Y’all. PTSD wasn’t even an official diagnosis in the DSM until 1980 (DSM-III). And even then, it was *controversial* in the field, because it was due to an external stressor. (Never mind that ‘refrigerator mothers’ had been blamed for psychotic symptoms for decades at that point because misogyny.)
Plus, you have to think about the fact that, initially, a stressor that met criteria for a diagnosis included things like combat, natural disaster/situation in which your life was in danger, or sexual assault. Although, this wasn’t explicitly stated. The criteria just said ‘Existence of a recognizable stressor that would evoke significant symptoms of distress in almost everyone.’ This was updated in the revised version to specify that a traumatic event included ‘serious threat to one's life or physical integrity; serious threat or harm to one's children, spouse, or other close relatives and friends; sudden destruction of one’s home or community; or seeing another person who has recently been, or is being, seriously injured or killed as the result of an accident or physical violence.’
How old is Bruce Wayne currently? If he’s roughly 30 or older, it’s unlikely he would have had access to treatment with someone who specialized in effective treatment of PTSD in kids. And if he’s younger? What do you think the odds are that a dude two generations older would shatter the stigma norms and take a kid to therapy?
As my elderly father would say: slim to none.
Plus, Bruce was originated in 1915. Talk therapy wasn’t even a thing in the US then. Although there’s evidence that Rhazes, a Persian physician, used a form of psychotherapy based on theory, it wasn’t a thing in the modern ‘west’ until Sigmund Freud in the late 1800’s. And he brought it to the US in 1909, but it wasn’t really popular until the ‘30s/‘40s. And psychoanalysis is not really a peer-reviewed, empirically-supported treatment for PTSD. Even though that standard is not without critique, it’s the one most treatment in the US is currently based on.
And Prolonged Exposure, an empirically supported treatment (that doesn’t mean that it works for everyone, just that it’s better than supportive therapy for the majority of participants in a randomized controlled trial) is based on reversing avoidance. Avoidance is like the lighter fluid of the fire that is PTSD symptoms—while it may help escape pain in the short term, it doesn’t resolve symptoms in the long term.
Being able to revisit traumatic events in a space *where there is objective safety* can help a person reprocess those events in an effective way that wasn’t available to them at the time of the event, when survival was the primary goal. And it’s not the only treatment out there; a person can recover without it (though some studies show that, when added to other emotion regulation skills, it leads to longer-lasting recovery from PTSD than those skills alone).
Anywho. I got started and couldn’t stop talking about two of my favorite things: human psychology and the history of psychotherapy.
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