Life after Trauma

Trauma and Recovery - a Book Review

Traumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life.

Judith Lewis Herman 

   

Distressed woman (photo: Alex Thompson, flickr creative commons)

  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

Memorial to those soldiers who were executed in World War I for shell-shock (combat trauma) (photo: flickr creative commons)

 

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. 

 

Man crying at the Vietnam War Memorial (flickr creative commons)

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

Beatrice Mauwa, Survivor of Sexual Violence in the Congo, telling her story (The Advocacy Project, flickr creative commons)

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

Women protest violence against prostitutes and others, Columbia, 2009 (The Advocacy Project, flickr creative commons)

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.

 

Childhood and PTSD - love and resilience

What we give our attention to - stays with us. What we let go of - will let go of us.

Cat Forsley

  The pink snowsuit my father's parents got me for my second Christmas 

My mother's youngest sister died Friday. In January, her oldest sister died. Both deaths rocked my world. My aunts were potent symbols of a childhood world where I felt safe and loved. I was the third grandchild in my mother's large family and the first grandchild in my father's smaller family. In my father's family I was spoiled, no doubt about that. At Christmas, I was showered with presents. My mother's parents couldn't afford to be so generous with things, but they more than made up for it with people. Their house overflowed with people and there were no strangers in that small rural community where my mother grew up. Most people knew my name and, if they didn't, all they had to do was ask my mother's name, and then they knew who I was. I loved that sense of belonging. 

           Me in Kentucky with one of my uncle's dogs, circa 1955 (personal collection)

I felt safe and loved at my grandparents' houses. My own home was sometimes full of fighting. My parents were young and when I was born my father was patrolling the DMZ in Korea. When he got home, adjusting to each other and a new baby created tension and fighting. The fighting frightened me. And that's why I felt safe with my grandparents. 

I loved visiting my father's parents where I was the center of attention. I remember Grandma asking me what I'd like for lunch; I always asked for the same thing: Campbell's Cream of Chicken Soup and a peanut butter sandwich made with Skippy's peanut butter. Afterwards, if I'd been good I could go to the cookie drawer and get a cookie. Sometimes, I spent the night and Grandma would tuck me in and tell me, "Nightie, night." Grandma taught me how to play cards and we played game after game of War. When I turned eight, my grandparents got me a record that played, "Happy Birthday to you/Happy Birthday to you/Happy Birthday, dear Angela/Happy Birthday to you." I still have that record. It's bent after all these years and I have no way to play it, but I keep it in a box with other treasures and sometimes I take it out and think about what it was like to be a beloved grandchild. (photo above, me and my father's mother, circa 1955) 

My mother's house was a busier place. I rarely had my grandparents full attention and that was just fine because the house was full of uncles: my mother's four youngest brothers. We sometimes played Chinese checkers together and hung out together and sometimes, because they were teens after all, they loved to tease me. Once my Uncle Sam scared me with a devil's darning needle, a kind of walking stick that was actually harmless. Best of all, was when my uncle Clifton, the tallest of my mother's brothers, would lift me up on his shoulders and I felt like I could touch the sky. (photo: Clifton and me, circa 1962) 

When we went to Kentucky, we were "going home," or "down home." My mother took me there for the first time when I was only six weeks old because she wanted her family to see me "real bad." The house was full of people, including my ailing great-grandfather.

We went to Kentucky every summer. My grandparents would be waiting in the front yard when we drove up and my grandmother would always say the same thing, "I looked for y'all to come today," and fold us into her arms. My grandfather was quieter, but, in his own way he welcomed us too. My grandfather died when I was 12 and, after that, us girls slept in grandma's room. I loved her room. It had a screen door that opened onto the front porch and lots of windows and even in the Kentucky heat, it was cool and comfortable. Grandma would tell us stories as we were falling asleep and after her voice stopped, I could hear the whip-poor-will calling from the woods across the road. 

  

On the day we left, Grandma would give my mother a jar of her homemade strawberry jam and they would hug and then we would get in the car and my father would back down their red clay driveway to the road and head north. 

What's the take-away from all of this? For me, these good memories gave me something powerful to hold onto. The love I found with my grandparents and my mother's family, helped me weather the terrible times after I lost my daughter. Was my childhood happier than other people experiencing similar trauma? Maybe not. What matters, according to an article in Psychology Today, was what I felt about my childhood. Those happy memories gave me resilience. That reminds me of my Kentucky grandmother and her hollyhocks. Every year, my grandmother would plant flowers and every year her chickens would scratch them out. The only flowers that survived were the hollyhocks. Hollyhocks grew at the back of the house and I can picture them now: resilient flowers that were strong, beautiful, and chicken-proof. 

In other ways, however, my childhood was no bed of roses. (More on the vulnerabilities and losses of childhood and how they relate to trauma in my next post.) Meanwhile, here is a song that expresses the bittersweet feeling I have about losing my aunts. Bitter because so many of the people I love are now dead. Sweet because when I hear this bluegrass tune, for a few precious moments I'm back at my grandparents in Kentucky with the television tuned to the Nashville station. Maybe the Grand Ole Opry is on and old-timey music is playing and I'm happy. Those memories are talismans I can hold onto as I keep going, living with PTSD.