Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life.
Judith Lewis Herman's book, Trauma and Recovery, is a landmark book. I don't use this term lightly. A woman who calls herself SwedishJewfish has written a lengthy review of Trauma and Recovery on The Daily Kos, describing it as a "life-changing" book. I definitely agree. I first picked up Trauma and Recovery several years after I'd been diagnosed with PTSD. I'm not sure how I had overlooked it before, but I think it was because I wasn't ready to read something theoretical yet. I was too caught up in my own head. The genius of Herman's book is that it operates on so many levels. The book is not only a history of the study of trauma and recovery, as the title suggests, it also deals with many topics that few have written about in quite the same way. I'll go through the book's sections below - hopefully briefly. If you're interested, you should get your hands on a copy because Herman's book is so filled with insights into trauma that it is impossible to share them all in a brief review.
Introduction
In most books, you can skip the introduction. However, I suggest that you read Herman's introduction. It's brief and clear about why we should be interested in trauma. Herman argues that, "Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims." (p. 1) She then goes on to describe the conflict that is at the heart of Post-Traumatic Stress Disorder: "the conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma." And that's just on page one!
A Forgotten History
In the first section of the book, Herman discusses the history of the treatment of trauma. She begins with Freud and shows how he suppressed the evidence that sexual abuse was more widespread in the well-to-do population of Vienna than anyone suspected. Controversy is still raging on this subject, so I'll leave it to you to decide who's right. Right or wrong about Freud, Herman raises many important points about the study of trauma. She argues that it has been hard for psychologists to get "respect" for studying something that most people would rather deny. "To study psychological trauma," Herman says, "means bearing witness to horrible events." (p. 7)
The next section of the book, discusses the work of W.H.R. Rivers with shell-shocked soldiers in World War I. I've written about this work at length on an earlier post and Man Booker Award winning author, Pat Barker, has written about it in Regeneration. Barker's book - part of a trilogy on the subject - beautifully evokes the shift from punishing combat trauma to treating it humanely. That wasn't necessarily because people became more empathetic, Herman suggests, but simply because there were so many shell-shocked men in World War I, that if they had all been executed - as many were - there would have been no one left to fight the war.
Next, Herman goes on to discuss the treatment of combat trauma in the Vietnam War, when PTSD first came into usage as an official diagnosis. As Vietnam Vets returned home, they increased awareness of this issue and, in the 1970s, the Women's Movement took up the issue of rape and what they called "the rape trauma syndrome." It's amazing to realize today that it was only in 1971 that the first rape crisis center was opened in the United States. Before that, women kept quiet or were silenced about sexual violence, unless - and this is a big unless - the perpetrator came from a group that was discriminated against by society, eg. African-American men in the U.S.
Describing PTSD
In this section of the book, Herman does a splendid job of describing the hallmark symptoms of PTSD.
- Hyperarousal
- Intrusion
- Constriction
- Disconnection - with family and community
Unfortunately, I don't have room here to share her many insights.
A New Diagnosis
Herman makes a strong case for a new diagnosis: complex PTSD and outlines why she believes that people who have experienced repeated/chronic PTSD, particularly at a young age, will need different treatments and approaches to recovery.
Stages of Recovery
As important as the first part of Herman's book is, the part that glued me to the page was the stages that trauma survivors must pass through in order to successfully recover from PTSD. (Caveat: to recover doesn't mean that people who have experienced significant trauma will return to their pre-trauma state. It means, rather, that the survivor will be able to reconnect with others both on the individual level and on the community level.)
Safety
The first, and most important stage, is that the survivor must be safe. Some survivors, tragically, cannot leave unsafe conditions and may not have the luxury of a safe recovery. Most people, however, can begin to understand that the trauma is over and they are safe now. First, comes physical safety, then the establishment of a "safe" therapeutic relationship. Both facilitate healing.
Remembrance and Mourning
This is a very difficult, although vital, stage for recovery. It may be a long stage, if my own experience is any indication. Much depends upon how many traumas you've experienced and whether or not others are receptive to hearing about them. Telling your story of trauma in this stage is essential. Ideally, you can do this through a combination of therapy and writing, voicing your story to a wider audience. Be aware, however, that this story is not something most people want to hear, so choose your audience carefully. This is what sets Herman's book above many others on trauma; she recognizes the essential role that the community and the political climate have on trauma survivors' ability to recover.
Reconnection with (Ordinary) Life
The first person the survivor must come to trust is the self. Indeed, it is only recently that I have come to trust myself in ways I hadn't done since the initial traumas in my life occurred. Herman urges survivors to connect with a larger community and become involved in action to expose or end the trauma of others. This can only be done, however, when the survivor is strong enough. This step, however, can be a powerful one. Herman suggests that survivors can, "transform the meaning of their personal tragedy by making it the basis for social action. While there is no way to compensate for an atrocity, there is a way to transcend it, by making it a gift to others" (p. 207). Herman has more to say about the connection between trauma survivors and communities. However, I've run out of both space and energy. In the final analysis, Herman's book is not just informative, it's courageous. Herman is not afraid to speak out about the so-called "unspeakable" and to bring traumas that are hidden out into the open. It's only there, Herman suggests, that true healing can occur.
And what about Judith Herman the person? She was born in 1942 and grew up in New York City. She's a medical doctor and a professor of psychiatry. Those of you interested in Herman and her work will enjoy the lengthy interview below. It gets off to a bit of a slow start, but stick with it or fast forward to about minute 12. Herman shares wonderful stories about her work with trauma survivors and insight into how trauma is connected to our larger society.
Finally, a video by Solomon Burke. Herman worked in the Civil Rights movement and much of her work has been motivated by a sense of justice. I think she would like this song; it makes me think of her.
