Psychosocial and Alternative Models

Judith Herman's Work

In her book Trauma and Recovery, Judith Herman (1992) takes a very humanistic and sociopolitical approach to understanding posttraumatic stress and reactions. Her work is based in part on psychodynamic theory but also on a sophisticated and humane understanding of the role that traumatized people play in the social order, society, and our culture. She has combined both a clinical and social approach. Herman believes that trauma is an almost taboo subject and experience in most societies and that trauma victims suffer not only from the direct effects of the traumatic stressor themselves but also from a type of social trauma. She states, "The ordinary response to atrocities is to banish them from consciousness" (p. 1). That is, victims and those around them, including society as whole, wish to forget. For Herman, healing from trauma for both the individual victim and society requires that the events be acknowledged and their reality validated. We must bear witness if healing is to occur. This process is extremely difficult and often consists of oscillating periods between open acknowledgment and denial, a process she calls the dialectic of trauma.

A basic understanding of trauma requires that a political movement and sociopolitical context of support exist in order to combat the natural forces of denial, repression, and avoidance. Herman (1992) is adamant about the role that discrediting trauma victims plays in increasing their suffering and symptom-ology. Forgetting what happened, whether it is on an individual level, a family or group level, or at the level of society, is a critical feature in maintaining the syndrome. Herman states that perpetrators of trauma want everyone to forget and use secrecy, silence, and attacks on a victim's credibility to help this process along. Posttraumatic Stress Disorder is seen as an affliction of the powerless accompanied by extremely strong subjective experiences of helplessness and of being overpowered and overwhelmed. When the natural or normal responses to danger fail to bring safety and security, thus comes the experience of trauma.

The intrusive symptoms of PTSD are a consequence of the way traumatic stimuli are encoded in memory. Because of abnormal levels of sympathetic (fight or flight) arousal, the normal pathways of iconic and linguistic memory are not established, and memories associated with the stimuli are not organized in a manner easily talked about or discussed. Victims lack verbal narrative and context. Memories are stored in the form of vivid sensations and images. This is, perhaps, why talk therapy can be so effective with trauma survivors.

In keeping with her emphasis on the social context in which a trauma occurs, Herman (1992) focuses on the role played by a victim's sense of disconnection from other people and from his or her environment in PTSD. Trauma can challenge one's sense of attachment, especially in situations in which the trauma is a consequence of human action, such as violence. One can become disconnected from oneself as his or her ties to others bring into question a sense of having a stable identity as it relates to other people. Belief systems related to an orderly and stable social order and even the world at large can lead to strong feelings of instability and of experiencing the world as unpredictable. The sense of disconnection then can be felt in relation to others, oneself, and even the world as a whole.

With trauma, our sense of basic safety is significantly challenged. Herman reminds us that our sense of basic trust is initially established in our interactions with our primary caregiver, a la Erik Erikson's work on basic trust versus mistrust. Our basic sense of trust enables us to engage the world. Herman (1992) states, "the original experience of care makes it possible for human beings to envisage a world in which they belong, a world hospitable to human life" (p. 51). Trauma challenges this and leads to an experiencing of relationships as alien and fraught with abandonment. In keeping with her psychoanalytic roots and similar to the work of Freud, Herman states that trauma reactivates old psychodynamic conflicts and our struggles related to autonomy, initiative, competence, identity, and intimacy. As our autonomy fails to triumph over the powerful traumatic stimulus, our ability to self-regulate our emotions and levels of arousal breaks down. Trauma, with its invasiveness, injuries, damage, and potential for death, violates our very basic bodily integrity, according to Herman. Finally, strong feelings of guilt and shame come from the passing of judgment of the victim upon oneself for having failed to be safe and avoid the overwhelming stimulus.

Disconnection does not just refer to a victim's orientation to the outside world but also to their intrapsychic or mental organization. Symptoms can become disconnected from the original stimulus or event and can become fragmented, leading to a sense of chaos and disorganization. They can take on a life of their own of sorts, and the purposeful action and responses of everyday living are disrupted and break down. Perception becomes untrustworthy, false, and fear-based despite no evidence of danger. Judgment and decision making fail as a consequence of bad data. The nervous system is reconditioned, resulting in a perpetual state of alert with no or very little habituation.

Herman (1992) adds that traumatic reactions are individualized and unique to each person with no two people necessarily reacting the same. Individual differences, with some people being relatively immune to PTSD and still others being vulnerable, are important factors. Stress-resilient people are typically highly social people who are thoughtful, have an active coping style, and have a strong sense of being able to control their own destinies. Interestingly, true belief in the concept of having good luck for having survived a trauma intact seems to be an important buffer. Social support is also a mitigating factor. Coming full circle, Herman states that the community reaction is an extremely important factor with importance being placed on acknowledgment and assigning blame and responsibility to perpetrators with recognition and restitution being necessary to "rebuild a survivor's sense of order and justice" (p. 70).

Feminist Theory

Coinciding with the theoretical and empirical development and investigation of PTSD in Vietnam veterans was the painstaking work of feminist-oriented therapists and their experiences with women survivors of sexual assault, domestic violence, childhood abuse, and sexual harassment. Similar to the work of Judith Herman, feminist practitioners, theoreticians, and researchers took a more contextual and social view of trauma, and, as Laura Brown (2004) states, "moved the locus of the problem of interpersonal violence from its historical location in the victim's personality to the misogyny of the culture expressed through the actions of perpetrators of violence" (p. 464). Trauma is framed within its social, emotional, and political environments, and Brown (2004) summarizes the feminist theory of trauma best:

[The] feminist theory of trauma argues that what is traumatizing to a person is not simply the experience of threat to life or safety. Rather, it is what will be symbolically evoked by this experience and the manner in which the social context responds to the person who has been traumatized. (p. 465)

Trauma, specifically interpersonal violence, is seen as an individualized representation of societal or institutional forms of discrimination, repression, and oppression such as racism, sexism, or heterosexism. Vulnerability is set up by the presence of unjust "hierarchies of value in the culture," according to Laura Brown (2004, p. 465). Thus, trauma is a violation that serves to uphold the oppressive cultural status quo.

Root (1992) proposed the concept of insidious traumatization in which persons of target and marginalized groups experience subthreshold traumatic stressors on a daily basis. Three examples are cited: (1) news that a member of one's group has been the target of bias-based violence or discrimination, (2) negative and stigmatizing images of one's group in media, textbooks, and discourse of peers and coworkers, and (3) various forms of institutionalized racism, heterosexism, and other exclusionary systems of value in which the individual is denied access to material or human resources solely on the basis of group membership. Such subthreshold stressors are cumulative and "serve as constant reminders of the precariousness of one's safety in contexts where one's group is the target of bias" (Brown, 2004, p. 466). This can lead to relatively small stressors leading to PTSD symptom expression. In my own practice, I have evaluated numerous individuals, who seem to have a dormant form of PTSD, thats' become activated by a serious, but certainly not dangerous or life-threatening, situation or event. One such patient began to have both PTSD symptoms and debilitating panic attacks after being yelled at by her boss and after he jumped up out of his seat and pointed his finger at her. Roots believed that what is traumatic in such situations is the representation of a threat to one's safety.

Lay Person Alert

Don't Let the word feminist get in the way of the power and importance of such models of trauma. In fact, the work of feminist-oriented professionals might be extremely important if someone finds him- or herself in a situation at work or in a relationship that he or she finds extremely troubling but does not understand why. If someone finds that he or she may be having what most people think is an extreme reaction to a minor event, consider the concepts of insidious traumati-zation. Confusion, doubt, and strong feelings of shame and guilt might be indications of something more serious going on, something that before the work of feminists might have been disregarded, ignored, dismissed, or just forgotten.

The Constructivist Narrative Perspective

Social scientists and psychologists from the constructivist perspective hold central the tenet that people actively construct their individual realities and "create their own representational models of the world" (Meichenbaum & Fitzpatrick, 1993, p. 707). We don't respond to the world in its pure form but rather to our interpretations of the information we receive about the world and to the implications of that information.

The meaning of information is constructed in a narrative process or stories that we "tell ourselves to others, as well as to ourselves" (Meichenbaum & Fitzpatrick, 1993, p. 707). Narrative psychology is the study of such stories. We make sense and meaning of the world in terms of such stories. Victor Frankl was a famous psychologist and survivor of a Nazi concentration camp in World War II. In his book Man's Search for Meaning, Frankl spoke of the importance of finding meaning in life as crucial to both physical and psychological survival, but implicit in his work was the idea that meaning could be derived almost despite the adverse circumstances in which one finds himself. Meichenbaum and Fitzpatrick (1993) proposed that meaning making through narrative often occurs in response to disruptions in a person's routine and when reacting or adjustment is necessary, "especially when their physical or psychological well-being is judged to be at stake" (p. 708). Stressful events or traumatic stressors would certainly qualify as such. The process of posttraumatic adjustment is thought to be critically influenced by how a person goes through the narrative construction process and that, ultimately, good adjustment and health emerge from what Schafer (1981) called narrative repair.

Traumatic stimuli and events have the effect of challenging or damaging one's personal reality-one's assumptive world (Epstein, 1991). Thus, constructing a new narrative and assumptive world that assimilates the traumatic experience is crucial to recovery. Engaging in the why process is a natural example of a question that fuels the narrative construction process. Many posttrauma survivors have even questioned their "god," sometimes finding answers in religious and spiritual revelation. Baumeister, Stillwell, and Wotman (1990) report that whether a survivor defines himself as a victim or perpetrator will influence distress levels and symptom expression. Even the symptoms of intrusive imagery are thought of as an attempt to make sense of the event. Posttraumatic Stress Disorder and chronic distress can result from an inability to construct meaning from an event, leaving one feeling chronically overwhelmed and fragmented. Although a search for meaning and narrative construction are seen as health-generating processes, Tait and Silver (1989) found that a persistent search for meaning for an event was inversely related to psychological health and well-being when there was no final resolution or conclusion. It would seem that telling a story about what happened can help if the story has an ending but not if it just goes on and on.

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