Aspects of Trauma and Treatment, Essay Example

Introduction

It is in a sense ironic that trauma should present such significant challenges to the counselor.  With a wide variety of psychological disorders and illnesses, there is an inevitable difficulty in tracing the origins and/or trajectory of the condition.  Trauma, conversely, is typically specific in that the event(s) generating the disorder or dysfunction are identifiable.  The causes are definitive and carry immense impact; consequently, modes  of treatment would seem to be more accessible.  To some extent, this is true, but the dominant reality is that trauma creates complex problems in the human mind by no means easily addressed due to comprehended causal agents.  As Judith Herman’s Trauma and Recovery: The Aftermath of Violence – from Domestic Abuse to Political Terror makes clear, trauma generates fixed ideas of vulnerability so extreme, human consciousness is altered in multiple ways, and the counselor must then enter into the victim’s perception of reality if recovery is to be achieved.

Discussion

Among the more interesting points raised in Herman’s book is her expansive comprehension of psychological trauma.  More exactly, Herman places traumatic events in a human and social context, which in turn underscores their significance to both victims and external parties.  She insightfully notes how, when such events are of human origin, roles of perpetrator and victim are established, and typically take expected forms which amplify one another.  Victims often seek to repress or forget the violent or horrific act done to them, as perpetrators are inclined to promote secrecy, deception, and outright denial (Herman, 1997, pp. 7-8).  Both parties are essentially locked in cycles of disorder, and this reflects an important aspect of all trauma.  That is to say, in a further irony, the traumatic event exists as ongoing in the minds of all concerned, and this is of course particularly distressing for the victims.  Herman’s reflection on the bystander element is relevant here as well for, no matter how either victim or perpetrator seeks to deny the event, there must be a sense that others know, and which must exacerbate the victim’s vulnerability and the perpetrator’s agenda to deny.

From a clinician standpoint, this factor of the perceived perpetuity of the traumatic event is critical.  It most certainly goes to victim efforts to suppress, because there is often a significant – and conscious – belief in the victim that the trauma is not ended.  This would explain why, to the ordinary person, trauma is frequently difficult to comprehend; it is felt that the victim must know that, in most circumstances, the violations committed upon them are in the past and not likely to recur.  This is not, in plain terms, the reality of the victim, and nothing is more essential for the counselor to know.  The human mind, once abused and dramatically threatened, will not easily consign the abuse to the past because a protective reflex is established, and an ongoing vulnerability is the most likely consequence.  On the most basic level, there is a rationality to this psychological and emotional response, as what has happened before may happen again.  Any pragmatic approach seeking to alleviate trauma effects, then, is inapplicable, if not demeaning to the patient.  To properly address trauma, the counselor must enter into the reality perceived by the sufferer, and work with them from that foundational point.

There is also extensive thought in Herman’s book going to the complexities involved in recovery processes, which involve the counselor’s comprehension of the full – and lasting – impact of the trauma.  As Herman observes, forgiveness, or the inability to forgive, must greatly hinder any mourning process.  This in turn may be amplified by a dread of mourning itself because the nature of the trauma, once accepted as a thing to be mourned, is likely so extreme that the victim resists what is perceived as a limitless grieving stage (p. 195).  She cites cases of victims overwhelmed by anticipated grief when they attempt to mourn, which reinforces the vulnerability of them.  This suggests to the counselor a further complication and inevitable dilemma; to mourn, the trauma must be recognized as in the past, and the protective psychology holding onto it likely becomes all the more potent when mourning is encouraged.  Consequently, grieving over the trauma’s effects on the individual, so crucial to recovery, is hindered by the individual’s impulse to remain  secure.

This single phase of the recovery process illustrates how a consistent and aware approach is necessary for treating trauma.  As noted before, the counselor must enter into the victim’s reality, and this translates to the further need to remain within that reality as treatment progresses and it evolves.  The victim must be helped to understand that mourning, while intimidating on several levels, is a critical step in achieving control and perspective.  It is drastic, certainly, as it demands the conscious acceptance of the trauma by the victim, and most victims practice long periods of deliberate suppression and/or less conscious denial.  It is in  fact arguable that no phase of recovery is more essential, in that mourning implicitly creates distance between victim and traumatic event, and most definitely assigns the event a place in the past.

Equally interesting in Herman’s book, in terms of generating ideas of approach, is her extensive discussion of treatment as effective in group or individual settings.  It seems that group counseling scenarios are particularly effective in addressing certain types of trauma, which indicates an interesting dimension to the condition itself.  Herman notes that battered women, war veterans, and Holocaust survivors tend to progress far more dramatically in group treatment (p.  216).  Regarding the latter two victim types, this seems logical; the traumas occur in group circumstances, so it appears as almost an organic process that treatment proceed more effectively when a group is recreated, as it is likely the commonality element is infused with the trauma itself in the victim’s mind.  This may be deceptive reasoning, however, and by virtue of how battered women respond to groups.  That is, it may instead be that certain types of abuse more demand group identification by virtue of their violating individual identity.  War and Holocaust experience certainly strip individuality, even as individuals are traumatized to unique degrees.  This same denial of self, however, may be acutely felt by battered women because the violence directed at them also usually ignores the reality of individual being.

Conclusion

No single work, no matter the integrity and insight of it, can convey the range of issues involved in trauma.  Herman, however, does a remarkably admirable job in focusing on many of these issues, and she illuminates aspects of them too often neglected.  More importantly, the work enables thinking on the part of the counselor which takes the concepts further, and this is due to Herman’s commitment to the central concerns of the complex problem.  Judith Herman’s Trauma and Recovery: The Aftermath of Violence – from Domestic Abuse to Political Terror helpfully clarifies how trauma generates fixed ideas of vulnerability so extreme, human consciousness is altered in multiple ways.  The counselor benefits from the awareness that they then must address these variations by fully acknowledging the victim’s reality.

References

Herman, J. L. (1997).  Trauma and Recovery: The Aftermath of Violence–from Domestic Abuse to Political Terror. New York: Basic Books.