We Are All Victims Now

In formal Japanese, I’m told, the word ‘trauma’ is written as a compound of two Chinese characters: one meaning ‘external’ and the other ‘injury’. Trauma is thus a hurt on the outside, as in ancient Greek – a wound. We still use the word in this way when we speak of ‘trauma surgeons’ or ‘trauma wards’, but this is not the sense that has made it so resonant and ubiquitous today. Having once been relatively obscure, it is now found everywhere: used in the New York Times fewer than 300 times between 1851 and 1960, it has appeared 11,000 times since.

The reason for this is not a resurgent interest in wounds but the elaboration of a new meaning which emerged in the late 19th century, when trauma’s unambiguous outsideness began to give way to interiority: it became a psychic injury, a ‘thorn in the spirit’, as William James put it, an injury done not to the body but to the mind by violence, or by any unspeakable or unassimilable experience. In the 19th century and much of the 20th these mental wounds were understood to be represented in the body by such symptoms as paralysis, sleeplessness, fatigue, palpitations etc. But today one doesn’t need to have any symptoms at all to be regarded as traumatised. The ‘condition of victimhood’ is democratically available; the past itself can lodge a ‘thorn in the spirit’. ‘All children,’ according to Alice Miller (or at least according to her obituary, which appeared as I was writing this review), ‘suffer trauma and permanent psychic scarring at the hands of parents.’

How trauma made its initial move from exteriority to interiority doesn’t much concern Didier Fassin and Richard Rechtman. Their book is an essay on the ‘historical construction and the political uses of trauma’ and a report on anthropological fieldwork aimed at ‘denaturalising’ it and ‘repoliticising victims’. Working in a Foucauldian tradition, they are interested in the way professional communities, through their daily practices, the internal standards of their disciplines and their interactions with the state and with clients, construct certain subject positions (categories of being in the world, like ‘trauma victim’ or ‘homosexual’) which those communities then regulate, benignly or otherwise. Governance, Foucault argues and Fassin and Rechtman agree, works as much, if not more, through the ‘production of truth’ as through the imposition of laws. The question is not whether someone actually is a victim of trauma but how the criteria for deciding who is a victim come into being and who manages them. ‘Governmentality’, as Foucault calls this process of determining how truth and falsehood are regulated and brought to bear, is what concerns these authors. The construction – not the reality – of trauma in the different areas of mental health, and the political implications of that process for assigning who can or cannot claim the rights of victimhood, form the subject of their book.

One could of course ask, and historians have, whether the symptoms of, for example, post-traumatic stress disorder were present in wars and disasters before the 19th century and whether their incidence has gone up or down over the centuries. But as a morally and medically exigent category, PTSD didn’t exist before the late 19th century. The American Civil War is the first war for which there exist relatively abundant medical records that allow retroactive diagnosis of symptoms close to our modern concept of trauma as an interior wound. Anxious to find a precise pathophysiology for seemingly inexplicable physical symptoms, 19th-century physicians combed these records in search of possible links between a violent past and present suffering. And they found something. In 1871 Jacob da Costa published a paper based on the cases of 300 soldiers whose strange somatic symptoms he connected to stress, but was unable to explain physiologically. It may be that the terror of charging into heavy enemy fire at close range as a lone unprotected figure in the open formations of the Civil War, as opposed to the tight square formations of earlier military tactics, induced something like shellshock and contributed to the emergence of the idea of trauma. Perhaps doctors were identifying a genuinely new clinical condition.

Fassin and Rechtman aren’t interested in the incidence of psychic wounds. They are concerned with the ways in which the category of the psychic wound is shaped – constructed – in debates about the moral legitimacy of victims. Their book is determinedly neutral on the much debated question of whether trauma is best understood psychogenically, as a culturally determined response to stress, or, as many now argue, neurologically, as a lesion in the brain caused by unassimilable memories. This lesion can be detected by distinctive EEG readings which are associated, for example, with post-traumatic nightmares as compared to everyday ones. If the brain lesion argument were proved correct, its proponents argue, the questions raised by Fassin and Rechtman about the social construction and normative evaluation of trauma would be irrelevant. A mental wound would no more need to be ‘constructed’ than any other lesion; the trauma victim would be no more or less culpable than the victim of a lightning strike or gunshot.

But the questions aren’t irrelevant, and the reasons are to be found outside medicine. Once the category of trauma was established in the 1880s, many doctors – and not only doctors – focused on an epidemiological inquiry into its incidence: why do only a small percentage of those exposed to a given violent or stressful event develop symptoms? A century later, the inquiry had become an ethical one: how might they, as doctors, read trauma as evidence of the experiences of their patients (i.e. treat their patients as reliable witnesses to their own suffering) and thus understand them and others who might, under similar circumstances, suffer similarly? If the question is posed, as it once was, primarily as a problem of incidence, then investigators will focus on the vulnerability of victims; if it is posed in terms of what has been witnessed, attention turns to the event. No clinical advance can explain the historical shift from one mode of inquiry to the other: the framing of the question about trauma has little if anything to do with substantive knowledge of psychology, psychiatry or neurology. It does have a great deal to do with what Foucault called the production of truth, with the way these disciplines can be mobilised for novel purposes.

The Empire of Trauma tells the story of three new professional arenas for the production of such ‘truths’. ‘Psychiatric victimology’, developed in Toulouse after an explosion at a chemical plant, validates victim status and focuses on reparation; ‘humanitarian psychiatry’ draws attention to the causes of suffering in the Occupied Territories and, more controversially, in Israel; ‘the psycho-traumatology of exile’ concerns the persecution of refugees seeking asylum in an inhospitable country, France. Together, these movements represent a radical shift in the ‘anthropological significance’ of victimhood, from a world in which victims were suspect, to one in which ‘their suffering, no longer contested, testifies to an experience that excites sympathy and merits compensation.’

This comes as a surprise, because at first the book seems to take the line that so much talk of trauma is folly. Nine thousand mental health workers rushed to New York after 9/11, we’re told, but very few people suffered even temporarily from what might be labelled post-traumatic stress. The authors also cite the case of a schoolchild in Toulouse who was said to have been traumatised not by the explosion itself but by seeing a teacher in tears. ‘Traumatised’, they point out repeatedly, can mean almost anything: it is a ‘floating signifier’ that denotes any number of ills which have little in common other than a name.

Yet the authors turn out not to be neutral observers but ‘observant participants’ in the story they tell. Fassin is an anthropologist now at Princeton and also a physician, a former vice president of Médecins sans frontières and president of Comede, the Medical Committee for the Exiled. Rechtman is an anthropologist and psychiatrist who directs a clinic and has worked for a long time with Cambodian refugees. Both, therefore, are active in organisations that have helped to construct the notion of ‘trauma’ in our time. They don’t rank victims or condemn what some see as the increasingly widespread and inappropriate attribution of victim status: they claim, rather, that this is ‘a sophisticated but classic way of denying injustice, inequality and violence’. They also refuse to moralise, saying that their role is not to condemn or applaud but only note, although in this they are not entirely successful. It is clear where their hearts lie. They believe that trauma has become the arena in which people can acquire their status as victims and find treatment for their suffering; that it has created new avenues for exposing the reality of persecution and prejudice; and that it has given the victims of such persecution a tool in their struggle for recognition and compensation. All this they applaud; they are not anti-imperialist in their attitude to the empire of trauma.

The dual genealogy of trauma as a medical and a moral category begins with Charcot, who in the 1870s encountered what others would call ‘trauma neurosis’ through his studies of hysteria. The strange somatic symptoms he encountered among his patients at the Salpêtrière were not only exhibited by women (the usual suspects because of their ‘constitutional weakness’) or effeminate men, but by a wide spectrum of people of both sexes. Hysteria, and by extension trauma, could not, therefore, be regarded as a gynaecological problem or one of gender mix-up; and Charcot was too much the materialist to relegate the problem to some vague psychological realm. He postulated instead an inner wound, a pathology of the nerves, to which even navvies and blacksmiths were vulnerable: trauma was a neurological condition. Of course, a congenital weakness – this was the great age of degeneracy theory – might explain why only a few people’s nerves were injured while those of many others in similar situations were not. But Charcot’s formulation contributed relatively little to the moral strand of the story.

It was Pierre Janet in 1888, and, still more important, Freud in the following decades, who introduced the idea that trauma was fundamentally a psychic not a physical injury. This injury was sustained either in response to an event or, as Freud would argue after he abandoned the seduction theory (the notion that hysteria was caused by real sexual abuse), as a result of the process through which infantile and childhood sexuality was shaped into its adult form. How exactly a psychic wound translated into somatic symptoms remained obscure. Janet used the model of hypnosis; Freud developed a theory of repression according to which the traumatic ideas associated with compacted psychic energies have to be recalled and worked through for their symptoms to be relieved: un-mastered memory, like a festering wound, needs to be opened up to air and light.

Trauma thus had a dual valency, functioning as both a sign of the weakness of the victim and a testament to the magnitude of the event that caused the trauma. Fassin and Rechtman believe that the emphasis was on weakness: those who suffered from trauma were generally suspect. Early in the last century, workers who sought compensation for the psychic consequences of stress or injury in a factory or mine, for example, were thought to be suffering from what the French called sinistrose, a condition caused more by the benefits they hoped to gain from what had happened to them than by objective conditions.

The Great War raised the hermeneutics of suspicion to a new level. Shellshock could not be ignored: it was now endemic. And it was politically unacceptable to regard it – as PTSD would be regarded after Vietnam – as evidence for the horrors and perhaps the illegitimacy of the violence that had caused it. To be shellshocked was to be unpatriotic, or to be insufficiently protected by patriotism, or to be like those workers who became ill because it was to their advantage. Soldiers who showed signs of it were treated accordingly. Not everyone was as brutal as Clovis Vincent, a doctor at Tours, whose ‘persuasive’ technique involved high-voltage shocks combined with threats and orders to get better, or the well-known Austrian psychiatrist and later Nobel Prize-winner Wagner von Jauregg, who was tried after the war for his use of electroshock treatment. Some physicians tried to treat men humanely, but most seem to have believed that trauma bore witness to individual weakness, not to the evils of war or to unbearable stress.

Psychoanalysis in the 1920s, and again after the Second World War, did a great deal to remove the stigma of shellshock by arguing that it was caused not by malingering or even by an unconscious wish to gain advantage but by the same demons from early childhood that caused ordinary neurosis. An overdeveloped narcissism, for example, might keep one from wanting to die for one’s country. By the 1950s the individual who suffered was no longer thought to be to blame, but the psychic wound still did not testify to its cause. The traumatic event itself remained largely irrelevant, just as actual child abuse no longer figured in the aetiology of hysteria once Freud had abandoned the seduction theory.

All this changed, according to Fassin and Rechtman, with an unexpected pas de deux. The Holocaust gave psychoanalysis a much bigger audience, and psychoanalysis played a crucial role in making the Holocaust the ‘traumatic event of the century’. Violence on such a scale came to define the ‘limits of universal human experience’. There could be no doubt that it was ‘generally outside the range of usual human experience’ and constituted a ‘a recognisable stressor that would evoke significant symptoms of distress in almost anyone’, as the 1980 Diagnostic and Statistical Manual III (DSM-III) of the American Psychiatric Association put it in its ur-definition of PTSD. This definition (probably the most spectacular effort on record to disguise a fraught universe of ethical, sociological and anthropological assumptions in the objective language of science) may have suggested a problematic moral equivalence between all victims, but it manifestly lifted a burden from the sufferer. Auschwitz set trauma on a new course.

And psychoanalysis reciprocated the favour. Not only did analysts like Robert Jay Lifton and Bruno Bettelheim help construct the Holocaust as the paradigmatic case of a traumatic event that could not fail to leave ‘a trace on the individual and collective memory’, they also developed a clinical entity, ‘survivor syndrome’ or ‘survivor guilt’, that had no precedent. Only events themselves, their ‘irrefutable reality’, and no longer the putative psychological failings of the sufferer, could account for the psychological damage caused by the Holocaust. Shellshock might have been attributable to a ‘delicately adjusted nervous system’, as one commentator said in the New York Times after the First World War; the strange psychological ailments of an injured worker might be the consequence of an unconscious wish for compensation or more time off. But survivors of Auschwitz were beyond reproach, while uncovering the effects of the camps could be regarded as not only individually but culturally therapeutic. Remembering – one of the central tasks undertaken in an individual’s psychoanalysis – became the basis for a broader social commitment to the notion of ‘never again’. (Primo Levi, who for years couldn’t get If This Is a Man published, saw it become the exemplary memoir and himself the iconic survivor.) Together, according to Fassin and Rechtman, the Holocaust and psychoanalysis created an epistemic rupture: a new regime of truth was brought into being, an old ‘system of knowledge’ was shaken. ‘What used to excite suspicion’ came to have the ‘value of proof’; the victim as witness was born; trauma could now speak ‘to us of our era – the spirit of the age’.

On 11 September 2001, news from New York interrupted a meeting of the National Committee for Medical and Psychological Emergencies that Fassin and Rechtman were attending in Paris. (The founding of this body in 1997 itself attests to the new public linking of inner and outer wounds.) In the wake of the collapse of the Twin Towers there was much talk of mass trauma, presented as an affirmation of a common humanity as if in parallel with the common threat posed by terrorism. Soon afterwards, on 21 September, the explosion at the AZF chemical factory in Toulouse showed how far trauma had come. The call for compensation for the psychic and social consequences of an industrial accident that had killed 29 people and left thousands homeless invoked trauma as a result of the efforts of a new alliance of mental health professionals devoted to recognising and ministering to the needs of victims in a society that had long been uninterested in them.

The French Ministry of Justice set up an agency to compensate the victims of crime in 1982. (The United States got there first, and in general has been more hospitable to victims’ interests.) Then, in 1986, Françoise Rudetzki, a lawyer who had been injured in a still unsolved bombing at the Grand Véfour restaurant in Paris, founded an organisation called SOS Attentats in the belief that victims like her were twice injured, once by the bomb and a second time by social indifference; their claim for reparation was a demand for recognition as victims. Academic research in the 1980s and 1990s helped broaden the new category: not only those who consciously experienced injury suffered psychic trauma; even those who didn’t know they were traumatised could count as victims.

When those claims were greeted with scepticism by most traditional psychiatrists, a new discipline – victimology – took up the cause. A play on ‘criminology’, it sounds like a joke in English and has the same semi-serious ring in French. But in 1995 it gained semi-official recognition when Jacques Chirac, responding to that year’s terrorist attacks, came up with the notion of a psychological emergency as something the state had to be ready for. By the time of the Toulouse explosion, victimologists had succeeded in having their clients taken seriously. The possibility of financial compensation was no longer regarded as a potential ‘cause’ of traumatic symptoms as it had been in early 20th-century cases of sinistrosis; instead, it was now recognised as a form of therapy. Where once there was some doubt as to who was a legitimate victim of trauma, now it was claimed that a whole society could be traumatised.

In this sense trauma had broken through professional boundaries in Toulouse. It ceased to be primarily a clinical category and had become a moral one, ‘a mark of the humanity of those who suffered’. Or rather, something that had always really been a moral category had been radically re-evaluated. The authors don’t make clear how specific decisions were made about compensation when everyone supposedly could and should count as a victim and clinical criteria were not definitive. Neither do they tell us why these adjudications were made by traditional healthcare professionals and not by victimologists. But they do show in some detail how even with an assumption of universal suffering, some were seen to have suffered more than others; politics and prejudice still determined who would be excluded from the big tent of trauma. Patients at a large mental hospital who had had to be evacuated were out of the running: no one thought that they might suffer trauma. And workers at the plant didn’t count either: their union encouraged them not to claim for fear of alienating their employer, and in any case one of them had caused the accident. But despite these ‘inequalities’, Rechtman and Fassin found a remarkable degree of social cohesion in Toulouse based on the collective identity of victimhood. Conceiving the event as a mass trauma, they found, healed the social fabric even in poorer districts.

What victimology was in Toulouse ‘humanitarian psychiatry’ was in the Occupied Territories. In a sense it is the legacy of a long tradition of humanitarian medicine, of doctors as specialists in the diagnosis, aetiology and treatment of suffering, bearing witness to its causes and effects beyond the bounds of biology. One of the founding moments of the anti-slavery movement came when the physician William Sharp alerted his brother, the future abolitionist leader Granville Sharp, to the suffering of a slave who had been brutally beaten by his master. Humanitarian doctors throughout the 19th and 20th centuries both spoke on behalf of and treated those who suffered.

A more recent iteration of the concept, this time focusing on wounds of the mind, emerged from a meeting organised by MSF in 2002 but has a genealogy going back to concerns about the effects of torture in South America, to studies of the psychological problems caused by the 1988 Armenian earthquake, and to MSF and Médecins du monde’s work in Bosnia, Kosovo and Congo. (Médecins du monde split off from MSF to take a more active stand on human rights.) It was very much part of the politics of humanitarianism of the 1990s to ask who was deserving of empathy. To whose suffering ought one to testify? The Greek branch of MSF, for example, was kicked out for claiming that the Serbs, too, deserved attention. But all this happened without reference to trauma.

In their earlier engagements in Palestine, the psychiatrists of MdM and MSF hadn’t used the word ‘trauma’. In fact, there seemed no medical reason for them to be there. The Palestinians didn’t need much medical help, being well supplied with doctors themselves; evidence for clinical symptoms was scarce; young men often didn’t want to be seen as victims whatever symptoms they might have. The question then is why doctors subsequently began speaking of trauma. The answer seems to be that it allowed them to follow in a tradition of bearing witness to suffering and its causes without actually treating or even acknowledging specific symptoms. Wounds of the mind, ever more broadly understood, gave them standing as physicians and as humanitarians. They could bear witness to victims’ experience without resorting to the clinical language on which their authority rested; they could speak to the deeper historical truths of victimhood in and through individual cases; they could attest to the moral equivalence of all suffering while at the same time testifying to particular injustices perpetrated by one side. Trauma became the medium through which these apparently irreconcilable agendas could be reconciled.

But perhaps they remain irreconcilable. MSF issued a report criticising Israel for the mental wounds it inflicted on the Palestinians in the Occupied Territories; MdM issued another in which they acknowledged that Israelis were traumatised by Palestinian attacks on Israel. It is clear from the ensuing controversies that far more than differences in medical judgment were at stake. If trauma was to become, as Fassin and Rechtman claim, ‘an exhibit for the defence of the oppressed, and an argument for the prosecution of the oppressors’, it isn’t clear who benefited in this case, except perhaps the humanitarian psychiatrists for whom trauma somehow opened ‘new horizons in our understanding of the world’, and acted as a ‘significant added value in the construction of testimony’.

In their concluding chapters, Fassin and Rechtman deal with what they call the psychotraumatology of exile. Twenty years ago trauma had nothing to do with the assessment of applicants for asylum. Now, in an age when torturers leave few marks on the body, trauma is called on to ‘bear witness to the unspeakable’. In 1951, Eugène Minkowski founded the first centre for immigrant psychology based on a universalist model – all humans suffer alike – and concerned principally with the pain of exile; in 1979, Comede was founded to deal specifically with immigrants from the Cambodian crisis; MdM focused on illegal immigrants; in 1984, AVRE, a centre for the care of victims of torture and other cruel treatment, was set up. Even then the word ‘trauma’ was seldom used for what was acknowledged to be an ‘incommunicable’ experience. Only with the founding of the Association Primo Levi in 1995, dedicated to the treatment of victims not just of torture but political violence more generally, did trauma and a psychotraumatology of exile emerge.

A concern with torture and an awareness of the special needs of refugees thus preceded a recognition of mental wounds as a category of medical or moral exigency. Gaining refugee status came increasingly to depend on evidence of persecution. Trauma, which in an earlier age had been a source of suspicion, was now adduced in support of a claim to authentic suffering. Doctors were now in the uncomfortable position of being called on as forensic scientists to search for sequelae in the patients’ minds when signs of trauma on their bodies had vanished. As bureaucrats became less willing to accept refugees’ stories, medical experts were asked to attest to the truthfulness of people whose words, they felt, should speak for themselves. In the end, the notion that violence harms the psyche came to be accepted by the authorities, but more in general than in particular cases. Trauma, as the authors put it, only speaks ‘that truth about the victim that society is prepared to hear’. Doctors issued certificates in ever greater numbers, while the chances of their doing any good became ever slimmer. Trauma came to link ‘violence and suffering, politics and psychiatry, experience and care, memory and truth’ at the same time, it seems, as it contributed to their unravelling.

What has taken place is a moral revolution. We now take it for granted that the marks of torture dwell in the spirit more painfully and far longer than on the body, and that watching a friend or a relative being tormented is itself torment. Almost everyone has become a ‘survivor’ of something. ‘Survivors’ and ‘survivors’ groups’ are everywhere: victims of cancer generally and of specific cancers; victims of incest, rape, child abuse, divorce, grief, of having an alcoholic parent or a sex-addicted spouse; as well as victims of torture, war, exile and catastrophe. The empire of trauma has also spawned a vast intervention network, of which the psychiatric emergency teams that Fassin and Rechtman write about are only a part: national and local government agencies as well as ordinary workplaces stand ready to help would-be victims. At the behest of the state, scholars in Italy are studying how citizens mourn, with the idea of easing the process; visitors to the magnificent cemetery in Vienna can pick up a list of city-sponsored grief counsellors; after the death of a very popular office manager everyone in my department received an email telling us about the resources available to help us cope. And of course there is a whole world of for-profit care: $2000 buys a week-long programme at a well-regarded addiction treatment centre that promises ‘Freedom from the Past’, how to avoid feelings of loss and, if that doesn’t work, how to disrupt the ‘patterns of destructive behaviour’ that follow trauma.

Trauma, Fassin and Rechtman believe, transforms our ‘view of humanity’ by allowing us to think about ‘individual experience and collective memory in terms of wounds’; it is ‘the most salient trace of the tragic event in human experience’; it gives ‘a new meaning to our experience of time’; it ‘has imposed itself on society in such a way as to become the central reality of violence’; it ‘reinvents “good” and “bad” victims’; it ‘defines the empirical way in which contemporary societies problematise the meaning of their moral responsibility’; it marks a broad shift in the ‘political and moral anthropology of contemporary societies’. It is the product not of clinical advances but of ‘a new relationship to time and memory, to mourning and obligations’. Fassin and Rechtman are asking for a lot of heavy lifting from a concept that came into its own just half a century ago; indeed, ‘psychiatric victimology’, ‘humanitarian psychiatry’ and the ‘psychotraumatology of exile’ emerged only in the last 20 years. Trauma may be up to it, but only if we grant that it really is a ‘floating signifier’, that it can mean anything, and only if we erase its real histories: only if we conflate it with long-established moral categories (suffering, witnessing, sympathy); only if we make it central to a broader ethics and politics of memory; and only if, even at an individual level, we conflate it with other residues of the past.

As I see it, the Holocaust, as it came to be talked about after the Eichmann trial in 1961, doesn’t account for the moral transformation of trauma into a psychic wound that ‘excites sympathy and merits compensation’. It has come to represent an ultimate, unassimilable violence. And those who survived it are the paradigmatic innocent victims; one hardly needs to add the word ‘Holocaust’ to ‘survivor’. As the un-representable evil it may even have absorbed the essence of a pathological modernity tout court. But this is not a historical claim. It seems more likely that trauma achieved its new status by way of the women’s movement, the veterans’ movement and other late 20th-century mobilisations.

PTSD, the best-known clinical manifestation of trauma, entered the psychiatric repertoire when it was admitted to DSM-III in 1980, in an effort to remove normative judgments from clinical practice. (This was the same edition of the manual in which it was stated that homosexuality was no longer considered a disease or a moral failing.) Any ‘recognisable stressor’ outside ordinary experience could render someone a victim of trauma, which meant in effect that Vietnam vets, even those who had engaged in actions that would seem to be those of perpetrators not victims, could nevertheless be treated as victims and compensated. Whether their new status gained them much sympathy is debatable. The Holocaust made its way into the Western imaginaire in many ways that were at best loosely and retrospectively associated with trauma. As the case-studies in the book make clear, the recent history of trauma bears almost no relationship to the 20th century’s exemplary evil.

When compensation for the Holocaust was a live issue, roughly from the late 1940s until the 1960s (another round of reparations litigation began in the 1990s), it was explicitly not for mental wounds. There was no compensation for the trauma of genocide, no prima facie assumption of victims’ equality. A great effort was made by the parties to quarantine the issue of money from questions of sympathy, forgiveness or morality. Both right and left in Israel opposed the whole exercise because to some it seemed impossible to disengage reparations as payment for damage done from its broader sense of money paid to make amends or compensate for a wrong. It seemed to them barbarous to suggest that a price could be put on genocide and somehow make it right again. (The German word for ‘reparation’ – Wiedergutmachung, literally ‘making things good again’ – must have been in the minds of many survivors and made the deal sound worse still.) Opponents of compensation lost the fight because the Ben-Gurion government, desperate for revenue, insisted that the money it was demanding from Germany had nothing to do with the deeper questions: Germany should compensate the State of Israel for what it cost to resettle tens of thousands of survivors who’d been rendered homeless. It asked for $3000 a head and a total of $1.5 billion, and after some hard bargaining got $1 billion. This suited the Germans fine: a tort action on a national scale and nothing more, no need for anyone to address the larger issues for several more decades.

The same can be said for the many individual claims that followed. They were for specific damages: to people’s educations, careers or property. I can say from experience that the talk among survivors had little to do with trauma or morality and a great deal to do with whether one person’s lawyer was cleverer than another’s in constructing the elaborate counterfactuals that went into arriving at a settlement: how great a career would X have had but for the Nazis and hence how much money was owed? Whatever my parents’ generation got was well deserved but not morally edifying or even therapeutic. The renewed litigation of the 1990s was again about specific damages: confiscated bank accounts, unpaid insurance claims, stolen art. Of course, success in these as in other tort actions generally depends to a considerable extent on judgments about moral worthiness and relative culpability, and here victims of the Holocaust come out well.

Trauma, once it expands to become the psychic and metaphorical trace of all pasts in anyone’s present, erases as much of a victim’s life as it might recover. Art Spiegelman’s Maus: A Survivor’s Tale is a graphic novel about Nazi cats and Jewish mice, the story of the cartoonist’s parents’ terrifying encounters with, and ultimate escape from, genocidal violence in wartime Poland. It is also about their son’s efforts to come to understand his widowed but remarried, ageing and difficult father living in Queens. World-historical catastrophe here comes up against the reality of everyday life, of parents and children, in the form of his father’s concentration camp tattoo and his mother’s suicide. Artie, the cartoonist’s persona, despairs of his father’s nudginess, his pathological cheapness. ‘I used to think the war made him that way,’ he muses. ‘Fah, I went through the camps,’ responds his long-suffering second wife, Mala. ‘All our friends went through the camps. Nobody is like him!’ Every family of survivors has this sort of story, has to sort out trauma and victimhood in Fassin and Rechtman’s sense from other ways of understanding suffering, unhappiness and frustration.

More generally, trauma did not assume a new guise in the shadow of the Holocaust. In 1866, a British surgeon called John Erichsen described how patients who had been in railway accidents, and seemed at the time to have sustained no injuries, later – sometimes much later – developed severe psychic and somatic symptoms: they became confused, lost the ability to conduct their business; they heard noises or singing in their heads, or their hearing became more acute, their vision blurred. This was called ‘railway spine’, and its history suggests a trajectory different from that of the high intellectual tradition recounted here.

Erichsen, like Charcot, was convinced that the injury his patients had sustained was neurological and not psychological, that the great force of a railway accident resulted in microscopic, at that time undetectable, but nevertheless real injuries to the spinal cord that were manifested in the clinical symptoms he saw. He came to this view not, like Charcot, primarily for theoretical reasons, but for more immediate and pragmatic ones. Survivors were starting to sue railway companies, and English tort law was not sympathetic to the idea of psychic injuries. ‘Mental pain and anxiety the law cannot value,’ as Lord Wensleydale, a judge in the Court of Exchequer, wrote in 1861.

If plaintiffs’ suits were to be successful their lawyers would have to argue that ‘railway spine’ was an injury comparable to one sustained falling off a wagon, for example. And this is what Erichsen, as a regular expert witness for plaintiffs, told juries. They listened. In the first decade after his book was published English railway companies lost 70 per cent of the suits brought against them and paid out £11 million in damages. (That bought about as much then as just under a billion pounds would buy today.) It wasn’t just the medical argument that persuaded jurors to award these sums. The plaintiffs were regarded as morally worthy, as above suspicion, because being injured in a railway accident was, in our supposedly post-Holocaust sense, traumatic: injurious because it was horrible almost beyond words. As a Birmingham surgeon, John Furneaux Jordan, an expert on surgical shock, wrote of train wrecks in 1873, ‘The vastness of the destructive forces, the magnitude of the results, the imminent danger to the lives of numbers of human beings, and the hopelessness of escape from the danger, give rise to emotions which in themselves are quite sufficient to produce shock or even death.’ Defence lawyers and their experts disagreed. Herbert Page, a railway company surgeon, argued that people who suffered railway spine had somehow allowed themselves to be overcome by fear; they developed symptoms that mimicked real diseases as if they had submitted themselves to hypnosis. This strange state produced somatic changes but these were manifestly ‘in the head’. And, mutatis mutandis, that is precisely where trauma was.

Consciously or not, plaintiffs produced suffering because they had something to gain by suing. Settlements, the railway company lawyers and doctors observed, seemed to produce peace of mind. The reason symptoms from train accidents persisted, a Boston surgeon argued, had nothing to do with ‘the specific peculiarities of train accidents’, and a great deal to do with the putative victims’ desire to pursue ‘annoying litigation and exorbitant claims for pecuniary damage’. Had no one noticed, an English colleague joined in, that ‘those who suffer most are notoriously the occupants of third-class carriages?’

The terms of the discussion have changed little over the last century and a half: on the one hand, a morally cognisable event, on the other the weakness, self-interest or unavoidable misfortune of the putative victim. In February 1972, a dam in West Virginia broke, releasing a wave of poisonous water down the narrow valley of Buffalo Creek: 125 people were killed and hundreds had their homes destroyed. Rather than accept the pitiful settlement offered by the coal company, survivors asked one of Washington’s most prestigious law firms to take on their case and put trauma on the national agenda. Lawyers for the defendants, the Pittston Coal Company, helped inadvertently by demanding evidence that the plaintiffs had indeed suffered psychological injury and not just property damage. The plaintiffs’ lawyers hired a team of experts – the ubiquitous Robert Jay Lifton was one; others included Robert Coles and Erik Erikson – who insistently used the word ‘trauma’ in place of the forensically crucial terms ‘psychological injury’ or ‘mental suffering’, even though it had no legal status.

The fact that company officials offered no sympathy fed the anger that led to the lawsuit. (The moral obtuseness of Lord Robens and the Coal Board after a tip of coal waste slid onto the village of Aberfan in 1966, killing 144 people – 116 of them children – had a similar effect.) But its success depended first on establishing that the breaking of the dam was the result of human action, rather than an act of God, then on the increasing acceptance of mental suffering as a form of injury. Suspect in 19th-century tort law, this notion had become commonplace by the 1970s. The relatively recent willingness to concede that death from accidents or even so-called natural disasters could have human causes, and the acceptance of mental suffering as a compensatable injury, worked against Pittston. It lost its bid to have the suit dismissed on the grounds that the plaintiffs had not been physically harmed and therefore could not make a claim for psychological damage.

To be sure, some of the plaintiffs’ expert witnesses were committed to a psychoanalytical account of trauma – that is to say, to an understanding of trauma as an inner wound – but the real revolution, which made possible their victory in court, had been on a far broader legal, political and moral front. I think Fassin and Rechtman do an injustice to this history by conflating trauma with all suffering of which we take moral cognisance. And I think they do violence to another history when they claim that trauma represents – and that the empire of trauma has brought about – ‘a new relationship to time and memory, to mourning and obligations’. That there have been important changes in this relationship in the last century is clear, but they are not the result of changes in the way we understand psychic wounds. They are better seen as part of the expansion of what Avishai Margalit has called the ‘ethics of memory’, which holds that communities are made and remade through shared memories and obligations to remember.

We live in an age in which claims and counter-claims to collective memory abound: in memorials, in truth and reconciliation commissions, in an explosion of memoirs, in collections of names of the dead. Post-Holocaust human rights protocols, practices and tribunals are all predicated on some sort of mastery of a past in the interests of the future. In this broader arena, Maurice Halbwachs, one of Durkheim’s protégés, is more important than Freud. As he saw it, what matters are not the wounds the past has left in the present, but how we remember and how we construct a past as a collective act that grows out of a vast range of imperatives. Germans can now speak of their suffering in the fire bombing of Hamburg not because we, or they, have suddenly recognised the psychic wounds of survivors, but because these memories are now, collectively, allowed. Germans can be victims too in a way that they could not be for decades after the Second World War. However we understand the process by which this came about there is no evidence that the category of trauma played a substantial role in it.

I don’t think Fassin and Rechtman would disagree with any of this. They and I differ only on what has produced the changes in sensibility with which they end their book. They have suggested that the Holocaust signalled a radical change in our moral evaluation of the trauma victim, from someone regarded with suspicion and meriting little sympathy to someone who deserves our sympathy and our care. But, more important, they argue that the category of trauma victim as we know it was created as a new subject category within a particular professional community with its own rules, norms and constraints on the production of truth. They extrapolate a finely wrought set of case-studies of three Parisian tribes, and uncover an empire.

I take trauma as it is wielded even in these communities to be largely epiphenomenal and strategic, and part of a larger story. The empire of trauma, the elevation or degradation of the term into a floating signifier, is the result of processes that we see at work elsewhere. Like so many others (‘tragedy’, ‘agony’), it is a word that has been translated from another realm and retains only wisps of its original meaning. Many more people are ‘passive aggressive’ than ever before; Bernard Madoff is a ‘sociopath’ not a ‘scoundrel’. This doesn’t matter very much; I don’t think that the drift of any of these words away from their narrower technical meanings into common usage makes much difference; I don’t think, and I am not sure Fassin and Rechtman do either, that the ubiquity of a word speaks to its efficacy, though they do seem to think that it testifies to the power of the newly constructed category.

More important, I don’t think they make the case that the category of trauma as it has been constructed in particular professional communities has in fact transformed reality, offered a language for victims to speak about historical wrongs and so on. I would suggest that the empire of trauma, in the sense of a universal acceptance that the suffering of others matters, that psychic wounds demand our attention, is part of a revolution that began in the 18th century, and whose moral dilemmas are still with us. ‘I do believe that in the end humanity will win,’ Goethe wrote in 1782. ‘I am only afraid that at the same time the world will have turned into one huge hospital where everyone is everyone else’s humane nurse.’