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I know Mac Davis to be a passionate reader of and contributor to psychoanalytic ideas and political realities in general so I was looking forward to reading his thoughts about my book Wounded by Reality: Understanding and Treating Adult Onset Trauma. Despite some of his generous comments, I am disappointed. It strikes me that Davis' antipathy for relational theory and practice has led him to misunderstand many of my ideas, and he has elaborated these misunderstandings in ways that are simply inaccurate.

Davis (2007) characterizes my message thus: "What counts as cure or a return to health may really amount to no more than a restoration of the false conceptions of self, identity, coherence, agency, etc., that one claimed for oneself prior to the trauma because they gave a deluded conception of both oneself and one's world" (p 402). Putting aside Davis' contempt for such constructs as self, identity, coherence, and agency, he is implying here that it is my therapeutic goal to return survivors of adult onset trauma to the level of functioning they had achieved prior to the catastrophe. Nowhere in my book do I use the words "cure" or "return to health." I am extremely uncomfortable with the very concepts. I don't believe that it is possible to be "cured" of an adult onset trauma, nor do I claim that a return to the previous level of functioning is possible, let alone desirable. Rather, in working with a survivor of adult onset trauma, my goal is to enable the survivor to live with the memory of the trauma rather than being lived by it.

I am accused of "nostalgically" seeking to return survivors to "the strength found in innocence" (p 402). Was Davis so hampered by his distaste for relational theory that he jumped to the most simplistic interpretation possible? This wonderful expression, "the strength found in innocence," is taken from Terrence Des Pres (1976) who uses it with pointed irony, as I do. Lest anyone should have been missed that point, I make it explicit at the conclusion of Chapter IX.

Implicit throughout my book, however, is the message that innocence is a precarious strength. I do not mean by this, simply, geopolitical innocence that I would agree with Davis as citizens of the first world in the 21st century we have a responsibility to overcome – but innocence on a much more fundamental and psychic level – innocence of mortality. Nonetheless, many of our psychoanalytic forebears have understood it to be a necessary illusion. Ernst Becker (1973), Donald Winnicott (1958), and Ronald Fairbairn (1952) suggest that our psychological worlds are necessarily constructed in such a way as to buffer us from the ongoing terror of annihilation. This is the line that those who survive adult onset trauma have crossed and they can never comfortably share in that sheltering illusion again.

Davis and I have very different ideas about therapeutic action. For him psychoanalytic treatment requires a "genuine descent into the psychotic register" leading to the "tragic" understanding that whatever we call "self" is "a creature of defenses and denials, vigorously opposed, as Winnicott shows, to reality" (p 403). In marked contrast, I believe that adult onset trauma brings about a descent into a world without illusions. As I have formulated it, terror can lead to a collapse of the self and consequently a collapse of the internal object world. For me, therapeutic action lies in reconstituting a self, not the previous self which cannot be reconstituted without denial of this confrontation with mortality, but a self that can once again relate to its objects. That work can only be undertaken in the presence of an analyst who is also prepared to give up the strength found in innocence.

Finally, Davis criticizes me for making reference to Lacan merely in the interests of being pluralistic and argues that I am distorting Lacan's meaning. It seems Davis would have liked me to engage in a discussion of Lacan's Mirror Stage and his argument about the instability of self, although I did not choose to take that path. However, I do use Lacan's concept of the Real because no other psychoanalyst has successfully described the unsymbolizable and unbridgeable gap at the heart of traumatic experience. The problem that any of us has in referring to Lacan's Real is that we are subject to the criticism that in writing about it we are attempting to tame it, in effect, by bringing it into the Symbolic realm. I don't know any way around that problem, but that difficulty cannot preclude using the Real in order to evoke the psychic quality of an experience that defies our attempts to master it.

I do not for a moment claim that I have arrived at the only possible psychodynamic formulation of adult onset trauma, but I regret that Walter Davis was not able to engage the ideas as they are presented in my book rather than jumping to erroneous – and in some cases offensive – conclusions about my message.