First Do No Harm

The Paradoxical Encounters of Psychoanalysis, Warmaking, and Resistance

Adrienne Harris, Steven Botticelli, Adrienne Harris, Steven Botticelli

• Publisher: Routledge
• Year: 2011
• Print ISBN: 9780415996495
• eBook ISBN: 9781135842956
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

At the outset of World War I - the "Great War" - Freud supported the Austro-Hungarian Empire for which his sons fought. But the cruel truths of that bloody conflict, wrought on the psyches as much as the bodies of the soldiers returning from the battlefield, caused him to rethink his stance and subsequently affected his theory: Psychoanalysis, a healing science, could tell us much about both the drive for war and the ways to undo the trauma that war inherently breeds, but its principles could just as easily serve the enemy's desires to inculcate its own brand of "truth."

Even a century later, psychoanalysis can still be used as much for the justifications of warfare and propaganda as it is for the defiance of and resistance to those same things. But it is in the investigation of the motives and methods behind these uses that psychoanalysis proves its greatest strength. To wit, this edited collection presents published and unpublished material by analysts, writers, and activists who have worked at the front lines of psychic life and war from various stances. Set at a point of tension and contradiction, they illustrate the paradoxical relation of psychoanalysis as both a site of resistance and healing and a necessary aspect of warmaking, propaganda, and militarism. In doing so, we venture from the home front - from the trauma of returning veterans to the APA's own complicity in CIA "black sites" - across international borders - from the treatment of women in Latin American dictatorships to the resistance to occupation in Palestine, from mind control to an ethics of responsibility. Throughout, a psychoanalytic sensibility deconstructs the very opposition that it inhabits, and seeks to reestablish psychoanalysis as the healing discipline it was conceived to be.

Part 1
Psychoanalysis and antiwar work

Healing

In this section we draw on the work of clinicians, analyst-activists, and psychoanalysts rooting their work in history and political life. We consider what psychoanalysis offers as a route to healing. These practitioners and theorists are interested in the relief of war suffering for soldiers and for civilians. We see the value and function of a psychoanalytic lens turned toward the immediate and very long-term damage of warmaking.

The diagnosis of posttraumatic stress disorder (PTSD) implies that the trauma is over, providing some comfort and distance for both the survivor and the clinician. Increasingly, many clinicians must deal with people repeatedly exposed to traumatic events or living in traumatized societies. Tom McGoldrick (Chapter 1) uses his unsettling early work with returning American soldiers of the Iraq and Afghanistan conflicts as an illustration of the difficulties and rewards of working with those for whom traumatization is not over. What are the ethical, existential, and personal dilemmas faced by the clinician working with “those who return to the battlefield”?

Jean-Max Gaudillière (Chapter 2) gives us a historical account of the development and the abandonment of psychiatric and psychoanalytic understanding of war trauma. He is writing about the psychic costs of amnesia, and the unconscious communications between patient and analyst, each carrying a forgotten tie to warfare. We think it is important to note that Gaudillière writes from a European perspective, which means he writes in the context of over a century of wars, colonial and domestic. His chapter speaks to his deep conviction that it takes half a century to process a war, and that in repeated and overlapping traumatic battles, the layering of symptoms and half known, unknown losses underlie much pathology in the culture, in patients, and in analysts. Through clinical vignettes, Gaudillière’s chapter presents the historical resistance of psychoanalysis to history, and a way to break it, using in the transference, some traumatic spots of the history of the analyst when confronted with trauma and madness brought by a patient as instruments of research regarding erased parts of history.

Ghislaine Boulanger’s chapter (Chapter 3) is about the consequences of violence and narrowly missing violent death or witnessing violence but not, in fact, escaping it. Focusing particularly on combat trauma, the author points out that the wounds inflicted by reality in adult life become psychic reality and lead to the collapse of the self. These facts are frequently obscured by politicians, by the media, by psychoanalytic metapsychology, by diagnostic practices, and by our own personal reluctance to face up to the consequences of adult onset trauma. Horror of this magnitude does not happen in every lifetime, but psychoanalytic clinicians must always be alert to the evidence of selves that have collapsed under the weight of terror.

Nina Thomas (Chapter 4) focuses our attention on a different point in the long process of bearing, witnessing, and metabolizing the trauma of warfare. In the particular situation she writes of, the ordeals and horrors of ethnic cleansing, she tracks the long shadow of survivors’ searching for accountability and justice. The psychic dilemmas of witnessing and testifying are explored, in a way that requires the suspension of easy idealism. Thomas builds an argument for the need for rigorous work, underwritten by a psychoanalytic understanding, in thinking about forgiveness, its limits, and its possibilities and impossibilities. We feel the very long arm of trauma, and the queasy questions of justice and accountability, even as institutions and individuals work for an ethics of collective responsibility.

Chapter 1
Where is the “post” in posttraumatic stress disorder?

First impressions working with Iraq and Afghanistan soldiers

Tom McGoldrick

CASE ONE

Jim, a 25-year-old Marine, came in two weeks before his second deployment to Iraq. Newly shorn and unnervingly polite, he would have looked more like a 16-year-old high school student were it not for the telltale thousand-yard stare that marks those who have seen entirely too much. He sat stiffly in my office, eyes cast down. He reflected on the ways in which he had changed and wondered if he would ever be the same. He was embarrassed to admit that he was actually anxious to get back to the field where he felt confident and his so-called symptoms were adaptive. On the other hand, he had a tremendous sense of fatalism regarding his redeployment.

THERAPIST: Well, when you come back we can begin to make some sense of what you’ve been through.

JIM: [Looking up, making eye contact for the first time in a piercing way] I’m not coming back.

THERAPIST: [Speechless] What do you mean?

JIM: I’m not going to make it this time.

THERAPIST: So why go back?

JIM: My men need me. They will be safer with me.

THERAPIST: So you’ll have to stay safe to make sure that they are safe.

JIM: And if not, at least we’ll die together.

CASE TWO

Bill arrived for his initial session accompanied by his mother. Bill had been with an Army infantry unit in Afghanistan and served as a sniper with a Ranger team whose regular sniper had been killed. His first combat kills were not only multiple, but up close and personal through the scope of a sniper rifle. He was so thoroughly shaken by his experiences that he sought the help of the mental health team at the battalion aid station despite the threats of his platoon sergeant that only a weak shirker and coward would leave his men. When Bill returned, he was shunned by the other men and given punitive details by the platoon sergeant. Since coming home, he had spent all of his time in the basement of his mother’s home with the shades drawn. He barely spoke during the session. It was his mother’s opening salvo that I recall. She angrily stormed into my office almost dragging her withdrawn son and said, “What have you done to my son?” For a moment I am Uncle Sam, George W., the U.S. Army, and the complacent American people all rolled up into one.

CASE THREE

I had been working with a major in the Army Reserves who was a head nurse in a medical-surgical hospital attached to Abu Ghraib prison, one year after the well-publicized scandal there. A strong, articulate woman in her 50s, she had nearly 20 years in the Army Reserves and was near retirement from the service. She was uncharacteristically late for one of her appointments. I received a call 10 minutes into the session.

LOIS: Sorry I didn’t call. I’m in Texas at Ft. Sam Houston. A few of us were ordered to go for advanced training to do emergency work in the field at FOB’s (i.e., Forward Observation Bases).

THERAPIST: But you are getting out soon.

LOIS: I guess Uncle Sam has other plans for me.

I have worked with combat veterans for over 20 years. The vast majority have been Vietnam veterans with a smaller group of World War II, Korea, and Persian Gulf vets. In all cases, the war was literally over, although the “war within” still raged on. When people in treatment would say that they felt like they were back in combat, both they, and I, were safe in the notion that the war was removed in time and space. It was both post- and tele- (i.e., distant in time and space). I began working with the Vietnam vets 10 years after the war had officially ended. Many of the vets had already tried a number of avoidant solutions in drugs, alcohol, and angry confrontations. They had no place to turn other than therapy.

I am also 10 years younger than the Vietnam veterans. When I first started, I became the “kid brother” too young to have faced the draft, and therefore not morally culpable when asked the question, “Were you there?” “Of course not. You’re like my kid brother. He would have gone but he was too young.” This implies that I would have gone too.

I was also a kid therapist cutting my therapeutic milk teeth with these men. I use this image with all of the parental nurturance that this implies. For these men did become nurturing older brothers who discussed the horrors of war and its aftermath while also trying to protect me from their rage. There was also a tacit understanding, “I went so that you didn’t have to.” I became Telemachus, the dutiful son willing to hear of his father Odysseus’ combat and 10 years of wandering among the monsters of intrusive memories and the lotus eater’s trap of drug-induced forgetfulness (Shay, 2000). As the name translates, I too was “far from the battle.”

Perhaps every combatant naively hopes that theirs is “the war to end all wars,” and that they fought so that their sons and now daughters would not have to. I had a complementary naive fantasy that I was the last of war therapists. Since the Vietnam War was seemingly the last major conflict involving the United States, there would be no need for readjustment counseling or for the Department of Veterans Affairs for that matter. We would peacefully grow old together. In the same way that all trauma survivors long to return to their pretraumatized, innocent selves, I too long for the perhaps false sense of safety and security of wars long ago and far away.

Inherent in the diagnostic term posttraumatic stress disorder is the distance of time and space. The therapist and the survivor begin in a safe place to explore explosive material with the reassurance that the trauma is unlikely to reoccur. Indeed the very word survivor implies that the person is now no longer at risk; otherwise they would be only potential survivors.

Many of us who treat trauma survivors are now thrust into an unaccustomed role in which the traumatic situation is not post. The survivor is an ongoing participant or is being revictimized in various ways. The traditional safety of time and space evaporates as we, ourselves, go into the war zones to debrief those who are sometimes in the midst of traumatic situations. Or, in the case of 9/11, the trauma is brought to our doorstep threatening our own assumptions of safety.

This state of affairs is familiar to those who work with first responders, as well as those whose clients live in violent inner-city neighborhoods or whose clients are in abusive domestic relationships. Our patients are preparing for, or defending against, the very real probability of future trauma. Indeed, for some, trauma becomes routine, and mundane experiences are regarded as childish fantasies. The traumatized person views us, the “yet to be traumatized,” as naive children believing in the fairy tale notions of personal safety, agency, and faith in the possibility of interpersonal healing. The therapist is forced to look at what we all take for granted living day to day. What does this do to our faith in psychotherapeutic theories, practice, professional, and personal ethics? Indeed what does this do to our sanity when we are living in an insanely traumatized world?

Working with those who are in or soon to return to the war zone also opens up the possibility of actively intervening in someone’s life perhaps to prevent retraumatization. What are the ethical, therapeutic, and existential dimensions of such interventions or decisions not to intervene?

There is also the issue of the type of work that can be done with those who are on alert to return to the battlefield or the inner city. Is not a certain amount of emotional numbing and guardedness essential for survival? In brief interventions, we may suggest that someone refrain from speaking about past traumas in order to not compromise their defensive alertness. This is certainly a major consideration when seeing first responders at their work site and now especially true for those who face redeployment. Jim, the Marine from the first vignette, was emotionally prepared for battle and for the reality that he might die. It was neither the time nor the place to ask about his first deployment other than in the most cursory way.

Time is a matter in another way. Those who work psychoanalytically are used to working over a period of years, multiple times a week. As the staccato rhythms of my initial vignettes suggest, I often see more people for far fewer sessions, often one or two. For those who stay, their concern is often a circumscribed, practica...

Table of contents

• RELATIONAL PERSPECTIVES BOOK SERIES
• Contents
• Acknowledgments
• Contributors
• Editors’ introduction
• Part 1 Psychoanalysis and antiwar work
• Part 2 The paradox
• Part 3 War and militarism deconstructed
• Part 4 Resistance
• Index