T&R Intro






The aftermath of violence – from domestic abuse to political terror © 1992


By Judith Lewis Herman, MD





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. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told.  Murder will out.  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 recognized, 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 traumatized people simulta­neously call attention to the existence of an unspeakable secret and deflect attention from it.  This is most apparent in the way traumatized 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, precise language, call “dissociation.”  It results in the protean, dramatic, and often bizarre symptoms of hysteria which Freud recognized 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 traumatized people, we have been cut off from the knowledge of our past.  Like traumatized 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 speakouts of 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 realized the power of speaking the unspeak­able and witnessed firsthand the creative energy that is released when the barriers of denial and repression are lifted.


Trauma and Recovery represents the fruits of two decades of research and clinical work with victims of sexual and domestic violence.  It also reflects a growing body of experience with many other traumatized people, particularly combat veterans and the victims of political terror.  This is a book about restoring connections: between the public and private worlds, between the individual and community, between men and women.  It is a book about commonalities: between rape survivors and combat veter­ans, between battered women and political prisoners, between the survi­vors of vast concentration camps created by tyrants who rule nations and the survivors of small, hidden concentration camps created by tyrants who rule their homes.


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 recognize the impact of victimization.  The first part of this book delineates the spectrum of human adaptation to traumatic events and gives a new diagnostic name to the psychological disorder found in survivors of prolonged, repeated abuse.


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.  The second part of the book develops an overview of the healing process and offers a new conceptual framework for psychotherapy with trauma­tized people.  Both the characteristics of the traumatic disorders and the principles of treatment are illustrated with the testimony of survivors and with case examples drawn from a diverse literature.


The research sources for this book include my own earlier studies of incest survivors and my more recent study of the role of childhood trauma in the condition known as borderline personality disorder.  The clinical sources of this book are my twenty years of practice at a feminist mental health clinic and ten years as a teacher and supervisor in a univer­sity teaching hospital.


The testimony of trauma survivors is at the heart of the book.  To preserve confidentiality, I have identified all of my informants by pseudo­nyms, with two exceptions.  First, I have identified therapists and clini­cians who were interviewed about their work, and second, I have identi­fied survivors who have already made themselves known publicly.  The case vignettes that appear here are fictitious; each one is a composite, based on the experiences of many different patients, not of an individual.


Survivors challenge us to reconnect fragments, to reconstruct history, to make meaning of their present symptoms in the light of past events.  I have attempted to integrate clinical and social perspectives on trauma without sacrificing either the complexity of individual experience or the breadth of political context.  I have tried to unify an apparently divergent body of knowledge and to develop concepts that apply equally to the experiences of domestic and sexual life, the traditional sphere of women, and to the experiences of war and political life, the traditional sphere of men.


This book appears at a time when public discussion of the common atrocities of sexual and domestic life has been made possible by the women’s movement, and when public discussion of the common atrocities of political life has been made possible by the movement for human rights.  I expect the book to be controversial—first, because it is written from a feminist perspective; second, because it challenges established diagnostic concepts; but third and perhaps most importantly, because it speaks about horrible things, things that no one really wants to hear about.  I have tried to communicate my ideas in a language that preserves connections, a language that is faithful both to the dispassionate, rea­soned traditions of my profession and to the passionate claims of people who have been violated and outraged.  I have tried to find a language that can withstand the imperatives of doublethink and allows all of us to come a little closer to facing the unspeakable.






Remembrance and Mourning pp. 175-76


IN THE SECOND STAGE OF RECOVERY, the survivor tells the story of the trauma.  She tells it completely, in depth and in detail.  This work of reconstruction actually transforms the traumatic memory so that it can be integrated into the survivor’s life story.  Janet described normal memory as “the action of telling a story.” Traumatic memory, by contrast, is wordless and static.  The survivor’s initial account of the event may be repetitious, stereotyped, and emotionless.  One observer describes the trauma story in its untransformed state as a “prenarrative.”  It does not develop or progress in time, and it does not reveal the storyteller’s feelings or interpretation of events.Another therapist describes traumatic memory as a series of still snapshots or a silent movie; the role of therapy is to provide the music and words.2


The basic principle of empowerment continues to apply during the second stage of recovery.  The choice to confront the horrors of the past rests with the survivor.  The therapist plays the role of a witness and ally, in whose presence the survivor can speak of the unspeakable.  The reconstruction of trauma places great demands on the courage of both patient and therapist.  It requires that both be clear in their purpose and secure in their alliance.  Freud provides an eloquent description of the patient’s approach to uncovering work in psychotherapy: “[The patient] must find the courage to direct his attention to the phenomena of his illness.  His illness must no longer seem to him contemptible, but must become an enemy worthy of his mettle, a piece of his personality, which has solid ground for its existence, and out of which things of value for his future life have to be derived.  The way is thus paved . . . for a reconciliation with the repressed material which is coming to expression in his symptoms, while at the same time place is found for a certain tolerance for the state of being ill.”3


As the survivor summons her memories, the need to preserve safety must be balanced constantly against the need to face the past. The patient and therapist together must learn to negotiate a safe passage between the twin dangers of constriction and intrusion.  Avoiding the traumatic memories leads to stagnation in the recovery process, while approaching them too precipitately leads to a fruitless and damaging reliving of the trauma.  Decisions regarding pacing and timing need meticulous attention and frequent review by patient and therapist in concert. There is room for honest disagreement between patient and therapist on these matters, and differences of opinion should be aired freely and resolved before the work of reconstruction proceeds.


The patient’s intrusive symptoms should be monitored carefully so that the uncovering work remains within the realm of what is bearable.  If symptoms worsen dramatically during active exploration of the trauma, this should be a signal to slow down and to reconsider the course of the therapy.  The patient should also expect that she will not be able to function at the highest level of her ability, or even at her usual level, during this time.  Reconstructing the trauma is ambitious work. It requires some slackening of ordinary life demands, some “tolerance for the state of being ill.”  Most often the uncovering work can proceed within the ordinary social framework of the patient’s life.  Occasionally the demands of the therapeutic work may require a protective setting, such as a planned hospital stay.  Active uncovering work should not be undertaken at times when immediate life crises claim the patient’s attention or when other important goals take priority.




Reconstructing of the trauma story begins with a review of the patient’s life before the trauma and the circumstances that led up to the event. Yael Danieli speaks of the importance of reclaiming the patient’s earlier history in order to “re-create the flow” of the patient’s life and restore a sense of continuity with the past.4  The patient should be encouraged to talk about her important relationships, her ideals and dreams, and her struggles and conflicts prior to the traumatic event.  This exploration provides a context within which the particular meaning of the trauma can be understood.


The next step is to reconstruct the traumatic event as a recitation of fact.  Out of the fragmented components of frozen imagery and sensation, patient and therapist slowly reassemble an organized, detailed, verbal account, oriented in time and historical context.  The narrative includes not only the event itself but also the survivor’s response to it and the responses of the important people in her life.  As the narrative closes in on the most unbearable moments, the patient finds it more and more difficult to use words.  At times the patient may spontaneously switch to nonverbal methods of communication, such as drawing or painting.  Given the “iconic,” visual nature of traumatic memories, creating pictures may represent the most effective initial approach to these “indelible images.”  The completed narrative must include a full and vivid description of the traumatic imagery.  Jessica Wolfe describes her approach to the trauma narrative with combat veterans: “We have them reel it off in great detail, as though they were watching a movie, and with all the senses included.  We ask them what they are seeing, what they are hearing, what they are smelling, what they are feeling, and what they are thinking.”  Terence Keane stresses the importance of bodily sensations in reconstructing a complete memory: “If you don’t ask specifically about the smells, the heart racing, the muscle tension, the weakness in their legs, they will avoid going through that because it’s so aversive.”5


A narrative that does not include the traumatic imagery and bodily sensations is barren and incomplete.6  The ultimate goal, however, is to put the story, including its imagery, into words.  The patient’s first attempts to develop a narrative language may be partially dissociated.  She may write down her story in an altered state of consciousness and then disavow it.  She may throw it away, hide it, or forget she has written it.  Or she may give it to the therapist, with a request that it be read outside the therapy session.  The therapist should beware of developing a sequestered “back channel” of communication, reminding the patient that their mutual goal is to bring the story into the room, where it can be spoken and heard.  Written communications should be read together.


The recitation of facts without the accompanying emotions is a sterile exercise, without therapeutic effect.  As Breurer and Freud noted a century ago, “recollection without affect almost invariably produces no result.” At each point in the narrative, therefore, the patient must reconstruct not only what happened but also what she felt.  The description of emotional states must be as painstakingly detailed as the description of facts.  As the patient explores her feelings, she may become either agitated or withdrawn.  She is not simply describing what she felt in the past but is reliving those feelings in the present.  The therapist must help the patient move back and forth in time, from her protected anchorage in the present to immersion in the past, so that she can simultaneously re-experience the feelings in all their intensity while holding on to the sense of safe connection that was destroyed in the traumatic moment.8


Reconstructing the trauma story also includes a systematic review of the meaning of the event, both to the patient and to the important people in her life.  The traumatic event challenges an ordinary person to become a theologian, a philosopher, and a jurist.  The survivor is called upon to articulate the values and beliefs that she once held and that the trauma destroyed.  She stands mute before the emptiness of evil, feeling the insufficiency of any known system of explanation.  Survivors of atrocity of every age and every culture come to a point in their testimony where all questions are reduced to one, spoken more in bewilderment than in outrage: Why?  The answer is beyond human understanding.


Beyond this unfathomable question, the survivor confronts another, equally incomprehensible question: Why me?  The arbitrary, random quality of her fate defies the basic human faith in a just or even predictable world order.  In order to develop a full understanding of the trauma story, the survivor must examine the moral questions of guilt and responsibility and reconstruct a system of belief that makes sense of her undeserved suffering.  Finally, the survivor cannot reconstruct a sense of meaning by the exercise of thought alone.  The remedy for injustice also requires action.  The survivor must decide what is to be done.



1.  R Mollica, “The Trauma Story: The Psychiatric Care of Refugee Survivors of Violence and Torture,” in Post-Traumatic Therapy and Victims of Violence, ed. F. Ochberg (New York: Brunner/Mazel, 1988), 295-314


2.  F. Snider, Presentation at Boston Area Trauma Study Group (1986)


3.  S. Freud, “Remembering, Repeating, and Working-Through (Further Recommendations on the Technique of Psycho-Analysis, II,” [1914]) in Standard Edition, vol, 12, trans. J. Strachery (London: Hogarth Press, 1958), 145-56.  This paper also contains the first mention of the concept of a repetition-compulsion, which Freud later elaborated in “Beyond the Pleasure Principle.”


4.  Y. Danieli, “Treating Survivors and Children of Survivors of the Nazi Holocaust,” in Post-Traumatic Therapy, ed. F. Ochberg, 278-94, quote on 286. Interview. J. Wolfe and T. Keane, January 1991.


5.  Interview, J. Wolfe and T. Keane, January 1991.


6.  L. McCann and L. Pearlman, Psychological Trauma and the Adult Survivor: Theory, Therapy, and Transformation (New York: Brunner/Mazel, 1990).


7.  Breurer and Freud, “Studies on Hysteria,” [1893-95] in Standard Edition, vol. 2, trans. J. Strachey (London: Hogarth Press, 1955), 6.


8.  This simultaneous present and past orientation is well described in V. Rozynko and H. E. Dondershine, “Trauma Focus Group Therapy for Vietnam Veterans with PTSD,” Psychotherapy 28 (1991): 157-61.