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This chapter argues for the need to recognise those who do not heal after atrocity. It analyses Gilbert Gatore’s The Past Ahead and Faruk Šehić’s Quiet Flows the Una and sets them alongside the ICTR case Prosecutor v. Renzaho and the ICTY case Prosecutor v. Brđanin. The chapter distinguishes narration of pain from the narration of healing, suggesting that both can play a role in (narrative) healing. It shows that momentary relief or respite is a form of healing, and that the moment of death, in particular, a suicide, emerges as the end point of successful and unsuccessful healing. Drawing on pain and healing in trauma and literary studies, the chapter reminds the reader of the longevity of pain experiences and healing processes which are dependent of the person and their physical and social environment. Since the absence of healing may isolate from collective and societal change, this chapter seeks to increase the visibility of those who do not heal in the field of transitional justice and challenge assumptions of the permanence of decrease in pain.
This chapter analyses psychiatric and psychological responses to Holocaust survivors, from liberation through post-war therapeutic encounters and broader efforts to understand perpetrators. Initial Anglo-American medical responses to prisoners liberated from concentration camps mixed commentary on the extreme physical degradation of the surviving prisoners with speculation about their psychological state. Survivor-clinicians also provided important accounts of the mental effects of imprisonment informed by their own experiences. The chapter examines the contested ‘Muselmann’ figure in the clinical literature of the camps, as well as the tensions in the post-war psychotherapeutic literature on the most effective therapeutic approach to suffering survivors. Finally, it examines a parallel literature that sought psychological explanations for perpetrator behaviour. These various efforts to understand both survival and perpetration demonstrate the limits of mid-century ‘psy’ expertise when confronted with the extremity of the Holocaust, while showing how such frameworks nevertheless extended into political and historical interpretations.
‘Anne Enright, Trauma and Fiction’ provides an overview and psychologically inflected analysis of the novels of Anne Enright, focusing on two key ideas: motherhood and the workings of the unconscious. It is argued that Enright’s work, beginning with The Wig My Father Wore (1995) and continuing on to The Wren, The Wren (2023), constitutes something new in the feminine exploration of the psyche in Irish fiction. Central to this analysis is a cross-referencing of Enright’s novels to her non-fiction, particularly her book about motherhood, Making Babies (2004). These concerns, and the related interest in mother–daughter relationships, are traced through What Are You Like? (2000), The Pleasure of Eliza Lynch (2002), the Booker Prize-winning novel The Gathering (2007), The Forgotten Waltz (2011), The Green Road (2015), and Actress (2020). The chapter concludes by putting Enright’s work in the context of other recent Irish fiction by women that explores the nature of the psyche.
‘Northern Ireland and Troubles Fiction’ begins by noting the creative challenges Irish novelists faced during the protracted sectarian conflict that engulfed Northern Ireland after 1969, central to which was the problem of how to convey the horror of an apparently interminable cycle of violence. The chapter proceeds to examine two of the commonest forms of Troubles fiction, novels based on the thriller genre and novels that centre on trauma and grief. The first part of the chapter demonstrates how writers of literary fiction, including Eugene McCabe, Benedict Kiely, Bernard MacLaverty, Brian Moore, Eoin McNamee, and Edna O’Brien, adapted the thriller form to explore the cultural and psychological landscapes of republican and loyalist paramilitarism. The second part surveys representations of Troubles-induced trauma and survival in novels by Linda Anderson, Robert McLiam Wilson, Deirdre Madden, and Seamus Deane, each of which questions the efficacy of fiction in rendering the devastating effects of political violence.
Chapter 10 draws the book’s themes together by returning to the problem of how the past persists. It reflects on the endurance of trauma, the struggle to reintegrate after catastrophe, and the ways communities rebuild meaning from ruins. Bringing archaeology and epic memory into a single perspective, it argues that Homer remains powerful because the poems preserve recognizably human experiences across time.
Chapter 4 explores how the epics represent combat and its consequences. It discusses divine and human agents of war, battle strategies, and the material culture of fighting, from armor to weapons. It then turns to violence, trauma, and the memory of war, showing how Homeric poetry captures both the immediacy of battle and the longer psychological aftermath.
‘A Splintered Past: History in the Irish Novel since 1990’ considers the ways in which contemporary Irish novelists have represented three phases of modern Irish history: the Famine; the revolutionary period; social liberalisation since the 1960s. Joseph O’Connor’s Star of the Sea (2002), in its relative optimism about the contribution of the catastrophe to national self-consciousness, is contrasted with Paul Lynch’s Grace (2017) and Emma Donoghue’s The Wonder (2016). Roddy Doyle’s A Star Called Henry (1999) provides a child’s-eye view of the Easter Rising, while Sebastian Barry’s A Long Long Way (2005) witnesses the Rising from the perspective of a soldier returned from the Second World War, and Seamus Deane’s Reading in the Dark (1996) filters partition through childhood memories. As we reach Colm Tóibín’s Nora Webster (2014) or Claire Keegan’s Small Things Like These (2021), historical traumas become comprehensible only in personal terms, and the capacity for collective narrativisation is less prevalent or accessible.
Chapter 9 examines how the Odyssey has been continuously reimagined across nearly three millennia, from Dante to contemporary film and literature. It explores how each generation has found in Odysseus’ journey a framework for understanding war trauma, exile, diaspora, and displacement, demonstrating that the epic endures not as a fixed text but as a living narrative that speaks to experiences of loss, return, and the ongoing struggle to rebuild meaning after catastrophe.
In the United States and elsewhere, the concepts of stress, trauma, and mental health provide an authoritative language for articulating the psychological impact of violence. This medicalized language is insufficient if we are to grapple with the moral and political dimensions of trauma, what experts now call “moral injury.” Drawing on interviews with influential experts in the US military, this chapter explores how the post-9/11 wars led psychologists to rediscover the moral dimension of trauma. Psychology has the potential to address the moral and political sources of trauma and alleviate some of war’s painful consequences, but this effort requires a complex understanding of what violence does to those who experience it, including those who perpetrate it. The challenge for psychology is to tackle the ethical complexities of war and trauma without reducing the issue of moral responsibility to a question of moral or psychological injury.
Here we document an exceptional and previously unreported event: the stranding of a false killer whale, Pseudorca crassidens, newborn in northeastern Brazil resulting from a fatal collision with an Indo-Pacific sailfish, Istiophorus platypterus. Detailed necropsy, pathological examination, and genetic identification of the embedded foreign structure demonstrate unequivocally that the trauma was caused by the bill of an Indo-Pacific sailfish. To our knowledge, this represents the first confirmed case of interaction between these two species for the Brazilian coast, and one of the very few documented worldwide, providing valuable insight into the ecological dynamics of pelagic predators in the Southwestern Atlantic. This case also underscores the importance of long-term beach monitoring programmes for detecting unusual biological events and improving our understanding of marine mammal ecology, behaviour, and mortality sources.
Post-traumatic stress symptoms (PTSS) are a substantial yet underrecognised mental health concern in oncology. Large-scale epidemiological data across diverse cancer types are scarce. This study aimed to estimate the prevalence of post-traumatic stress disorder (PTSD) and to identify socio-demographic and psychosocial correlates in a large, unselected outpatient cohort.
Methods
In this cross-sectional study, 4,103 adult outpatients with solid tumours or haematologic malignancies were screened during routine care using the PTSS-8-Cancer scale. Socio-demographic, clinical and psychosocial variables were collected concurrently. Associations between screening results and patient characteristics were examined using correlational and chi-square analyses.
Results
Overall, 32.5% screened positive for probable PTSD. Prevalence was highest in breast cancer (39.7%), female genital cancers (37.2%) and head and neck cancers (36.1%). A positive screening for PTSD was more common among women, younger patients, those with lower income, without a partner and with a history of psychiatric illness. While these associations were statistically significant, effect sizes were generally small.
Conclusions
One in three cancer outpatients experience substantial PTSS, with elevated prevalence in certain diagnostic groups. Small effect sizes for socio-demographic predictors underscore that psychological distress is broadly distributed. Findings support universal psychosocial screening and integration of trauma-informed care into oncology services to address a significant, population-level mental health burden.
Traumatic breastfeeding experiences can lead a subset of mothers to develop moral injury and subsequent clinical presentations such as depression, anxiety and post-traumatic stress disorder (PTSD). However, to date, no clinical conceptualisation has been utilised to formulate or guide treatment for breastfeeding trauma reactions, leaving a gap for clinicians. In this clinical guidance paper, we present a cognitive formulation of breastfeeding trauma, drawing from the cognitive model of moral injury in PTSD. The paper aims to support cognitive behavioural therapists to conceptualise breastfeeding trauma through the lens of moral injury where appropriate, and provide treatment guidance through an illustrative case study.
Key learning aims
(1) To increase awareness of the impact that negative breastfeeding experiences can have on an individual, including moral injury, and/or the development of mental health conditions such as PTSD and depression.
(2) To support mental health clinicians, perinatal health professionals, infant feeding professionals, and antenatal educators in their understanding of breastfeeding trauma.
(3) To propose a conceptualisation of understanding and treating traumatic breastfeeding experiences, drawing from an existing formulation model for moral injury in PTSD, using cognitive therapy.
(4) To emphasise the importance of individualised assessment, formulation and therapy when working with individuals who have experienced traumatic breastfeeding experiences.
Adolescent mothers in forced displacement experience intersecting risks related to adolescent development, displacement-related traumatic experiences and early motherhood. Despite these risks, their mental health needs remain understudied in humanitarian research and policy. This narrative review synthesizes evidence from conflict-affected settings. Drawing on literature published between 2000 and 2025, we propose the Triple Jeopardy Framework, a conceptual model describing how adolescence, forced displacement and motherhood interact to influence mental health outcomes, including depression, anxiety, post-traumatic stress disorder and intergenerational mental health risk. The framework distinguishes the separate risk and protective factors associated with each area, then shows how their intersections can create synergistic risk by weakening protective systems, limiting access to care and increasing psychological distress. At the same time, displaced adolescent mothers may exercise agency and draw meaning from motherhood while also experiencing significant distress and constraint. Effective responses require interventions that address structural determinants, strengthen community-based support systems, integrate maternal and mental health care and remain responsive to young mothers’ capabilities and caregiving realities. The Triple Jeopardy Framework provides a basis for developing gender-responsive, life-course approaches to adolescent maternal mental health in humanitarian settings.
Chapter 1 argues that thinking about boxes will allow us to comprehend the reparative work that comics can do in approaching transgenerational Holocaust memory and trauma. What would it mean to read Maus as a Jewish text in our moment of global attention to Jewish identity and Holocaust memory? Building upon Hillary Chute’s landmark scholarship on Spiegelman’s Maus and comics and/as archives, I show how Spiegelman’s slippery, evocative metaphor of comics panels as built boxes links his magnum opus to Jewish traditions surrounding the material preservation and transmission of historical texts. Reconsidering Maus together with boxes, in light of what can – and can’t – be enclosed and contained, illuminates formal congruences between Maus, the architected space of the Mishkan, and the textual practice of Midrash. Unpacking these congruences in turn reveals Spiegelman’s survivor’s “tale” as a text, commentary, object, memorial, testimony, even a kind of secular phylactery or reliquary, through which the son of survivors negotiates his inherited trauma and his own Jewishness.
Chapter 3 examines an absurd, tic-tac-toe-faced avatar created by Art Spiegelman, known as “OXO.” I argue that Spiegelman’s adoption of the “OXO” persona functions as a coded emblem of his process of coming to terms with traumatic loss. The figure of “OXO” and his tic-tac-toe-faced family first appeared in 1983, contemporaneously with Spiegelman’s work on Maus. Conjugating comics with tic-tac-toe yields a new understanding of the comics grid itself as an alternating game of reading and looking: a game that undisciplines the grid and makes it playful. Moreover, perceived as a face, tic-tac-toe embodies the complexities of inherited identity, or an identity dictated by the play of external forces. OXO’s symbolic richness helps Spiegelman revisit his 1972 “Prisoner on the Hell Planet: A Case History,” the first comic he produced on his long road to Maus. This chapter presents an extended case study of a one-page “OXO” comic, “Lost,” in which the cartoonist reenters and reimagines both recent and distant memories of loss, in an ongoing and necessarily incomplete effort to master them.
This book places the larger autobiographical projects of Art Spiegelman and Alison Bechdel alongside each other for the first time, drawing on a range of previously unanalyzed works. It argues that the structurally layered, word-and-image form of comics is particularly well-suited to negotiate complex filial inheritances and manage identity in the face of transgenerational trauma. Each chapter is organized around a different formal trope that highlights an aspect of the visual language of comics and its material processes: boxes, spirals, tic-tac-toe, mirrors, and webs. From Jewishness to gender, from high modernism to lesbian feminist communities, Filial Linesshows how the comics form is capacious enough to accommodate the push–pull of inheritance and invention, enabling both creators to negotiate their place in (or beyond) various lines of familial, cultural, and artistic descent. Integrating formalist and psychoanalytic frameworks, and parsing alignments and differences with different forms of practice, the book situates today’s graphic memoir canon as an unexpected outpost – and expansion – of avant-garde formalism long after the modernist moment of form.
To identify resilience to trauma using longitudinal psychological assessments and uncover its genetic components.
Methods
This prospective cohort study included 12,946 surgical patients from the China Surgery and Anesthesia Cohort (CSAC) with assessments of depressive symptoms from pre-surgery through 1, 6, and 12 months post-surgery, using the 9-item Patient Health Questionnaire (PHQ-9). Linear mixed-effects models predicted post-surgery PHQ-9 scores; individuals with much lower observed PHQ-9 score than expected (i.e. lowest 25th percentile of residuals) were defined as resilient. We performed genome-wide association study (GWAS) analysis to identify variants associated with psychological resilience. We examined the identified variant in 2,285 patients from the China Severe Trauma Cohort (CSTC) using genotype stratification and additive models.
Results
CSAC participants had a mean age of 52.2 years and 58.5% were female. Overall, 2,328 (18.0%) were identified as resilient and exhibited a lower prevalence of psychological symptoms. GWAS identified a lead single-nucleotide polymorphism (rs11766511, P = 3.082 × 10−8) mapped to the gene sidekick cell adhesion molecule 1 (SDK1), as a candidate locus implicating neural signaling pathways in stress response and resilience. In CSTC, genotype stratification suggested a lower symptom burden among GG genotype of rs11766511 compared with AA carriers (e.g. Beta = −0.94 [−1.76 to −0.12] for PHQ-9 score). The additive genetic model showed a directionally consistent but non-significant protective pattern of the G allele across psychological symptoms.
Conclusions
Longitudinal assessments of depressive symptoms offer a reliable method for measuring psychological resilience. The rs11766511 locus mapped to SDK1 may represent a candidate genetic signal for psychological resilience and warrants confirmation.
To evaluate the viability and impact of South Korea’s inaugural Military-Civilian Partnership (MCP) pilot program in overcoming peacetime volume deficits and enhancing military clinical readiness.
Methods
Over a 1-year period (September 2024-August 2025), an active-duty military surgeon maintained regular duties at a military facility, completing 65 shifts, while performing 41 intermittent 24-hour shifts at a civilian regional trauma center (RTC). The patient demographics, injury severity, and procedural/surgical volumes of the surgeon’s cases were retrospectively analyzed.
Results
The surgeon managed 103 and 193 patients at the military facility and civilian RTC, respectively. The civilian RTC presented a significantly higher burden of severe trauma, with more patients presenting with Injury Severity Score (ISS) >9 (49% vs 35%, P = 0.023) and ISS >15 (35% vs 23%, P = 0.035). While the civilian RTC provided a higher volume of invasive procedures (142 vs 23) and complex visceral repairs, the military facility uniquely exposed the surgeon to military-specific mechanisms (gunshots, blasts) and preserved baseline dexterity through unrestricted general surgery access.
Conclusions
These results suggest that a tailored, intermittent MCP model effectively sustains military clinical readiness by blending high-density civilian trauma exposure with military-specific trauma care.
This article investigates Sarah Kane’s Blasted (1995) through Dominick LaCapra’s concept of ‘empathic unsettlement’, analyzing how the play transforms theatrical spectatorship into an ethical confrontation with violence. Kane’s ‘in-yer-face’ dramaturgy dismantles naturalistic boundaries, collapsing a private hotel room into a war-torn landscape where the personal and political fuse in a relentless exposure of brutality. Drawing on LaCapra’s distinction between ‘acting out’ and ‘working through’, the discussion explores how Kane converts trauma from representation to experience, compelling audiences to oscillate between immersion and reflection. Ian’s progression from perpetrator to victim, his detached journalism, and the play’s fragmentation of time and space collectively enact an ethics of witnessing that resists voyeurism and moral closure. By situating Kane’s theatre within debates on trauma, spectatorship, and media desensitization, including the ideas of Susan Sontag and Judith Butler, the article argues that Blasted teaches empathy through discomfort, inserting the passivity of spectators and demanding moral responsiveness. In doing so, Kane redefines theatrical realism not as a mirror of violence but as a site where empathy, horror, and ethical awareness co-exist in productive tension.
Four narratives by Black women – Phyllis Montana-Leblanc’s Not Just the Levees Broke, Sarah M. Broom’s The Yellow House, Margaret Wilkerson Sexton’s A Kind of Freedom, and Kionna Walker LeMalle’s Behind the Waterline – each offer counterstories and counterhistories against singular, fixed ways of articulating what the cataclysm of Hurricane Katrina meant and means. To contextualize these narratives in intersecting theories of trauma, displacement, home, violence, and Southern Black Womanhood is to see the high stakes often hidden by facile, dominant representations of this territory in shopworn tropes of “resilience” and “soulfulness” and “entertainment.”