Herman's Trauma And Recovery

Trauma in of itself has been associated with a controversial history- controversy involving legitimacy, it’s affect, and neglect of its existence itself. From political settings that sought to fight against progressive studies to trauma’s effects being associated with something other than true symptomatic effects like weakness or cowardice (17). Other issues include dismissal of psychological disorder traits as personality traits- integrating a “genetic”-type labeling of a trait/behavior as being part of an individual’s pre existing personality as opposed to a post-trauma consequence that can and/or should be clinically treated. As certain political movements, scientific interest, and vocalization by masses increased, the study of trauma had

gained. Though today trauma and PTSD are medically and socially accepted as legitimate forces of mental (and in turn physical) pain, some controversy still follows; we have moved on past legitimacy and into diagnosis and therapy/treatment.

In Trauma and Recovery, Herman discusses the need for a change in how we define trauma related to repeated, ongoing, lasting abuse versus a “brief stress reaction”. In addition, she finds problem with the fact that symptoms of any trauma an individual experiences is lumped together into one category- one diagnosis. She states, “The responses to trauma are best understood as a spectrum of conditions rather than as a single disorder,” (87). Thus comes her first step to a solution in transitioning simple diagnoses of trauma and PTSD, breaking it down from a lumped diagnosis
no matter the event(s) that caused it or the specific symptoms associated with individual cases. She termed “Complex Trauma Disorder”.
The origin of “Complex Trauma Disorder” is associated with a way to break down the clumping of symptoms, events, and disorders into a diagnosis of PTSD. “Complex Trauma Disorder” reiterates the uniqueness of

cases and degrees (as well as range) of symptoms. In other words, trauma and/or PTSD cannot be used as a single umbrella for all cases, it is more “complex” than that. The effects of single events versus ongoing, repetitive trauma, the subject being a child versus an adult, and the group of symptoms specific to each individual are all examples of the variability that occurs under a PTSD diagnosis. One of Herman’s goal in coining the term “Complex Trauma Disorder” was to bring about attention to those who suffer from continuous stress: “Naming the syndrome of complex post-traumatic stress disorder represents an essential step toward granting those who have endured prolonged exploitation a measure of the recognition they deserve,” (88). It is important to note that she is not the only one who sees a necessity of distinction between singular and continuous events of trauma, not because one should be more important/more sympathized than the other, but because consequences on the individual’s mental and physical health can follow different patterns based on the type of traumatic experience. Herman mentions that “Lenore Terr distinguishes the effects of a single traumatic blow, which she calls “Type I” trauma, from the effects of prolonged, repeated trauma, which she calls “Type II.” Her description of the Type II syndrome includes denial and psychic numbing, self-hypnosis and dissociation, and alternations between extreme passivity and outbursts of rage,”(87). Labelling all heart diseases and conditions with a singularly defined term and treating all of them with the same order of treatment would not be considered appropriate or helpful- it is similar with trauma and stress disorders.
Another issue that Herman’s “Complex Trauma Disorder” seeks to fix is the repetitive pattern of misdiagnosis and negative associations of complex trauma that develops during childhood: “They [survivors of childhood abuse] are likely to receive a diagnosis that carries strong negative connotations. Three particularly troublesome diagnoses have often been applied to survivors of childhood abuse: somatization disorder, borderline personality disorder, and multiple personality disorder,” (89). One of the big problems with this is the route treatment will take with these misdiagnoses: not all diagnoses are equal and should not be treated in a single, standard way. The above three diagnoses are distinct meaning their group of symptoms and patterns of behaviors can be distinct. Of Course overlapping of symptoms may exist but as Herman states that they“might perhaps be best understood as variants of complex post-traumatic stress disorder, each deriving its characteristic features from one form of adaptation to the traumatic environment…. The overarching concept of a complex post-traumatic syndrome accounts for both the particularity of the three disorders and their interconnection,” (91). This is one of the most important concept I took out of Herman’s book, the creation of a C-PTSD that highlights one of the goals of adding this diagnosis: just because disorders have shared symptoms or a common overarching cause (trauma) does not mean they are of equal diagnoses, equal treatment, and equal long term life complications.
One important distinction within the community of disorders related to trauma is the occurrence of the traumatic during childhood vs adulthood. When a traumatic event occurs during adulthood, it has an effect on a preexisting personality and psyche. That is not the case for those occurring in childhood, in which the patient is in the process of developing. In other words, Herman states “Repeated trauma in adult life erodes the structure of the personality already formed, but repeated trauma in childhood forms and deforms the personality,” (70). At first we think of parents and/or guardians as physical caretakers- they provide shelter, food, clothing, and physical necessities of a child. However, those responsible for a child are a direct influence, and in my opinion a leading influence, on the psychological development of a child. If a child is neglected, abused, or maltreated, the developing psychological aptitudes of the child can be molded to somehow cope with the present conditions yet in the future have detrimental effects: “Unable to care for or protect herself, she must compensate for the failures of adult care and protection with the only means at her disposal, an immature system of psychological defenses,” (70). Children deal with abuse in a multitudes of ways ranging from avoidance to appeasement. In many cases, their minds begin to adjust the abuse in context of a supposed normality of life in order to dismiss the abuse as something else. Though a coping mechanism in the present, this dismissal leads to an altered reality of which the child will develop their psychological defenses on (74). C-PTSD gives recognition to this ongoing childhood abuse as a continuous effect as being different from a. Traumatic event(s) as an adult and b. Singular traumatic events. Childhood abuse would benefit from the addition of C-PTSD as a diagnosis. PTSD though applicable sometimes fails to recognize the extent of the connection between past traumatic events and current mental disorders as the child starts to grow older. Herman’s C-PTSD encourages attention by a professional to traumatic disorders as being a complex encompassing of symptoms that have developed over a long period of time. The diagnosis also lends a hand to the patients in terms of giving more relevance to their traumatic experiences of the past; C-PTSD offers legitimacy to the effects of trauma certain people face instead of shame, embarrassment, or fear that they symptoms and experience will not be taken seriously and cautiously enough. “It is an attempt to find a language that is at once faithful to the traditions of accurate psychological observation and to the moral demands of traumatized people,” (88).
The creation of C-PTSD as a diagnosis is not so much as a creation as it is a step forward in the legitimacy of mental health overall.

C-PTSD reminds patients, doctors, and just as importantly, society that mental disorders stemming from a type of trauma have variables and complexities that make experiences and reactions to those experiences unique. Headaches can be a symptom of a wide range of physical “traumas” from tension, sinus issues, to more serious things like brain cancer. If we take this idea and apply it to mental health we can see that symptoms can stem from a variety of types of traumas and its implications on an individual’s mind varies as well. The creation of C-PTSD also serves as a necessary reminder of careful observation and treatment for a patient with the underlying understanding that patient’s experiences of trauma are unique to the individual while being interconnected by shared symptoms. Herman’s creation of this diagnosis represents a progressive step for patients of traumatic experiences as it emphasizes taking treatment into account on a case-by-case basis. Additionally, Herman took one step forward for mental health as history has shown its the less legitimate little brother of physical

health.