Trauma is the disruption of the ability to maintain relationships. Psychoanalysis can help.

smartphone-1790833_1920Trauma is the disruption of the ability to maintain relationships. Psychoanalysis can help. Stephen Mitchell tells how. Unfortunately, the cure takes time and money.  A lot of time and money.  Here I’m going to lay out what I think it would take, and roughly how it would work.  Those uninterested in psychoanalysis may be tempted to skip this post, but I think laying out an ideal, a utopian treatment plan, shows us how far we are from an ideal, as well as directing our next steps, even if the pathway is currently blocked for most people.

Trauma is the loss of relationality

Trauma is the loss of relationality to self and to others.  By relationality I mean the ability to participate in relationships.  Trauma is the loss of access to sources of vitality deep within oneself, sources that are brought to life in spontaneous and authentic relations with others, from families to strangers. 

Primary process, secondary process

Think about the mind divided not into parts, but two processes, both of which are continually online.  Primary process is dedifferentiated as Stephen Mitchell puts it in Relationality.  In primary process we are part of all that makes life worthwhile, above all our connections to those who have loved and cared for us, those we love, as well as those we hate. Often they are the same people.  Only “connections” isn’t quite the right word.  In primary process we are those we love and hate, and they are us.  Freud’s (p. 11) discussion of that “oceanic feeling,” of being one with the all captures primary process experience .  As Mitchell puts it,

there is a mode of organizing experience that continues throughout life and in which later distinctions between self and other, internal and external, fantasy and perception are dissolved. (p. 19)

Secondary process is that part of life we are familiar with: our hopes, dreams, plans, and ways of getting from here to there.  Secondary process is where and how we interact with the objective world, or at least it is that part of interaction that we are aware of. 

Mitchell’s idea is that this primary dedifferentiation between self and world is not an illusion, nor is it less real that the differentiated process of primary process thinking.  Psychoanalytically oriented therapy is not about bringing the traumatized person back into touch with reality.  Rather, it is about

substituting meaning for rationality, imagination for objectivity, vitalization for control. The central ameliorative impact lies in relinking. (p. 25)  

By “relinking,” Mitchell means relinking primary and secondary processes. 

How this differs from ordinary trauma therapy

Most treatment for trauma has as its goal bringing the traumatized person back into present reality, where IEDs (bombs) and snipers are not hidden at the shopping mall, and in which every sexual relationship need not enact the abuse one suffered as a child. 

Relationality therapy (my name for it) believes that these fears will take care of themselves, once the traumatized person is relinked to his or her primary processes, where the meaning of life resides in our most intimate  identifications with people and experiences.  Primary process is where the enthusiasm for life resides, the sheer pleasure in being alive. It is the place where our most intense living and feeling is done.

How the vitality in living can be restored

Traumatized people devote too much of their time and energy to controlling themselves.  Hypervigilance is a good example, but numbing and avoidance are also means of self control.  These are, of course, the primary symptoms of PTSD, along with intrusion (for example, flashbacks).  Substituting control for vitalization, as Mitchell puts it, is the way trauma does its work, robbing everyday life of its meaning and pleasure. 

It’s a terrible dilemma: monitoring and control are the way traumatized people keep themselves together.  At the same time, constant monitoring and control is what keeps the traumatized person from engaging in a life worth living.  This self-holding, as D.W Winnicott calls it, kills the spontaneity that allows the traumatized person to dip into his or her primary processes for renewal and refreshment (1992, pp. 245-248; 1996, p. 261).    

The cure for trauma (and I do not put cure in quotes) takes time and money: several years of therapeutic work, sometimes more, and money to pay a skilled therapist.  Neither is readily available to most people.  The therapist’s degree doesn’t matter: MD, PhD, LCSW.  Necessary is only that the therapist have experience and commitment to the work.

The VA relies on short-term therapy, “evidence based” therapies such as cognitive behavioral therapy and “prolonged exposure therapy.”  The latter is often retraumatizing, and should be banned.  Most people don’t have the time or money to pay for better treatment, a treatment that takes years.  

The cure

It’s a long, tough road.  First an atmosphere of safety and relatedness must be established between therapist and patient.  This can take months, even years, and may come and go throughout the therapy.  Only when an atmosphere of safety is established is it possible for therapist and patient to enter the world of primary process thinking, a step at a time.  Some patients are never ready for this next step.  The separation of primary and secondary processes is the key to the defenses they have built up.  If these defenses work well enough, there may be little motivation for change.  For them the price of living a constricted, less spontaneous and vital life is worth it. 

The therapist should not push this next step, but be ready to work with it when it occurs.  This means listening for experiences (I will not use the word fantasy) of union, separation, and ancient loves lost.  Experiences of hate and terror too.  If the patient can be drawn into a mutual reverie with the therapist in which primary and secondary processes meet and mingle, when self and other briefly become one, then the first steps on a path toward a cure may be taken.  How far each patient goes is mostly up to him or her, but the goal remains the same: to encourage the type of musing and reflection in which primary and secondary processes talk with each other.  For this is the path to vitality in living.  When life is vitalizing, the need for defenses marked by constriction in living lose their usefulness.

A utopian cure?

As things stand now, very few traumatized people will be able to take advantage of this ideal therapy.  Some because they cannot let go of defenses that have worked.  More because the time and money is not available.  I am not suggesting that the therapy I propose is likely to become widespread.  More likely it will become rarer; managed care wants rapid results.  Still, it is worth imagining what the best trauma treatment would look like, even if it remains an unapproachable ideal for most people.  While it is unlikely the ideal will stimulate better treatment, it can remind us of what really good treatment looks like, and in this way act as a guide to therapy. 

References

Sigmund Freud, Civilization and its Discontents, ed. James Strachey.  W. W. Norton, 1961 [original 1929]. 

Stephen A. Mitchell, Relationality: From Attachment to Intersubjectivity.  Psychology Press, 2014

D. W. Winnicott, Mind and Its relation to the psyche-soma. In Through Paediatrics to Psycho-Analysis, pp. 243–254. Karnac, 1992.

D. W. Winnicott, Withdrawal and regression. In Psycho-Analytic Explorations, ed. C. Winnicott, R. Shepherd, & M. Davis, pp. 255-261. Karnac, 1996.

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Comments (16)

  1. John

    The late, great Stephen Mitchell had everything to say about the relational effects of interpersonal trauma. Although he largely worked with the professional class in New York City, the issues they struggled with were traumatic to them as any combat Marine, any sexual assault survivor, any Muslim-American hatefully targeted for one’s religious beliefs. His ideas and practice conformed not only with D.W. Winnicott’s version of Object Relations Theory, but also with Clare Winnicott’s social work practice ideas.

    It is not anomalous that his final book was one about love. His wife characterized his theory associated with the relational school as interested in “quality of life, the meaningfulness of personal experience, one’s sense of self, and a connectedness with others”. These are issues deeply affected by the destructive force of trauma. And love can often be the way back. Another theme that emerges again and again in Mitchell’s writings has to do with hope. And within the relational context this is a shared hope between therapist and client that is necessarily discordant at the start of therapy. Mitchell himself ties these elements together, “Both love and hope are extremely risky; a general hopefulness about the analytic process is not possible in any real way at the beginning but is something attained only through struggle, it takes great courage”. Yes, it does.

    What could possibly induce a trauma victim to revisit that most horrible day, those most horrific events? According to Mitchell and his most influential predecessor, Fairbairn, only a relationship infused with hope and love to counteract the internal saboteur would induce one to return to those painful periods. Simultaneously within the therapeutic relationship, the therapist is being attacked in his or her capacity to understand, and must withstand these attacks. What could induce a therapist to engage with this material for 8 hours a day, 6 days a week, for months on behalf of dozens of clients? Again, Mitchell answers that therapists too must find again and redefine their own sense of hope and love and to speak in a voice that is different than those voices from the client’s past which offered their own perpetually enticing and perpetually disappointing false promises.

    Relational, interpersonal, and intersubjective approaches all share this in common: love and hope that is corrective because it is correct. The events that lead to trauma are all-too-common, loathsome and need to be banished from human experience before the fact. I fear that society itself is becoming posttraumatic.

    • A fine comment. Sorry I’m responding almost a month late. I’m puzzled by your last sentence, that society is becoming post-traumatic. I wonder what that means exactly? Perhaps you would tell me. In any case it doesn’t sound good. Either post here or e-mail me at: calford@umd.edu

  2. James

    Despite his being charged with being behind the Nazi ideology, Nietzsche appears to have captured perfectly that place where “the enthusiasm for life resides, the sheer pleasure in being alive. It is the place where our most intense living and feeling is done” as illustrated in the following short passage:

    What, if some day or night a demon were to steal after you into your loneliest loneliness and say to you: “This life as you now live it and have lived it, you will have to live once more and innumerable times more; and there will be nothing new in it, but every pain and every joy and every thought and sigh and everything unutterably small or great in your life will have to return to you, all in the same succession and sequence – even this spider and this moonlight between the trees, and even this moment and I myself. The eternal hourglass of existence is turned upside down again and again, and you with it, speck of dust!”

    Would you not throw yourself down and gnash your teeth and curse the demon who spoke thus?… Or how well disposed would you have to become to yourself and to life to crave nothing more fervently than this ultimate eternal confirmation and seal?

    — from Nietzsche’s The Gay Science, s.341, Walter Kaufmann transl.

  3. calford@umd.edu

    James, when I was a toddler, just learning to walk, sometimes I would fall. My vanity injured, I would throw myself to the ground a couple of more times while crying “meant to do that, “meant to do that.”

    I always read this passage by Nietzsche with my childhood experience in mind. We must accept what happens to us, but we need not love it. Loving it is in effect saying “I wanted it to be this way.” Well, for me, at least, there are lots of bad experiences I could do without. Some bad experiences make us stronger, but not all. In any case, I don’t pretend that I really wanted everything to be just as it is. Fred

  4. James

    Hi Fred,

    I have been thinking about my last comment on this post, and it occurred to me that perhaps another way of reading this passage by Nietzsche might be helpful. Allow me to explain: in the 2006 movie adaptation of the Spartan battle against the Persians in the Battle of Thermopylae, the narrator says of King Leonidas:

    “All his 40 years have been a straight road…to this one gleaming moment in destiny…this one radiant clash of shield and spear…sword and bone, and flesh and blood…”

    The idea of destiny, or Karma, may seem like resignation, but it seems to me that Nietzsche was speaking exactly in the style of the Buddha advising us NOT to fight nature on the one hand, nor to accept it passively. At bottom, I think life is meaningless. The universe is merely a brute fact, with no purpose except that which we imbue it with. To actively embrace our destinies, it seems to me, appears to be what Nietzsche’s Zarathustra asks for. It is not to pretend that we WANTED bad things to happen, but to drink so deeply from the cup of existence, down to its dregs, that every single moment becomes an act of serendipity, both the moment we have ourselves created as well as that which has been thrust at us against our will, or even expectation. Of course, this is the incurable romantic reading of Nietzsche I have always seemed to espouse, but then again, perhaps I AM an incurable romantic.

    • calford@umd.edu

      “At bottom I think, life is meaningless.” Of course it is, and it is our job as humans to give it meaning. Who else could give it meaning but us? Subjectivity is meaning making. As far as trauma is concerned, I think it comes closest to Nietzsche’s eternal return you mentioned earlier. Except that it is a lie to say “yes, I wanted it,” or something like this. I think the best attitude, or at least my best attitude to my trauma, is something like “I can make meaning and sense out of this experience, and in this way give it a place in the narrative of my life.” I think this is the goal of trauma therapy. I don’t think we are in much disagreement, but let me know if you think I’m wrong. Fred

      • James

        Thank you so much for responding to my comment! I couldn’t agree more that we are in agreement.

        PS

        Your godblog, which I discovered today, is awesome! Absolutely!

  5. This is very thought provoking and at the same time I feel sad that most suffering people could not afford the treatment.Is there any other way we can reconnect to the deep life source within us or through other people?I’ve not suffered severe trauma but since a loved on died I cannot read novels.I wonder if I can’t go into a world created by someone else because I feel insecure in my own world.I used to read several novels a week but now I read history,biography and I have read several of your books

    • calford@umd.edu

      Kathryn, I wish I could be more helpful. In regards to the deep life source within, it helps me to get into nature. I can no longer use my kayak. When I could it was a great comfort. But of course it’s never that simple. Re: novels. Novels require a suspension of disbelief. My theory (and sometimes I just have too many theories) is that it’s difficult to suspend disbelief right now, because that conflicts with coming to terms with reality–that your loved one has died. Still, I feel arrogant and ignorant telling you these things: I don’t really know, and even if you accepted what I said intellectually, it alone wouldn’t help. So, I don’t know what else to say, except that I appreciate your writing to me. Fred

      • That does make sense to me.I can reread novels I already have read and we both liked Nicholas Freeling.I find writing poetry helps me indirectly.It gives me an occupation.Sometimes I write humorous little pieces like 10 ways to become more boring.They make me laugh and maybe other people too.I can tell in my dreams I am moving along but unsure where to.You are the only person to whom I’ve mentioned this who gave me a response.It means I’ve read a lot of very hard but good books [non fiction]So thank you again.Somehow I can believe in God more strongly after reading your books and blog.Does that seem odd? I know there is something Other owing to an experience when I was young but among intellectuals in the UK it is rare now to find people who still believe or even think much about it

        • I attended Sunday services at St. Martin of the Fields in London several years ago. Huge church, and almost no one was there. A little discouraging. Fred

          • Yes,here is very different from the USA.I think nearly everyone is an atheist.I liked your remarks about meaning.I find Nature does help.I’ve always like flowers that grow in cracks as they symbolise the possibility of love breaking through even a very hard barrier.Leonard Cohen’s cracks in Anthem!

        • James

          If I may comment, I find it rather interesting that deep and life-altering trauma can either make one a true believer, in the positive sense of the phrase, or an incorrigible agnostic. Somehow, I think both cases reflect more authenticity than a faith that was received without much question. Soren Kierkgaard comes to mind as an example of the first, as does Albert Camus of the second. I think what matters most is to realize that at bottom we, in the sense of Martin Buber’s “I and Thou”, are the makers of our own meanings, and are the true sources of “the deep life source within us or through other people.”

  6. James

    Re-reading these comments, I am reminded of Arthur Koestler’s books, particularly”Darkness at Noon” and “Promise and Fulfilment.” His “The Act of Creation” also comes to mind. There’s something very honest and troubling at the same time about his style. I was not surprised to later, after revelling in his work, learn that he committed suicide. His books were perhaps projections of his own despair.

    • James, I’m imagine you know much more about Koestler than I. In any case, I believe he was very ill when he and his wife committed suicide together. I’m more curious about why she did. He had Parkinson’s disease, terrible at the end.

      My favorite Koestler quote goes something like this: “one should not regard the world as a metaphysical brothel for one’s emotions.” I think this actually applies to trauma theory, as recovery from trauma requires or results in not expecting the world to respond or care, though of course we should expect this from those close to us. But that’s family and close friends, not a brothel. Fred

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