Foreword: “The Cost of Survival” and “Wounded by Reality”

The Two Essays that follow were written in another era. It was an era before the terrorist attacks of September 11, 2001 made the cost of physical and psychological survival of immediate concern to all of us in New York and in Washington, if not in America and in the rest of the world. The first of these articles explores the epistemological muddle that psychoanalysts can get into when they try to account for long-term reactions to massive psychic trauma. The second article proposes a way out of this muddle.

In the immediate aftermath of the terrorist attacks, I asked myself if these papers were still relevant. Mental health professionals generally, among them many psychoanalysts, have risen magnificently to the overwhelming need to offer support to survivors, the families of the missing, and relief workers. In New York, there are constant appeals for mental health volunteers to meet with families as they search hospital records for missing relatives. Licensed professionals are sought to support husbands, wives, children, and parents as they come to terms with the fact that there will never be a body to bury, that only a death certificate will bring some type of closure to this period uncertainty. Volunteers speak with fire fighters or police or medical examiners weighed down by their personal losses and the grisly tasks they are being asked to perform. Other professionals have been invited to debrief corporations, trying to get on with business as usual, where managers and workers alike fear the world will never be usual again. The requests for volunteers are filled almost as soon as they appear on the different listserves and telephone trees to which we all subscribe. And all this painful work comes on top of the ongoing treatment of our regular patients, some of whom have already experienced other more private catastrophes in their own lives. For them, the analytic work has taken on new urgency. With other patients, we