Psychotherapy with trauma victims is like a journey into the āland of the deadā. After suffering the trauma of his separation from Freud, Jung made this assertion in his memoirs: āI had the feeling that I was in the land of the dead. The atmosphere was that of the other worldā (Jung 1965: 181). In this metaphoric territory, trauma victims experience an emotional loss of soul and a bisecting of the meaningful and creative relationship between the conscious and the unconscious. The wholeness of the psyche dissipates, and life dissociates into fragments resulting in suffering and despair. Such a process can take place after serious traumas that affect the victimās linguistic symbolization. Verbal images are no longer easily created, and the mechanisms integrating body and psyche cease to operate. Victims who have undergone major traumas in their childhood ranging from blood-curdling abandonment anxieties to sexual abuse to complex traumas involving physical and emotional exploitation are cast into this dark and terrifying land, as are those who have survived terror attacks or fiercely disruptive war experiences. On the therapeutic journey with these post-trauma victims, therapists become acquainted with the traumatic memories and shocking experiences that flood their psyches. The alchemical mystery of how their bisected and shattered psyches reintegrate remains just that ā a mystery.
The question of how to fuse and heal a psyche split by trauma has engaged modern psychologists for the past hundred years and continues to be a fertile field for clinical and theoretical research and writing. Monahan (2009) mentions many of the leading contributors to the study of trauma and dissociation, following Jung and Janet. The basic principles of healing the trauma complex were laid out as follows by Jung:
Such an intricate therapeutic journey incorporates healing components that at times may generate wear and tear in the body-mind connection of therapists as well as of patients. The emotional-physical experience of confronting the dissociative defences of their emotionally torn patients elicits physical sensations and powerful emotional experiences among therapists as well. Often these sensations and experiences are essential to the growth of new tissue to help the trauma wounds heal.
The political, social and cultural situation in Israel serves to intensify the vulnerability of individuals and groups within society. Against this background, in this chapter we present two clinical cases demonstrating our experience with the victims of serious post-trauma disorder who have permitted us to follow their quest through the āland of the deadā. We describe the psychotherapeutic process and demonstrate how it merges with and penetrates the dissociative defence mechanisms that protect and shield patients while at the same time causing them harm and leading them astray. We do not put forward any special technique or tidy paradigm ultimately leading to a definitive protocol for treating trauma. Rather, we strive to describe interventions and to present explanations for the psychotherapeutic processes as we have observed and understood them, though they remain somewhat abstract, subjective and obscure. We do not offer comparative data with respect to other cultures or societies across the globe, where psychotherapists must cope with national existential as well as personal traumas. We do however describe the situation on the ground in Israel, where, against a backdrop of turmoil, existential danger and national and historical traumas, analysts must cope with the personal traumas of patients who are exposed daily to the anxiety and stress of living under threat.
Land of the dead
In the midst of her painful attempt to āreintegrateā, Dana (pseudonym), a 24-year-old victim of appalling sexual violence since childhood, wrote these lines during her fourth year of therapy:
Talma (pseudonym), a 30-year-old woman, became a victim of a terror attack by a female suicide bomber six years previously. In her second year of therapy, she made the following remarks:
Life in Israel is marked by the constant stress of military, political and social conflict alongside the threat of war, terrorism, injury and death. This ongoing existential conflict drastically lowers the emotional threshold of Israelis. The national psyche is marked by restlessness, anxiety and over-arousal, extreme responses and impatience alongside emotional flooding and rushing to help others in need. Israel is also a social melting pot. Since its establishment in 1948, the country has been absorbing waves of immigrants from diverse cultures and societies across the globe, creating a pressure cooker seething with a cultural, social and socioeconomic mixture. Many of these groups immigrated in the wake of trauma and crises in their countries of origin. Against this background ethnic tensions and feelings of inequality, deprivation and victimization have continued from the time the state was established. In this shaky reality, personal traumas continue to occur, often reflecting societyās collective trauma. For most, dissociative defence mechanisms come into play when the trauma occurs, and the body-mind fixation is what leads directly to the āland of the deadā. The complex and turbulent situation outside intensifies personal traumas: a rape committed by a security guard who himself is a victim of terror, represents the embodiment of a shadow complex by the trauma tyrant that has turned him into an offender. His identification with the shadows of destruction and aggression has caused him to indiscriminately turn these emotions toward a helpless victim and mercilessly rape the one he was supposed to protect. Hence, in Israel therapeutic sessions take place in a hall of mirrors reflecting infinite projections from outer worlds of trauma as well as the patientās own individual trauma. In such an analytic situation, it is extremely difficult to establish or preserve a separate temenos or sacred place isolated from everyday life outside. For example, if the noise of a helicopter taking off from a nearby military airfield penetrates the clinic, it is impossible to determine for certain what associations the noise may have for the patient and for the analyst: a terror attack, the evacuation of the wounded, thoughts of routine military operations, or the outbreak of war. Such noises piercing the therapeutic bubble stir up shocking events for the patients that catapult them back to the world of their trauma.
Sometimes someone would prepare a light meal in the treatment centre kitchenette, and the odour of burnt toast would waft through the rooms. When this burnt toast smell would reach the treatment room, Talma was overcome by the urge to get up, abandon the session with her analyst (GM) and flee.
GM: You say that when youāre at the seashore, something special happens to you, and you donāt feel you have to be on your guard all the time.
Talma: Right. Thatās the only place I can let go.
GM: That happens at the seashore, and in some way maybe it happens here as well, though a bit differently.
Talma: A bit differently, but it happens.
GM: Here you also feel protected and safe.
Talma: Right. Iām less on guard here, but there are still times ā¦ When someone makes toastā¦
GM: In the kitchenette? When someone makes toast?
Talma: Itās hardest when someone burns the toast. Itās very hard for me. It makes me feel I canāt go into the therapy session ā¦ But except for that, itās okay ā¦ If I let my defences down a bit, something can happen. I prefer to be prepared for the worst ā¦ though I donāt understand what Iām preparing forā¦
Therapists themselves must also live in the complex and difficult reality outside and often react with physical, emotional and spiritual responses associated with their own personal traumatic memories. The relationship developing behind the closed door of the therapy room is loaded with associations of national and personal traumas deriving from a shared and very challenging existential reality.
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The healing journey to reintegration must pass through the carved āland of the deadā. This is a harrowing journey that involves recreating the experience of Dionysian dismemberment along with an uplifting of the spirits. Often this situation facilitates an archetypal self-care system, so brilliantly named and described by Kalsched (2003), who explains that the operation of archaic and primitive defence mechanisms safeguards the survival of the inner psycheās core. This system of defence identifies and attacks dangers from outside the psyche, while at the same time launching a type of autoimmune attack against parts of the self (Kalsched 2003). He further comments:
Indeed, it seems that parts that normally would be connected were split apart by powerful forces that then pitted them one against the other. The defence mechanism turns into a persecution mechanism that does not cease when the trauma is over. It continues to survive and reside within the trauma victimās psyche, thus merging the emotional wound with the physical one.
