Trauma, Torture and Dissociation

A Psychoanalytic View

Aida Alayarian

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429923302
• Subtopic: History & Theory in Psychology
• Index: Psychology

Theoretical material is presented in close conjunction with clinical data in the form of vignettes and case studies to illustrate the key points outlined in this book, which focuses on the multidimensional approach to the understanding of childhood trauma. It examines the contributions of psychoanalysis, emphasising the act of 'dissociation' (healthy and unhealthy). Specific attention is given to the internalisation of the m/other/object as the 'listening other', and the dissociated part/s that may results in an over idealised yet feared object. The final discussion focuses on how patients in therapy become able to transform fears into 'psychic space' and to break away from vulnerability, by developing a better 'sense of self', as the result of having the therapist as the 'listening other'.

Part I
Literature Review

Chapter One

Introduction to literature review

The literature review is intended as a means of examining the psychoanalytic and psychological literature on resilience, as well as other related key concepts in psychoanalysis, with the aim of drawing out a possible theoretical response to the research question. This part lays the foundations for the discussions on trauma, resilience, and dissociation in the following three chapters. It starts with a brief discussion of two enduring pieces of psychological research into resilience, and goes on to assert the importance of certain psychoanalytical conceptualizations in working with people who have endured trauma. The significance of unconscious processes and states in driving human behaviour is a central tenet emphasized here and throughout this study. Specific attention is given to object relations theory as a way of understanding how internal and external realities are structured in the mind, as well as intrapsychic relationships. In this context, a perception of “psychic space”, the “sense of self” and its relation to the external world, and the distinction between secure and insecure attachment in early development are discussed. The self (true and false) and disruption of the self in relation to trauma, vulnerability, retraumatization, and resilience as major tenets of an individual’s personal characteristics are discussed. Some key defence mechanisms identified as specifically used by traumatized patients, and which are central to the hypothesis of resilience, are described, including dissociation. Dissociation is emphasized throughout this study as intrinsically linked with the concept of an inner psychic space or lack of it, relevant to having a “listening other”, as therapeutic tools for the development or regaining of the sense of self which have been lost as the result of the trauma the patient has endured.

Resilience

Resilience in psychological literature

Two important contributors to the psychological study of resilience during the twentieth century were Werner (1984, 1989, 1990, 1992, 1994, 1995, 1996; Werner & Smith, 1982) and Garmezy (1970, 1981, 1991, 1993; Garmezy, Masten, & Tellegen, 1984). Werner’s study of nearly 700 infants from the island of Kauai, Hawaii over a period of forty years (from the 1950s to the 1990s) from birth to adulthood identified protective factors that enabled some children to emerge healthily despite coming from an impoverished, high-risk background, and also allowed her to trace the long-term effects of negative early life experiences.

Due to multiple risk factors, such as chronic poverty, alcoholism, abusive or psychotic parents, one-third of the infants in her study were considered high risk at birth. By studying these children over a long period, Werner was able to begin to understand how the effects of trauma are passed down from one generation to the next. Her findings were that, somehow, one out of every three of the high-risk children grew into emotionally healthy, competent adults, while two-thirds of the high risk group did develop psychological and psycho-social problems. Over 80% of the original high risk group had bounced back and were doing well by their thirties. Werner was specifically interested in these children who, despite the presence of multiple risk factors in their early childhood, and despite the exposure to trauma and family risk factors such as those mentioned above, developed healthy personalities, stable careers, and strong interpersonal relationships. She discovered hope where she expected to find despair. She sought to identify the protective factors that contributed to the self-righting tendencies and resilience of these children, enabling them to overcome the adversities in their developmental process and achieve a successful transition into adulthood.

A caring connection with someone other than a family member (often a neighbour, teacher, social worker, or an official) was found to be a powerful protective factor, and was identified as a key contributor to developing resilience and self-righting competencies in these individuals. On reflection, many of the resilient group said that the reason they had been able to rebound from adversity had to do with someone—an adult or peer—who reached out to them. Many viewed their teachers as having had a more significant effect on them than their parents. Some remembered a teacher who had helped them with reading, or had encouraged them, and that good experience remained with them twenty or thirty years later when they were being interviewed by Werner.

Werner (1994) identified two clusters of personal protective factors: (1) those that elicit positive responses from a variety of caring people, and (2) skills and values that lead to resilience and efficient use of abilities. Her study suggests that protective factors have a more profound impact on the life of children growing up under adverse conditions than do specific risk factors or stressful life events. Her subjects showed an awareness of the self-righting tendencies that led them to healthy adult development even under the most persistent adverse circumstances, and those protective factors transcend ethnic, social class, geographical, and historic boundaries.

Norman Garmezy, a clinical psychologist, after a long process of working with children of schizophrenic parents in the 1940s and 1950s, also identified resilience in some of those children. He found that some of the children presented healthy development and competence despite living under the most chaotic and stressful circumstances (Garmezy, 1970). He began investigating different forms of schizophrenia and loosely categorized them as ‘process’ and ‘reactive’ schizophrenias. He observed that people with process schizophrenia tended to be chronically ill, while those with reactive schizophrenia progressed better and were able to improve with therapeutic intervention. He suggested (ibid.) that this was due to the different ways in which these patients handle stress. Garmezy emphasized that children whose parents have schizophrenia live in one of the most stressful situations imaginable; they have no control over what is happening to them and are angry at how their lives are being spoiled. Usually, such parents have no time for children, so these children have no childhood and feel lonely; it is impossible for them to ask friends home, and they dread that they might inherit their parent’s illness. Garmezy, in his early research work on schizophrenia, studied how adversity in life affects mental health. He focused on resilience rather than on pathology, taking into consideration cognitive skills, motivation, and other protective factors that might hold clues to preventing mental illness. He later thought that if he could understand how some of these children developed healthily in spite of their genetic backgrounds and profound family difficulties, this might lead to an increased knowledge of mental illness (Garmezy, 1981).

Garmezy’s recognized that understanding the origins of the competence and resilience of many children he studied might hold essential clues to preventing mental health problems and promoting life success in children at risk. Garmezy’s studies (1971, 1981, 1991, 1993; Garmezy, Masten, & Tellegen, 1984) concluded that the quality of resilience plays a greater role in mental health than anyone had previously suspected. He cut across prevailing ideas and practices by suggesting that instead of trying to devise models of treating children when they became ill, it might be more useful to study the forces helping children to survive and adapt and avoid mental illness.

With Emmy Werner, Garmezy influenced much research on the processes that protect human development in perilous conditions and promote healthy development in children whose life is affected by poverty, family violence, war, and other disasters. Although he was known for his early work on schizophrenia, Garmezy’s later work on resilience in the face of disadvantage is important in building a foundation for understanding the capacity to function adaptively.

One of Garmezy’s examples is a nine-year-old child who became known as “the boy with the bread sandwich”. This child’s father had left home when he was baby, his mother was an alcoholic, and he grew up in severe poverty. He would bring a sandwich to school each day that he had carefully made himself from two pieces of dry bread without anything in between. He reported that he did this so that no one would feel pity for him and no one would know about his mother.

Werner’s findings are also corroborated by further researches in education, which suggests that the support teachers can provide to students by listening to them and validating their feelings, demonstrating kindness, compassion, and respect, enhances resilience (Gordon 1995; Higgins, 1994, Meier, 1995). Teachers’ high expectations can structure and guide students’ behaviour; indeed, can challenge students to go beyond what they believe they can do (Delpit, 1996). Caring teachers, who treat students as responsible individuals, allowing them to participate in all aspects of the school’s functioning, and to express their opinions and imagination, make choices, problem solve, work with and help others, create a physically and psychologically safe and structured environment (Kohn, 1993, Rutter, 1995; Rutter, Maughan, Mortimer, Ouston, & Smith, 1979; Seligman, 1995). In this context, students’ strength and resilience can be recognized by: (1) not taking personally the adversity in their lives; (2) not seeing adversity as permanent; and (3) not seeing setbacks as pervasive.

Werner and Smith (1992, p. 202) indicate that resilience skills include the ability to form relationships (social competence), to problem solve (metacognition), to develop a sense of identity (autonomy), and to plan and hope (a sense of purpose and future). Werner emphasized the importance of social skills and intelligence, and of humour, this last enabling the individual to laugh when they would rather cry. She used the analogy of life as a lemon, and a resilient person knowing how to make lemonade out of it. Rutter (1995), in line with Werner (1994), emphasizes that promoting self-esteem and the opening up of positive opportunities is a method for fostering resilience. He (Rutter, 1995) lists several resilience fostering categories, such as: (1) reducing the personal impact of risk, (2) reducing negative chain reactions, (3) promoting self-esteem, (4) opening up positive opportunities, and (5) the positive cognitive processing of negative experiences.

A key implication of Werner’s work and the other researchers after her is that in difficult circumstances, where a community member comes to a child’s rescue, this is of benefit in helping the child overcome those circumstances. From a psychoanalytical viewpoint, Lifton (1994) suggests that an innate self-righting mechanism that resilient individuals have is the capacity to transform and change the adverse life circumstances, regardless of what their risks are. Many factors discussed by Werner and Smith (1992, p. 202) are close to psychoanalytic thinking. They indicate that “resilience skills” include (1) social competence, which is the ability to form relationships—having a “listening other”, (2) metacognition, which is the ability to solve the problem without falling apart—having enough “psychic space”, (3) autonomy, which is development of the “sense of self”, and (4) to plan and hope, which gives a sense of purpose and of a future.

The psychological research has identified resilience in children, and some of the external factors and personality differences that are involved in it, but the standpoint of this research is to consider resilience in psychoanalytic terms. From this perspective, the psychological literature is considered inadequate, as it fails to look at how resilience can be understood in terms of internal processes and relations between the self and other. In psychoanalytic terms, this protective factor can be understood as the internalization of a good object in the process of development, a concept that will be explored further in the discussion of object relations theory that follows. In this way, perhaps, we can hope to come to an understanding of what is missing in patients without resilience.

Object relations theory

The term “object relations” refers to the self-structure that a person internalizes from early childhood which functions as a foundation for establishing and maintaining prospective relationships. Object relations theory is primarily concerned with love, especially the need for parental or primary carer love. It developed from drive theory, which derived from the discharge mechanics of the libido. Psychopathology is an expression of traumatic self-object internalizations from childhood acted out in our present relationships. Laplanche and Pontalis (1973) say:

We may speak of the object-relationships of a specific subject, but also of types of object-relationship by reference either to points in development (e.g. an oral object-relationship) or else to psycho-pathology (e.g. a melancholic object relationship). [pp. 277 278]

As a relational model, object relations is the most useful theory in working with people who have endured trauma. The theory accounts for the distortion of objects by pointing to the inherent difficulty of the search for relatedness. An important aspect of object relations theory is that it looks not only at what others have been for us, but also what we wanted them to be. Although cognitive development is not independent of affective factors and psychodynamic struggles, early primitive forms of cognition are unavoidable and universal. Greenberg and Mitchell (1983) suggested that

Early forms of perception and cognition, lacking a sense of time, space, and object constancy, contribute to the painful intensity of the struggles within early object relations. For the relational model theories one need not fall back on drives to account for distortions of interpersonal reality. [p. 406]

Object relations theory is relevant to people who have endured trauma, as it emphasizes the importance of relatedness and self-definition. Central to the theory is the idea of a struggle taking place in the interpersonal and intersubjective relational medium. In the first stage of object relationships, various defences are constructed in response to external demands. Thus, ego organization, or lack of it, which is in the service of adaptation to the environment, may be fragmented by the procurement of object relations. Repeated compliance with such demands, associated with a withdrawal from self-generated spontaneity, leads to an increased stifling of impulses for spontaneous expression, thereby culminating in a false self-development; hence, there will be no sense of self.

The concept of the sense of self and its relevance

The concept of false self that Winnicott (1965) discusses is usually adopted in vulnerable states of mind, as a defence against the unthinkable, and to the denigration of the true sense of self. It may be constructed in response to a fear of death, both of the self and of others. However, such fear is a form of existential anxiety, which people who have endured trauma in adult life have experienced in the past and/or present. However, it is possible that the unconscious displacement of the emerging false self is presented within the interpersonal conditions of the earliest object relations. In this context, the false self, as a collection of behaviours, thoughts, and feelings, is motivated by vulnerability and the need to cling to the object. In my view, this is not just a result of external trauma in the adult life of a patient, but must be rooted in earlier trauma. The false self can defensively function against separation anxiety, the fear of abandonment, the fear of death and annihilation—which signify and correspond to the vulnerability which impedes integration of the whole self-object representations—and that is the foundation of resilience. This will affect the ability to “dissociate healthily” as there is no psychic space and no integrated and cohesive sense of self to begin with. As a result, the capacity for spontaneity, autonomy, creativity, and resilience is blocked further and lost in a false-self created to survive the unresolved internal conflicts resulting from early life experiences and external traumata in adulthood. Mourning, for this type of patient therefore, may not be just about the loss of the object, but also be about the loss of the sense of self. It is about both fear of annihilation of the self and fear of the loss of the other, and, in cases where the false self is totally lost, there is neither a true nor false self existing.

Klein’s emphasis (1935) on the different angles of loss is helpful in understanding psychical pain. It provides clarity on the difference between the paranoid–schizoid position (that is, fear of annihilation and total destruction of the self), and the depressive position (that is, fear of the loss of the other). There is clarity in terms of the loss of the object and the grief which the psyche, as an internal space, goes through; that is, to distinguish how other the lost other is. The concept of projective identification initiated by Freud’s theory of mourning is also helpful in understanding that the loss of a loved m/other/object is equal to a temporary disruption of the self. So, if the sense of the self has not been totally fragmented, there may be a need for containing, restoring, and reclaiming part of the lost self, which, as a result of not being able to go through consolatory mourning, has been projected on to the lost other. This is necessary and can be done by having a therapist as the listening other for reclaiming the sense of self and an autonomous and resilient self. It is clear that if the good object becomes damaged and lost, it does affect the ego, and the ego becomes less organized and loses part of its identity. A persecutory feeling and dread of the superego may first replace part of the ego that has been lost if the person loses internal resources and no longer is able to identify with the good internalized object. The mourning of the lost ego and of the loved object creates persecutory anxiety: the ego loses its function and is gradually replaced with fear and guilt. As a result, the psyche is populated by, and presents with, circumstances which indicate an abnormality about internalizing the object—the inability to give or to identify good enough objects which may be available. This can be an indication of a total loss. So, what we may see is the failure of the system of defence and the modes of functioning: the loss of the sense of self.

Winnicott’s contribution is of vital importance in working with patients who have endured trauma. Especially, his concepts of self (true and false), his conceptualization of psychic development of the child in relation to a real and influential parent, his idea of environmental impingement, his conceptualization of space (1947), which is quite close to psychic space, the concept I am using in this study, his idea of the ‘holding environment’, which facilitates the transition to being self-sufficient, and his conception of the ‘transitional object’ (1951) are all useful concepts in working with traumatized people. He defined trauma for the infant by linking it with the idea of impingement, and suggested that in the developmental stage, impingement occurs in the form of a parent intruding when the infant needs to be left alone, or the parent being absent when is needed (Winnicott, ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ACKNOWLEDGEMENTS
• ABOUT THE AUTHOR
• FOREWORD
• PREFACE
• AUTHOR’S PREFACE
• INTRODUCTION
• PART I: LITERATURE REVIEW
• PART II: CASE STUDIES
• REFERENCES
• INDEX