home pic

Farmington Hills: 248 851-3380 |  Ann Arbor: 734 213-3399

Michigan Psychoanalytic Institute & Society

Living with Terror, Working with Trauma: A Clinician’s Handbook

Edited by Danielle Knafo
Jason Aronson, 2004

By Henry Krystal, M.D.

This is a remarkable book containing 28 chapters by many well-known authors who address the ways mental health practitioners can assist survivors of terrorism to deal with their trauma. Drawing upon experiences of leading practitioners and experts in the Middle East (both Israeli and Palestinian) and the United States, it offers ideas to help people to heal and even grow from their traumatic experiences. The editor, Knafo, herself has an interesting background, having lived in South Africa and Israel and now practicing psychoanalysis in the United States. Among the well-known authors, Harold P. Blum introduces us to the issues of psychic trauma and traumatic object loss, Judith Herman reviews the concept of complex PTSD, and Marvin Hurvich explores the context of trauma in reference to the fears of annihilation.

The concepts are so broad that they permit a reconsideration of the implications of living in the atomic age that is so profoundly a part of our history that we cannot overlook it. Robert J. Lifton challenges us in his chapter, "Is Hiroshima our Text?" He suggests a need to attend consciously to what we tend to ignore as if it were an irrelevant part of the "background."

One of the special merits of this book is that the experiences of the contributors are so varied. For instance, Kinzic has worked for twenty years with Cambodian refugees in this country. Handlin and Haas have been working with Viet Nam veterans. Van der Kolk brings in the neuroscience perspective and reminds us cogently, "The body keeps the score." Serlin and Cannon approach trauma and its therapy from what they call a "humanistic" view, and John Wilson concentrates on problems of the countertransference, empathic strain and compassion fatigue in working with traumatized people.

Coming from another psychoanalytic quarter, Martin and Maria Bergmann (separately) open another territory to be followed by a few pioneers who review and reflect upon the post 9/11 New York people's survival and various challenges of life with terror. Bennett Roth takes us on an exploration of the idea of large group destruction. Isaac Tylim alerts us to the challenge of dealing with a population in the context of terror and massive loss. Volkan takes on a new concept of preventive medicine in traumatized societies. There seems to be no limit to the topics: terror and revenge, forgiveness, creative and clinical transformation.

In addition to brilliant and renowned clinicians, the book is enriched by poetry and art of a number of different types. It includes such poets as Alkalay-Gut, Ruth Knafo-Seaton and artists such as Kiki Elephant, Bracha Ettinger, Wlodzimierz Ksiazek and Carolee Schneeman. Besides the artists who participated in creating this book, the editor also presents some work of Charlotte Salomon (1940-1942)-a teenage artist, poet and playwright who perished in Theresienstadt.

I also have a couple of contributions in this book. The first one is a chapter entitled, "Resilience: Accomodation and Recovery." This is a forty-year retrospective study of my work with my fellow Holocaust survivors. I have been working with Holocaust survivors since the early sixties. Since Germany passed a law on compensation to victims in terms of industrial disabilities, we had to establish in German courts that mental and emotional disabilities should be included. We won, and since then I have been working with the German restitution authorities and German psychiatrists. We have been involved in the development of the concepts and therapy of trauma and its sequelae. In addition, I had a number of such patients in analysis and/or psychoanalytic psychotherapy. One of the earliest comments I made in this respect was that the most important asset that favored surviving was an ample residue of "primary narcissism" which, I ventured, was derived from an early "eyeball-to-eyeball" (or actually right hemisphere-to-right hemisphere) programming of the infant with the message of his or her essential lovability and goodness. This leads to a lifetime expectation that the next person encountered will like him/her. Ongoing work made possible the reinterpretation of such assets as being derived from secure and enduring attachment to the mother. Other assets and resources were similarly traced through the experiences of the persecutions, and separately and independently, the capacity for post-liberation recovery and establishment of families. An example of the complexity of survival and recovery included the question of religion. How was the survivor going to establish faith in a benign and omnipotent God after what he had witnessed?

My other contribution is a chapter entitled, "Optimizing Affect Function in the Psychoanalytic Treatment of Trauma." Acknowledging the existence of problems of alexithymia, impairment of affect tolerance and problems of affect regression, it becomes clear that it is not possible to treat posttraumatic individuals successfully with the techniques developed for, and effective in, the treatment of, "good neurotics." In this chapter, I review a preparatory phase of treatment and its necessary modifications. The key observation of recent decades is that this challenge can be met adequately only by a phenomenon beyond a didactic program. It is achieved only in the relational interaction, which fosters a kind of harmony and the kind of joint creativity in which the cultivation of affect tolerance and affect maturation is possible. In this process, the affects become verbalized, and can serve as signals in life and in treatment. Otherwise, the regressed affects that are mostly physical do not serve as effective signals in information processing.

For those colleagues who are prepared to face the challenges of up-to-date revisions in the many aspects of trauma and its after-effects, this book is a perfect source.