Book Review

Trauma: A genealogy

N Engl J Med 2000; 343:1052October 5, 2000

Article

Trauma: A genealogy
By Ruth Leys. 318 pp. Chicago, University of Chicago Press, 2000. $19 (paper); $55 (cloth). ISBN: 0-226-47766-5 (paper); 0-226-47765-7 (cloth).

Since the introduction of “post-traumatic stress disorder” into the psychiatric nomenclature in 1980, there has been growing interest in literary and medical accounts of reactions to extremely stressful events. These modern reviews aim to document the continuities among these accounts. In Trauma: A Genealogy, Leys breaks with this tradition, taking instead a “genealogic” approach, in which themes resurface in isolated episodes. She presents these themes as two opposing perspectives on post-traumatic reactions. The mimetic perspective views psychological trauma as an experience that “shatter[s] the victim's cognitive-perceptual capacities,” making the memory of the experience unavailable to conscious awareness and to the cognitive processing that could otherwise integrate this memory into conscious awareness. From this perspective, the post-traumatic state is a dissociated experience in which the affected person imitates, or identifies with, the aggressor or the traumatic memory, as if in a hypnotic trance. The antimimetic perspective, taken by some neurobiologic theories, views psychological trauma as an external event in which the shock is registered without the active participation implied by mimesis.

Leys suggests that the antimimetic perspective arose in response to the threat posed by mimesis to the concepts of autonomy and responsibility for one's actions and to the confabulation implied by the mimetic link to hypnosis. Although this may be true in part, or in some cases, the material Leys reviews indicates that the antimimetic perspective also arose from a struggle by some theorists to understand psychological trauma within the confines of the mimetic extreme.

The book begins with an examination of the work of Freud, whose contributions to the understanding of psychological trauma are often minimized today, no doubt because he called into question the validity of accounts of sexual assault. The second chapter presents Morton Prince's famous case study of a person with multiple personalities, “Sally Beauchamp.” Leys then turns to World War I and shell shock, focusing on the debate about the nature of psychological trauma and the value of catharsis, and links this debate to the work of Pierre Janet on hypnosis. The issue of catharsis is raised again in a discussion of work during World War II, in which drugs were used to facilitate recall of traumatic memories. In the chapters on war neuroses and on the truth of the traumatic narrative, the collision between the mimetic and antimimetic paradigms is most cogently illustrated. Leys's criticism of the neurobiologically based theory of van der Kolk and the literary theory of Caruth is perhaps the strongest of any criticism in the book and will undoubtedly spawn further debate about the validity and fairness of the author's claims.

The book is likely to be most useful to readers who have a strong interest in, and knowledge of, psychoanalytic and other historical approaches to psychological trauma. Readers whose background comes mostly from the perspective of work on post-traumatic stress disorder may find it less useful, because Leys's analysis does not explain how the contradictions between the mimetic and antimimetic viewpoints apply to current knowledge about psychological trauma and this disorder. Formalization of the diagnosis of post-traumatic stress disorder has led to a substantial accumulation of information about psychological trauma, and it is understandable that the coverage of this material is extremely selective. Unfortunately, the discussion does not adequately represent current thinking about psychological trauma. For example, a cornerstone of Leys's criticism of van der Kolk's ideas rests on his emphasis on the literal nature of traumatic memories. Most work on the neurobiology of post-traumatic stress disorder does not share this emphasis but is strongly grounded in well-established findings about learning and memory.

Nevertheless, Leys presents her arguments clearly, and her sobering conclusion is that theories about the nature of psychological trauma that are based on the extremes of either the mimetic or the antimimetic theory are bound to fail. Even readers who disagree with her analysis of the recent literature on trauma will be able to see the merits of her logic and should give serious consideration to its implications.

Paula P. Schnurr, Ph.D.
Veterans Affairs National Center for Post-Traumatic Stress Disorder, White River Junction, VT 05009