American Psychiatric
Press, Inc. This 429-page volume is part of the Progress in Psychiatry Series produced by the American Psychiatric Association Scientific Program Committee and the American Psychiatric Press. An American Psychiatric Association Symposium in 1993 on trauma and dissociation is the proximate cause for concluding that, after more than 80 years since Janet's formulations of trauma and dissociation, there is now an "electric atmosphere" and a reshaping of this area of psychiatry. The goal of this book, which consists of 12 chapters by 24 authors, is to present a consolidation of the work of some of the major investigators in the fields of trauma, memory, and dissociation. References follow each chapter and the book ends with a subject index. Although the book is intended to present an exciting, detailed body of new information about areas of psychiatry, what it actually offers is a rehash of the psychiatric "spun glass" theory of the human mind. The mind is viewed as made of spun glass, delicate and fragile, that is shattered by trauma or any untoward and unfortunate experience. The discovery that the world is not a safe place is the most harmful of all blows. Once shattered, the broken mind does not work very well and there is great difficulty in trying to put it back together again. The 12 chapters include an historical description of how the concepts of dissociation, trauma, hypnosis, and therapy for these maladies began. They remain intertwined to this day. There is some discussion of the internal fights over variants of Freudian theory within psychiatry. Unless there is interest, i.e., in hypothesized differing forms of abreaction and differing chains of intervening variables to account for what abreaction is and may or may not lead to, there is not much value in this material. What is missing from this book is any acknowledgment that human beings may be able to cope with trauma successfully. Trauma is always injurious and the only ways of coping that are described are those that are ineffective and lead to the problems associated with the concept of dissociation. These negative effects include multiple identities, borderline personality disorder, post-traumatic stress disorder, and dissociative identity disorder. The causes are any childhood trauma, but the one most often mentioned and presented as a special destroyer is childhood sexual abuse. If this scenario is taken seriously, it is difficult to figure out how the human race has survived for several millennia. The world is not a safe and secure place. Bad things happen. If trauma has such powerful effects leading to maladaptive behavior that never improves effective responses to the trauma, survival of the fittest would predict that the evolutionary advantage of the few that may cope well should result in ever-increasing numbers of successful copers, not in ever-increasing numbers of individuals who respond to trauma with dissociative phenomena. No credible data relating to the outcome and the efficacy and utility of suggested treatments are presented beyond a brief discussion of the behavioral technique of flooding. Other treatment suggestions are built on the questionable dogma that insight and understanding are restorative. Here only anecdotal material, including a few case studies, are offered to support such therapy. This book is a profoundly grim and limited view of human capacity, courage, and coping with a real world of sufficient lawfulness that a good life for human beings is possible. Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.
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