Intergenerational transmission of trauma: recent contributions from the literature of family systems approaches to treatment.

A young woman in her thirties commits suicide by choking herself on an aerosol can. Her mother, a Holocaust survivor, tells of having survived the camps by singing for the guards. The mother's current symptom is a feeling of choking so severe that she cannot talk although she can sing. In another case, a nine-year-old girl is referred for treatment for depression after her mother abandons the family. Later, it is determined that the mother at the age of nine was abandoned by her own mother. When the patient's mother is able to reconnect with the grandmother, she is also able to connect with her daughter. In a third case, a man in his forties is hospitalized with chronic suicidal ideation. Neither he nor his two intelligent siblings are able to function adequately. It is determined that their father, a high-functioning professional, had two brothers who had committed suicide. All these vignettes, drawn from cases seen either in a hospital setting or in private practice, are examples of trauma experienced through the generations. In each case, a "secret" trauma, not verbally expressed, was nevertheless passed on, in one way or another, from parent to child, or from grandparent to parent to child. Trauma has long been recognized as having an impact on mental health and is a component of many classic cases, such as Freud's case of Schreber, who was physically mistreated by his doctrinaire, disciplinarian father. The long-range generational effects of trauma have been widely reported in the literature, especially regarding the Holocaust. It has been almost two decades since the publication of the classic work, Generations of the Holocaust (1), edited by Martin S. Bergmann and Milton E. Jucovy. This book powerfully illustrates the impact of wartime experiences on the children of Holocaust survivors. However, it is clear that intergenerational trauma is not confined to war experiences, but is quite widespread. In work with residents and other trainees in urban and public-sector settings, we have found that a majority of individuals and families requiring help for emotional problems have undergone some form of trauma from within the family or created and fostered by the social systems with which they interact. Recent attention has been focused on the importance of recognizing trauma to arrive at a valid diagnosis and treatment of emotional disorders. Hospitals are forming trauma committees to consider inclusion of the role of physical and sexual abuse in psychiatric assessment. Schools are forming crisis teams to deal with suicide, homicide, death, and other crises. National attention is riveted on disasters and community trauma teams are organized to deal with catastrophic events immediately at the scene. In short, both the field of mental health and society at large are beginning to acknowledge the influence of trauma. This creates new challenges for mental health professionals. A central clinical feature is the silence that occurs in families surrounding traumatic experiences. The process of psychotherapy sometimes replicates that means of coping by not encouraging open discussion. Many patients and families have had experiences that are intolerable to our sense of ordering and managing the world. Families often cope by denial, repression, or by consciously omitting important family information. Clinicians may participate in the denial, thus reinforcing the silence. Among the reasons cited is a fear of inflicting more pain on people already suffering or suggesting a problem that has not been defined by the patient. Countertransference reactions include an intolerance for the therapist's own pain and a stirring up of issues from the therapist's own life. It is important to be conscious of this tendency and to mitigate against repeating the process of denial and silence in the treatment. Rather than sensing that something has happened, and waiting for the material to emerge, some professionals are becoming more active in helping patients to confront these experiences. …