Judith Herman, Bessel van der Kolk, and Contemporary Trauma Research: Home

No modern figure has done more to shape the field of trauma studies than author and psychiatrist Judith Herman (b. 1941).

Born in New York, Herman grew up in an intensely academic family--her mother was the great Helen Block Lewis, a pioneering figure in the field of psychoanalysis, while her father, Nephtali Lewis, was a renowned classics scholar and president of the American Society of Papyrologists. Herman's family combined its intellectual pursuits with an intense political consciousness: Herman's mother was called to testify before Congress as a suspected communist during the Army-McCarthy Hearings of 1954, and as a young woman, Herman became involved in early feminist and civil rights activism. Her preoccupation with the thorny questions of equality and justice did not leave her when she took an MD in psychiatry from Harvard in 1968, becoming a full professor there in 1981. From the beginning of her career as a psychiatrist, Herman's research focused on the psychological response of those who had experienced some of the worst betrayals of trust and authority: victims of rape, victims of childhood incest, victims of torture. Her first book, Father-Daughter Incest (1981) explored the long-lasting effects of abuse in the lives of survivors at a time when incest was dismissed as a rare, 1-in-a-million occurrence (Freedman et al, 1975). Contemporary psychoanalytic practice in the 1960s and 70s, often interpreted client reports of childhood incest and abuse as indicative of subconscious disturbances, neuroses, and sexual fantasies on the part of the client, rather than as real events. Herman's work served as the first rigorous study of this most taboo of subjects, serving both to raise clinical awareness of incest in the mental health community and to expand the concept of "trauma", then applied almost exclusively to war veterans, to survivors of this form of abuse. In 1984, Herman co-founded the Victims of Violence Program at Harvard's Cambridge Hospital with fellow psychologist Mary Harvey. This organization would serve as one of the first true psychological trauma centers in the United States, with a focus both on supporting survivors of trauma and on educating mental health providers to provide better treatment. Herman's work with this organization would provide her with wider access to survivors, whose stories she would use as a foundation for her future work.

In 1992, Judith Herman published her magnum opus Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror, a book which came redefined the study of posttraumatic stress disorder with a particular focus on women survivors of sexual abuse and domestic violence. Almost single-handedly, Herman had created a new psychological diagnosis: complex post traumatic stress disorder (CPTSD), which combined the flashbacks and panic attacks of post-traumatic stress disorder (PTSD) with self-hatred, inability to trust, self-hatred, and existential despair. Herman found that for survivors, the experience of sexual violence often upended their entire worldview--not only did they hate and distrust their abuser, but survivors also lost trust with the people and systems which had ignored or otherwise enabled this abuse, who Herman called "implicated bystanders." These "implicated bystanders" included anyone who knew or should have known about the abuse and did stop it, and included teachers, family members, clergy, God, or even institutional structures such as the Church, law enforcement, or even society at large. In fact, Herman found that for many survivors, it was the apparent ambivalence of these "implicated bystanders" that was the most shattering thing of all. Herman found that survivors of sexual violence often reserved their most visceral anger for these bystanders: it is one thing, after all, to experience rape--but it is another altogether to know your own mother knew and did nothing. It is one thing to suffer and another to feel betrayed and abandoned by those you trusted to protect you. Viewed from this perspective, the anguish of the survivor could hardly be considered a pathology at all but a perfectly clear-sighted and rational disillusionment with a violent and insane world.

Following Herman's work, CPTSD was added as a diagnosis to the ICD-11, and her research would go on to be cited in thousands of books and academic articles. However, in 1994, Herman would suffer a suffer a severe knee injury which would leave her with chronic pain for decades and limit her ability to conduct further research. Herman would publish research articles and contribute to a couple of treatment manuals, including The Trauma Recovery Group: A Guide for Practitioners (2011) and Group Trauma Treatment in Early Recovery: Promoting Safety and Self-Care (2019). But for nearly 30 years, Herman would not publish another book until Truth and Repair (2023). No longer content simply with describing the diagnosis and treatment of trauma, in Truth and Repair, Herman interrogates the idea of justice for survivors, in particular, what survivors want for their abusers.

This question, which goes far beyond Herman's typical realm of empirical inquiry, implicates all of society, not merely the criminal justice system. How should we, as a society, respond to allegations of abuse? What systems should we put in place to best protect survivors? In Truth and Repair, Herman finds most all current models insufficient in one way or another. Current retributive models often fail to secure justice for victims, and when they do, exact a tremendous financial and psychological cost from survivors, while doing very little to rehabilitate offenders. Rehabilitative models, on the other hand, often assume that what the survivor most needs is some sort of apology from and reconciliation with the offender, and so fail to appreciate the gravity of the offense. In any case, Herman envisions "justice" as a crucial step in the recovery process. As in Trauma and Recovery, Herman contends that abuse is a social and political act which requires a social and political reparation: justice is not only a means of punishing and deterring perpetrators, but serves as an opportunity for a society of "implicated bystanders" to reconcile with the victim.

References:

Freedman, A. M., Kaplan, H. I. & Sadock, B. J. (Eds.). (1975). Comprehensive textbook of psychiatry (2nd ed.). Kaplan.

Herman, J. (1981). Father-daughter incest. Harvard University Press.

Herman, J. (1992). Trauma and recovery: The aftermath of violence--From domestic abuse to political terror. Basic Books.

Herman, J. (2023). Truth and repair: How trauma survivors envision justice. Basic Books.

Herman, J. & Kallivayalil, D. (2018). Group trauma treatment in early recovery: Promoting safety and self-care. Guilford.

Mendelsoh, M., Herman, J., Schatzow, E., Coco, M., Kallivayalil, D., & Levitan, J. (2011). The trauma recovery group: A guide for practitioners. Guilford.

It is perhaps unsurprising for one of the great trauma researchers of our day to be born in a time of hunger, war, and oppression. Bessel van der Kolk was born in 1943 into the Nazi-occupied Netherlands. His father had returned from a stint in a German labor camp full of rage, and his mother was a frightened, dour woman who showed very little in the way of affection for young Bessel. The German occupation of the Netherlands was marked by hunger, violence, and terror, and many children of Bessel's age died of cold, disease, and starvation during the great Dutch famine of 1944-45. Trauma had disfigured Bessel's family, neighbors, city, and nation, and growing up, Bessel was surrounded by survivors--prisoners of work camps, veterans of war, Jewish survivors of the Holocaust, child survivors of hunger and disease. His own father, Bessel wrote "never talked about his war experiences, but he was given to outbursts of explosive rage that stunned me as a little boy. How could the man I heard quietly going down the stairs every morning to pray and read the Bible while the rest of the family slept have such a terrifying temper?" (van der Kolk, 2015). As a teenager, Bessel left home at the first opportunity, spending some time in the Taizé Community during the 1950s where he considered becoming a monk.

In 1962, van der Kolk moved to the United States to attend college at the University of Hawaii, receiving his M. D. at the University of Chicago in 1970. He completed a residency in psychiatry at the Massachusetts Mental Health Center in 1974. Though Bessel was only dimly aware of it at the time, the 1970s were a major decade for trauma research in the United States, as hundreds of thousands of young men returned from combat in Vietnam. van der Kolk's work at a VA Clinic put him contact with many troubled young men returning from war who had been misdiagnosed with psychosis or substance-use-disorders, disregarding trauma entirely as a potential explanation for their unhappiness and dysfunction. "The assault on people who had been traumatised has been relentless – to this day, almost," Bessel noted in an interview. "You’re not allowed to tell the truth about the horrible things that people do to each other”  (Williams, 2021). For many of the veterans van der Kolk counseled, it was as though their lives had stopped at the moment of their trauma. The attendant emotions of terror, guilt, excitement, rage, and panic had become the only emotions their trauma had left them capable of. In 1982, van der Kolk opened a trauma center in Boston, Massachusetts, to treat people suffering from post-traumatic stress disorder. This trauma center was one of the first of its kind in the nation and provided van der Kolk with the experience to refine his thoughts on trauma.

Van der Kolk has contributed many research articles and book chapters about trauma over the course of his career, but by far is best known for The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2015), which gathers insights on the neurological effects of trauma van der Kolk gleaned from over four decades of research and client work. Drawing both on academic research as well as the author's own clinical experiences, The Body Keeps the Score describes the psychological and physiological residue of trauma.

As with Herman, van der Kolk recognizes that, though trauma responses are often pathologized, they are also quite often understandable, even rational, given the horror of the triggering experience. However, unlike Herman, who is much more interested in investigating the qualitative experiences of trauma survivors through interviews van der Kolk's research focuses instead on describing the lingering physiological sequelae of this trauma--often employing brain-imaging technology. Van der Kolk found that the experience of trauma often left the brains of survivors stuck in fight or flight" (van der Kolk, 2015). These severe attendant neurochemical and physiological changes lead to long-term disruptions in executive functioning--disruptions that talk therapy is unable, for the most part, to address by itself: "No matter how much insight and understanding we develop, the rational brain is basically impotent to talk the emotional brain out of its own reality." The treatment of PTSD must begin, van der Kolk argues, with treating "the imprints of the trauma on body, mind, and soul," a process that requires the therapist to be attuned not simply to the cognitions of his or her clients, but to their physiological responses as well (van der Kolk, 2015).

References:

van der Kolk, B. (2015). The body keeps the score. Penguin.

Williams, Z. (2021). Trauma, trust, and triumph: Psychiatrist Bessel van der Kolk on how to recover from our deepest pain. The Guardian. https://www.theguardian.com/society/2021/sep/20/trauma-trust-and-triumph-psychiatrist-bessel-van-der-kolk-on-how-to-recover-from-our-deepest-pain