Analysts in the Trenches

Streets, Schools, War Zones

Bruce Sklarew, Bruce Sklarew, Stuart W. Twemlow, Sallye M. Wilkinson, Bruce Sklarew, Stuart W. Twemlow, Sallye M. Wilkinson

• Publisher: Routledge
• Year: 2014
• Topic: Psychology
• eBook ISBN:
  9781317707080
• Subtopic: Applied Psychology
• Index: Psychology

The horrific events of 9/11 and its sequelae have reinforced what thoughtful analysts have long known: that they have a responsibilty to respond to the complex social and emotional issues arising in their communities - to function, that is, as "community psychoanalysts." Analysts in the Trenches vividly illustrates what socially engaged analysts can offer to violent and disturbed communities. Contributors bring analytic expertise to bear on the emotional sequelae to violence, including sexual and physical abuse; to multiple and traumatic losses; and to learning inhibitions. Thay also explore and devise community responses to the scapegoating of classes and groups, to homelessness, and to variations in family structures. This volume provides heartening testimony to the relevance of psychodynamic thinking in the post-9/11 world and will spur professional readers to develop their own programs of community involvement.

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Reverberations of Danger, Trauma, and PTSD on Group Dynamics

Robert S. Pynoos ♦ Alan M. Steinberg ♦ Grete Dyb Armen K. Goenjian ♦ Sue-Huei Chen ♦ Melissa J. Brymer

Individuals, families, groups, organizations, communities, and societies face an ever-present and ever-changing ecology of natural and man-made dangers. Tragically, catastrophic situations occur that may affect only one person or an entire population. Trauma resulting from human violence encompasses childhood physical and sexual abuse, domestic and community violence, political violence and torture, and war. Trauma can also unfold from natural or manmade disasters, serious accidental injury, occupational or transportation catastrophes, and life-threatening medical illness (Pynoos, Steinberg, and Wraith, 1995). Over the life cycle, an individual may experience different types or a series of traumas, and, within a group, members may endure a wide range of traumatic situations. As a result of traumatic experiences, including witnessing injury and traumatic death, individuals develop posttraumatic stress and complicated grief reactions, are often faced with ubiquitous post-trauma reminders and adversities, and live with trauma-generated expectations that reverberate in complex ways through their various group affiliations. An understanding of the interactions of danger, trauma, and PTSD among group members can elucidate the impact of trauma on groups at various levels and suggest strategies of response that promote individual and group recovery.

There is an intricate reciprocal relationship between an individual’s traumatic experience and his or her wider group affiliations. Consideration of a number of aspects of trauma will help to explicate this interrelationship: (1) the human appraisal and response to danger; (2) the nature of trauma and the complexity of traumatic experiences; (3) the role of trauma reminders in posttrauma behavior; (4) posttraumatic stress disorder; (5) posttrauma adversities; and (6) traumatic expectations.

Over the past decade, we have refined a developmental psychopathology model of traumatic stress that incorporates these features (Steinberg and Ritzmann, 1990; Pynoos et al., 1995; Pynoos, Steinberg, and Piacentini, 1999). Building on this perspective on the individual, we hope to illuminate selected issues that illuminate the impact of trauma on parent–child relationships; family, peer, school, and occupational groups; and the broader community and society.

Human Appraisal and Response to Danger

Our developmental framework assigns a prominent role to the ontogenesis of the human appraisal and response to danger. This framework includes three principal components: (1) estimation of the nature and magnitude of external and internal danger; (2) emotional and physical reactions and efforts at their regulation; and (3) estimation of the needed type, degree, and efficacy of protective intervention. These three operations are strongly influenced by the individual’s developmental stage, including neurobiological maturation, and by experiential history, learning, current affiliative attachments, and the social ecology. In addition, families, school communities, social groups, nations and international alliances also evaluate dangers, shape the parameters of emotional response and regulation, and form strategies of preventive and protective intervention. Culture permeates each of these levels of individual affiliation and group behavior. Intercultural differences in estimation of danger and response can lead to intense conflicts among groups within a society and to extreme forms of violence. Miscalculations in the perception of threat and mobilization of resources for protective intervention between nations can lead to massive catastrophic consequences.

With respect to child development, for example, young children rely on a parent for social referencing of danger, for assistance in emotional regulation of fear responses, and for provision of a protective shield (Lieberman and Pawl, 1990). While school-age children begin to test their own appraisal of danger, to develop private means to regulate fear responses, and to play at protective self-efficacy, in situations of serious danger they remain primarily reliant on parent, teacher, or older caretaker to successfully appraise and protectively intervene. By midadolescence, there is significant reliance on self- and peer appraisal of threat, consequence, and protection, and sufficient emotional regulation to permit decision making about direct interventions on behalf of self and others. Successive developmental transitions, including marriage, having children, occupational and community life, and political and cultural affiliations, are additional dimensions that broaden the scope of appraisal of danger, complicate emotional responses and regulation, and elicit a wide range of considerations for preventive and protective action.

Trauma and the Complexity of Traumatic Experiences

Trauma

Trauma refers to the actualization of an expected or unexpected danger. It involves both objective and subjective features. The objective features include circumstances of extreme life-threat to self and other, actual injury or death, and exposure to grotesque features of mutilating injury, even indirectly. Trauma usually entails an experience of physical helplessness, where imagined or attempted protective interventions have failed. The subjective features include the experience of terror, horror, helplessness, and a range of extremely negative emotions (e.g., feelings of shame, guilt, rage, betrayal, and profound loss). Of particular note for traumatic situations, the reappraisal process, if it is to remain reality based, serves only to confirm the extreme magnitude of danger, the appropriateness of the emotional responses, and the absence of effective protective intervention.

The impact of trauma on family and groups can be categorized according to the agent of the trauma, affiliative assumptions, and expectations regarding sources of protective intervention. Issues of accountability are embedded in traumatic situations. Through various cultural means, among them historical narratives, witness accounts, modes of artistic representation, religious doctrine, and political ideology, groups maintain versions of traumatic situations that assign accountability. Intrafamilial agency can generate intense conflicts of loyalty, severe challenges to basic affiliative assumptions, and profound estrangement among family members (Green, 1993). Extrafamilial agency can provoke extreme fantasies of retaliation and counterretaliation. Preoccupation with revenge can be transmitted across generations, maintaining feuds and vendettas. If affecting a sufficient number within the population, revenge can be mobilized by societal or governmental agencies to engage group members in organized aggression. In addition, since judicial proceedings adjudicate blame, there is a link between judicial outcome, reparation and reconciliation, and the resolution of individual and group dynamics motivated by revenge. Even natural disasters are often imbued with issues of human agency and accountability within and outside the group (Pynoos, Goenjian, and Steinberg, 1998; Goenjian et al., 2001). These phenomena appear to operate across the levels of family, school, workplace, community, and nation.

As one example of extrafamilial agency, one of the authors (GD) and her colleagues developed and implemented a psychiatric response for parents and children after alleged sexual abuse at a community day-care center in a rural Norwegian community. The traumatic impact on parents encompassed extreme concern about their children’s physical and mental health and a sense of failure and guilt for having placed their children in danger. Because the school had closed after the reports of the abuse, the children lost their playmates and their daily routine was disturbed. They displayed posttraumatic reactions, confusion, anger, and withdrawal.

There was a two-fold impact on the family matrix. Parents became united in their efforts to insure appropriate physical examinations and mental health care for their children; participated with authorities in conducting the police investigation; and supported one another when testifying in court proceedings. At the same time, there were differences in spousal response to the ongoing police investigation, legal proceedings, and media coverage. Fathers were generally more inclined than mothers to engage with police, to follow the media reports, and to meet with local authorities to generate community resources for their family. Spousal disputes arose over whether to relocate the family out of the community or to send their child to another day-care center. Some mothers left their employment or reduced their working hours so as to be able to stay home with their children.

Siblings of the day-care children felt that they were getting much less attention from their parents than before, and they were at a loss as to how to respond to their affected sibling. The family dynamics were disturbed; parents became overprotective of their older children, not allowing them to go on field trips or to sleep over at a friend’s house. About half the affected families relocated from the community. Other families reduced their social activities and changed their constellation of friends.

The parents of the day-care children took on a group identity with the school community. They met on a number of occasions and elected several spokespersons to represent them to the media and community agencies. The formation of this group allowed members to exchange information, share their experiences, and support one another emotionally. Sometimes, however, hearing traumatic details from other parents proved quite distressing for parents whose children had not reported highly intrusive abuse.

The school administration and staff faced many difficult issues, such as conflict over whether the abuse had actually occurred and guilt over failure in their responsibility for the care and supervision of the children. Not only was the school closed after the reported abuse, but also the headmaster took an immediate leave of absence with subsequent early retirement. The teachers were subjected to intense questioning from parents and police, and were the focus of media attention.

Like the school community, the wider community suffered from an extreme split about whether or not the alleged abuse actually occurred. This conflict filtered through workplace interactions and a variety of social situations. Moreover, an extreme disruption to the community arose from the intense media coverage, both during the investigation and for months during the trial. The story was broadcast across the nation, and community members suffered from the stigma of identification of their town with this event.

To help remediate disturbances in family functioning, the psychiatric program provided group counseling to children and parents. Given the finding of “not guilty” for the accused in this case, mental health services after the trial and verdict were needed for parents and children to address anger over the verdict, the ultimate absence of human accountability, and disillusionment and loss of trust in social institutions.

Complexity of Traumatic Experiences

The complexity of traumatic experiences complicates the intersubjective experience of family or group members. Commonly, a family or group is challenged by the repercussions of variable experiences among members to the same traumatic situation. Some family or group members will have been present, while others not. Even members who were present during a traumatic situation will have had disparate moment-to-moment experiences. There will inevitably be differences in the initial and ongoing appraisal of danger and estimation of effective intervention by self and others. These differences often correspond to different vantagepoints and changing concerns for self and other. As members try to regulate their own emotional reactions, their efforts are strongly influenced by the emotional reaction of others and the success or failure of mutual emotional assistance. Members often evaluate the actions of self and other as successfully protective, passive, disorganized, or more endangering. They often simultaneously or serially confront direct life-threat, and they witness threat, injury, or death to others. They may have to contend with ongoing life-threat even in the midst of loss of significant others. Circumstances may result in temporary or prolonged separations from significant others and intense worry about their safety. Traumatic experiences contain additional features that extend after the cessation of violence or threat, including efforts at rescue, evacuation, and medical care.

The concatenation of these highly individual, yet group-shared experiences inevitably leads to a Rashomon-like phenomenon that complicates the interpersonal life of the family or group. The intense contrast in experience between those present and those who were not can create an emotional divide that interferes with mutual reintegration, despite genuine efforts at communication and comfort. There is often a discordance in the ongoing reappraisal of threat and intervention because the mind of the nonexposed person is not as confined to the traumatic situation as it unfolded as is the mind of the person who was there. Even when shared, the experience is highly privatized, with important consequences to family or group dynamics. In families or groups, violent assault can lead to a radical break in concern for others when the threat to self is imminent. As this profound sense of estrangement persists into the posttrauma milieu, the sense of closeness in pretrauma relationships may be disturbed. Within the adolescent group, we have described the added element of an “existential dilemma” as friends have to choose, under life-threat, between self-protective actions and intervention on behalf of a peer (Layne, Pynoos, and Cardenas, 2001). We have observed how, after such experiences, best friendships can be lost and not replaced.

As another example, we provided consultation to a school where a fifth-grade classroom had been taken hostage by a psychotic woman who made the class write out a suicide note for her, then shot and killed herself in front of the students and teacher. Although the students were together, often sitting next to close friends, they each felt extremely alone during the episode. The children described inhibiting their wish to comfort one another for fear that such an action might draw attention to them and provoke a violent response. This was a group experience. But afterward, one of the most intense trauma reminders involved moments when children felt alone, even at home. To address the fragmented posttrauma classroom milieu, it was critical to elicit a shared understanding of this common feature of their experience. At the same time, to address the regressive reverberations in the children’s family life, it was essential to enhance parental appreciation and support for the children’s difficulty in being alone.

Radical shifts in self-object representation can occur as a result of traumatic situations. This shift can occur when a family member suddenly becomes the agent of violence in the family, for example, when a parent attempts a murder-suicide. However, similar radical shifts can occur when a parent is seen as ineffectual, or a teacher is viewed as having endangered students by misappraisal of a life-threatening situation. For instance, we have seen how a child can become severely estranged from a father who, with the child, was made to watch the mother being raped. Moreover, in one of the earliest school shootings we studied, a classroom of students was sent out to the playground by a teacher who misinterpreted the sound of a semiautomatic weapon for the backfire of a car. Over the next year, the students reported a deep distrust of this teacher. These radical shifts can occur in the relationship of traumatized members to the action or inaction of outside social agencies responsible for prevention, protection, and reparative interventions. As happened at Columbine High School, failures in rescue efforts continue to be a source of profound disillusionment to students in a classroom who had tried to keep a teacher alive until help arrived.

In the acute aftermath of trauma, the interpersonal matrix of the family or group may not only be severely altered by injury and loss, but, as is often overlooked, by differing psychological agendas arising from each member’s unique experience and posttrauma reactions. Family dynamics are challenged by members who have different psychological agendas with different sets of traumatic reminders, different courses of recovery, and differences in post-trauma stress and adaptation to posttrauma adversities.

Group, institutional, and intergroup accounts of trauma often introduce versions of the traumatic situation that do not capture the complexity of the individual’s experience. Indeed, over time, they may introduce conflicting accounts, misunderstandings, distortions, misattributions, or new information that affect the individual’s or traumatized group’s relationship with other group members, their wider community, official agencies, and other groups. To traumatized members of a group, there is nothing more important than “getting it right” when it comes to validating their own private experience and its traumatic consequences (Meichenbaum, 1995).

Trauma Reminders

Trauma reminders derive from the trauma-specific features of a traumatic situation and subjective reactions. They are ubiquitous in the aftermath of trauma and constitute an additional source of ongoing distress. Psychological and physiological reactivity to reminders contributes to the periodic or phasic nature of renewed traumatic anxiety and traumatic expectations that often elicit maladaptive reenactment and avoidant behavior. The interplay of trauma reminders, their effects on interpersonal behavior, and group forms of remembering and commemoration are pervasive influences on group dynamics.

It has been our consistent observation that the powerful influence of trauma reminders on group behavior is too often overlooked. As groups move from mobilization during the trauma and crisis responses in the immediate aftermath to more sustained efforts at recovery, they often fail to incorporate interventions to mitigate the pernicious impact of trauma reminders. Simply introducing the concept of “trauma reminder” can stimulate a valuable shift in perspective in appreciating the impact of trauma reminders on daily life.

The consequence sometimes can be dramatic. For example, in an intervention program after the Taiwan Chi-Chi Earthquake in 1999, one of our colleagues (S-HC) introduced the concept of trauma reminder to a group of residents from a rural community in Pu-Li, a town near the epicenter. One traumatized housewife began to experience more frequent posttraumatic symptoms a year after the earthquake. She and her family attributed her problems to a mild traffic ac...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Contributors
• Introduction
• 1. Reverberations of Danger, Trauma, and PTSD on Group Dynamics
• 2. Life Without Walls: Violence and Trauma Among the Homeless
• 3. From the Events of History to a Sense of History: Aspects of Transgenerational Trauma and Brutality in the African-American Experience
• 4. Concurrent Intervention During Massive Community Trauma: An Analyst’s Experience at Ground Zero
• 5. After the Violence: The Internal World and Linking Objects of a Refugee Family
• 6. Topeka’s Healthy Community Initiative: A Psychoanalytic Model for Change
• 7. A Retired Psychoanalyst Volunteers to Promote School-Based Mental Health
• 8. The Uses of Aggression: Healing the Wounds of War in a Community Context
• 9. The School-Based Mourning Project: A Preventive Intervention in the Cycle of Inner-City Violence
• 10. Psychoanalytic Responses to Violent Trauma: The Child Development-Community Policing Partnership
• 11. Children’s Exposure to Community Violence: Psychoanalytic Perspectives on Evaluation and Treatment
• 12. Early Mental Health Intervention and Prevention: The Implications for Government and the Wider Community
• Index