Living with Terror, Working with Trauma: A Clinician's Handbook (Book Review)
Author: Knafo, Danielle
Publisher: Jason Aronson
Reviewed By: Jon Mills, Winter 2008 (Vol. XXVIII, No. 1) p. 40
What exactly do we mean by trauma? And what exactly do we mean by dissociation? These are important questions that sustain the central arguments behind two recent books on these popular contemporary topics. In Living with Terror, Working with Trauma, Danielle Knafo has compiled an impressive list of contributors in psychology, psychiatry, and traumatology, many of whom are identified as psychoanalysts, but there are several who specialize in the trauma field as well; therefore the reader will appreciate divergent perspectives coming from different albeit complementary disciplines. What differentiates this work from other trauma books is that it situates its subject matter in locations where living in situations of continuous terror and/or struggling with the aftermath of horrific trauma is often experienced on a daily basis. What is of further value is that this book is not merely theoretical or sociopolitical in scope and content, rather it is written as a clinician's guide to help the practitioner navigate through the arduous waters of trauma recovery.
There are twenty-eight chapters in this book written by notable and respected professionals from diverse yet interrelated disciplines covering a broad range of topics from the theory or meaning of trauma, to the intrapsychic and social dynamics of the victims and survivors, to diagnostic concerns and clinical methodology, to the speculative future of the state of trauma studies and its impact on the field of mental health. As might be expected, topics range from those most affected by trauma, such as those living in war torn countries, especially those faced with the ubiquity and often senseless ethnopolically and religiously inspired warfare in the Middle East, to the residual psychological, national, and cultural aftereffects of many great world atrocities including an analysis of traumatic effects encountered in the Holocaust, Hiroshima, Cambodia, Vietnam, the Palestinian-Israeli conflict, and 9/11 in the United States.
There are some profound psychoanalytic insights in Knafo's collection of essays, but what also makes this book a success is how she is able engage in dialogue traumatologists who challenge and expand our current conceptualizations of trauma that depart from the DSM IV symptom check-list approach, as well as the cooker cutter recipe, manualized treatment paradigms that boast treatment efficacy. Any clinician working with trauma patients knows how laborious, painful, and long their healing process can be. This is a definitive sourcebook on the interface between psychoanalysis and the field of trauma studies. But it raises many important philosophical questions on the nature of where do we draw the line on what constitutes trauma, normativity, and pathology that cannot be systematically explored in an edited volume of this kind. I believe potential answers to these issues have profound significance for the future of psychoanalysis.
In The Dissociative Mind, Elizabeth Howell seeks to provide a more substantial integration between psychoanalysis and traumatology and provides a superb inquiry into the question of trauma, dissociation, psychopathology, and the theoretical frameworks that guide our conceptual formulations and modes of clinical practice. She impressively examines the theoretical nuances in many historical models of dissociation including the work of Janet, Freud, Ferenczi, Fairbairn, and Sullivan, as well as contemporary thinkers such as Bromberg, Stern, and Davies. Through her clinical vignettes, one develops a deep respect for her work as a clinician. Sensitive to concurrent work in trauma studies, neuroscience, attachment theory, defense, and personality structure, this book should be digested slowing for its rich and subtle flavors.
Howell bases many of her arguments following the relational tradition that seeks to displace dynamic unconscious processes in favor of postmodernism and a dissociative model of mind. In fact, she specifically views trauma and dissociation at the locus of all psychopathology, reduces repression to dissociative phenomena, decenters the notion of a unitary self as a consolidated agency, which she thinks is an illusion, favors a plurality thesis of multiple selves and self-states, and generally adopts a postmodern emphasis on constructivism along with anti-epistemological and anti-metaphysical postulates. Her radicalization of the mind as a dissociative multiplicity rather than a synthetic process system that accounts for multiplicity and plurality within a unifying complex totality or dynamic holism becomes a serious theoretical limitation to her thesis. Furthermore, by making the mind merely a dissociative entity, she eclipses many other viable theories of mental processes including a conflict model of defense that accounts for desire and drive, wish and counter-wish, and intrapsychic fantasy relations that classical approaches, modern conflict theorists, and contemporary Freudians and Kleinians would likely find objectionable. What I believe is missing in her book, but would lead us into fruitful discussion, is the relationship between dissociation and the question, nature, and latitude of the unconscious in contemporary theory.
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