BOOK REVIEW

Brian Engdahl, PhD., VA Medical Center, Minneapolis

Chronic posttraumatic stress disorder and related psychopathology not only affect many trauma survivors for decades, but also might affect their offspring, substantially increasing the public health impact of trauma. Many professionals study and treat those who experience the intergenerational effects of trauma exposure, a fact convincingly demonstrated by this book.

Its breadth of coverage is impressive. Contributions have been pulled together from virtually every part of the world. They describe multigenerational effects stemming from many trauma sources, among them the Holocaust, genocide in Cambodia and Armenia, World War II and the Vietnam War, repressive regimes, domestic violence and crime, and life-threatening diseases. Intergenerational effects revealed after the fall of communism -- central to which are issues of submerged ethnic identity -- are given considerable attention within this volume.

The book brings less familiar populations of concern into focus, many for the first time in print, including offspring of the Nazis and their collaborators, Japanese atomic bomb survivors, Australian Aboriginal people, breast cancer patients, Stalin's purge victims, Nigerian civil war survivors, American Indians, and Baha'i martyrs in Iran.

The contributions understandably vary widely in their levels of presentation. Where work is in an early stage, e.g., among Japanese atomic bomb survivors, a chapter may be centered on a clinical vignette. Where more research has been conducted, e.g., in the area of domestic violence, models supported by data are presented. Danieli provides a unifying intervention-oriented framework that helps readers conceptualize the domain of multigenerational trauma. The framework, coupled with her chapter editing, creates coherence seldom found in edited volumes.

The ways in which trauma may effect subsequent generations (the mode of transmission question) is addressed from multiple perspectives throughout the book. Psychodynamic, family systems, genetic, and socio-cultural perspectives are presented. In a unique chapter, Suomi and Levine review animal studies and suggest at least three routes through which parents' trauma exposure may have effects on offspring: observational learning, parental behaviors, and prenatal effects.

Data drawn from several populations show that offspring of negatively affected trauma survivors are themselves less well adjusted. The chapter by Yehuda and colleagues -- an overview of their biologically oriented work with Holocaust survivors and their offspring -- most clearly demonstrates this. This chapter (and more recent work in the field) does not elucidate the modes of transmission. Instead it makes it clear that having a parent with PTSD has direct effects on one's adjustment and may be a risk factor for the development of the disorder in response to one's own traumatic experiences.

Previous books have been limited to coverage of only one survivor-offspring group, and typically have used a single theoretical perspective. In that it describes many groups from multiple perspectives, the International Handbook of Multigenerational Legacies of Trauma is the first volume of its kind. At the same time, it is no preliminary attempt. The book is truly a great leap forward and crammed with implications for survivors and their families, clinicians, researchers, and policymakers. It defines this domain within traumatic stress studies, and will be a standard reference for years to come.