“Trauma and Recovery”: Up to Date with Judith Herman’s Classic

Originally published in 1992, psychiatrist Judith Herman‘s Trauma and Recovery: The Aftermath of Violence–From Domestic Abuse to Political Terror has been viewed as a seminal work in the area of trauma and PTSD. The latest edition, out tomorrow, has a new afterword in which the author “chronicles the incredible response the book has elicited and explains how the issues surrounding the topic have shifted within the clinical community and the culture at large.

SELECTED QUOTES FROM THE ORIGINAL TEXT OF TRAUMA AND RECOVERY

Many abused children cling to the hope that growing up will bring escape and freedom. But the personality formed in the environment of coercive control is not well adapted to adult life.
The survivor is left with fundamental problems in basic trust, autonomy, and initiative. She approaches the task of early adulthood――establishing independence and intimacy――burdened by major impairments in self-care, in cognition and in memory, in identity, and in the capacity to form stable relationships.
She is still a prisoner of her childhood; attempting to create a new life, she reencounters the trauma.

The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma.

The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable.
Atrocities, however, refuse to be buried.

In order to escape accountability for his crimes, the perpetrator does everything in his power to promote forgetting. If secrecy fails, the perpetrator attacks the credibility of his victim. If he cannot silence her absolutely, he tries to make sure no one listens.

When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom.

The dialectic of trauma gives rise to complicated, sometimes uncanny alterations of consciousness, which George Orwell, one of the committed truth-tellers of our century, called “doublethink,” and which mental health professionals, searching for calm, precise language, call “dissociation.”

The guarantee of safety in a battering relationship can never be based upon a promise from the perpetrator, no matter how heartfelt. Rather, it must be based upon the self-protective capability of the victim. Until the victim has developed a detailed and realistic contingency plan and has demonstrated her ability to carry it out, she remains in danger of repeated abuse.

After a traumatic experience, the human system of self-preservation seems to go onto permanent alert, as if the danger might return at any moment.

By developing a contaminated, stigmatized identity, the child victim takes the evil of the abuser into herself and thereby preserves her primary attachments to her parents. Because the inner sense of badness preserves a relationship, it is not readily given up even after the abuse has stopped; rather, it becomes a stable part of the child’s personality structure.

The mental health system is filled with survivors of prolonged, repeated childhood trauma. This is true even though most people who have been abused in childhood never come to psychiatric attention. To the extent that these people recover, they do so on their own. While only a small minority of survivors, usually those with the most severe abuse histories, eventually become psychiatric patients, many or even most psychiatric patients are survivors of childhood abuse. The data on this point are beyond contention. On careful questioning, 50-60 percent of psychiatric inpatients and 40-60 percent of outpatients report childhood histories of physical or sexual abuse or both. In one study of psychiatric emergency room patients, 70 percent had abuse histories. Thus abuse in childhood appears to be one of the main factors that lead a person to seek psychiatric treatment as an adult.

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