Using a very simple method, Charles Figley has produced a fascinating book. He has collected autobiographical essays by 17 pioneer trauma scholars (himself included) and, in so doing, has produced a book which very richly describes the evolution of modern psychotraumatology.
Each author was asked to answer four questions about the events that led to their interest in trauma, their greatest achievements in the field, the people who most influenced them and their hopes for future research. The contributors are past winners of lifetime achievements or pioneer awards from the International Society for Traumatic Stress Studies and many have themselves been presidents of the Society.
Several of the contributors are Jewish whose relatives perished during the Holocaust. Henry Krystal is himself a survivor of Auschwitz. Others found their way into the trauma field by getting involved in treating Second World War or Vietnam veterans. The editor is himself a Vietnam veteran. Some of the non-American contributors (Van der Kolk and Weisaeth) grew up in Europe during the German occupation, yet others appear to have entered the field of trauma by chance.
Many terms now in everyday psychiatric language were coined by these pioneers (e.g. rape trauma syndrome (Burgess), conspiracy of silence and multigenerational transmission of trauma (Danielli), compassion fatigue (Figley), complex post-traumatic stress disorder (PTSD) (Herman), psychic numbing (Lifton) and disorders of extreme stress not otherwise specified (Van der Kolk)). Apart from the development of these concepts so familiar to us now, these individuals have made other huge contributions to the field. Herman and Van der Kolk showed that those with borderline personality disorder were, in over 80% of cases, victims of childhood sexual abuse. It was Horowitz who first developed the Impact of Events Scale. Ochberg first described the Stockholm syndrome although he did not coin the term. Kolb and Van der Kolk have made major contributions to our understanding of the physiology associated with the long-term effects of trauma. It was Lifton who wrote so eloquently about the Nazi doctors, stating that, in his view, no individual is inherently evil, murderous or genocidal, but under certain conditions virtually anyone is capable of becoming all of these things.
There are a number of common themes running through most of the chapters including the importance of working collaboratively with others, both in research and clinically. The need for mental health professionals in general, and those working in the trauma field in particular, to take an active part in socio-political matters is emphasised. Several of the authors suggest that PTSD is the first psychiatric disorder which can be prevented as the population at risk is often known and, when a trauma has occurred, high-risk cases can be identified early. Although we have some knowledge of possible beneficial early interventions, much more research is needed in this area. Friedman, perhaps simplistically, states that all we have to do is stop war, rape, genocide, child abuse, interpersonal violence and the perpetuation of other human-made traumatic events.
Overall, this book provides a historical account of developments in the field of traumatology during the latter half of the 20th century, which clinicians and researchers would enjoy. It provides a good overview of much of the research in the field and gives pointers to where future research should focus.