Trauma and the Destructive-Transformative Struggle

Clinical Perspectives

Terrence McBride, Maureen Murphy, Terrence McBride, Maureen Murphy

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781000186451
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The impact of trauma can be both destructive and transformative. This important new book presents not only a range of theoretical frameworks through which different trauma can be understood, from the effects of childhood abuse to those of war and catastrophes, but also gives readers insights into how trauma presents itself in the consulting room.

In each chapter the author uses clinical vignettes and detailed case histories to discuss the multiplicity and complexity of the trauma involved, eschewing a simple binary conception of internal vs external forces. A wide range of topics are covered, including: the lasting imprint of early trauma such as neglect or abuse on subsequent development; the somatic solution involved in life-threatening illness; unmetabolized mourning and embodied memory; the vibrating relationship between catastrophic external forces such as intergenerational effects; and the 9/11 terrorist attacks and the lasting effect of war on combatants and their families.

Each chapter is screened through a different theoretical viewpoint, from Freud and Fairburn to Winnicott, Bion and Ogden, while the work of several contemporary theorists is also discussed. Crucially, the final section of the book looks at those issues faced by analysts when working with traumatized patients, highlighting the key idea of dissociation, the dilemma around empathy and the factors that affect the patient's unconscious meaning.

T rauma and the Destructive-Transformative Struggle: Clinical Perspectives illuminates the resilience needed by both patient and analyst. It will be a vital resource for both clinical practitioners specializing in trauma and psychoanalytic researchers in the field of trauma studies.

Part I

The legacy of early trauma

Chapter 1

From the black hole to the last frontier

The trauma of childhood abuse and the oedipal stage of development

Terrence McBride

[T]he boundary of the black hole is like the edge of a shadow—the shadow of impending doom…[it] acts as rather like a one-way membrane around the black hole: objects…can fall through…into the black hole, but nothing can ever get out…One could say…what the poet Dante said of the entrance to Hell: “All hope abandon ye who enter here.” Anything or anyone who falls through the [boundary] will soon reach the region of infinite density and the end of time.

Stephen Hawking (1988, pp. 98–99)

Introduction

The purpose of this chapter is to explore the relationship between the trauma of early childhood parental abuse and the dynamics of the oedipal phase of development, elaborating on the reciprocal effects of each on the other. It is based on the case study of a long-term analytic patient, Mr. B, who was verbally and emotionally abused by his father from about the age of two to the age of ten, and inappropriately exposed to incest-inducing fantasies by his mother during latency, which is interpreted as a form of sexual abuse. The interplay between the intrapsychic structural damage of the trauma of both instances of abuse and preexisting and subsequent oedipal conflicts that were in play at the time is the subject of discussion.

Developmental trauma

The concept of developmental trauma disorder has been conceived outside of psychoanalysis in the fields of psychiatry and neurobiology by Van der Kolk (2005) and colleagues as an argument for a rational diagnosis for children with complex trauma histories. Since the majority of traumatized children do not meet the criteria for the DSM-IV diagnosis of post-traumatic stress disorder (PTSD) for adult-onset trauma, it was proposed as an alternative. It is based on the term “complex trauma”, which is described as multiple, chronic and prolonged exposure to developmentally adverse traumatic events, most often of an interpersonal nature, with early-life onset. Van der Kolk’s comprehensive list of the deleterious effects of childhood trauma on development is consistent with psychoanalytic views of psychopathological consequences from childhood trauma (Fonagy & Target, 2003). Included are disruptions of affect regulation, disturbed attachment patterns, self-hatred and self-blame, aggressive behaviors against self and others, altered schemas of the world, loss of autonomous strivings, chronic feelings of ineffectiveness and failure to achieve developmental competencies (p. 406). It is also noted that, although major, trauma is not the sole factor in developmental disturbance, but is included in a more complex interaction with adequate care and nurturing, as well as biology and genetic constitutional endowment (Malberg & Mayes, 2015). A psychoanalytic view adds the critical element that preexisting unconscious fantasies and intrapsychic conflicts also play a central role in the impact of the trauma and subsequent effects that it may have (Busch, 2005; Sugerman, 2018; Spivak, this volume).

Psychoanalytic perspectives on development

According to Tyson and Tyson (1990), the developmental perspective in psychoanalysis has been present from the beginning. It “has had its own evolution, which parallels the history of psychoanalysis” (p. 2). Anna Freud (1965) stressed the value of looking at personality functioning through a developmental psychoanalytic lens in order to organize diverse aspects of complex clinical phenomena and to permit their full meaning to emerge (p. 328). In spite of those who dispute the importance of a patient’s developmental history, most psychodynamic theorists think that understanding development is intrinsic to treatment (Gilmore & Meersand, 2014, p. 4).

Pioneers of early theories of development provide the relevance on which contemporary views of infant and childhood developmental trauma and its detrimental effects are based. These effects can lead to lifelong psychopathology of varying degrees. All authors stress the interactions and interdependencies between maturational and environmental factors. Anna Freud (1965, 1967) conceived of eight lines of development from infancy to adolescence which can be disrupted or impeded by trauma from internal or external forces. Nagera (1966) emphasized the concept of “developmental interference”, which involves gross external (environmental) interferences that can disturb the typical unfolding of development before the child’s ego capacity is able to cope with them. Erikson’s (1950) epigenetic phase-specific developmental tasks emphasize both the challenge and the hazard involved in each developmental stage, beginning with the first stage—the establishment of a sense of basic trust. Although the phases overlap, if the tasks of one phase are insufficiently mastered due to some disturbance, the course and outcome of subsequent stages of development can be affected that persist into adulthood and throughout the life cycle. Mahler et al. (1975) provided a model of the separation–individuation phase of development, ranging from infancy to toddlerhood, requiring the mastery of certain developmental tasks during each of four subphases. Toddlers are especially vulnerable to psychic trauma and overwhelming distress during the rapprochement subphase which can undermine the outcome of the separation–individuation process.

Finally, Bowlby (1969) conceived of a theory of attachment based on the infant’s predisposition to attachment. His theory provides a link between earlier models of development and contemporary views of the relationship between trauma and development, especially from the object relations perspective. His critical contribution was the infant’s need for unbroken early attachment to the mother (Fonagy & Target, 2003, p. 232) and the trauma of separation if the attachment is disrupted (Bowlby, 1960). Ainsworth et al. (1978) extended Bowlby’s model by describing patterns of attachment from secure to insecure attachment. This affects the quality of information processing about the external environment, affect regulation and the capacity for bonding and attachment throughout life, depending on the early provisions for the child’s needs.

In the modern view of development, there is disagreement about the linear structure, standard progression and distinct pathways of the classical developmental phases cited above, especially in regard to the oedipal phase because of its transformative function. It is based on the nonlinear dynamics systems model of development (Galatzer-Levy, 1995; Gilmore, 2008). This model views development as a nonlinear, hierarchically ordered perspective on mental organizations that occur in a relatively reliable way across individuals and cultures. “Each phasic shift is the product of multiple interacting systems, none of which can fully realize the given state independently” (Gilmore & Meersand, 2014, p. 2).

Trauma and development

A developmental view has also been present since the beginning of psychoanalysis in regard to trauma. According to Bohleber (2007), “Psychoanalysis began as a theory of trauma” (p. 329). While Freud never developed an organized theory of trauma, it remained a prominent idea in his mind throughout his career. His early theory of the origin of psychoneurosis was based on childhood seduction and childhood sexual trauma (Freud, 1896). He began with the view that the major emotional experience of the trauma of sexual abuse had to be repressed because of its unacceptability to the conscious mind. As a result, the effects induced by the forgotten event continued to press for discharge which caused symptoms. He later revised this view to define trauma as a situation that occurs when the quantity of excitation overwhelms the ego and breaks through the stimulus barrier (Freud, 1920). He developed this idea further in his revised theory of affects, where he defined trauma as the arousal of anxiety of such intensity that the ego’s organizing, synthesizing and defensive functions become overwhelmed and render the person helpless (Freud, 1926).

Psychoanalysts have long recognized that childhood traumatic experience can disrupt and impede the child’s progression in all periods of development. It can have a profound impact on the capacity to integrate sensory, emotional, cognitive, behavioral and relational information into a cohesive whole. The magnitude of influence that trauma can have on later development and the tenacity with which it can persist throughout life are not to be underestimated.

It must be also be noted that in the case of a single traumatic episode, i.e., shock trauma (Kris, 1956), an extremely resilient child can return to the normal course of development after some disruption with no residual damage (Tyson & Tyson, 1990, p. 24). In addition, it is possible for traumatic experience to provide an impetus in some children for further development and a better adaptation than would otherwise be achieved (p. 328). The intrapsychic meaning of a traumatic experience for the individual affected, for better or for worse, is dependent on multiple factors. These include the nature and magnitude of the trauma, early-life onset, the period of development, the longevity and intensity of exposure, the situation in which it occurs, the source of the trauma, the individual’s ego strength, prior traumatic experiences and the level of mastery of them, preexisting vulnerabilities, resilience and external support systems. What might be traumatic for one individual may not be for another, and what could be traumatic in one period of development for an individual might not be in another period of development (Arlow, 2006, p. 120). Anna Freud (1965) noted that development proceeds normally or not, regardless of internal or external stresses or disturbances.

The damage from trauma to the psyche of the child is due to the prolonged, repetitive traumatic situation, such as ongoing child abuse, that can have the potential to cause extensive damage to the psyche of the child, viz. Kahn’s (1963) concept of cumulative trauma. This can have enduring detrimental effects on the child’s development in ways that interfere with the achievement of important developmental tasks, which can lead to fixation, regression and psychopathology.

From a contemporary view of trauma and development, Bohleber (2010) believes that both the traditional psycho-economic model and the object relations model are necessary to fully comprehend and understand the psychic processes of trauma. In addition to Freud’s definition of trauma as the quantity of excitations that flood the ego with anxiety and helplessness, the object relationship itself takes on the quality of trauma. In regard to the traditional model, Bohleber (2007) states that “the destructive element, the direct traumatizing force, remains something excessive, a massive surplus that ruptures the psychic structure and cannot be bound through meaning” (p. 340). In the object relations model of trauma, among all of the circumstances in which trauma can occur—e.g., sexual abuse, extreme emotional neglect, separation trauma, attachment trauma, cumulative trauma, etc.—intrafamilial trauma can be among the most devastating. “The most intensely pathogenic element is mistreatment or abuse by the person whose protection and care is actually needed” (Bohleber, 2017, pp. 3–4). Such experiences can have a profound and life-long impact on the child, unlike in the case of adult-onset trauma. Children who are exposed to prolonged, unmanageable stress, especially at the hands of a parent, are highly vulnerable to being impaired in their ability to successfully accomplish the tasks of the early stages of development.

It is also necessary to consider that trauma itself is not the only consideration in evaluating clinical cases involving trauma of any kind. It is a common view that intrapsychic conflict may already exist prior to the traumatic event(s) (see Spivak, this volume). Busch notes that it is important to consider an integrated perspective between early trauma and intrapsychic conflict. He says that intrapsychic conflict can also be a result of early traumatic experience. He cites Smith’s (2003) view that there are various ways to consider conflict: “it is not only the trauma itself that remains traumatic. Inevitably, the feelings and fantasies that the trauma stimulates become part of a dangerous intrapsychic field. In this way, a trauma also becomes part of an intrapsychic conflict” (Busch, 2005, pp. 27–28, italics in original).

Sugarman (2008) states that in evaluating trauma one must consider that neither the external environment nor the internal world alone is thought to cause any single mental phenomenon. He argues against a relational treatment approach that excludes the perspective of preexisting internal conflict. He “assumes that trauma, even childhood trauma, is usually experienced and processed by an already more-or-less structured mind that will define what is traumatic, as well as attempt to make sense of it” (p. 801; see also Sugarman, 2018). Like Busch, he also finds that feelings and fantasies generated by the trauma become components of intrapsychic conflict and compromise formation.

Traumatic memories

In order to have a thorough consideration of the significant aspects of trauma, it is important to consider the role of traumatic memories. This is because of the function of memory in the controversy over the etiological role of trauma in pathogenesis. In Gaensbauer’s description of traumatic memories, he states that:

memory researchers have conceptualized two functionally distinct systems of memory: procedural, implicit, or early memory and declarative, explicit, or late memory…Procedural or implicit knowledge refers to the largely unconscious, automatically operating memory systems related to behavioral, emotional, and sensory experience (1995, p. 124).

These memories may be manifested in certain aspects of the transference, and in traumatic triggers that can be experienced in somatic sensations, traumatic dreams and intense affective states with no content. They inevitably appear to go back directly to the early trauma, as in the case of states of dissociation (see Diamond, this volume). “Declarative or explicit memory refers to knowledge that is conscious, can be recalled as coming from the past and can be communicated to others directly” (Gaensbauer, 1995, p. 124), such as autobiographical memory, which is the ability to represent oneself as having participated in a particular activity at a particular time and place in the past.

When discussing the nature of explicit memories in regard to trauma, Bohleber goes on to say that, based on recent studies in cognitive science, “memories of acutely and stressful traumatic events are predominantly highly detailed, extremely constant and, as far as can be judged, also relatively reliable” (2007, p. 337; also Bohleber, 2010); that is, they constitute a special set of experiences that are generally preserved in the particulars and with great precision over a long period. This is particularly significant because it contradicts the assertion by some that all childhood traumas originate from the outside, e.g., from traumatogenic relationships with important early objects, with no contribution from inside the mind of the child. Also, relational and self psychological analysts, as well as some contemporary Kleinians, tend to minimize the importance of internal conflict. A central feature of this position is that memories of the trauma are stored in implicit, non-declarative memory systems which are accessible to treatment only through reexperiencing the trauma through the analytic relationship (Sugerman, 2008). This has distinctive implications for the treatment approach. In contrast to an either/or position, Gaensbauer (1995) reports that research on preverbal traumas shows that they are remembered both procedurally and declaratively.

Case presentation

When Mr. B began analysis he had been desperately unhappy for most of his life. He appeared to be in the grip of a disorganized, primitive and prepsychotic state of mind. He was alienated from the outside world around him, including his family. He was suspicious of others, socially isolated and terrified of his own inner demons, as well as the outer forces which he feared could turn against him at any time.

Mr. B felt different from other “normal” people, toward whom he had festering feelings of envy, spite and hatred, as well as fantasies of revenge for his unfair lot in life. In turn, this state of his internal world caused him to have pervasive feelings of self-hatred, shame, guilt and paranoia, with fears of retaliation against him and intense anxiety. He felt that people could see all of these contents of his internal world. This made him an “open book”.

This prism through which Mr. B viewed himself functioned as a prison itself, isolating him from other people as well as from educational and job opportunities. His view of himself was that he had been born bad and was destined to live out his life in continuous misery. It stemmed from the fact that he had been verbally and emotionally abused by his father from around the age of two years to the age of ten, at which time his parents separated. Prior to that time, it appeared that he had been well cared for by his mother and his grandmother up to the age of two, and seemed to have had sufficient nu...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgments
• List of contributors
• Introduction
• PART I: The legacy of early trauma
• PART II: Embodied assaults
• PART III: Political catastrophes
• PART IV: Technical issues/analytic resilience
• Index