Trauma and Recovery. - book reviews

Christian Century, Dec 8, 1993 by Arthur W. Frank

Trauma and Recovery. By Judith Lewis Herman, M.D. Basic Books, 276pp., $27.00.

MISTERING TO PEOPLE means, probably sooner rather than later, witnessing their pain. I encounter the word "pain" often these days, but it usually refers to institutions, not persons. Churches are described as being "in pain" over certain issues or decisions. This metaphor may be fair enough, but an organization's pain is far different from the pain that begins in the bones and tissues.

In different ways both Pain as Human Experience and Trauma and Recovery reorient us to the fundamental embodiment of pain. They chart how pain affects lives, never allowing us to forget that lives are lived in bodies or that the body's experience shapes the mind and spirit. Both books speak of real people whose suffering is all too real. Neither contains more than a couple of references to God, faith or spirituality, but in my view both are of pretheological importance. These books begin to tell the truths that must be told about suffering and that theology must acknowledge in order to be authentic.

Mary-Jo Delvecchio Good and her colleagues write about chronic pain: most of the people they interview are functioning but severely impaired. Their chronic pain admits several diagnostic labels. Suffering is made worse by medicine's inability to specify the causes of some pains, and physical pain can be magnified by misconceived treatments. What matters in each of the examples is that the patient's pain is mostly impervious to medicine, either traditional or alternative.

Some of the subjects suffer pain as a result of accidents. In other cases the origin is obscure; pain developed during various childhood illnesses and was reinforced by the stresses of adult life. Good and her colleagues write as medical anthropologists, seeking to describe how pain marks their interviewees' lives. Their explorations create a new form of social science that they call "an ethnography of experience."

Judith Lewis Herman is a practicing psychiatrist working with abused women and incest survivors. These women are not, however, her only subject. Her book's epigram is taken from Salmon Rushdie's novel Shame, in which he had intended to tell a story of men but found that his women characters kept asserting themselves. "So it turns out," Rushdie wrote, "that my 'male' and 'female' plots are the same after all." And so it turned out for Herman, who found that her women patients' stories paralleled the stories of men suffering posttraumatic stress disorder resulting from their experiences in the Vietnam war.

"Rape and combat might thus be considered complementary social rites of initiation into the coercive violence at the foundation of adult society," she writes. "They are the paradigmative forms of trauma for women and men respectively." Another trauma that united men and women was the Holocaust, and Herman studies its survivors here as well.

Herman describes the conditions that create posttraumatic stress and then charts a model trajectory of recovery. Given the prevalence of sexual abuse, the controversies that surround it and the unpredictability of how abuse may trigger other problems, this book should be read by all who minister to people facing such issues. Herman's discussion of the practice of therapy with posttraumatic-stress patients makes her book invaluable for anyone working on any therapeutic level.

Part of what makes these books of pretheologieal significance is that both are applied exegeses of truth-telling. Both books present the difficulty of telling the truth of suffering, and the complementary difficulty of hearing the truth and helping those in pain to tell their stories. Both books emphasize that society does not want to hear about pain. Good and her associates begin their anthology with some brilliant comments on why traditional medicine does not accept the reality of chronic pain. "Chronic pain... challenges the central tenet of biomedieal epistemology," they write, "namely, that there is objective knowledge, knowable apart from subjective experience." By rendering pain objective, medicine silences the person in pain and thus protects society from hearing that person. Herman echoes this assertion, writing that she expects her book to provoke controversy because "it speaks of horrible things, things that no one really wants to hear about."

People's pain begins in their bodies' trauma and is exacerbated as they seek futilely for a language to express their suffering. Ultimately both chronic pain and trauma are inexpressible, and the impossibility of describing the inexpressible challenges those who would offer a scholarly description or provide a therapeutic response.

THOSE WHO suffer chronic pain or posttraumatic stress doubt the validity of their own experience because others doubt their expressions of it. Jean Jackson's paper in the Good volume states a problem every chronic pain sufferer faces: "After a While No One Believes You: Real and Unreal Pain." "Unreal" for whom? Jackson quotes a patient's recollection of a conversation with her physician: