Trauma inflicted on human beings by human beings does not just injure the body or even the psyche. Trauma has biopsychosocial and moral consequences that are cross-generational. Trauma experienced at the hands of members of one's social group results in a wounding of the social self so profound that the victim often feels outcast, doomed to wander in an inner - and often outer wilderness, alone abandoned and uncomforted.

Human beings are social animals. From the moment of conception, the fusion of egg and sperm, our development is relational. The human infant is "dyadically embedded and dialogically operative" and the developing human mind is dialogically constituted (Rommetveit, 1992). This dialogue occurs in the context of a constant "attunement to the attunement of the other" (Rommetveit, 1992; Stern, 1985). Throughout our lives we live within a web of complex relationships within which we are protected, nurtured, and trained.  These relationships determine how we view our selves, how we manage and interpret our affective experiences, how we think about ourselves, others, and the world around us. Without these relationships we perish.  Our survival is totally dependent on our interdependence with others from birth to death.

The earliest representatives of society are our primary caretakers, usually our parents. As we move from infancy into childhood and then adolescence, our social circle enlarges outward, including within its sphere of influence other family members, babysitters, teachers, clergymen, friends and their family members, leaders of youth groups, and other adults in a position to influence children. The whole that comprises all our relationships is called our "community" and is the source of our common assumptions, our common moral voice resonating with the voice of our own inner self (Etzioni, 1993).

Children who are raised in homes that are abusive and/or neglectful are traumatized by those primary caretakers who are the earliest embodiments of the social system. In such situations, children's basic needs remain inadequately fulfilled even though the child is dependent upon the supposedly legitimate authority of their caretakers who command their obedience. Such families are characterized by the abuse of authority which is upheld by at least four major characteristics of an authoritarian system as defined by Philip Slater : 1) deference or submissiveness involving the maintenance of a hierarchical order of dominance and submission; 2) systematic oppression through brutality and terror; 3) deflection, involving the direction of hostility and blame outward from the source of the hostility; 4) secrecy as a way of keeping those within the system ignorant of any alternative reality (Montuori & Conti, 1993).

Systems characterized by such abusive use of power are systems within which there is a preponderance of emotional misattunement, a lack of empathic responsiveness to the totality of the other's existence. Additionally, abusive homes are frequently characterized by such strong inclinations towards intolerance, moral rigidity, low humor and high sarcasm (Courtois, 1988) that the expression of the positive affects of interest/excitement and enjoyment/joy are responded to not with appreciation and mutual enjoyment but with hostility, shaming behaviors, and even overt punishment. Within such a context children are forced to sacrifice their "true self" for the creation of a "false self" (Stern, 1985, Nathanson, 1992) that enables them to survive in such a hostile environment. A similar phenomenon in adults has been recognized by Lifton by a term he calls "doubling" or the formation of a second self, related to but more or less autonomous from the prior self (Lifton & Markusen, 1990). Children who grow up in abusive homes develop malignant feelings of inner badness and basic fragmentations in the self. Their concept of social relationships are severely split and shifted towards the more malignant aspects of social interactional styles, resulting in fundamentally negative views and expectations of themselves and their world accompanied by increased splitting and dissociation in representation of self and other.  (Fischer & Ayoub, in press).As Judy Herman has pointed out trauma "destroys the belief that one can be oneself in relation to others" (Herman, 1992)

Human beings raised in abusive, terrorizing, deceitful, and secretive social worlds at home actually develop two inner models for the world around them. One model, a model of social betrayal and destruction, is based on very real experience, one which they know intimately, come to expect, and compulsively recreate even when freed from their abusive homes in adulthood. The other model is a wish carved out of childhood fantasies and perhaps experiences found in creative self pursuits, fairytales, movies, visits to the homes of other children, and the implicit promises that every society offers to its children that they will be loved and protected - the stuff that dreams are made of. This is the world for which they can largely only hope, must repeatedly test if it happens to appear even in potential, and frequently reject as real in fear of being disappointed and hurt again.  It is the community, through the parents who represent it, who have betrayed these children. It is the responsibility of the community to restore their lost faith in the essential possibilities for goodness in the world around them.

Social wounds require social healing. The healing that is achieved through the establishment of healthier individual attachment bonds is necessary but not sufficient to restore a sense of wholeness to the social self that has been so profoundly wounded.  Over the last several hundred years there have been many attempts to create environments that promote healing utilizing the therapeutic effects of an entire treatment milieu. The inherent difficulty in these social therapeutic settings is that to be effective, they inevitably must challenge the implicit social and moral alienation that characterizes the entire social group.  

In order to create and maintain environments that are truly healing sanctuaries for victims of trauma, the healers must begin the arduous process of healing their own social wounds as they tend to the damage done to their patients. The homes we have grown up in, the systems through which we have all learned our social values, vary only in degree from those of our patients. We all carry with us two internal social models, the real and the ideal. The magnitude of the gap between these two models has more to do with our own experience and perceptions then it does with any fixed and immovable reality. Likewise, the rigidly defined dichotomy of "patient" and "staff", "us" and "them" is a false one, a comfortable distancing of ourselves from our suffering neighbors that simply prevents us from having to become uncomfortably emotionally resonate with the pain of our patients' experience. Such a split, although protective for us, serves to perpetuate the internal split that occurs secondary to abuse, guaranteeing that the patient will remain forever the social Outcast, the Scapegoat, doomed to wander in an inner -and often an outer-wilderness, alone, abandoned, and uncomforted. In this way, psychiatric hospitalization, by its intense social nature, has historically too often reinforced rather than diminished the internal split of the patient's social self. If this split is to be healed, if we are to see society as having a definite responsibility in welcoming these people back into the fold, then the essential questions become, "How do we create healthy systems if we have never seen one?" and "How do we maintain systems that are safe places for both patients and staff members so that the affective attunement and empathic resonance so necessary for healing can safely occur?"

 
Courtois, C. (1988). Healing the incest wound: Adult survivors in therapy. New York: W. W. Norton and Co.
Etzioni, A. (1993). The Spirit Of Community: Rights Responsibilities And The Communitarian Agenda. New York: Crown.
Fischer, K. W., & Ayoub, C. (1997). Affective splitting and dissociation in normal and maltreated children: Developmental pathways for self in relationships. . In D. Cichetti & S. L. Toth (Eds.), Developmental Perspectives on Trauma: Theory, Research, and Intervention, Volume 8. Rochester, NY: Rochester University Press.
Herman, J. L. (1992). Trauma and Recovery. New York: Basic Books.
Lifton, R. J., & Markusen, E. (1990). The Genocidal Mentality. New York: Basic Books, Inc.
Montuori, A., & Conti, I. (1993). From Power to Partnership: Creating the Future of Love, Work, and Community. San Francisco, CA: Harper Collins.
Nathanson, D. L. (1992). Shame and Pride: Affect, Sex,and the Birth of the Self. New York: W.W. Norton.
Rommetveit, R. (1992). Outlines of a dialogically based social- cognitive approach to human cognition and communication. In A. H. Wold (Ed.), The Dialogical Alternative: Towards a Theory of Language and Mind. Oslo, Norway: Scandinavian University Press.
Stern, D. (1985). The Interpersonal World of the Infant: A View From Psychoanalysis and Developmental Psychology. New York: Basic Books.