Trauma and Recovery: The Aftermath of violence-from domestic abuse to political terror by Judith Herman

 - a book review by Jennifer Frechette, graduate student from Skidmore College.

Jennifer is a case manager at Monadnock Family Services in Keene, NH and is currently undertaking an independent study course on Trauma and Intimate Partner Violence. I am her independent study instructor for this course. She wrote this review as an assignment and it was so well done I asked for her permission to reprint it here.


Trauma and Recovery: The Aftermath of violence-from domestic abuse to political terror, written in 1992 by Judith Herman, published by Basic Book New York, NY reviews the history of psychological trauma including hysteria, shell shock and sexual and domestic violence. Judith Herman also wrote Father-Daughter Incest and other various journal articles. Judith Lewis Herman is a psychiatrist, researcher, teacher, and author whose primary focus has been on the treatment and knowledge of those that have had traumatic experiences as well as those that are victims of incest. Dr. Herman is a Professor of clinical psychiatry at Harvard University Medical School and Director of Training at the Victims of Violence Program in the Department of Psychiatry at the Cambridge Health Alliance in Cambridge, Massachusetts. She is also a founding member of the Women’s Mental Health Collective (Retrieved from http://en.wikipedia.org/wiki/Judith_Lewis_Herman). She received multiple awards ranging Lifetime Awards for Traumatic Stress Studies, Science Awards, and Psychiatric Association awards. Herman created the term “complex post-traumatic stress disorder,” which has now been included as an extension of PTSD (Post Traumatic Stress Disorder). Lenore Walker states that, “Herman's brilliant insights into the nature of trauma and the process of healing shine through in every page of this rich and compassionate book. Must reading for all who are concerned with this most crucial issue of our time" (Hopper, 1996-2010). Laura Davis, Coauthor of The Courage to Heal praised Herman’s work as a, "A triumph. Trauma and Recovery is astute, accessible and beautifully documented. Bridging the worlds of war veterans, prisoners of war, battered women and incest victims, Herman presents a compelling analysis of trauma and the process of healing. She presents a convincing case for the empowerment and care of all trauma victims” (Hopper, 1996-2010).

One of Herman’s biggest contributions to the field of psychology is the concept of complex post-traumatic stress disorder (CPTSD) which is an extension post-traumatic stress disorder (PTSD) to include repeated trauma and its impact on the psyche. (Wikipedia citation) Herman’s purpose for writing this book is to inform the reader of the effects of trauma on the victim, such as hyper arousal, inability to trust and disconnection. Herman cites the women’s liberation movement as the driving force behind her courage and reasoning for writing the book as well as the work that she did during her fellowship which is the backbone to Trauma and Recovery. Herman’s main concentration in Trauma and Recovery is to outline the fundamental stages of recovery which she designates as, “establishing safety, reconstructing the trauma story, and restoring the connection between survivors and their community“(Herman, 1992, p. 3). Herman (1992) cites that her reason for writing Trauma and Recovery was to give a voice to the numerous people who have participated in witnessing other people’s traumatic experience and expanding it to include a united front by which counselors can go forth to assist victims of trauma (p. 237).

The first section of Herman’s book, titled A Forgotten History, outlines the history of hysteria as it pertains to its relation to sexual trauma and the lack of acknowledgement of it in the psychiatric society. Herman states that the women’s movement was the breakthrough for the acknowledgement of women’s sexual and domestic violence and trauma histories and eliminated the silence that permeated psychology society. Herman (1992) states that “To study psychological trauma is to come face to face both with human vulnerability in the natural world and with the capacity for evil in human nature” (p. 7). One of the points that stood out to me in this first section was the importance that victims report their perpetrators and for others who know of violent and sexual crimes to report as well, as Herman (1992) states, “ All the perpetrators asks is that the bystander do nothing” ( p. 7).

Herman introduces the concept of hysteria and neurosis as a field dominated by Janet, Freud, and Breuer who reported that the physical manifestations of hysteria represented past traumatic experiences which had been suppressed in the subconscious. This concept, however, which eventually manifested in the discovery of the high percentage of child sexual abuse, was not well accepted by the public. Dora, a patient of Freud’s who had been sexually abused by her father, received the brunt of the negative public view of Freud’s finding which resulted in Freud dismissing Dora’s trauma history and invalidating her feelings. Herman (1992) also reviews the combat neurosis of what she calls the “sex war” and the prevalent public humiliation and degradation that women who have been raped experience which results in a societal decrease in reporting rape. Herman (1992) discusses the power of psychological trauma, the effects that it has on the somatic nervous system, as well as the significant changes in memory, emotions, adaptive abilities, and arousal (p. 34). She cites memory triggers as a debilitating force that can rear its ugly head at the most unexpected times. Herman outlines that memory for those that have been traumatized is not “ normal memory” and therefore encodes in a different way and triggers constant recitation of the traumatic memories causing constant intrusion into everyday experiences. Herman (1992) goes on to describe constriction or “numbing” which Herman cites as the “third cardinal symptom of post-traumatic stress disorder” (p.42). In this stage people literally become numb to the abuse and begin dissociating in order to cope with the trauma. She states that the most obvious feature of post-traumatic stress disorder is what she calls the “dialectic of opposing psychological states” (Herman, 1992, p. 47).

Herman’s third chapter is titled Disconnection. In this chapter she outlines the way in which traumatic experiences impact the community surrounding those that are traumatized. Herman (1992) cites Janoff- Banc as stating that, “traumatic events destroy the victim’s fundamental assumptions about the safety of the world, the positive value of the self, and the meaningful order of creation” (p. 51). This impacts the traumatized person’s ability to start new relationships, trust others, and maintain current long standing relationships and decreases the person’s ability to believe in themselves. This distrust also manifests into distrust of faith and can result in loss of faith completely. Herman (1992) describes a phenomenon of the traumatized person either clinging to or isolating themselves from those around them and the frequency of changing between the two. This is a phenomenon that I am very familiar with due to working with clients that have PTSD (p. 56).

Herman discusses the impact that trauma has on those it touches and the vulnerability that those face that have been traumatized. Herman (1992) states that the “experience of terror and disempowerment during adolescence effectively compromises the three normal adaptive tasks of this stage of life: the formation of identity, the gradual separation from the family of origin, and the exploration of a wider social world” (p. 61). Herman goes on to encourage reconnection and the vast improvements that it has on the traumatized person’s acuity of life prior to the trauma. She addresses the difficulty of rebuilding a sexual relationship due to distrust, triggers, and previous sexual experiences. Herman encourages open communication between sexual partners and the acknowledgement of the previous trauma by the other member of the sexual relationship. Commonly, women who have been raped experience blame for their actions in being raped as well as a shroud of secrecy regarding their rape by those around them not acknowledging it by its name (Herman, 1992, p. 67).

Captivity, the title of Herman’s fourth chapter, addresses the prolonged repeated trauma that those in captivity experience. She highlights the concepts of psychological domination citing the definition of “seasoning” which is “the systematic use of coercive techniques to break women into prostitution” as an example of psychological domination (Herman, 1992, 76). Alongside “seasoning” comes “breaking” whereby the women being isolated, beaten, and conditioned eventually break and become compliant to their abuser. Herman (1992) states that there are two stages to being “ broken,” stating the first one as when the person “ relinquishes her inner autonomy, world view, moral principles, or connection with others for the sake of survival”( p. 85), and the second is when the person loses the want to live. Herman also describes the phenomena of the victim bonding to the perpetrator due to the victim being emotionally bonded to the perpetrator through the traumatic experience.

Herman thoroughly describes throughout the fourth chapter what victims fear, how they are traumatized continually, and the features that epitomize post-traumatic stress disorder, such as hypervigiliance, anxiety, distrust and at times dissociation. She also addresses the somatic symptoms that can manifest such as headaches, abdominal, back, and pelvic pain, and stomach complications (Herman, 1992, p. 86). Herman describes the ways in which victims stay alive in captive situations not by concentrating on how to escape from their captures but making their situation better; many times this involves dissociation. Herman (1992) completes the chapter by discussing the concept of “survivor syndrome” where survivors often identify themselves alternatively to who they were before the trauma and identify as less than human and often this results in suicide (p. 94). Herman (1992) cites a study where out of 100 battered women, 42 had attempted suicide, stating that “the survivor may direct her rage and hatred against herself. Suicidality, which sometimes served as a form of resistance during imprisonment, may persist long after release” (p. 95).

Herman’s fifth chapter focuses on child abuse and ties together Freud’s diagnosis of hysteria with the modern day diagnosis of multiple personality disorder which incorporates sexual dysfunction, depression, suicidality, amnesia, somatic symptoms, and other symptoms (Herman, 1992, p. 97). Herman (1992) makes it clear that children who are victims of sexual abuse often are “silenced by violence” (p. 98), which often results in distrust and paranoia about telling their story for fear of inadvertently causing harm to their families. Herman goes into detail of what child victims endure during their abuse ranging from forced feeding, sleep deprivation, and the increase in bodily alert systems that they learn i.e. knowing the sounds of the footsteps of their abuser.. Children utilize avoidance techniques and what Herman calls doublethink to cope with the abuse, which many times they carry on into their adult lives which carries into their interpersonal skills and ability to form meaningful, trusting relationships with others. Many survivors of abuse begin to self harm as a way to relieve pain. Herman (1992) states that, “the adult survivor is at great risk of repeated victimization in adult life. The risk of rape…is approximately doubled for survivors of childhood sexual abuse” (p. 111).

In chapter six A New Diagnosis, Herman addresses the need for change in the mental health field for diagnosis mislabeling as well as the need for a new way to look at long term trauma. Here Herman introduces her concept of “complex post-traumatic stress disorder” (CPTSD) which includes “prolonged, repeated trauma” (Herman, 1992, p. 119). Herman (1992) outlines the diagnostic underpinnings of CPTSD including;

1. A history of subjection to totalitarian control over a prolonged period ( months to years)

2. Alterations in affect regulation

3. Alternations in consciousness

4. Alterations in self-perception

5. Alterations in perception of perpetrator

6. Alterations in relations with others

7. Alterations in systems of meaning (p. 121).

Herman (1992) states that she is troubled by the diagnoses that victims of trauma receive citing somatization disorder, borderline personality disorder, and multiple personality disorder as three of them (p. 123). Herman reports that she believes that these are negative diagnoses and can result in complications with standard of care with mental health workers and cooperation from family members. Herman (1992) goes on to elaborate about the diagnosis of borderline personality disorder and the qualifying diagnostic traits that they frequently exhibit such as clinging and withdrawing, unstable relationships, and fear of abandonment (p. 124).

In the second section her book, Stages of Recovery, Herman provides an overview of her stage therapy process which includes establishing safety, remembrance and mourning, and reconnection. In Herman’s overview she discusses the importance of each of these in the process of healing from trauma and provides the reader with working examples of how the stages are worked through as well as other stage theories that have come before hers. Herman outlines that the first task of a therapist is to identify the diagnostic markers and to collect as much information about the patient as they can.

Herman (1992) states that “The first principle of recovery is the empowerment of the survivor” (p. 133), which includes establishing safety within the therapeutic relationship and trust among the support systems that the survivor surrounds herself with. Herman recognizes the difficulty that therapists face with working with victims and the stress that it can place on the therapists stating that “the therapist is called upon to bear witness” (Herman, 1992, p. 135) and by being called upon must align him or herself with the victim and the victim’s experience. Herman discusses the challenges that the therapeutic relationship can face such as counter transference and mistrust as well as the challenges that the survivor faces when attempting to establish safety, especially when she continues to be in an unsafe environment at home. Herman(1992) states that in order to combat the feeling of safety which is taken away from victims when they are traumatized, “ the guiding principle of recovery is to restore power and control to the survivor” ( p. 159). In this section of her book, Herman gives many graphic descriptions of what survivors have been through and uses stories from her own patients to illustrate her therapeutic techniques as it relates to real life traumatic experience.

The second stage of recovery, according to Herman, is Remembrance and Mourning. By completing this stage women reconstruct the memory and are able to “transform the traumatic memory, so that it can be integrated into the survivor’s life” (Herman, 1992, p.173). The therapist’s position is that of witness and an advocate for the survivor. Herman states that it is important to incorporate the feelings of safety and empowerment throughout this stage from the first stage of creating a safe therapeutic relationship. Reconstructing the survivor’s story involves reviewing their life story before and after the abuse. The survivor has to discover what the abuse meant to them. Two common techniques for this are “direct exposure” and “flooding” which are both used to overcome the traumatic experience (Herman, 1992, 181). Finally, after this stage is complete the survivor has to decide what they would like to do about the abuse and have to come to “terms with the impossibility of getting even” (Herman, 1992, p. 189).

The next and final step in Herman’s step theory is Reconnection. In taking this step, survivors make new connections, renew old connections, and incorporate their trauma into their everyday lives. Herman (1992) states that there is a need for the survivor to “taste fear” (p. 198) in this stage and learn how to stick up for themselves. By doing so, they are able to begin to self advocate and might even be able to confront their perpetrator. Herman reflects on the deepening of the therapeutic relationship through the reconnection process and states that the patient (or survivor) becomes able to self evaluate and reflect on the improvements she can make on herself. Herman goes on to discuss the importance of group therapy in mourning the traumatic experience and creating greater connections through common experience. In this ending portion she presents the reader with examples of positive group interactions and the benefits it can have towards survivor’s recovery.

I found Judith Herman’s book a refreshing and vivid look into the world of traumatic experience and therapy interactions. Herman was clear on her stage presentation and provided examples of survivors working through the stage as well as complications that she herself experienced while working through the stages with the survivor in the therapy relationship. Herman didn’t allow for lax conversation in her book and presented the reader with vivid, graphic, and sometimes sickening trauma that victims have gone through and the ways in which she was able to help as well as ways that she was not. I was able to connect the body of work that I have read previously to Herman’s stage theory and found hers to be clearer and more precise than many of the other theorists I have read about. Her ability to adapt to the survivor’s individual experience while maintaining the integrity of her stage theory provided me with a clear opinion that she was versatile and wanting to truly assist survivors in the recovery process.


Works Cited

Herman, J. (1992). Trauma and Recovery: The aftermath of violence-from domestic abuse to political terror. New York, NY: Basic Books.

Hopper, J. (1996-2010). Praise, Table of Contents, & Excerpts [Review of the book Trauma and Recovery]. Retrieved from http://www.jimhopper.com/trauma_and_recovery/

Retrieved from: http://en.wikipedia.org/wiki/Judith_Lewis_Herman.