This book is a very original and thought-provoking history of the concept of psychic trauma and its evolution over the past century of psychoanalytic, psychological, and neurobiological thought. The author is a professor in the Humanities Center at Johns Hopkins University. She demonstrates a profound and far-ranging knowledge of traumatology with considerations of predisposition, vulnerability, reactivation, shock trauma, and strain trauma as well as the immediate effects, the long-range consequences, and sequelae of trauma. The author provides a valuable synthesis of the development and still-evolving theories of psychic trauma, with an exemplary review of the pertinent literature. Many of the footnotes guide the reader to important comments and references that might well have been incorporated into the text. The historical overview is fascinating, although at times there is a repetitive questioning of the time-tested issues concerning the existence of unconscious mental processes and unconscious conflicts and fantasy.

Dr. Leys’s overview encompasses not only the pre-Freud era but also the spectrum of issues concerning contemporary concepts of psychic trauma. Although the term "trauma" has been stretched to include mildly noxious experiences, the author points out that the concept of trauma has become indispensable to 20th-century thought because of the Holocaust, other genocidal disasters, the catastrophes of two world wars, and the threat of nuclear Holocaust. According to the author, not even the enduring effects of the Holocaust succeeded in reviving the interest in psychic trauma. Rather, she feels that it was the traumatic experiences of Vietnam war veterans and the sexual and aggressive abuse of children that led to new investigations of trauma and to the investigation of the long-term effects of psychic trauma.

Posttraumatic stress disorder (PTSD) was first officially recognized by APA in 1980, and the author points out that the diagnosis is not without controversy. The diagnosis of PTSD is enmeshed in overlap and confusion with neurotic conditions, stress-related reactions, and issues of compensation claims. The struggle of Holocaust survivors to receive compensation from German courts on the basis of psychic trauma is repeated in the controversy regarding the validity or abuse of PTSD. An interesting feature that emerges from this discourse in just how much psychoanalytic and psychiatric classifications and constructs may be influenced by social, political, and economic considerations.

The field of trauma research lacks cohesion. The author dissects interweaving, complementary, and contradictory strands in consideration of PTSD. Shifts in emphases on pathogenic defenses of repression or dissociation as well as curative efforts toward remembering or forgetting, reintegrating, or desensitizing traumatically induced psychopathology are considered.

Forgotten contributions to the theory of trauma are of particular interest. In 1895, Breuer and Freud recognized Janet’s place in the theory of the cathartic cure. Among current authors, Herman (in 1992) and Van der Kolk (in 1995) reconsidered Janet’s work on trauma, memory, and narration. Accordingly, traumatic memory was therapeutically converted into narrative memory, which narrates the past as past. Dr. Leys notes that Janet also sought to make the patient forget. The reader will be rewarded by the theoretical dissection, which shows the many inconsistencies within an individual author’s conceptualizations as well as between those of various contributors.

The author’s lucid reexamination of shell shock and combat fatigue raises important questions of literal, concrete reenactments versus disguise and distortion. This leads into contemporary controversy over reality and fantasy as well as true or false memories in clinical work. Given the ubiquitous tendency to use memory for defensive and self-serving purposes, I affirm and agree with those theorists who invoke the need for psychoanalytic and historical reconstruction (1). Psychoanalytic contributions are fundamental but understated.

The author cautions the historian, and implicitly the clinician, to avoid embracing extreme positions and to remain aware of the multiplicity, complexity, and interrelationships among the different models of traumatic disorder. This valuable study would have been enriched by further consideration of the relationship between trauma and preceding as well as succeeding unconscious intrapsychic conflict. Nevertheless, this book is a tour de force of historical and conceptual reconstruction. It is recommended to clinicians, historians, and all those who wish to further their understanding of psychic trauma.