The Encouraging News About Trauma and Recovery

It's been 30 years since the publication of Trauma and Recovery, and it seems that the basic concepts have held up remarkably well. It is clearer than ever that public and professional awareness and understanding of trauma require a movement that recognizes and honors survivors. The most encouraging news is that we are currently seeing a revival of such movements—for women’s lives, Black lives, the lives of other marginalized and subordinated peoples, and even the stirrings of a labor movement. The most discouraging news is that it has taken so much degradation worldwide—of public health, democracy, and the natural ecosystem that supports human life, to bring us to this point.

I fear for my children and grandchildren and take only small comfort in the fact that old people throughout history have often predicted that Ezekiel’s four horsemen of the apocalypse, sword, famine, wild beasts, and plague, would soon bring end times in this world. In our own time, we have already seen sword, famine, and plague aplenty, and it is the disappearance of the wild beasts that foreshadows even greater disaster.

​The basic concepts I proposed 30 years ago: Understanding trauma as an affliction of the powerless, and recognizing a spectrum of traumatic disorders, ranging from the relatively uncomplicated impact of single accidental events to the more profound effects of prolonged and repeated human cruelty, have now been supported by numerous forms of research, including 30-year studies that record the impact of abuse and neglect on every aspect of child development. The new diagnostic category of complex PTSD, which I first proposed to capture the more extreme end of the trauma spectrum, has now finally been granted the status of official recognition by the World Health Organization in their International Classification of Diseases.

That complex PTSD does not fit neatly into pre-existing diagnostic categories is exactly the reason that it is important for clinicians to recognize it in its many disguises. Too often, with patients who suffer from complex PTSD, the underlying trauma diagnosis is missed, the patients are treated only for their presenting symptoms (often with a slew of unhelpful medications), and they do not get the trauma treatment they need to promote recovery.

​The basic principles of recovery that I articulated are also unchanged. If disempowerment and disconnection are the hallmarks of trauma, then recovery requires empowerment and human connection. The three-stage treatment model is now widely (though not uniformly) recognized as a standard of care for complex trauma. For people whose trust has been repeatedly violated, the first step in any trauma treatment must be to establish a trusting relationship between patient and therapist. For people who have learned to live under constant threat, the first task of recovery is to establish a sense of safety in the present. Short-term treatment protocols that attempt to shortcut these steps show very high dropout rates, and for good reason. Survivors need the foundation of a secure treatment relationship, where they feel cared for, respected, and understood, to integrate trauma memories into a life story and emerge from imprisonment in a frozen past to embrace life in the present and future.

​Healing from trauma requires integration of body, brain, and mind: safety, remembering, grieving, and reconnecting with a community. Healing from the impact of human cruelty requires a relational context of human devotion and kindness. Psychotherapy and social support are the bedrock of recovery. Though promising new therapeutic techniques such as EMDR, psychedelic-assisted psychotherapy, and neurofeedback have been developed, it has been well-known for over a century that techniques that produce altered states of consciousness facilitate the processing of trauma, but only when they are utilized in the context of a caring and safe therapeutic relationship. No new technique or drug is likely to change these fundamental principles.