiagnosis created a cascade of epistemic injustice: trauma survivors seeking help were told their suffering stemmed from disordered thinking or personality defects, rather than from the legitimate effects of abuse. CBT, developed in the 1960s and rising to dominance before trauma-informed frameworks existed, inherited and perpetuated this legacy. The framework assumes that clients’ problems stem from cognitive distortions rather than adaptive responses to real harm—a assumption that systematically invalidates trauma survivors’ accurate assessments of danger, harm, and injustice.

Only recently, with the work of researchers and clinicians like Judith Herman, Bessel van der Kolk, and others, has trauma been recognized as a primary lens through which to understand much of what was previously labeled as “mental illness.” This recognition has profound implications for how therapy should be practiced—yet the dominant therapeutic modality (CBT) still operates from assumptions that predate this trauma-informed understanding.

For a full definition of epistemic injury, see Epistemic Injury. Briefly, epistemic injury occurs when an authority figure erodes an individual’s confidence in their cognitive faculties—especially their ability to interpret sensory, emotional, or social cues. In the clinical context, epistemic injury emerges when a therapist, under the guise of ‘challenging distortions,’ delegitimizes a client’s lived perception.

References

Herman, J. L. (2015). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.

Walker, P. (2013). Complex PTSD: From surviving to thriving. Azure Coyote.