She redefined trauma. Then trauma redefined her

In the fall of 1994, the psychiatrist Dr. Judith Herman was at the height of her influence. Her book “Trauma and Recovery,” published two years earlier, had been hailed in The New York Times as “one of the most important psychiatric works to be published since Freud.”

Her research on sexual abuse in the white, working class city of Somerville, Massachusetts, laid out a thesis that was, at the time, radical: that trauma can occur not only in the blind terror of combat, but quietly, within the four walls of a house, at the hands of a trusted person.

More than most areas of science, psychology has been driven by individual thinkers and communicators. So what happened to Herman — as arbitrary as it was — had consequences for the field. She was in a hotel ballroom, preparing to present her latest findings, when she tripped on the edge of a rug and smashed her kneecap.

“Just, wham,” she said. “Smack.”

On and off for more than two decades, Herman groped her way through a fog of chronic pain, undergoing repeated surgeries and, finally, falling back on painkillers. The trauma researchers who surrounded her in the Boston area moved on with their work, and the field of trauma studies swung toward neurobiology.

“She is a brilliant woman who lost 25 years of her career,” said her friend and colleague Dr. Bessel van der Kolk, whose 2014 book, “The Body Keeps the Score,” helped propel the field toward brain science. “If you talk about tragedy, that is a tragedy.”

At the age of 81, Herman has rejoined the conversation, publishing “Truth and Repair,” a follow-up to her 1992 book “Trauma and Recovery: The Aftermath of Violence — From Domestic Abuse to Political Terror.” During that period, trauma has gained broad acceptance in popular culture as a way to understand mental health.

But the dominant idea now comes from van der Kolk, who argues that traumatic experiences are stored in the body and can best be addressed through the unconscious mind. “The Body Keeps the Score” has appeared on the bestseller list for an astonishing 232 weeks. TikTok bulges with testimonials from members of Gen Z, identifying all manner of habits and health conditions as trauma responses.

Herman does not want to use this flush of attention to debate her old friend. But in “Truth and Repair,” she picks up where she left off in 1992, arguing that trauma is, at its heart, a social problem rather than an individual one.

Drawing on interviews with survivors, she lays out a theory of justice designed to help them heal, centering on collective acknowledgment of what they have suffered. Her approach is frankly political, rooted in the feminist movement and unlikely to go viral on TikTok.

This does not seem to trouble her at all. “In my own life, I feel like I’m in a good place,” she said. “On the other hand, I think psychiatry will have to be dragged, kicking and screaming, into any kind of progressive future.”

A pledge

When Herman and van der Kolk met in the 1980s,she was treating the daughters of working-class Irish and Italian families, who were coming forward with stories of sexual abuse. He had been treating veterans who seemed trapped in the past, exploding with extreme rage at minor frustrations.

She was reserved; he was expansive. Herman likes to call herself “plain vanilla,” doggedly faithful to psychodynamic psychotherapy; van der Kolk is “flavour of the month,” always exploring new treatments, first Prozac, then body work and eye movement desensitisation and reprocessing.

They had this in common: The patients they treated had been routinely dismissed by the psychiatric establishment as malingerers or hysterics. “We were in explicit agreement,” van der Kolk said. “We noted that people in academia were often very cruel to each other, and we made a pledge to have each other’s back.”

The diagnosis of PTSD was brand-new, having first appeared in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1980, and the Boston area, van der Kolk said, “was to trauma what Vienna was to music.” A trauma study group convened monthly in the elegant stretch of Cambridge mansions known as Professors’ Row.

They argued, Herman said, about “what counted” as trauma. “The guys who worked with the vets, we had some back and forth, shall we say,” she said. “We had some knockdown drag-outs, calling out the sexism of the men who thought combat trauma was trauma and everything else was just whining.”

Herman is widely credited with putting this question to rest. “Trauma and Recovery” addressed a general audience in “measured, gripping, almost surgically precise” language, as the Times review put it, and with the authority of a Harvard psychiatrist.

Her ideas also radiated into the communities where she practised, said Rosie McMahan, whose family worked with Herman and her colleague Emily Schatzow to confront sexual abuse by her father.

“She did this remarkable thing — ‘Wait a minute, the same things that were happening to those soldiers, in a sense, happened in families,’” said McMahan, whose book, “Fortunate Daughter,” describes her family’s reconciliation. “They recognised that it was trauma and called it such. They behaved as if it was.”

Their ideas were gaining ground. In 1994, the editors of the DSM expanded the definition of PTSD, dropping the requirement that the traumatic event be “outside the range of usual human experience.” Herman and van der Kolk began lobbying for the inclusion of complex PTSD, the result of recurring or long-term traumatic events.

Then came what’s known as the “memory wars” — a pushback from leading psychiatrists against therapy that encouraged patients to unearth memories of sexual abuse. The criticism often zeroed in on van der Kolk, who served as an expert witness in high-profile cases, and Herman, whose work on dissociation was regularly cited by defenders of repressed-memory therapy.

Herman shrugged off this critique as “predictable,” the same resistance that Vietnam War veterans and rape victims had encountered when they came forward. “You know, history is a dialectical process,” she said. “When you have a movement that challenges the power structure, you’re going to have a backlash.”

Since the mid-1990s, the editors of the DSM have consistently opposed further expanding the definition of PTSD. The original definition was “intentionally strict, meant to avoid the possibility that all mental disorders are simply caused by trauma,” said Dr. Allen Frances, who chaired the task force for the DSM’s fourth edition.

While stress contributes to most psychiatric problems, he said, PTSD diagnoses can be made quickly and carelessly, without pursuing underlying mental disorders, such as anxiety and depression. Taking that leap, he added, means “all the rest of the knowledge ever accumulated about mental disorders goes out the window.”

Pain of unexplained origin

On the day she broke her kneecap, Herman was preparing to deliver a workshop on her latest findings, and was carrying a carousel of slides to a projector. She was distracted and did not see that a binding had come loose from the rug.

Herman has offered vague explanations for the 30-year gap between her books. “Life intervened, in the form of illnesses and a move to an assisted-living community,” she writes in a forward to “Truth and Repair.” In an interview, she flicked away the question, calling it “a very long, sad tale which I won’t bore you with.”

But there is a story. Her kneecap healed, but nerve tumours had formed in her leg, and the pain grew steadily worse. For long stretches, daily life became a challenge. There were remissions, but there were also times she could not get out of bed, where even changing positions was “extremely, extremely painful.” At one point, she was so desperate that she asked a doctor if he could amputate her leg.

“All you could think about was pain,” she said. “It wasn’t even thinking about pain. It was being pain. One’s existence was just pain. It’s like being in a tunnel.” Like “your whole existence is pain, and nothing exists outside of it,” she added.

There was a subtext in her doctors’ response, early on, which she, as a fellow physician, was uniquely qualified to identify: They did not quite believe her. “I was a middle-aged woman with pain of unexplained origin,” she said. In the jargon of medical residents, she said, she was a “crock,” or a female hypochondriac.

Eleven years and three surgeries later, her doctors said there was nothing more they could do. This was the worst of it, when there was no hope of reprieve. “It made me not want to live,” she said. “That is literally what happened.”

A remedy appeared in 2019, almost by chance. She had gone to see a surgeon about arthritis in her hand, and instead, he peered at her knee. After she left, he emailed her an article about a surgery that had been developed at Walter Reed National Military Medical Center to treat amputees, war veterans from Iraq and Afghanistan.

Later that year, surgeons removed the damaged nerves, sutured them to a motor nerve harvested from her quadriceps and then implanted them into her muscle. She weaned herself off fentanyl, set aside the brace and the crutches. She compared the relief she felt to the sensation women have when childbirth ends.

“I mean, it’s really heavenly,” she said. “I’m in a permanent state of gratitude.”

And that, she said, was why she had the energy to finish another book.

“It’s a totally crazy story,” she said. “I owe it all to the forever wars.”

This article originally appeared in The New York Times

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