Trauma.

TRAUMA THEORIES IN PSYCHOANALYSIS

Dynamic Approaches to Psychological Development

DEFINITION AND HISTORICAL ACCOUNTS

Definition of Trauma

  • General Definition:

    • Trauma refers to an injury (such as a wound) inflicted on living tissue by an external agent.

  • Psychological Definition:

    • Psychological trauma is a type of damage to the mind that occurs due to a severely distressing event.

    • Trauma often results from an overwhelming level of stress that exceeds an individual's capacity to cope or integrate the emotions associated with that experience.

Historical Accounts of Trauma

  • Historical records indicate that accounts of catastrophic events have existed since ancient times. For example:

    • Pliny the Younger reported during the Vesuvius eruption in AD 79 about the panic-stricken crowds wanting to act on someone else’s decisions.

  • In the 19th century, Victorian psychology largely ignored trauma, seeing its effects as a sign of moral weakness.

SYMPTOMATOLOGY AND BIOLOGICAL EXPLANATIONS

Symptoms Reported by Survivors

  • Survivors of traumatic events, such as train accidents, report symptoms including:

    • Hysteric symptoms

    • Headaches

    • Sleep disturbances

    • Emotional disturbances

Biological Explanations

  • There are no observable post-mortem abnormalities in brain structure associated with trauma.

  • Trauma may involve:

    • A minor injury to the nervous system.

    • A functional issue where the equilibrium (harmony) of the nervous system is disrupted.

EARLY PSYCHOLOGICAL EXPLANATIONS

Notable Theorists

  • Charcot: Proposed a hypnosis hypothesis suggesting that trauma leads to self-suggestion, resulting in symptoms mimicking central nervous system (CNS) trauma.

  • Freud: Introduced a trauma-affect hypothesis.

    • After World War I, approximately 80,000 British soldiers were affected by shell shock.

    • Rivers suggested that trauma arises from actual conflict, highlighting the conflict between fear of death and duty/comradeship.

TRAUMA AND PSYCHOPATHOLOGY

Importance of Trauma and PTSD

  • With Post-Traumatic Stress Disorder (PTSD), psychiatrists recognize that:

    • Psychological disorders can result from external events rather than intrinsic predisposition or vulnerability.

IMPACT OF TRAUMA ON EVERYDAY LIFE

Prevalence of PTSD

  • Lifetime prevalence of PTSD is approximately 7.8%, with about 30% of cases being therapy-resistant.

  • Exposure to trauma is estimated at around 60-90%.

  • Common potentially traumatic experiences include:

    • Exposure to warfare

    • Natural disasters (e.g., floods, hurricanes, fires)

    • Traffic accidents

    • Sexual assault

THE AFFECT-TRAUMA MODEL BY S. FREUD

Origins and Experiences of Trauma

  • Developed primarily from Freud’s experiences with female patients suffering from hysteria.

  • Trauma comprises:

    • Cognitive Experiences: Memories related to traumatic events.

    • Affective Experiences: Feelings associated with trauma.

  • Due to the threatening nature of trauma, defensive processes are triggered.

Defensive Processes

  • Memories may be blocked from consciousness through repression, resulting in:

    • No recall of the traumatic event.

    • Affects remain active and seek discharge, leading to energy transfer to bodily organs, resulting in bodily symptoms.

  • Symptoms are not random; they carry significance linked to the traumatic event.

Theories of Seduction

  • First Theory of Seduction: Proposed that women with hysteria had experienced sexual abuse.

  • Freud later retracted this theory due to social pressures.

  • Second Theory of Seduction: Suggested that seduction occurs in fantasy rather than reality.

  • Ferenczi maintained the original theory, introducing the concept of a “confusion of tongues” where:

    • A child perceives intimacy differently than adults perceive sexuality.

THE PSYCHOFORMATIVE THEORY OF TRAUMA (LIFTON)

Principles of Psychoformative Theory and PTSD Reactions

  1. Life/Death Paradigm: Symbolization within oneself where both victimizers and victims experience death immersion.

  2. Concept of Survival:

    • Survival is considered an achievement with dialectical nature offering alternatives:

      • To be locked in numbness.

      • To use survival for insight and growth.

  3. Connectedness of Survivors:

    • Survivors feel a sense of belonging to the 'great chain of being' symbolizing immortality; trauma questions this continuity.

PTSD as Adaptive Reaction

  • PTSD is viewed as a normal adaptive response to an abnormal situation, emphasizing:

    • Acceptance and tolerance of emotional states.

  • Survivor Guilt: Tied to self-condemnation regarding unmet expectations such as:

    • Helping others or fostering emotional vitality.

  • Psychic Numbing: A phenomenon where individuals feel disconnected from feelings, leading to:

    • Discontinuity in self and experience due to trauma.

Search for Meaning and Transformation

  • Trauma challenges existing meanings; therapeutic processes should address these aspects.

  • Moral dilemmas arising from trauma symptoms have moral relevance, e.g., refusing to harm innocents in wartime can evoke feelings of deviance versus courage.

  • Trauma can serve as a psychoformative experience leading to significant self-transformation.

TRAUMA AS A PSYCHOFORMATIVE EXPERIENCE

Dimensions of Self-Structure and Trauma Effects

  1. Coherency: Organized integration and functional integrity of self.

    • Boundaries between self and others, with a balance in the experience.

  2. Connection: Affective connectivity in physical and psychological realms to oneself and others across time.

  3. Continuity: The ongoing connection with time, space, and personal history, leading to an enduring sense of self.

  4. Energy: Involves drive and motivation in goal-directed behavior and purposeful striving.

  5. Autonomy: Encompasses self-regulation and controls in both physical and psychological processes.

  6. Vitality: Denotes overall health and psychological vitality needed to sustain self-functions effectively.

Traumatic Impact and Altered Function

  • Fragmentation: Loss of integrated coherence and functional capacity leading to an absence of locus of control.

  • Separation: Emotional disconnection from self, others, and groups resulting in psychic numbing.

  • Discontinuity: Loss of continuity with past experiences impacting sense of self in time and space.

  • Immobility/Stasis: General fatigue and loss of motivation in the aftermath of trauma.

  • Loss of Autonomy: Feelings of diminished self-esteem and capacity for self-regulation, alongside shame and guilt.

  • Illness: Subjective decline in health and vitality that may be psychogenic.

MENTALIZING AND TRAUMA

Definitions of Mentalizing

  • Mentalizing is described as a form of primarily preconscious imaginative activity that entails interpreting human behavior based on intentional mental states such as needs, desires, feelings, beliefs, goals, and reasons (Fonagy, 2008, p.4).

  • Imagination is vital for effective mentalizing; direct access to others’ mental states is limited.

Intergenerational Transmission of Mentalizing Capacity

  • The attachment security of parents influences their ability to mentalize, impacting:

    • Childhood memories of attachment and the security of the child.

    • The child’s capacity for mentalizing affects emotion regulation and psychosocial functioning.

Trauma Spectrum

  • Types of Trauma:

    • Impersonal Trauma: Non-human agents as perpetrators.

    • Interpersonal Trauma: Human agents as perpetrators, especially those in attachment relationships.

IMPACT OF UNBEARABLE AFFECTIVE STATES

Fear and Loneliness

  • Fear: Associated with unbearable affective states stemming from traumatic experiences.

  • Loneliness: Linked to the lack of the experience of being mentalized leads to feelings of abandonment, neglect, and nonexistence, which impair mentalizing and create challenges in emotional regulation.

Perpetrator Dynamics

  • Perpetrator Threat: This can incite mind-blindness, often observed in Borderline Personality Disorder (BPD) contexts.

PTSD AND NON-MENTALIZING

Psychic Equivalence

  • A state where the mind equates thoughts with the external world leading to:

    • Re-Experiencing Symptoms: Flashbacks and nightmares.

  • Mentalizing Process: Allows for the representation of experiences in the mind, facilitating:

    • Remembering: The act of recalling adverse experiences can intrude into present cognition, often triggering dissociative symptoms.