The Perversion of Loss

Psychoanalytic Perspectives on Trauma

Susan Levy, Alessandra Lemma

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781135929336
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis!

The Perversion of Loss is an edited collection of psychoanalytic papers written by clinicians in the field of trauma. The text offers a psychoanalytic perspective on trauma and its effects on psychic functioning. In particular, it draws on attachment theory to explain how trauma undermines psychic resilience both within individuals and also within broader communities and societies. This collection contextualizes external traumatic events and addresses both individual, internal responses as well as the impact of trauma on broader social relations.

CHAPTER 1

The impact of trauma on the psyche: internal and external processes

ALESSANDRA LEMMA AND SUSAN LEVY

The meaning of trauma

On September 11 2001 an ashen-faced patient attended her session and informed her therapist that two jets had ploughed into New York’s Twin Towers and one into the Pentagon, destroying them completely and in the process ‘killing 25,000 people’. The therapist worked in an NHS mental health unit and wondered whether her normally sane patient had become rather floridly psychotic. The patient expressed intense panic and distress about the event and what she believed to be the massive loss of life. She had family and friends in New York and of course it was impossible to make any contact telephonically. She felt overwhelmed with anxiety and helplessness about their well-being.

The therapist had no idea of the veracity of this tale but gradually, as the session progressed, it became evident that her patient had not had a change of diagnosis over night. Something terrible had happened. The therapist too had family and close friends in New York and her face must have betrayed some of this concern. Although she remained calm it was clear that the news had impacted on her. There was a period where she was rather disoriented and at a loss. This reaction seemed to arouse a different kind of agitation in the patient, almost as if the therapist’s confusion had excited her. In fact the patient said, in a rather triumphant tone, ‘today I am not your patient and you my therapist. Today we are equal, both of us are helpless now, and therefore the same.’

It was as if the distress of the therapist created a more manageable kind of excitement for the patient. Perhaps the terror and confusion surrounding the attack was preferable to the more intimate and, for the patient, shameful experience of feeling small and helpless in relation to the therapist. Or perhaps the patient used her triumph at the therapist’s distress to dampen and mask her own panic. Or again, in identification with the victims the patient conveyed something of her own internal experience to her therapist – she had been raped in her home three years earlier. Whatever the roots, the patient’s response reflected an attack on a particular relationship of dependency with the therapist.

Two more patients were seen before the therapist had an opportunity to determine for herself what had really happened. One, an Iraqi male refugee, who had been tortured by Saddam Hussein’s regime, and the other an Englishman who had been brutally assaulted in a bar.

The Iraqi patient, a young man of 27, expressed excitement and pleasure that the arrogant US had finally been brought down a peg or two. He could not help smiling, he said to the therapist, when he saw the pictures of the Twin Towers. Then, at the same time as he smiled, he saw people’s faces and knew they were dying and suffering and he felt compassion for them and shame at his glee. He felt tom. He hated the US and wanted to see them fall, and yet ordinary people, just like him, were dying, and that made him uneasy. He worried too about what the therapist would make of him when she saw how much hatred was in his heart. But, he continued, in a more aggressive tone, why should he care at all what the therapist thought. She had her mind already set, as a ‘Westerner’. What did she know of real suffering? And then again a return to his anxiety, that indeed this was a terrible thing and he could not condone the suffering of innocent people.

It seemed that this patient felt two distinct identifications: he was triumphant over the victim, the US, and yet in identification with the individual US citizens affected. In the first identification, as the aggressor, the patient felt accused and attacked by the therapist, who in his mind, watched and judged him for his hatred. Cornered, he resorted to a defensive retaliation of condemning the ‘Westerner’ who did not understand. In the second identification, with the victims, he felt sorrow and guilt for his attack. The patient was conflicted, oscillating between these two internal positions. He was disturbed by what he saw, both in the misery of others and also in his own excited response to that misery.

The English patient, also in his late twenties, seemed almost unaware of the therapist’s presence. He was filled with panic, convinced that this apocalypse in the US was imminent in the UK. He felt terrified that he would die or be horribly injured. He did not know how to manage this fear. All he knew was that he hated Arabs, hated Muslims, hated refugees and was ‘sick of the pinko government allowing all of them in’.

It seemed, for this patient (with a history of severe violence and trauma), that thinking or knowing about the September 11 assault was immediately collapsed in his mind with being attacked. There was little separation between the event actually happening to him and a mental representation of his fear or anxiety that it might happen. In fact, September 11 was one of many external events that were experienced as a danger or imminent danger to him personally. The patient’s internal world seemed suffused with internal attackers who constantly threatened his existence. By transforming the assaults and locating the threat outside of himself, he could both expel these internal persecutors and also attack them, with great force, now for example, in the form of foreigners and Muslims. As a victim his retaliation was, in his mind, a legitimate, defensive and understandable response.

These vignettes illustrate a number of points about individual reactions to major life events. Perhaps the most important one being, that no matter how ‘equally’ we experience an event, there is no uniform response to it. For each patient, the event has a specific, personal, meaning, which reflects aspects of how they engage with the world. As clinicians these idiosyncratic responses tell us something about the nature of people’s inner worlds and the quality of their attachments.

According to contemporary psychoanalytic thinking, at core all external events, whatever their nature, are given meaning inside the mind in terms of a deeply personal, intimate relationship with an object. The relationship is experienced on a continuum, more or less benign. If a paranoid schizoid state of mind dominates, however, then all events are ascribed agency. Irrespective of the nature of the event (good or bad) there is the essential conviction that it was caused, wished for and brought about, and that the agent responsible has an intimate relationship with the individual (Garland, 2002).

A traumatic event is not simply understood as an external experience, a random life incident superimposed on an individual. Instead it is reinterpreted in the mind in terms of a relationship with an internal object. If the event is overwhelmingly catastrophic, then the more hostile and destructive aspects of that internal relationship come to life. The individual may experience his suffering as something ‘bad’ being done to him, for example, by a mother who means him harm, or even crows triumphantly over his pain. In this kind of scenario, an internal sense of goodness and safety is threatened and the individual is left with a feeling of despair that the world is no longer a secure place. A catastrophic event, then, does not exist objectively, in its pure form, but is taken inside the mind and ‘worked on’ in a way that makes the experience specific and personal to that individual.

This process is not only an internal affair, however, but also depends on external factors, in particular aspects of the person’s social and cultural background and how they engage in their society. People’s responses reflect a range of core political issues that are deeply embedded in both individual and group consciousness. Class, social relationships, demographic position, current and past circumstances are all relevant, as well as the broader contexts of people’s lives, for example, whether they lived in peacetime, or war, or famine or earthquake. From the very start then, the meaning of an experience is complex and dependent on a range of circumstances and conditions. These factors interact and coalesce, providing a template for the individual’s response to the world. We believe that clinicians need to be aware of how both internal realities as well as their political, social and cultural contexts shape a person’s identity.

If we look at our vignettes, for example, we can see that external circumstances contribute powerfully to how each patient constructs his or her current narrative. Both the refugee from Iraq and the Englishman from the council estate, for example, could be described as marginalized from mainstream society. It is likely that poverty or near poverty dominates both their daily lives. Certainly for the Iraqi patient, who is unemployed and single, concerns around food, housing, clothing and basic survival consume much of his energy. Central to his reality is the experience of exile and torture and imprisonment in Iraq. His refugee status spans two positions, one the alien seeking refuge and safety in a hostile UK and the other the exile, torn away from his homeland, which itself has been transformed into a malignant place of danger. The recent Gulf War would only have intensified this scenario.

His world, then, is upside down. Safety in the form of asylum in the UK is associated with poverty, loneliness and xenophobia. Home, and its typical associations with security and comfort, now spells imprisonment and torture. These predicaments are external, political realities from which he cannot escape and to a considerable degree they shape his life. In his internal narrative, however, these external exigencies transform into experiences of abandonment and cruelty, as if a once warm and loving parent has turned harshly away from him, leaving him alone and forlorn in a relentlessly cruel world.

The Englishman seems to present with a different internal narrative. As we mentioned in the vignette, he is easily aroused into feelings of vengeful and righteous hatred towards others. Unlike the Iraqi man, his family background was a violent one, with an absent father and an angry, often aggressive, mother who would beat and scream at her children. There is also a two-generation history of unemployment, poverty and alcohol abuse. In his current history he was violently attacked and left for dead in a pub brawl. For this man, any stressful or painful experience is collapsed into a conviction that ‘somebody’ – Muslims, foreigners – is out to get him, to harm him, steal from him, mock him or laugh at him. Internally it seems there is a world filled with cruel, assaulting objects. His defence is to externalize these foes into live enemies who need to be dealt with and attacked through racism and xenophobia.

We can see a relationship, then, between external and internal processes, between material conditions of life and how people make sense of these conditions in their minds. Cycles of poverty and human underdevelopment, however, are well documented and rehearsed, and this chapter is not offering a thesis on the relationship between poverty and mental states. We nevertheless believe that external and internal realities operate dialectically, each impacting on the other in such a way as to construct an individual’s identity. Of course, why one man assumes a position of race hatred and another not when both have suffered violent trauma is a complex and difficult question. The Iraqi patient, for example, experienced conflict in his revelling at the September 11 massacre. Unlike the English patient, his identification with the victims facilitated his seeing and knowing about a more aggressive aspect of himself. For the English patient, his conviction of victimhood fuelled and legitimated his violence towards others.

In our view this capacity to see and to know about less palatable aspects of ourselves has multiple origins, for example, the nature of our early attachments, family history, class background and education. These factors also cross generations: the quality of life of carers, for example, has a powerful impact on the next generation. Their histories and narratives, their class background, social, physical and political circumstances are transmitted in both subtle and also overt ways to their offspring.

This dialectic between internal and external processes informs and shapes our thinking about trauma. We identify four core themes, which we see as central to understanding both individual and also group responses to trauma.

First, we see trauma as an attack on attachment. In our view, individual responses to a traumatic event reflect an experience of a breach in the quality and security of attachment relations. We specifically use the term attachment to underscore the importance of both internal object relationships and the quality and presence or absence of external relationships at the time of the trauma. We believe that an attack on attachment is fundamentally an attack on the possibility of dialogue, of sharing our experience with an ‘other’ who can know about and receive this information. Traumatic experiences undermine or attack the psychically integrating function of narrative, of being able to put our own story into words, both in relation to another person and also in terms of the construction of an inner dialogue with our objects.

Secondly, we see the role of mourning as central in understanding the impact of trauma on the psyche. In particular we are interested in the breakdown or perversion of the capacity to mourn. In our experience, traumatic events typically involve irreparable losses. There is considerable pain and guilt associated with such losses. Often the experience is too much for the individual to bear. Instead of a normal grieving process, there is a breakdown, where the individual identifies with the lost person in a particularly cruel and relentless way (Freud, 1917). We understand this as a perversion of loss.

This point leads to our third theme, the nature of identifications consequent to trauma. Freud (1917) described identification as an important developmental and defensive tool: the infant identifies with the object as a way of taking in goodness and surviving. Internal objects are relationships with which the person has identified to a greater or lesser extent. Some identifications are sustaining, whereas others can be more destructive to the self. A traumatic event typically precipitates a more destructive type of identification. It is as if the individual takes on the shape and nature of the very thing that has caused him to suffer. He might become the school bully, the cruel abusing parent, the torturer. Whatever form it takes, this type of identification uses action, in this instance, aggression, to replace thought and understanding.

The role of identification in trauma links us to our final theme, namely the breakdown of symbolic functioning. Following Caroline Garland’s (2002) work in this area, we understand a major trauma as undermining the facility to think symbolically, to reflect upon the lived experience. The capacity to symbolize allows an individual to represent an experience mentally rather than concretely. In the aftermath of a trauma, painful and disturbing images, thoughts and feelings are often unable to be held in the mind in a way that distinguishes them from the actual reality of the event. They cannot be contained as memories. Instead these thoughts and images become concrete, live flashbacks that typically intrude into consciousness as a literal re-experiencing of the event. If the mental capacity is flawed or impaired in this way, there is also often an intrusion of the flashback experience into the body. This intrusion can take the form of psychosomatic illness.

All four of these processes are linked. The capacity to mourn, to bear loss, is at the heart of all psychic processes and underpins the infant’s developing facility for symbolic thought. In turn, there can be no true symbolic thinking without secure attachments, and all identifications depend both on the nature of early attachments and the greater or lesser capacity to symbolize these attachments.

Crucially, as we have already stated, the condition of the mind consequent to trauma has to do not only with an internal relationship to the event, how we give meaning to that experience, but also with the individual’s external context. We could say that external relationships and other structures (e.g. work, having a home) are adjuncts, which offer alternative realities to the catastrophe raging within. Similarly, the nature and quality of the person’s internal resources will profoundly affect how they respond to external life events. When external reality, however, mirrors an internal catastrophe and vice versa, when the internal scenario confirms an external disaster, then the chances of a severe traumatic injury are high.

The impact of trauma on psychic functioning

Freud’s early formulations about trauma were social and political in origin, based on his observations of First World War survivors who had suffered ‘shell shock’. These observations led him to reformulate some of his ideas and to think in particular about the tension between life and death forces, the primal anxieties around death and the considerable impact these conflicts and anxieties had on psychic functioning. Freud came to understand that a massive external event could impact on the mind in such a way as to leave the individual severely, possibly permanently impaired (Freud, 1920; Garland, 2002).

Briefly, Freud (1923) understood the mind, or mental apparatus, structurally. He divided the mind into the id, ego and superego. The ego is described as the mediator between id and superego functioning, a vital part of the psychic apparatus. Ego functioning is responsible for our everyday conscious life and could be described as that part of the mind which organizes reality. An important aspect of ego functioning is its capacity to distinguish different categories of psychic material. Internal and external experiences are categorized as separate; phantasies and dreams, for example, are distinguished from the world of reality. Crucially, past and present experiences are differentiated, allowing some to form part of the here and now experience, some to become the stuff of memories and other material to be repressed or split off from consciousness.

Freud (1920) understood that the mind needed to protect itself from the intrusion of ‘too much’ reality. He described a mental sheath, or shield, which acts as a type of protective lining, allowing some material into the mind and preventing other stimulation from gaining access. According to his thesis, the mental sheath operates not only as a barrier to stimuli from the external world, but also to stimuli such as distressing memories, coming from within the different structures in the mind. Freud emphasized that immoderate amounts of stimulation were a threat to mental stability and were generally prevented from penetrating the shield. The shield acts as a skin to the mind, constantly sorting and protecting what can enter and what needs to be ‘shut off’ from consciousness.

If a major traumatic event occurs, however, the shield can be broken or penetrated and is no longer able to function properly. With this rupture, normal ego functioning is shattered and mental equilibrium is severely disturbed:

We describe as ‘traumatic’ any excitations from outside that are powerful enough to break through the protective shield. It seems to me that the concept of trauma necessarily implies a connection of this kind with a breach in an otherwise efficacious barrier against stimuli. Such an event as an external trauma is bound to provoke disturbance on a large scale in the functioning of an organism’s energy and to set in motion every possible defensive measure. (Freud, 1920: 29)

What, then, are the precipitating factors for such a rupture? According to Freud, trauma is associated with what he termed ‘annihilatory anxie...

Table of contents

• Front Cover
• Half Title
• Other titles in this series
• Title Page
• Copyright
• Contents
• Series foreword
• Preface
• Acknowledgements
• Contributors
• Introduction
• Chapter 1 The impact of trauma on the psyche: internal and external processes
• Chapter 2 Why are we more afraid than ever? The politics of anxiety after Nine Eleven
• Chapter 3 Traumatic events and their impact on symbolic functioning
• Chapter 4 Containment and validation: working with survivors of trauma
• Chapter 5 Playing a poor hand well: succumbing to or triumphing over developmental adversity: a study of adults sexually abused in care
• Chapter 6 Bearing the unbearable: melancholia following severe trauma
• Chapter 7 On hope’s tightrope: reflections on the capacity for hope
• Chapter 8 Difficulties with potency post-trauma
• Chapter 9 ‘I smile at her and she smiles back at me’: between repair and re-enactment: the relationship between nurses and child patients in a South African Paediatric Burns Unit
• References
• Index