Book Review - Trauma and Recovery
This article is an electronic version of an article originally published in Cultic Studies Journal, 1997, Volume 14, Number 1, pages 165-169. Please keep in mind that the pagination of this electronic reprint differs from that of the bound volume. This fact could affect how you enter bibliographic information in papers that you may write.
Book Review - Trauma and Recovery.
Judith Lewis Herman. Basic Books, New York, 1992, 276 pages.
Judith Herman is Associate Clinical Professor of Psychiatry and Director of Training at the Victims of Violence Program at Cambridge Hospital's Department of Psychiatry. Although her groundbreaking Trauma and Recovery was published several years ago, the book remains a significant one, and in our increasingly violent society, may be even more significant than when it was first published. My response to this important work is both personal and professional.
From a personal perspective, as I read Trauma and Recovery the first time, I began to understand why even today, when I say good-bye to my 22-year-old daughter who lives in another state, I feel the same heart-wrenching pain I felt more than 15 years ago when I first had to leave her behind with her controlling, verbally and emotionally abusive father. Three years ago, she and her boyfriend were violently attacked by strangers in San Francisco and almost died. In our first phone conversation a few weeks later, she shared some deeply personal feelings and details about that experience. When I saw her the next time, she wasn't the daughter I knew. I learned from her only then that even during the months before their California experience, her boyfriend had been emotionally abusing and controlling her. He is the now the father of their 20-month-old son, and they are still together.
The accumulated pain and sadness I still feel sometimes overwhelms me. In Trauma and Recovery, Herman validates these feelings, bringing to bear her professional background, human sensitivity, and wisdom to address both the psychological bases for the pervasive effects of primary and secondary traumatic experiences and the critical components in effective clinical treatment. She offers insights into the impact of "terrible events" on both victims and witnesses. Although our culture often denies such events and the "crisis of faith" they often create, their existence resonates with me in light of my daughter's experiences and my own.
Herman draws clear and convincing psychological parallels between victims of war crimes, political terrorism, and domestic violence, with substantial historical and empirical evidence to support her views. In her own words, "This is a book about restoring connections--a book about commonalities, between rape survivors and combat veterans, between battered women and political prisoners." Herman summarizes the research into psychological trauma from the study of hysteria, the "archetypical psychological disorder of women" in the 19th century, through the long-term effects of combat studied long after the Vietnam War. By 1980, the American Psychiatric Association had included the post-traumatic stress disorder (PTSD) category in its official manual of mental disorders, legitimizing PTSD for combat veterans. The culmination of this progression, from Herman's self-acknowledged feminist perspective, is in the professional acknowledgment of the equivalent psychological syndrome in survivors of rape, incest, and domestic abuse.
Throughout the book, Herman elaborates on the most characteristic feature of post-traumatic stress: the victim's alternation between intrusive symptoms (intense fear and overwhelming emotion) and constrictive symptoms (emotional numbness, inability to act, feel, or respond). This fluctuation between emotional states can intensify the victim's sense of helplessness. With trauma, one's sense of the fundamental safety of the world is often destroyed; over time, this state can become one of "existential crisis" in which the sense of self remains shattered. The dialectic of constriction and intrusion becomes habitual, and any action has potentially dire consequences for the chronically traumatized person. Protracted depression is the most common finding in virtually all clinical studies of chronically traumatized people.
According to Herman, even the resolution of the developmental conflicts the individual has made during childhood and adolescence may come undone, causing the individual to relive basic struggles related to intimacy, autonomy, initiative, competence, and identity. By extension, traumatic events destroy the connection between the individual and the rest of the world. Trauma seems to exaggerate our common stereotypes about men and women: men who were abused in childhood are more likely to take out their aggressions on others, whereas women are more likely to be victimized by others or injure themselves. At the most extreme, survivors of childhood abuse may attack their own children or fail to protect them.
Paradoxically, the social response to traumatized men and women may be opposite, yet equally damaging. When PTSD is a result of combat, our society's inclination is to tolerate men who are emotionally detached, yet uncontrollably aggressive. This response can compound the damages they have experienced in war. Those who care the most about him may inadvertently exaggerate a traumatized veteran's "sense of shame, inadequacy, and alienation" by accepting his emotional withdrawal and angry outbursts as normal.
Conversely, women who experience PTSD as a result of sexual or domestic abuse may find their struggles similarly exaggerated by the narrow tolerance of those around them--society gives women little permission either to withdraw or to express their feelings. Families and friends may not be generally supportive of their need to express anger, or they may not support the survivor's need to reestablish a sense of autonomy. And because of our culture's deeply embedded standards of male entitlement, many acts that women experience as terrorizing violations may not be regarded as such, even by close family and friends.
One of the worst mistakes we can make is to interpret the symptoms of post-traumatic distress as part of the victim's personality, because to do so is to condemn the individual to a "diminished life, tormented by memory and bounded by helplessness and fear." Even in the context of my daughter's struggles with her father, at 17 she had a number of friends and significant teachers and counselors who supported her, and she was generally full of life, optimism, and emotion. Today, her world rarely extends beyond her baby, her boyfriend, his family, and his friends; her ability to trust is even more limited. She shows little emotion unless excessively provoked. And unless consciously engaged, she almost always looks sad. Those who know her now accept her current behaviors as who she is rather than a result of what's happened to her.
As a society, we must publicly acknowledge when a person has been traumatized and assume responsibility to help that individual overcome the effects of the traumatic experience(s). Our culture's tendency to blame the victim is so deep that it has negatively affected the direction of psychological inquiry, interfering with the understanding and diagnosis of a post-traumatic syndrome. Herman urges for a new definition of the syndrome that follows upon prolonged, repeated trauma--complex post-traumatic stress disorder. And, as with so many traumas, children are the most deeply affected. Herman contrasts the magnified impact of repeated trauma on children with its effect on adults. Chronic trauma on children can de-form that personality, causing lifelong effects. Evidence seems to support the view that chronic trauma and abuse in childhood is a primary factor leading a person to seek psychiatric treatment as an adult.
In the second part of the book, Herman focuses on the therapist's role in helping victims of trauma recover. She delineates three essential stages of recovery--establishing a safe environment, supporting the process of remembrance and mourning, and helping the victim reestablish trust--within herself and the larger community. Recovery must occur in the context of the victim's relationships with others, including the important therapeutic relationship. And unlike a more traditional medical model of therapy in which the therapist is in control, the need for victims of trauma to be empowered to control their own behavior is central to their successful recovery.
The challenges Herman poses for professionals are not easy. Because the "traumatic syndromes are complex disorders, requiring complex treatment," both therapist and victim must commit to work completely through each stage of recovery; and the course of treatment must address all the various components in the unique way that works for each individual client. She addresses the requirements for effective treatment of trauma at each stage thoroughly, professionally, and with deep sensitivity to the issues involved for both therapist and client. Again, I know how important this is. The ongoing support I receive from a psychologist who embodies the empathetic, validating therapeutic approach Herman describes is essential as I continue to address my own crisis of faith relative to my daughter's life.
In the broader context, this book's content and message are of equal import to professionals who work with traumatized individuals, to those individuals themselves, and to the family members and friends of those victims.
Cultic Studies Journal, Vol. 14, No. 1, 1997