Tuesday, April 10, 2007

Trauma and Recovery

By Judith Herman, M.D.
ISBN 0-465-08730-2

Reviewed by Marty N.

Craig W. turned me on to this book at one of our Book Nights at the Thursday night SOS meeting in Oakland. As the title implies, it is a book about recovering from trauma. Craig said that even though he had not suffered any particular physical trauma, such as being beaten or sexually abused or shellshocked in war, nevertheless the book spoke to him very centrally. After reading it, I came to agree, and began to understand why.

Dr. Herman spent twenty years studying women who had been raped or violently abused as children, as well as men who had been prisoners of war or had the Vietnam vets’ syndrome. She makes a strong case that the prevalence of violent trauma in our society is much greater than is generally believed. She puts herself in the shoes of the victims of societal atrocities and tries to describe what that feels like, and what happens inside.

The central experience of trauma, Dr. Herman writes, is powerlessness. When the organism first confronts a threat, it goes into a fight-or-flight reaction. But when neither fight nor flight avail, the human defense mechanisms disintegrate. Overwhelmed, the emotional and cognitive systems become severed (disassociated) from each other, so that the person thinks without feeling or feels without thinking. The victim adopts a permanent state of aroused vigilance, even when no immediate triggers are present. Echoes of the traumatic event intrude on ordinary activities. Finally, the victim may go into surrender mode, numbing down all except the most constricted systems, and frequently resorting to collaboration with the abuser.

There is a well-known link between childhood trauma and adult alcoholism, particularly among women. Dr. Herman describes alcoholism and other drug addictions as among the common traits found in survivors of childhood abuse, along with insomnia, sexual dysfunction, dissociation, anger, suicidality, and self-mutilation. She describes excess use of alcohol and drugs as a method of dissociation and constriction that many trauma victims employ when they are unable to achieve these protective altered states spontaneously.

While abuse of alcohol and drugs is a frequent sequel of trauma, the experience of being addicted to alcohol can be a kind of trauma in its own right. The realization that one is trapped in a joyless cycle of chemical self-destruction is authentically terrifying. I remember well those many mornings when I looked in the mirror and saw a slave. In those days, neither resistance nor escape availed. The experience of powerlessness is ingrained in the life of an active addict. And so, with that background, I began to read Dr. Herman’s book, just as Craig did, as a book about surviving and recovering from a trauma called addiction.

Part II of the book is entitled Stages of Recovery. Dr. Herman opens it with these words:
"The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation…. The first principle of recovery is the empowerment of the survivor. She must be the author and arbiter of her own recovery. Others may offer advice, support, assistance, affection, and care, but not cure. Many benevolent and well-intentioned attempts to assist the survivor founder because this fundamental principle of empowerment is not observed. No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interests."

I quoted this at length because it seems to me that this understanding is central to what we try to do, and largely succeed in doing, in our SOS meetings. As everyone knows by now, we do not see ourselves as owners and vendors of a magic "Program" which we try to impress on newcomers. We stress to the contrary that the recovering alcoholic can and "must be the author and arbiter of her own recovery," exactly as Dr. Herman writes. What we supply to each other is support, assistance, affection, care and advice if asked for, but not "cure." Because we adhere to "this fundamental principle of empowerment," we steer clear of ideologies that would assign the recovery-creating power to supernatural beings, or to magical objects such as doorknobs, because such an assignment takes away from the survivor a power that is rightfully and necessarily hers, and this cannot foster recovery, no matter how benevolent it may appear.
The principle of empowering the patient gives some therapists a great deal of trouble, accustomed as they are to seeing themselves as powerful and the patient as helpless. Dr. Herman is a vigorous advocate of "patient power." She speaks from two decades of experience of working in groups for battered and abused women, survivors of childhood abuse, incest, rape and other atrocities, as well as with men exposed to traumas of war and imprisonment. These are individuals who manifest all kinds of dysfunctionality, as do we alcoholics and addicts. Nevertheless, or rather, precisely because of this fact, insists Dr. Herman, "the more the therapist accepts the idea that the patient is helpless, the more she … disempowers the patient." Likewise, I think it’s fair to say that when addiction counselors begin with the premise of the alcoholic’s or addict’s helplessness, they disempower the patient’s recovery and become part of the problem rather than the solution.

Dr. Herman’s experience in her battered women’s survivor groups indicated that the first task is to establish a sense of safety. No progress can be made until the person feels and is safe. (p. 159) This is a point that applies to our recovery groups as well. We usually understand the "safety" issue as one of anonymity and confidentiality. These are basic, but there is more. A good atmosphere in a meeting is where participants feel free to speak about their personal experiences, but don’t feel pressured to disclose more about themselves than is comfortable for them at the moment. Sometimes our participants only offer their opinions on a topic; they say "I think " such-and-such and "I agree with X" or "I disagree," but rarely disclose any of their own experiences. This superficial level of talk suggests that these speakers don’t feel safe in the meeting, and if this becomes the standard for the whole meeting for a prolonged period, then it’s time to stop and reassess. Not much healing or empowerment will take place if people don’t feel safe to talk about what really is going on with them. Similarly, not much progress will be made if people talk in slogans or formulas.

Talking – the simple act of talking in a group about one’s experiences – is a therapeutic process. Members of self-help groups know this. Dr. Herman’s treatise validates it scientifically. In a remarkable chapter, she writes that even the medical symptoms of trauma, the "physioneurosis," can be reversed "through the use of words." Talk in a safe environment that comes straight from the heart, and allows repressed feelings to surface without premeditation, creates privileged moments of insight. This kind of talk is very probably the real active ingredient of all successful self-help groups. It is the reason why they work when they work. All the rest is ornament or baggage. SOS is wise to concentrate its effort on constructing and facilitating this central process, and in deflecting any effort to burden this force with any programmatic, religious, spiritual or political overlay.

The third and last stage of recovery, in Dr. Herman’s view, is reconnection with others. Here again the self-help groups play a vital role. In the groups, the individual survivors begin to experience bonding with one another, recover a sense of self-worth, and learn methods that allow them to make changes in their real world pathways. For many survivors at this stage, it is helpful to become engaged in campaigns to address the causes of their victimization, and in educating the public.

In conclusion, this is not intended as a book about alcoholism or addiction. On those occasions when Dr. Herman speaks of recovery from alcoholism directly, her text does not rise above the brainless rubber-stamping of 12-step methods that marks the run of the mill, and this is a definite weakness of the work. But if we look at the larger picture, this is one of the most illuminating books about addiction that has been written in recent years. If we understand addiction as not merely a sequel of trauma, but as a trauma in its own right, then the work is rich in insights and lessons for us. I am grateful to Craig W. for sharing the work and I would recommend it unhesitatingly to anyone interested in understanding more about the recovery process.

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