As I write this in October 2005, the people of New Orleans and adjacent areas have been experiencing multiple levels of trauma, including the destruction of their homes by fierce winds and lethal flooding; deaths of family and friends, sometimes helplessly witnessed, and their own escape from that fate; loss of contact with family members; and a general breakdown of social order – all with a sense of having been abandoned by their government, which was only partly relieved when help finally arrived.

These forms of trauma were mainly a result of Hurricane Katrina but also of Hurricane Rita, which hit some of the same areas just ten days later. Both storms were extraordinary in their destructive power. Hundreds of thousands of people are undergoing dimensions of trauma that will affect their psyches, their bodies, and their overall sense of human viability. Though some will undoubtedly show impressive resilience in finding new life patterns, many will be left with permanent psychological pain and impairment.

Within just weeks following those hurricanes, a disaster of much greater magnitude occurred in the form of an earthquake in Pakistan, killing at least 40,000 people and leaving millions at profound risk.

This book seeks to explore the scope of human trauma, wherever it occurs. The diagnostic category of posttraumatic stress disorder becomes a baseline, a psychological indicator. Any such category will have its contradictions and confusions, but it does at least provide a structure for a very real and often neglected form of human suffering.