Into the Darkest Places

Early Relational Trauma and Borderline States of Mind

Marcus West

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429915154
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book explores the roots of borderline states of mind in early relational trauma and shows how it is possible, and necessary, to visit 'the darkest places' in order to work through these traumas. This is despite the fact that re-experiencing such traumas is unbearable for the patient and they naturally want to enlist the analyst in ensuring that they will never be experienced again. This is the backdrop for the extreme pressures and roles that are constellated in the analysis that can lead to impasse or breakdown of the analytic relationship. The author explores how these areas can be negotiated safely and that, whilst drawing heavily on recent developments in attachment, relational, trauma and infant development theory, an analytic attitude needs to be maintained in order to integrate these experiences and allow the individual to feel, finally, accepted and whole. The book builds on Freud's views of repetition compulsion and re-enactment and develops Jung's concept of the traumatic complex.

CHAPTER ONE

Early relational trauma and borderline states of mind

For some patients, their experience of trauma is clear and they consciously flag it up from the beginning of the analysis; however, for many others the trauma manifests in a more disguised form, in anxieties, somatic reactions or borderline states of mind, and has become embedded in their personality and ways of relating. In this chapter I will outline some of the ways that early relational trauma can manifest in these situations. In the following chapters I will address the way that borderline organisations are traditionally understood in psychoanalytic frames of reference (Chapter Two), the history and innovations of trauma theory (Chapter Three), and early relational trauma in relation to attachment and intersubjective ways of understanding human interactions (Chapter Four).

Outline

The individual in whom borderline states of mind predominate has typically experienced a profound, early relational trauma that cannot be simply “got over”. Such traumatic experience sets the person at odds with themselves and the world. The experience occurring early in life, for example, of being unloved or unwanted, of being disliked or hated, or of being deprived, ignored, or abused, powerfully disrupts and comes to dominate the individual’s personality. This experience, which they cannot bear, is set at the heart of their identity and is installed in implicit/procedural memory as one of the individual’s key internal working models (Bowlby, 1969).

Whilst the individual cannot bear this sense of themselves, yet if they do acknowledge it, it feels as if it is who they really are. Mostly, however, they cannot bear to accept themselves and so are alienated from their core selves, feel self-critical and self-attacking, and readily fall into envy of others. Furthermore, being foundational to their identity, they feel that they cannot possibly change, so that they feel, over time, trapped, condemned, despairing, and hopeless.

In addition, the individual will usually experience powerful counterresponses to the trauma, often mirroring, in a talion-like manner, the original traumatising ways of relating themselves, which also feel unacceptable and causes further self-hatred. There is, therefore, an intense conflict which makes constructing a coherent identity very difficult, as Liotti (2004a) describes.

Trauma is, by definition, an experience which the individual’s psyche cannot bear, contain, or integrate at that time (van der Kolk, 1996b). This could be what Winnicott describes as the baby being left for too long, so that they experience, “unthinkable anxiety” or “the acute confusional state that belongs to disintegration of the emerging ego structure” (Winnicott, 1967, p. 369). The experiences that I am describing have usually occurred on many occasions over a long period. Bessel van der Kolk describes what happens when the experience is “too much”:

intense arousal (“vehement emotion” [Janet’s term]) seems to interfere with proper information processing and the storage of information in narrative (explicit) memory … [so that] memories of trauma may have no verbal (explicit) component whatsoever. Instead, the memories may have been organized on an implicit or perceptual level, without any accompanying narrative about what happened. (van der Kolk, 1996b, pp. 286–287)

The free-floating, affective-somatic elements form what Jung, borrowing from Janet, called “feeling-toned complexes”. These complexes incorporate both the primary, primitive defences against the trauma, and the patterns of relating associated with the trauma (the trauma-related internal working models (Knox, 1999)). These elements, not being integrated with the rest of the personality (“having no verbal (explicit) component”), are experienced as very real, powerful, and current (often more real, powerful, and true than “ordinary experience”, namely, that which has been integrated with the ego). These elements are readily triggered and associate themselves with any hook in the present, thus locating the traumatic experience very much in the here and now.

If, for example, the analyst asks the patient to wait in the waiting room before the start of the session time, or does not answer personal questions, or leaves too much or too many silences, they may be experienced as cold, uncaring, withholding, cruel, or sadistic if this experience happens to be associated with the person’s early experience of the caregivers’ unavailability in some way (rather than being seen “simply” as professional and clear-boundaried, as it might be experienced by someone who has not had that early experience and whose ego-functioning has not been disrupted). Such views will be held with utter conviction as the patient deeply experiences the analyst in this way.

Thus a negative transference is readily set up where the analyst is seen as cold, distant, and untrustworthy, despite whatever good or caring intentions they may hold privately towards the patient. These events—being kept waiting in the waiting room, silences, or not answering personal questions—can become the continual salt in the patient’s wounds, with the patient insisting that the analyst recognise the agony and distress to which they are subjecting them. This can run to the analyst being persuaded or cajoled into making allowances in terms of waiting or silences, or trying to “prove” that they do care, that they are a feeling human being, and that they are not simply “following the rules” (discussed in full in Chapter Eleven).

I will be describing how it is an important part of the microanalysis of the interaction between patient and analyst, to identify what is being triggered by which particular aspect of the analyst’s behaviour (Chapter Seven). This can help make sense of the experience so that it is not seen (by the analyst or by the patient) as simply an “over-reaction”, as (meaninglessly) “paranoid”, or as the analyst actually being cruel and sadistic. However, simply identifying what has triggered this experience will not, in itself, alter the patient’s sense of the analyst (and more on what the analyst “actually” feels below). I will explore this more in the second half of the book.

These feeling-toned complexes are of such an intensity and complexity that they disrupt the individual’s ego-complex. The ego-complex is that part of the psyche which orients us towards the world, holds our personal history and view of ourselves, and attempts to anticipate what will happen (although this latter part goes on unconsciously (West, 2007)). This is the feature which delineates borderline from neurotic functioning, as in neurotic functioning the individual’s ego-functioning is not dominated by the trauma-related complex and is able to function in a relatively well-adapted manner—the individual can carry on to a significant extent “as normal”, apparently getting over, or at least getting round, their traumas/complexes. For all individuals there will inevitably be complexes of varying power and complexity that may be triggered at certain times and under certain conditions. (For individuals with a neurotic character structure, a mid-life crisis is frequently initiated by the breakdown of the existing coping strategies which ran over the top of the underlying conflicts).

For the individual with a borderline psychology, however, their ego has incorporated these experiences into their sense of themselves, partly in order to allow them to anticipate what will happen and accommodate themselves to their traumatic circumstances. Often, these early experiences come to form core beliefs, such as, “I am too much for other people”, “People do not like me” (Ogden, Minton, & Pain, 2006, p. 3) and even, “There is nothing to like, I am not a person”. As time unfolds a second order of beliefs develop: “No one would like someone as negative and hopeless as me”, or “It is my fate to be like this”.

This “negative” experience, at the heart of the person’s identity and in conflict with their imperative attachment needs, makes it almost impossible to develop a coherent identity, suited to functioning in the everyday world. Of course, whilst these defensive organisations may have assisted the individual at some point in their life, making their emotional life more manageable, perhaps through lowering their expectations of being responded to, and perhaps even saving their life in “submitting” to a violent bully, these reactions cannot just be changed through rational introspection as they have become part of who the individual is.

The person cannot bear to be who they deeply experience themselves to be, yet they cannot manage successfully, in the long-term, to be anything else. As a result they feel flawed, wrong, cursed (Balint describes this as the “basic fault”). The individual will often feel that there is a void at the core of their identity as they cannot let themselves “be” who they fear themselves to be, for example, someone who is not liked, or is hated. Whilst they may proclaim these self-beliefs, preempting someone else from stating them, or in “identification with the aggressor”¹ (Ferenczi, 1932a), they cannot in practice really accept them as this would be truly unbearable. Liotti (2004a) and Meares (2012) both also understand conflicts in identity as representing the fundamental core of borderline functioning.

The person whose ego-functioning has been disrupted in this way will inevitably feel ill-adapted to the world. They can see that in order to “get on” you need to have confidence in yourself and be able to reach out positively towards others, but they just cannot congruently do so. In addition therefore, they feel a failure, bad and “no good”. These experiences are confirmed with each new interaction. As I have said already, they may very likely experience a deep, agonising envy of others who (appear to) thrive, which further confirms their sense that they are bad. There may be more primary responses to the trauma/deprivation itself, such as rage, outrage, violence, or murderousness, that also leave the individual feeling that they are bad or that they have been singled out for punishment or torture. Kleinian perspectives take these inner reactions and responses to be the primary ones, as I will explore.

A therapist who does not have a deep appreciation of trauma may unwittingly confirm and strengthen these self-views in a similarly well-meaning way to their friends or family. They will point out that the world is “not really like that”, that the person has no need to fear others, that they are essentially “good”, and that they do have good, worthwhile capacities and qualities.

Whilst such attempts are usually welcomed at first, they are not truly believed and, frustratingly for all concerned, they do not really go in. The person comes to feel bad that the kindly reassurance (if it comes at all) does not really help, and they feel like a colander who cannot retain a good sense of themselves. Alternatively they may require the reassuring view to be continually restated, which each time is less and less effective, and leaves the person feeling increasingly dependent on the other’s views. These factors give another turn to the vicious circle and are a further element in the person feeling bad about themselves.

In the long run, these well-meaning messages from friends or the analyst disconfirm the person’s deepest experience of themselves and confirm that they are wrong to feel as they do. It may make them feel that the analyst cannot really accept them as they actually experience themselves to be. Sometimes such “positive” re-framings are met with hostility, and the analyst is told that they are talking from their own enviably comfortable position and that they do not understand the patient or have the faintest idea what their life is really like.

A different response from the analyst is to point out that they may be working from a “pathogenic belief” (Weiss, 1993), that these selfbeliefs are destructive, and that the person is bringing about (or at least playing a large part in) their own bad experiences. The patient almost certainly knows this already. A further step is to suggest that the patient is in some way “doing this on purpose”, whether this is because they want to defeat the analyst (this might be seen as a projective identification of their own sense of failure), or whether they are manifesting a “negative therapeutic reaction” (Freud, 1923b) and “prefer suffering to getting better” as a manifestation of their masochistic tendencies (Freud, 1924c), or as an example of the death instinct in operation (Freud, 1937c). These interpretations are usually experienced as critical and punitive, even though the patient might readily join in with the self-criticism or, according to Joseph (1982), may even be unconsciously intending to induce such responses in the analyst.

I have made variations of such interpretations on many occasions and, whilst it is sometimes important to challenge the patient’s corrosive, negative self-view, reframe their experiences, and help them see things in a wider context, I have found that these comments have only a limited, and frequently a negative, effect (van der Kolk describes something similar (2014, p. 128)). This is not only because the interpretation feels like a criticism and is alienating, but because it is not the kind of interaction that is helpful, and does not reflect a full understanding of the situation.

I have come to understand that in their apparently self-destructive and ill-adapted behaviour, the individual is staying true to their original, most powerful, experiences of trauma, which desperately need to be recognised, accepted, and understood. In order to really draw the poison out of the patient’s early experiences the analyst has to also profoundly accept and appreciate the reality of those experiences and “locate” the original experience to which it belongs (as far as that is possible) (Chapter Ten).

This requires that the analyst learns the language of non-ego experience—the language of the defeated ego (see below), and appreciate the manner in which the exposed core self operates according to primary process functioning. This is not “pathological” in the sense that this is a normal, necessary form of functioning; however, it usually goes on unconsciously as part of processing the individual’s experience. Due to the disruption of ego-functioning, it has been brought to the surface and come to dominate, so that the individual is on continual red-alert, with ill-consequences for adapted functioning.²

As the trauma-related patterns of interaction have become installed in implicit memory they will inevitably be reconstructed and relived in the analytic relationship. This is a co-construction, involving both patient and analyst, and I will be exploring the mysterious processes by which this happens in later chapters. Sometimes the progress of the analysis depends upon the analyst and the patient allowing themselves to participate, sometimes more, sometimes less consciously in this reconstruction, and the analysis is necessarily delayed until it becomes possible for them to safely do so. This is what I mean by accompanying the patient into the darkest places, and I hope this book will make clear the process by which this can happen.

It can lead to the individual being able to accept themselves, and to feel accepted, as they are rather than as they feel they should be, or even as they may want to be. This process may therefore entail much mourning for what they had hoped to be and what they had hoped to receive and experience—idealisation is understood as an intrinsic element of trauma (Chapter Nine)—as well as a difficult struggle to accept what happened and how they are as a result. This is not necessarily a quiet, passive acceptance, but may well include a murderous, raging, longing for revenge, as well as a wishing for the person who let them down or abused them to suffer—and at some point this will likely include the analyst.

Significantly there may be great resistance for the patient to allow themselves to behave this way towards others, similar to the way they were treated, and yet this reaction will have been constellated in them on a primitive level. It is a response that they may well find abhorrent and defend against, reacting against it when they experience it in others. Whilst Kleinians may see this in terms of the individual projecting this part of themselves into the other in the process of projective identification, I see it, instead, in terms of the individual reacting to the retraumatising other and having to do some considerable work on themselves to recognise their talion reaction to the other—their identification with the aggressor (Chapter Six).

As I will explore further, I have found that the “witnessing” of the original trauma by both analyst and patient is highly significant. On some occasions this “simple” exchange has been almost miraculous in lifting the spell of the original trauma and allowing the events to find a natural place in the person’s sense of themselves in the context of a life that is now moving forward. Freud and Breuer discovered this long ago (Breuer & Freud, 1893). It is as if the psyche has been simply “waiting for this moment to arrive”, as John Lennon and Paul McCartney put it in their song “Blackbird”—a song that seems to me to sum up the experience of trauma to the core self so beautifully (with the “blackbird” being a fitting symbol for the traumatised soul). Before this point nothing has been able to shift the person’s distress and prevent their anguished reliving of the original trauma.

As I have just described, most significantly, this acceptance and exploration is not limited to what the person actually experienced directly, but also to how they reacted to/against it and incorporated it within them—their primitive reactions and their identification with the aggressor. Thus a vital aspect of working the complex through is to recognise the ways the patient may enact a form of the same trauma both upon themselves and others. As I will explore in Chapters Five and Six, this recognition of the traumatic pattern of behaviour, in both direct and reversed forms and on different “levels”, is often the key aspect of resolving the conflict and helping the individual develop a realistic id...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• INTRODUCTION
• CHAPTER ONE Early relational trauma and borderline states of mind
• CHAPTER TWO The clinical picture and the traditional psychoanalytic understandings of borderline phenomena
• CHAPTER THREE A brief outline of trauma theory
• CHAPTER FOUR The relational and attachment perspective
• CHAPTER FIVE Trauma, complex, and narcissistic defences of the core self—from fight and flight to personality organisation
• CHAPTER SIX Internal working models on different levels and in direct and reversed forms
• CHAPTER SEVEN Into the darkest places: microanalysis of the analytic relationship—intersubjectivity, co-construction, and re-enactment
• CHAPTER EIGHT Broad and flexible ego-functioning and the core self—the ego–self axis and ps–dp
• CHAPTER NINE Idealisation and the longing for paradise—relinquishing the wish for an idealised, conflict-free relationship
• CHAPTER TEN Bringing it all together—an extended clinical example
• CHAPTER ELEVEN The pressures on the analyst—being human and bearing to be inhuman
• CHAPTER TWELVE The analyst’s journey and the defeat of the analyst’s ego—Orpheus and Eurydice and the journey through the underworld
• CHAPTER THIRTEEN Trauma and the analytic attitude
• CHAPTER FOURTEEN When the earth swallows you up—shame, regression, and the collapse response
• CHAPTER FIFTEEN In thrall to the spectre of death—suicidality, submission, and collapse
• CHAPTER SIXTEEN Dissociation and dissociative identity disorder
• CHAPTER SEVENTEEN The body remembers—working analytically with the body
• CHAPTER EIGHTEEN Jung’s early relational trauma and spiritual experience
• CHAPTER NINETEEN Summary and conclusion—emerging from trauma and returning to everyday life
• REFERENCES
• INDEX