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Trauma and Recovery
By Judith Herman M.D., New York: Basic Books,1992, 290 pages, $15.00
Trauma and Recovery, by Judith Herman, M.D., provides trauma victims, their supporters, and clinicians with a greater understanding of the complexities and variations of Post Traumatic Stress Disorder (PTSD). Survivors and their advocates are provided with a framework that links different traumas such as child abuse, spousal abuse, incest, rape, torture, war, captivity, and the holocaust. Herman’s framework begins with a history of trauma and its treatment. It then delves into various etiologies of PTSD and other trauma related disorders. Herman’s framework also pioneers the understanding of a form of PTSD, referred to as “Complex PTSD,” that evolves from long term trauma. Her work also presents a model describing the stages of recovery. Through this framework, survivors can feel less alone, better understand themselves, and learn to have a more fully integrated identity. Clinicians can become better equipped to help clients through this process, while also improving their own understanding of Complex PTSD symptoms, and while developing a sense of empathy. Trauma and Recovery can help highly literate clients and clinicians through Herman’s passionate and articulate delivery of a massive quantity of research, interviews, and experience.
Trauma and Recovery is divided into two parts: Part I, “Traumatic Disorders” and Part II, “Stages of Recovery”. Part I begins with a chapter entitled, “A Forgotten History” that compares the history of trauma to episodic amnesia. Herman explains that the study of psychological trauma has alternated between periods of active interest and periods of oblivion. She illustrates how study progressed during the late nineteenth century from Charcot’s sterile behavioral observation of hysteria, to Janet’s and Freud’s gender biased psychological explanations of trauma responses. She provides a strong argument that the only reason trauma started being examined more closely was because of the “shell-shock” that soldiers of World War I were experiencing. More was learned about trauma and treatment through World War II and the Vietnam War, but Herman attributes the social change of the women’s liberation movement of the 1970’s as the catalyst that allowed people in the 1980’s to recognize that survivors of rape, domestic battery, and incest were experiencing a syndrome akin to what war veterans experienced. Therapists can have a client read about the history of trauma as an initial way of providing the modeling necessary to help them realize that they can face their trauma in the same manner that others have. This detailed account of the evolution of the psychological study of trauma can be used to encourage a survivor to face his or her own trauma by becoming a part of a positive trend in history.
With insight into how trauma has come to be understood, Herman probes into the meaning of terror and elucidates the manner in which the “extraordinary” experiences of trauma are often everyday atrocities that have the capacity of overwhelming the mind. Reading about this may help survivors gain a sense of commonality. She elaborates on the fashion in which people adapt through dissociation while experiencing extended trauma. She also talks of how dissociation and symptoms of the fight or flight response, can linger on in a manner that no longer is adaptive to the survivor who is no longer in danger or in captivity. People also have a tendency to withdraw when they would really benefit from the support of a social network. Herman discusses the role that society plays in this; legal and social safeguards protect perpetrators of many kinds, while victims struggle on in a position of seeming powerlessness. This position can leave a victim, who is already having problems trusting, continue to develop trust issues while also demeaning their autonomy and sense of identity. A true merit of Trauma and Recovery is Herman’s description of the role that extended trauma such as child abuse plays in the development of “Complex PTSD”. Herman suggests that damning labels such as Borderline Personality Disorder and a proposed “Masochistic Personality Disorder” do little to help survivors heal while the symptoms that these disorders describe do mesh well with the more constructive and encompassing “Complex PTSD”. A brief description of this disorder’s criteria include long subjection to any kind of totalitarian control and alterations in: affect regulation, consciousness, self perception, perception of the perpetrator, perception of relations, and sense of meaning.
While the comprehensiveness of Part I can serve as an asset to a clinician trying to understand a survivor, it’s entirety could be too much for a survivor to handle at once. Herman’s Trauma and Recovery presents a detailed and frank depiction of what it is like to survive extreme trauma and also delineating risk factors for future problems such as low resiliency or limited social networks. At risk survivors could look at this material and make appropriate changes, or they could fall into a self-fulfilling prophecy. Careful assignment of chapters by a clinician, who has a sense of what the client is prepared for, can ensure a better chance that insight will be gained and that meaningful discussion will be sparked in the next session.
Part II of Trauma and Recovery outlines the stages of recovery. This section, particularly chapters 8-10, could be helpful to clinicians and survivors alike. In these three chapters, Herman indicates that recovery typically follows a process during which the survivor attains safety, then goes through a period of remembrance and mourning, and then finally reconnects with himself or herself and the world around him or her. Herman makes certain to indicate that these stages are not firm, but rather individual in nature, and can intermingle sequentially. Perhaps slightly more useful to the clinician, the other chapters of Part II describe the complexities of the therapist/client relationship, and a model of group therapy. While Herman suggests that group psychotherapy can provide survivors with a needed sense of commonality, she warns the clinician to exercise extreme caution in selecting group psychotherapy as a mode of treatment and further suggests that group composition and focus be based largely on the client’s present stage of recovery.
Any clinician working with trauma victims should have a copy Trauma and Recovery among their collection. It is a text that someone in the field of psychology can gain great insight from and revisit again and again. In utilizing this book for bibliotherapy, clinicians should first make sure that the book is at an appropriate level for the client. Herman writes eloquently, but she also writes at a very sophisticated level. The book may not be appropriate for young people or for those who are not fluent in English or who have not completed at least a high school education. Similar to the manner in which Herman suggests that stage of recovery should be considered in forming a survivor group, stage should also be considered in deciding which chapter or parts of chapters to read. Selected appropriately, there is no question that excerpts from Trauma and Recovery could stimulate valuable discussion between survivor and clinician while also helping a client to gain insight and feelings of commonality. A weakness of the book may be that it might not be appropriate for less fluent or less educated readers. Because of its comprehensiveness, another weakness might be that it could be unsuitable for some of the most literate of readers in its entirety. One might also say that it provides too little guidance in terms of following steps toward recovery. These arguments seem outweighed, however by the apparent usefulness of a book that can clearly make a clinician a more knowledgeable professional and that can clearly provide survivors greater insight and feelings of commonality in a world where they could otherwise feel very much alone.