Trauma and Recovery by Judith L. Herman, M.D., Basic Books, $27.00

Reviewed by John A. Speyrer

Trauma and Recovery is a well written book surveying the recent history of psychological trauma over the past century beginning with hysteria, shell shock or combat neurosis and ending with sexual and domestic violence.

A short but interesting history of the phenomena of hysteria, along with facts concerning its leading figures, Janet, Charcot and Freud is given. The author writes that Freud glimpsed the truth of sexual trauma but recoiled from it in horror and it was not until the women's movements in the 1970s that the real extent of the sexual victimization of women and children was realized.

The author mentions that the first in-depth attempt to study and treat shell shocked combat veterans was begun after World War I. Emotional flooding techniques were used to alleviate symptoms and return the soldier to combat. The author has a strong feminist agenda as she makes an obvious effort to tie in the three forms of trauma to political movements.

Dr. Herman (a Professor of Psychiatry at Harvard) describes some of the effects trauma has on its victims including hyperarousal, feeling that one has been intruded upon, surrender or constriction and the feeling of disconnection. The psychological symptoms of being held a captive for both a short term and long term are examined. The effects of child sexual abuse are then examined. The author claims that childhood abuse is one of the principle reasons why adults seek psychiatric help for a bewildering array of nervous and depressive symptoms. And so ends part one of Trauma and Recovery which I thought was interesting and well presented.

The second half of the book is about recovery from traumas. Dr. Herman discusses the development of healing relationships with therapists and support groups. She reasons that since the effect of the trauma is to disempower and disconnect the victims from others, recovery from the effects of the trauma means that the victim becomes empowered and able to form new attachments. In order to recover, the victim must feel safe, writes the author. In the safe environment of psychotherapy, the dissociated trauma enters into consciousness and the victim with support becomes less isolated and becomes able to form more social connections.

Some patients might feel that re-living the trauma in therapy will solve their problems but the author feels that the therapist should be cautious and not be like the perpetrator and inflict pain on the survivor. The author feels that current cathartic treatments, which have become popular, are simply just a quest for a quick magical cure.

She says that exploring repressed memories in depth sometimes causes more symptoms to erupt. The watchword here is safety, but after having emphasized that point, the author concedes that nonetheless the trauma itself must be examined and integrated into the victim's life. In therapy the victim tells the story of the trauma, but the emphasis of Dr. Herman seems to be on caution and security, since she believes that approaching the trauma too quickly leads to a damaging and fruitless re-living. However, she acknowledges that showing the feelings which accompanied the trauma is important.

In a chapter on Reconnection, the author emphasizes the importance of self-integration. The author writes not about re-living the trauma but rather about how important it is for the victim to reconnect to the outside world and develop new relationships. The trauma, she believes, has made the victim too self-centered and has interfered with her capacity to relate to others so relating to others and connecting to the outside world shows that recovery has taken place.

Unfortunately, the author believes that this restored behavior points to the beginning of resolution of the trauma. However, to me, it seems probable that the new behavior may be merely a strengthening of the victim's defenses based on insight.

Dr. Herman concludes Trauma and Recovery by writing that when the victim gets to the point where she sees her own troubles as a "drop of rain in the sea'' then she can rest from her work and the victim's recovery has been accomplished. Are not defenses, and especially denial, wonderfully curative?

The only thing Trauma and Recovery has going for it are the excellent descriptions and case studies of the psychological consequences of trauma.