Paperback, 288 pages
Published by Basic Books
Publication date: May 1, 1997
Originally published 1992
The author, a professor of psychiatry at Harvard, draws upon published research and her own clinical work to build a model of psychological trauma that she applies to such diverse situations as hysteria, combat neurosis (shell shock), captivity, torture, political terror, child sexual abuse, and domestic violence. These varied forms of trauma have a common effect on survivors, including feelings of disempowerment and denial. Diagnostic criteria for Complex Post Traumatic Stress Disorder (CPTSD) may include hyperarousal, feeling that one has been intruded upon, surrender or constriction and the feeling of disconnection from people and things.
The author believes that just as "traumatic syndromes have basic features in common, the recovery process also follows a common pathway." Her model has three major stages: Establishing Safety, Remembrance and Mourning, and Reconnection.
Since she believes that the effect of trauma is to disempower and disconnect the survior from others, recovery can be measured by the extent to which the survivor can be made to feel empowered and able to form new attachments. In other words, trauma creates overwhelming fear and leaves in its wake a feeling that the world is not a safe place. Therefore recovery requires establishing a safe space for healing to begin.
The author takes issue with some current cathartic treatment models which encourage re-living the trauma. Herman feels that forcing pain on the survivor puts the therapist in the role of the perpetrator. Rather than perpetuating the abuse, she argues that therapists and other helping professionals should be cautious and should do as much as possible to make the survivor feel safe. Exploring repressed memories too quickly without sufficient safeguards can cause more symptoms to erupt in a damaging and fruitless way. A survivor can heal by telling the stories in a gradual manner that does not risk shattering the protective security of the therapeutic relationship.
Once safety is established the phase of "Remembrance and Mourning" can begin. During this period the survivor can grieve both for things actually lost and for possibilities never realized. As dissociated memories of trauma become conscious they can be integrated into the survivor's self-image in an appropriate way. The grief process continues as long as necessary to establish some degree of detachment from the loss.
The final phase of "Reconnection" emphasizes that the goal is not simply to re-live the trauma. but rather to reconnect to the world and develop new relationships. With support the survivor can become less isolated and can experiment with forming new social bonds. Recovery is marked by establishing new connections to the world and developing new relationships that are supportive to the survivor.
The author's view that that childhood abuse is one of the most common reasons why adults seek psychiatric help for a bewildering array of nervous and depressive symptom has made her a controversial figure in the "false memory syndrome" debate. Herman currently lectures on "the politics of memory" among other topics. Critics charge that "repressed memories" of child abuse, satanic rituals, alien abductions, and similar traumatic events are in many cases simply fantasies which have taken on undue reality thanks to the reinforcing feedback of therapists. Herman's strong feminist political agenda, linking the abuse of women and children with other forms of trauma, has also drawn fire from some quarters.
This book shows up on many college-level reading lists as a standard work on post-traumatic stress disorder (PTSD). It's also recommended for a general audience by the U. S. Department of Veteran's Affairs National Center for PTSD.