TRAUMA AND RECOVERY

By Judith Lewis Herman.276 pp. New York:Basic Books. $27.

THIS book is one of the most important psychiatric works to be published since Freud. Judith Lewis Herman's voice is grave, measured, gripping, almost surgically precise, as she describes the effects of terror on men at war and in enemy captivity, effects that she goes on to equate with the trauma suffered by women at home in what she calls "domestic captivity." The phrase refers to victims of incest, rape, battery and all forms of child abuse. According to Dr. Herman, "the subordinate position of women is maintained and enforced by the hidden violence of men. There is a war between the sexes. Rape victims, battered women and sexually abused children are its casualties. Hysteria is the combat neurosis of the sex war."

"Trauma and Recovery" is not a polemic. It is very sophisticated, both clinically and philosophically, yet accessible to a lay audience; in places it reads like a work of political science or history or even a novel. This profoundly feminist work goes a long way toward restoring morality to a profession that has too often denied or minimized male violence at home, and treated as mental illness the normal female response to what, after all, are crimes against humanity.

Dr. Herman, the author as well of "Father-Daughter Incest" and an associate clinical professor of psychiatry at the Harvard Medical School, confirms that women and men are not "crazy" or "defective" when, in response to trauma, they develop post-traumatic symptoms, including insomnia, flashbacks, phobias, panic attacks, anxiety, depression, disassociation, a numbed toughness, amnesia, shame, guilt, self-loathing, self-mutilation, social withdrawal. Victims may in turn attempt to mask these symptoms with alcohol, drugs, overeating or extreme forms of dieting.

The "shellshocked" soldiers of World War I were shamed, threatened with courts-martial and tortured with electric shock in the name of psychiatric therapy until they behaved like "men" again. "Only after 1980," Dr. Herman writes, "when the efforts of [Vietnam] combat veterans had legitimated the concept of post-traumatic stress disorder, did it become clear that the psychological syndrome seen in survivors of rape, domestic battery and incest was essentially the same as the syndrome seen in survivors of war." And not until the "women's liberation movement of the 1970's," she says, "was it recognized that the most common post-traumatic disorders are those not of men in war but of women in civilian life."

Female suffering and degradation are often minimized and denied by everyone, including the victim herself. According to Dr. Herman, sexually violated women, incest survivors especially, have been misdiagnosed as "borderline personalities" by therapists who dislike or even hate them. By joining "heroic" male and "degraded" female suffering, Dr. Herman manages to render female suffering visible, human, redeemable, and the female search for relief noble rather than pathetic or despicable. (She in no way minimizes male suffering by doing so.)

In a comparison that may shock some readers, Dr. Herman places the "coerced prostitute" Linda Lovelace -- the unwilling star of "Deep Throat" -- among the pantheon of revered political prisoners. She feels that Linda Boreman (the star's real name) has more in common with Jacobo Timerman or Irina Ratushinska ya, a Russian dissident, than with our ideas about the "happy hooker."

Dr. Herman is exquisitely attuned to what haunts trauma victims and survivors even more than the crime itself: the silence, the cover-up, the denial of the crime by the "passive bystander." She quotes Linda Lovelace: "Most [bystanders] don't know how hard I judge them. . . . All I do is cross them off the list. Forever. These men had their chance to help me and they didn't respond." She also cites Mr. Timerman, the Argentinian political "prisoner without a name" and torture victim, who has argued that "the Holocaust will be understood not so much for the number of victims as for the magnitude of the silence. And what obsesses me most is the repetition of silence."

AS horrifying as are the sufferings of those who went to the torture chambers or slave labor and death camps of Nazi Germany and the Gulag, of South Africa, South America and Southeast Asia (and the author in no way minimizes any of these unique and irreducible passages of pain), Dr. Herman also understands that chronic, hidden family violence is actually more, not less, traumatic than sudden violence at the hands of a stranger, or of an enemy during war. She demonstrates that after even a single act of abuse, physical violence is only infrequently needed to keep one's victim in a constant state of terror, dependent on her captor and tormentor.

The author has worked with survivors of rape and incest; her first book is still the best psychiatric study of father-daughter incest. Contrary to what might seem likely -- that those who are abused eventually become hardened and learn how to deal with their lot -- she maintains that women injured by those who are supposed to love and protect them in childhood begin life grievously weakened and at higher risk. They are less able to hold their own against an exploiter and they suffer each subsequent act of abuse more, not less, intensely than the previous one.

Dr. Herman challenges myth after myth: that people can heroically resist coercion and degradation -- most of us can't; that the capacity to form strong attachments is permanently destroyed under the most diabolical conditions -- it isn't (people can and do recover). And she disposes of the assertion that Freud's own retreat from the reality of incest early in his career proves that the psychoanalytic process is worthless.

Dr. Herman herself stands on Freud's shoulders to address some of the major criticism that feminists have raised about his views of women. She also goes beyond Freud in delineating the psychological consequences of "extreme trauma," such as rape and incest, and in describing the recovery or healing process. In a style that is level-headed and low-key, Dr. Herman acknowledges that yes, Freud did fail his patients when he denied the reality of childhood abuse, incest especially. However, as she says, "Freud's rival Janet [Pierre Janet (1859-1947), French psychologist and neurologist], who never abandoned his traumatic theory of hysteria and who never retreated from his hysterical patients, lived to see his work forgotten and his ideas neglected."

Dr. Herman argues, correctly, that the "systematic study of psychological trauma . . . depends on the support of a political movement. . . . In the absence of strong political movements for human rights, the active process of bearing witness inevitably gives way to the active process of forgetting." Without such a movement, "Freud's discovery [of incest/childhood abuse] could not gain acceptance." Even today, supported by a feminist movement (albeit one under permanent siege) and a worldwide human rights movement, Dr. Herman knows that "to speak publicly about one's knowledge of atrocities is to invite the stigma that attaches to victims" and to risk being subjected to a kind of "professional isolation."

In "Trauma and Recovery," Dr. Herman models a new vision of therapy and of human relationships, one in which we are called upon to "bear witness to a crime" and to "affirm a position of solidarity with the victim." Dr. Herman's ideal therapist cannot be morally neutral but must make a collaborative commitment, and enter into an "existential engagement" with the traumatized. Such a therapist must listen, really listen, solemnly and without haste, to the factual and emotional details of atrocities, without flight or denial, without blaming the victim, identifying with the aggressor, or becoming a detective who "diagnoses" ritual or Satanic abuse after a single session, as some have been doing lately, and without "using her power over the patient to gratify her personal needs." While the love and understanding of relatives, friends and political movements are necessary, they are not substitutes for the hard psychological work that victims must also undertake with the assistance of trained, grass-roots professionals; in fact, enlightened professionals like Dr. Herman cannot themselves undertake this work without a strong support system of their own.

The book is almost -- but not exactly -- perfect. For example, I would have liked a more thorough analysis of female violence, denial and complicity with the status quo. Also, while I understand and am persuaded by the reasons for Dr. Herman's proposal of a new official diagnostic category ("complex post-traumatic stress disorder"), I would prefer moral outrage and political and legal action rather than a system of medical diagnosis to prevail over evil.

What, then, is Dr. Herman's view of recovery? The author knows that women and men heal best by discovering "some meaning in their experience that transcends the limits of personal tragedy" and "by joining with others in social action." The recovered victim or survivor "recognizes that to some degree, everyone is a prisoner of the past. . . . Commonality with other people carries with it all the meanings of the word common.

It means belonging to a society, having a public role, being part of that which is universal. It means having a feeling of familiarity, of being known, of communion. It means taking part in . . . the everyday. It also carries with it a feeling of smallness, of insignificance, a sense that one's own troubles are 'as a drop of rain in the sea.' The survivor who has achieved commonality with others can rest from her labors. Her recovery is accomplished; all that remains before her is her life."

Fifty years ago, Virginia Woolf wrote that "the public and private worlds are inseparably connected . . . the tyrannies and servilities of one are the tyrannies and servilities of the other." It is now apparent also that the traumas of one are the traumas of the other. The hysteria of women and the combat neurosis of men are one. Recognizing the commonality of affliction may even make it possible at times to transcend the immense gulf that separates the public sphere of war and politics -- the world of men -- and the private sphere of domestic life -- the world of women. . . .

But history teaches us that this knowledge could also disappear. Without the context of a political movement, it has never been possible to advance the study of psychological trauma. The fate of this field of knowledge depends upon the fate of the same political movement that has inspired and sustained it over the last century. In the late 19th century the goal of that movement was the establishment of secular democracy. In the early 20th century its goal was the abolition of war. In the late 20th century its goal was the liberation of women. All of these goals remain. All are, in the end, inseparably connected. --

From "Trauma and Recovery."