Psychodynamic Contours of Post-Traumatic Stress Disorder

Abstract

In Psychotherapy ofthe Combat Veteran, Harvey]. Schwartz, M.D . offers th e reader a n intellectually challe nging but rewarding journey throu gh a psychodynamic ex ploration of the " wa r neuroses." Though th e conce pt of a post-t rauma tic stress di sorder (PTSD) was noted by Dr. Schwa rtz to have occurred in th e lit era tu re by 1978, and it was ens hrine d in the DSM III in 1980, th e work in this volum e lift s th e veil of the purely descriptive approach to explore th e psych odynamic con tours of the top ic. Dr. Schwartz has assembled many aspect s of th e lit erature includi ng th e hist ory of traumatic neu roses, sleep research , psych o-pharmacology, gro up therapy, bri ef th erapy, psychoanalytic psychotherapy, prevention, a nd a n investiga tion of th e effects of th e broader social environme nt. Schwartz frames th e book with a n exce lle n t int roduct ory cha pte r th at se ts ou t th e volume's main tasks: (I) an investigation of th e psych ological effec ts of massive trauma, including th e interaction of overwhelming ex ternal eve n ts wit h underlying infantile conflicts or fantasies; and (2) a n explora tion of wha t an effective " holdi ng enviro nmen t" may be for th e suffere rs of PT SD. Thes e tasks are accom plish ed with a fin e coll ec tion of ar ticl es which re vie w past lit erature and present original formulation s. Transferen ce and count ert ransference in work with severe ly traumatized patients are add ressed by Sha piro and in two articles by Schwartz. Blitz and Greenberg postulate a n a pproach to d rea m mat eri al related to conce pts of se lf psychology. Most helpful to m e were t he ab undant case exa m ples in this volume, whi ch provided vivid glim pses of th e psych ot he rapeut ic work . Those who have had some ex pe rience wi th t ra uma survivors a nd ca n a pprec ia te th e abstract nature of psychodynamic lit era ture will be able to ex t ra ct useful pointers for the direction and pitfalls in psych odynamic psychoth erap y with sufferers ofPTSD. Dr. Schwartz presents several cases including a/p a rt icula rly moving study of a severe ly di ssociated patient ca ugh t up in relivin g a n overwhelming trau ma tic experi-