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Wounded By Reality

Understanding and Treating Adult Onset Trauma

• By Ghislaine Boulanger

• Price: $39.95 $35.96
• Binding: Hardback
• Pages: 202
• Published by: Routledge
• Publication Date: 2nd March 2007
• ISBN: 978-0-88163-430-3

About the Book

The culmination of three decades of studying and treating survivors of adult onset trauma, Wounded by Reality is the first systematic attempt to differentiate adult onset trauma from childhood trauma, with which it is frequently confused.

When catastrophic events overtake adult lives, they often scar the psyche in ways that psychodynamically oriented clinicians struggle to understand. For Ghislaine Boulanger, the enormous challenge of working with these patients is unsurprising. Survivors of major catastrophe, whether a natural disaster, a life-threatening assault, a serious accident, or an act of terrorism, experience a near-fatal disruption of fundamental aspects of self experience. The sense of agency, of affectivity, of bodily integrity, the capacity for self-reflection, the sense of time, and the ability to relate to others - all are called into question.

Reviews

"Ghislaine Boulanger’s remarkable book begins a new era of trauma therapy. She has overcome difficulties in psychoanalytic metapsychology to make two significant contributions: She clearly distinguishes the consequences of adult onset catastrophic trauma from childhood trauma; and she spells out the details of treating adult trauma. She shows how, in confronting sudden death and other overwhelming situations, the self is shattered; its component parts, such as memories and affect, are broken up and scattered. They become shield-like obstacles rather than tools to enhance the capacity to experience life and happiness fully. The life-maintaining resources are rendered ineffective. Boulanger demonstrates the obstacles that an analyst (or other therapist) encounters. She supplies the techniques to make treatment effective. She gives us a whole new way to help people whose problems are very difficult to treat."

- Henry Krystal, M.D., Author, Integration and Self-Healing:Affect, Trauma, Alexithymia (Analytic Press, 1993)

Ghislaine Boulanger has filled a critical gap in our knowledge with this beautifully written, exhaustively researched, highly readable book on catastrophic trauma in adulthood. Even those of us with secure childhoods, it turns out, are much more fragile than we would like to believe. Boulanger explores this harsh reality gently but authoritatively, in the context of a wealth of scholarship, and draws wise and clinically useful conclusions about helping the traumatized and those who love them. Because therapists of all orientations and interests may find themselves working with traumatized adults, and because prior approaches to the traumatized person have mostly neglected those wounded in adulthood by literally unbearable realities, this eloquent work deserves a place on the bookshelf of every clinician.

- Nancy McWilliams, Ph.D., Author, Psychoanalytic Psychotherapy: A Practitioner’s Guide

Wounded By Reality is an exceptional work. Scholarly and inquiring, it integrates many theories and disciplines to address a neglected issue: adult onset trauma. Boulanger has a unique and expansive vision of dissociation; she challenges psychoanalysis even as she cherishes it. Her clinical material reflects a commitment to her patients' darkest times.

- Sue Grand, Ph.D., Author, The Reproduction of Evil: A Clinical and Cultural Perspective (Analytic Press, 2002)

Ghislaine Boulanger offers a useful and necessary review of how classical and recent psychoanalysts have conceptualized adult onset trauma. The rewards of this demanding and relentless interrogation are clear when Boulanger describes the transferential and countertransferential themes that emerge in clinical encounters with patients who have survived massive psychic trauma. These patients are themselves witnesses in search of a reliable witness for their testimony, so that it can be converted into history that can be remembered and therefore forgotten -- at least for a while. Every psychoanalyst should be aware of these new patients, who are, in fact, as old as psychoanalysis itself, but who now knock at our door with increasing urgency. It is better to be prepared for that difficult but potentially rewarding encounter.

- Jean-Max Gaudillière & Françoise Davoine, Authors, History Beyond Trauma: Whereof one cannot speak…thereof one cannot stay silent

"Valuable and comprehensive as the theoretical richness of this book is, the most precious and spiritually moving part is Boulanger's ability to share her clinical self. For the purposes of teaching about trauma to psychology students, Wounded by Reality is a perfect example of the theoretical masterwork that does not lose its touch with clinical reality. In addition to correcting the course of development of the theoretical understanding of trauma in every chapter, it fleshes out the voices of the subjects, both the patient and the author/analyst who discover meaning together. The clear, strong writing make it suitable for all: advanced undergraduates, graduate students, psychoanalytic candidates, and practicing clinicians. She has written a book that poses the explicit and implicit questions to us as clinicians - where can we find the courage to enter into the world of the shattered adult? And how can we live with ourselves if we don't oppose the forces that make it happen? Boulanger shows the way, for she has been there."

- Elizabeth Hegeman, Ph.D., Psychologist-Psychoanalyst, Fall 2007

"One of the pleasures in reading this book is how well it is organized...Information does not appear in clusters of facts, simply stated and left to the reader's zeal in making connections. Insights from various disciplines, once explored, become part of discussions of case material. With great frankness about her reactions to her patients, Boulanger both enlivens her discourse and encourages the reader's thoughtfulness about the reader's own clinical experience. Beautifully stated and direct, her descriptions make palpable what it means to work with people who can manage to go on after terrible trauma only by numbing themselves, unable to construct a trauma narrative, at the mercy of harrowing bits and pieces of isolated memory. Despite its scholarly value, this book passionately entreats the reader to see what a traumatized adult must resort to in trying just to go on."

- Johanna Krout Tabin, Ph.D., ABPP, Psychoanalytic Psychology, 25.1, 2008

"Wounded by Reality, as its provocative title suggests, inspires the reader to follow the author Ghislaine Boulanger into the pain, horror and grief that is the emotional like of surviving 'the extremes of experience.' Written with sensitivity, grace and honesty, the ideas, insights and suggestions clear enough to be accessible to non-analytically oriented readers, clinicians from varying backgrounds and experience with trauma will find this book heartwarming and instructive."

- Elizabeth Goren, Ph.D., Trauma Psychology Newsletter, 3.1, 2008

Table of Contents

Toward a Psychodynamic Understanding of Adult Onset Trauma. Catastrophic Dissociation and Childhood Trauma: Some Distinctions. The Cost of Survival: Historical Perspectives on Adult Onset Trauma. Wounded by Reality: The Relational Turn. The Core Self in Crisis: Deconstructing Catastrophic Dissociation. The Relational Self in Crisis: Further Deconstructing Catastrophic Dissociation. From Voyeur to Witness: The Crisis in Symbolic Functioning During Catastrophic Dissociation. The Ancient Mariner's Dilemma: Constructing a Trauma Narrative. The Strength Found in Innocence: Resistance to Working Psychodynamically with Survivors of Adult Onset Trauma. The Psychological Politics of Catastrophe: Local, Personal, and Professional.

About the Author(s)

A member of the supervisory and teaching faculty in the Clinical Psychology Program at Teachers College, Columbia University, Ghislaine Boulanger, Ph.D. is a clinical psychologist in private practice in New York City. Her interest in adult onset trauma began in the mid seventies, when she joined a congressionally mandated research team to do an epidemiological study of Vietnam Veterans. Her findings about the long-term consequences of surviving violence have led to a career of research, writing, and teaching about the psychodynamic causes and consequences of adult onset trauma.

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