In the Afterword, Herman reflects on Trauma and Recovery, restating her intention to build a comprehensive “body of knowledge” (337) and reaffirming that the study of trauma is “inherently political,” due to its close ties to systemic oppression. She recalls that the book was first published during what seemed like a more hopeful era, when social progress in the United States felt within reach. However, many forms of structural violence—such as racism in the justice system and the ongoing “war on drugs”—remain deeply entrenched. The 9/11 attacks, she notes, revealed the country’s vulnerability and triggered counterinsurgency wars that, like the Vietnam War, have left many veterans struggling with combat-related trauma. To illustrate this, Herman includes excerpts from Phil Klay’s “Redeployment,” a short story whose protagonist experiences post-traumatic symptoms following military service.

Herman observes that PTSD is now widely recognized, yet veterans continue to report high rates of the disorder. Those with a history of childhood trauma or those who harmed non-combatants are at increased risk. She also notes the growing number of women in the military, many of whom report experiencing sexual violence—now formally categorized as “MST, or military sexual trauma” (344).

Although war trauma remains a dominant cultural focus, Herman argues that the majority of traumatic experiences take place in civilian life. Most perpetrators are men; most victims are women and children. She draws attention to increased awareness of “institutional betrayal,” such as the Catholic Church’s concealment of sexual abuse by clergy.

Scientific understanding of trauma has also advanced. Herman discusses developments in research on false and repressed memories, neurobiological changes associated with trauma, and dissociation—a focus in Bessel van der Kolk’s The Body Keeps the Score. PTSD has been reclassified in the DSM and is now understood as distinct from other anxiety disorders, with a new category for complex PTSD. Studies such as the Adverse Childhood Experiences (ACEs) survey and psychiatrist John Bowlby’s research on attachment confirm that early trauma is often the root of long-term relational impairments. However, findings from the Family Pathways Project demonstrate that early intervention can help prevent or reverse these effects. Despite this evidence, Herman argues that a political movement is necessary to implement widespread change—and none has yet emerged. The sources of war trauma remain unaddressed in systemic ways—“without a strong antiwar movement, the war machine grinds on” (359)—and domestic violence remains underreported and poorly handled by adversarial legal systems. Children, in particular, are often left unprotected, as they lack political agency.

Herman reflects on the reception of her three-stage recovery model, which has gained widespread acceptance. She critiques the broader medical culture’s emphasis on standardization, noting that psychotherapy resists full standardization due to its inherently personalized nature. Still, some newer modalities, such as cognitive-behavioral therapy (CBT) and prolonged exposure therapy, balance standardization with individual responsiveness. However, Herman notes that exposure therapies have high drop-out rates, which may be due to neglecting the first recovery stage—establishing safety. Herman also highlights promising research on “mentalization”—the capacity to understand self and others—which has shown effectiveness in PTSD treatment. While she affirms that psychotherapy is fundamentally a “craft,” she also believes it can be rigorously studied. Finally, Herman describes the work of the Victims of Violence Program, which continues to promote reconnection between survivors and the broader community.