Trauma And Recovery

Trauma And Recovery.

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. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. 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. The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner, which undermines their credibility and thereby serves the twin imperatives of truth telling and secrecy. When the truth is finally recognised, 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 psychological distress symptoms of traumatised people simultaneously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatised people alternate between feeling numb and reliving the event. 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 a calm and precise language, call “dissociation.” It results in the protean, dramatic, and often bizarre symptoms of hysteria which Freud recognised a century ago as disguised communications about sexual abuse in childhood.

Witnesses as well as victims are subject to the dialectic of trauma. It is difficult for an observer to remain clearheaded and calm, to see more than a few fragments of the picture at one time, to retain all the pieces, and to fit them together. It is even more difficult to find a language that conveys fully and persuasively what one has seen. Those who attempt to describe the atrocities that they have witnessed also risk their own credibility. To speak publicly about one’s knowledge of atrocities is to invite the stigma that attaches to victims. The knowledge of horrible events periodically intrudes into public awareness but is rarely retained for long. Denial, repression, and dissociation operate on a social as well as an individual level. The study of psychological trauma has an “underground” history. Like traumatised people, we have been cut off from the knowledge of our past. Like traumatised people, we need to understand the past in order to reclaim the present and the future. Therefore, an understanding of psychological trauma begins with rediscovering history.

Clinicians know the privileged moment of insight when repressed ideas, feelings, and memories surface into consciousness. These moments occur in the history of societies as well as in the history of individuals. In the 1970s, the women’s liberation movement brought to public awareness the widespread crimes of violence against women. Victims who had been silenced began to reveal their secrets. As a psychiatric resident, I heard numerous stories of sexual and domestic violence from my patients. Because of my involvement in the women’s movement, I was able to speak out against the denial of women’s real experiences in my own profession and testify to what I had witnessed. My first paper on incest, written with Lisa Hirschman in 1976, circulated “underground,” in manuscript, for a year before it was published. We began to receive letters from all over the country from women who had never before told their stories. Through them, we realised the power of speaking the unspeakable and witnessed firsthand the creative energy that is released when the barriers of denial and repression are lifted.

People who have endured horrible events suffer predictable psychological harm. There is a spectrum of traumatic disorders, ranging from the effects of a single overwhelming event to the more complicated effects of prolonged and repeated abuse. Established diagnostic concepts, especially the severe personality disorders commonly diagnosed in women, have generally failed to recognise the impact of victimisation. Because the traumatic syndromes have basic features in common, the recovery process also follows a common pathway. The fundamental stages of recovery are establishing safety, reconstructing the trauma story, and restoring the connection between survivors and their community.

Credit: Dr Judith Herman, 1992.