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Kim, H.A. (1999). Creating Sanctuary: Toward the Evolution of Sane Societies: Sandra Bloom, M.D., Routledge, New York, 320 pp., $19.95 paperback, $65.00 hardcover. J. Amer. Acad. Psychoanal., 27(1):173-174.

(1999). Journal of American Academy of Psychoanalysis, 27(1):173-174

Creating Sanctuary: Toward the Evolution of Sane Societies: Sandra Bloom, M.D., Routledge, New York, 320 pp., $19.95 paperback, $65.00 hardcover

Review by:
Hae Ahm Kim, M.D.

Trauma, both physical and emotional, has become one of the central dynamics in recent years in psychiatry because it is definable, observable, and lacks ambiguity for reimbursement. Although the conclusions drawn are not from controlled research but from clinical experience, Dr. Bloom states that by creating sanctuary, a safe environment, we can offer therapeutic healing through attachment.

I found the book not an easy read; however, when I read it a second time it was clearer and it did come alive. I admired Dr. Bloom's scholarship, which included not only the works of psychiatrists, but also writers of literature and a wide sociocultural base.

Dr. Bloom emphasizes that, “Human lives can become completely organized around trauma.” By which she means trauma can become the central organizing principle for thoughts, feelings, behaviors, and action. She asserts that attachments are the natural healing mechanism to help people deal with trauma. She advocates a sanctuary model of inpatient psychiatric treatment, which reminded me of the inpatient facilities that flourished in the 1960s in the United States and England. These previous models ended with disappointing outcomes, however, which she claims was caused by staff burnout as much as social factors. I question whether we can put the blame on social factors. Dr. Bloom considers her work as moving toward a more sane society, however, which is more humanistic, especially in its treatment of the mentally ill.

My own reaction is that one cannot be reductionistic, but that there are multiple determinants affecting the outcome of treatment such as inborn temperament, genetic endowment, family support, the skill of the therapist, the fit between the therapist and patient, medication, as well as social attitudes. Dr. Bloom's recommendations for sanctuary reminded me of my involvement in the mid-1960s at the inpatient unit of the Adolescent Treatment Center in Manhattan. Adolescents were engaged in intensive analytic sessions 5 times a week.

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