An Existential Approach to Interpersonal Trauma

Modes of Existing and Confrontations with Reality

Marc Boaz

• Publisher: Routledge
• Year: 2022
• ISBN:
  9781000556377
• Edition: 1
• Topic: Psychologie
• Subtopic: Posttraumatische Belastungsstörung (PTBS)

An Existential Approach to Interpersonal Trauma provides a new existential framework for understanding the experiences of interpersonal trauma building on reflections from Marc Boaz's own personal history, clinical insight and research.

The book suggests that psychology, psychotherapy and existentialism do not recognise the significance of the existential movements that occur in traumatic confrontations with reality. By considering what people find at the limits and boundaries of human experiencing, Boaz describes the ways in which they can disillusion and re-illusion themselves, and how this becomes incorporated into their modes of existing in the world and in relation to others. In incorporating the experience of trauma into the way people live – all the existential horror, terror and liberation contained within it – Boaz invites them to embrace an expansive ethic of (re)(dis)covery. This ethic recognises the ambiguity and spectrality of interpersonal trauma, and expands the horizons of our human relationships.

The book provides an important basis for professionals wanting to work existentially with interpersonal trauma and for people wanting to deepen their understanding of the trauma they have experienced.

Part IEarly and contemporary psychotraumatology

doi: 10.4324/9781003181675-2

1Early psychiatric and psychoanalytic psychotraumatology

DOI: 10.4324/9781003181675-3

In this chapter, I set out for the reader some of the dominant earlier understandings of ‘trauma’ within the fields of psychiatry, neuroscience and clinical psychology. Rather than a full sociohistorical analysis of the genesis of knowledge and practice in these professions, I will give a description of some of the foundational constructions of psychological trauma. As we will come to see, within these disciplines, the term ‘trauma’ has been used in various ways to describe the lasting impacts that specific experiences have on people’s psychological and emotional worlds.

I have gone back to some of what are considered to be the foundational ideas and texts within interpersonal psychotraumatology to explore their notions of what constitutes psychological trauma. I will focus primarily on the literature relating to developmental, childhood and sexual trauma, which are the areas I have researched in more depth previously. Where possible, I have left out substantive discussion of intra-psychic processes and mechanisms, as it can detract from the focus of our inquiry and create an unnecessary complexity that does not translate well across the different approaches presented.

This close reading of the original texts is not exhaustive, but provides sufficient grounding for my later discussion. Inevitably, having done my training and research in the United Kingdom, the majority of works are taken from European and British schools of psychiatry, psychology and psychotherapy, with wider contributions from international schools, where they are based on European or British traditions. Further, I have included the writers and texts that either I have been exposed to through my own training, supervision or teaching, or that I have sought out to help make sense of my own experiences or those of my clients in the therapy room.

The ideas presented in what follows will provide an initial orientation and context for the analysis and discussion in subsequent chapters that investigate a more existential approach. I hope those readers who are new to the world of psychotraumatology, or who are looking to refresh or deepen their knowledge, will find these pages a useful navigation and summary of what is a colossal literature base in the recent founding works on psychological trauma. Those readers who are well versed on these works may want to meander their way through the following initial discussion and head towards the next chapter to explore what I see to be the emerging paradoxes that are disclosed across this canon.

Pierre Janet: emotional shock and the disaggregation of ideas

Let us begin with a near history of the partial genesis of ‘trauma’ within the fields of neurology, psychiatry and psychology.¹ Neurology was thriving in the late 1800s in Europe, with significant interest being given to the governance and disciplining of people’s behaviours, minds and nervous systems (following Foucault, 2009 [1961]). By the start of the century, attention, within the growing field of neurology, turned to what were seen to be medically unexplainable symptoms. Neurology more specifically marked a rationalist search for medically unexplainable physical symptoms. Neurologists attempted to move away from explanations of witchcraft, spirit possession and mesmerism (Porter, 1985), towards understandings of an underlying neuropathology as the basis of the phenomenon of ‘hysteria’ (Tasca et al., 2012).

In France, social reform was spearheaded by Philippe Pinel (1806), who instigated a transformation in the models of care delivered at both the Bicêtre and La Salpêtrière Hospitals (then asylums) in Paris. Initially, it was Paul Briquet (1859) who undertook a decade-long detailed evaluation of 430 cases of hysteria at the Hôpital de la Charité in Paris. This important study shifted understandings of hysteria and relocated the origins of medically unexplainable symptoms (in women) from their wombs to their brains and neurological functioning.

The renowned French clinician Jean-Martin Charcot (1873; see also Micale, 1985) worked at La Salpêtrière, which was a teaching hospital in Paris. His clinical observations were instrumental in investigating unexplainable physical presentations of seizure, paralysis, fainting, shaking and other somatic phenomena. Charcot’s inquiry eventually led him to the conclusion that these ‘hysterical’, unexplainable symptoms had their roots in people’s emotional responses to traumatic experiences. In this, Charcot suggests that the way that his patients emotionally made sense of their experiences of traumatic events is at the heart of the unexplained symptoms.

The French psychiatrist Pierre Janet studied under Charcot at La Salpêtrière, initially following his own interest in hypnosis, catalepsy and altered states of consciousness. Like Charcot, Janet recognised the reality of traumatic life events in his patients’ lives. He noted that ‘the various symptoms of hysteria’ that he and his contemporaries were describing were ‘not spontaneous manifestations, idiopathic of the disease’, but rather had a ‘close connection with the provocative trauma’ (Janet, 1901: 496). Building on the work of Charcot, Janet similarly suggests that it is the emotional consequences of traumatic experiences that render them traumatic. As such, he focuses on the emotional shock of these events, and its impact on people’s ideas about themselves, others and their environment (ibid.: 320, 375).

Janet suggests that it is this emotional shock that affects people’s memories of lived events and prevents them from being able to behaviourally adapt to stressful lived experiences, and their potential reoccurrence in the future (ibid.: 150, 203, 230, 249, 461). Importantly, Janet demonstrates how this emotional shock overwhelms the person and exposes them to intense feelings of ‘sad[ness], despai[r]; continual weariness, disgust of life, fear, terrors, extreme despair […] [and] bursts of wild cheeriness [that] are merely accidents’ (ibid.: 213).

Reflecting on his patients’ emotional states of ‘monotonous sadness’, Janet suggests that they have ‘lost a will and sentiment, and they are disgusted with their miserable existence’ (ibid.: 213–214). This formulation begins to give us a sense of Janet’s understanding that the emotional consequences of a traumatic event have a substantive impact on the person’s attitude towards themselves and commitment to action in their lives. The emotional shock, he writes, can lead to ‘mental accidents’, which include the ‘accidental phenomena […] of impulsions and fixed ideas’ (ibid.: 198–199).

Heim and Bühler (2006: 113) explain that for Janet, ‘ideas’ are not ‘abstract thought’, but rather ‘a given psychological experience that includes […] memories […] emotions as well as various responses to persistent emotional influences’. They contend that for Janet, thoughts and experiences are part of a reflexive structure, which enables us to consciously synthesise the internalised experiences of our world, and results in more complex emotional and behavioural responses (ibid.). The ‘special element’ that is affected by the emotional shock of traumatic events, is the ability to create and retain new ideas (Janet, 1901: 199–200).

Janet suggests that the synthesis of new ideas into existing or older ones is disrupted in many ways, including through the use of an exaggeration. An exaggeration is an ‘immense development’, where an old idea remembered, or a new idea formed, loses its original context and becomes dreamlike and/or substantively abstracts from reality (ibid.: 200–201). Putnam (1989) suggests that Janet’s identification of exaggerations is an early development of dissociation being on a continuum of normative and psychopathological responses to everyday life and traumatic experiencing.

Janet (1901: 202) continues that abstracted new ideas, or remembered old ideas, can ‘pass before us like the colours of a kaleidoscope’, and while seemingly incoherent, they have a ‘certain vague unity about them’. This ‘vague unity’ suggests for Janet that the patients do not incorporate and synthesise the memories or new ideas. Rather, people gloss over these ideas, or relate them back to a circular or ‘monotonous story’ about themselves, others or their lives (ibid.). van der Kolk and van der Hart (1989: 1533) note Janet’s astute identification of this phenomenon in his patients, and the ways in which this kept them attached to the emotional shock of the traumatic event.

Rather than connecting to the present moment, these patients ‘no longer know how to adapt the present to the future, and in their lack of forethought, they, so to speak, confine human existence to the present moment’ (Janet, 1901: 203). For Janet, there are two core conditions that result in so-called mental accidents resulting from a traumatic event. The first is the localisation of psychological and somatic phenomena ‘according to the laws of emotion’, which in this case is the emotional shock of the traumatic event (Janet, 1911: 636, my translation). The second is an ‘original or acquired mental predisposition to decrease synthesis and disaggregation of the mind’ (ibid.). Both the disaggregation of ideas and the manifested phenomena (psychological, somatic or otherwise) around the emotional shock are prerequisites to what Janet and others called traumatic hysteria (see also Ellenberger, 1970: 331–417). Of the two conditions, Janet (1901: 453) sees the abstraction of old and new ideas as existing at the ‘bottom of all hysterical symptoms’.

The abstraction of new, and old (or seemingly forgotten), ideas is described by Janet as a ‘disaggregation of consciousness’ (ibid.: 149, 220) and latterly the disaggregation of the mind or spirit (Janet, 1911: 189, 443, 634–636).² This description indicates that the ‘psychological disaggregation’ is a ‘subconscious phenomenon’, which is developed ‘outside of the will and personal perception of the patient’ (ibid.: 197, 278–280).³ This makes disaggregated ideas an automatic abstraction from the synthesis of conscious thought (ibid.: 264, 278; see also van der Hart & Horst, 1989).⁴

When ideas disaggregate (désagrégate), or disassociate (dissocier), and become systematised, they are ‘transformed’ into what Janet calls ‘fixed ideas’ (1901: 278–356). Heim and Bühler (2006: 112) usefully summarise fixed ideas as a ‘kind of distorted experience, memory, imagination, or appraisal of the traumatic event’. Fixed ideas orientate around the emotional shock resulting from the traumatic event(s); however, they are not fully synthesised into conscious thoughts, and disrupt the subsequent acquisition and synthesis of new ideas (Janet, 1901: 280). In my reading of Janet, it is not that the ideas are fixed per se, as this would run contra to his more dynamic model of the human psyche. Therefore, it is through the dynamic process of not being synthesised into conscious thought, that ideas become fixed-like, in that the person returns to them in seemingly repetitive and obsessive fashion. Echoing this, Janet suggests that the fixing of ideas becomes a ‘crisis of terror’, where the person re-experiences the ‘repetition of an emotion’ related to the original traumatic event or accident (ibid.: 284). As Janet reflects, it is the relationship between the event and the idea of the event that ‘may be more or less direct, but it exists always’ (ibid.: 496).

So-called hysterical responses are marked out as different from the responses of the other psychiatric patients Janet treated, by the fixed idea that seemingly eludes them, and that they struggle to remember, express or articulate (ibid.: 279–282). The elusion can be to the extent that people seem to forget the traumatic events and lose the origin of the fixed idea (ibid.: 230, 290, see also 147 for the case of Bertha). The emotional shock, and the fixation of ideas, become manifest in people’s feelings, sensations and bodily states, many of which they cannot themselves explain nor make sense of (ibid.: 230, 290–291). These seemingly unexplainable bodily states disclose the forgotten emotional shock of the traumatic experiences people have had, and/or the fixed ideas they have formed in relation to it (Janet, 1911: 662).

Fixed ideas, through a lack of synthesis of new ideas, result in a repetitious circularity of the associated emotions and somatic manifestations. The person’s inability to incorporate new ideas into their thinking and action is seen by Janet to constitute a ‘weakness of mental synthesis’, and it is this weakness that maintains and sustains the fixed ideas (ibid.: 634–637). This results in a ‘persistency of an idea or dream’ that continually eludes the person (Janet, 1901: 496, see also 354).

Together these features of ‘mental accidents’ prevent the person from being able to adapt to new situations. In each new situation, the emotionality of disintegrated or dissociated fixed ideas is restimulated or arises from the subconscious. Being unable to respond with newly synthesised ideas, people respond with maladaptive and/or non-adaptive fixed ideas (see van der Kolk, Brown & van der Hart, 1989; van der Kolk & van der Hart, 1989). The inability to adapt to new stressful situations results in hysterical and unconscious phenomena, manifesting in the person’s actions, words, dreams and unexplained somatic responses (Janet, 1901: 280–281; 1911: 634; van der Kolk et al., 1989; van der Kolk & van der Hart, 1989).

Sigmund Freud: memory and experience in the traumatic neuroses

Meanwhile, in Vienna, the neurologist Joseph Breuer had been working with a patient called Bertha Pappenheim who had developed a hysterical cough, and other unexplainable symptoms, while caring for her father, who had tuberculosis and subsequently died from the illness. The case of Bertha Pappenheim (who was given the pseudonym Anna O.), would become foundational in the creation of psychoanalysis. Around this time, a young Sigmund Freud returned from his studies in Paris under the guidance of Charcot and joined Breuer in his clinical studies. Freud also saw Pappenheim as a patient. Through their experiences with Pappenheim, and other (predominantly female) cases of ‘hysteria’, they developed a ‘talking cure’ as the basis for treating medically unexplainable symptoms (Breuer & Freud, 1982 [1908]).

Building on these cases, Breuer and Freud (ibid.: 166) suggested that people’s affect (emotional experiences and expressions) were being unconsciously converted into somatic symptoms as a form of symbolic communication. Freud suggests that conversion could occur ‘as immediate effect’ (ibid.: 124) of experiencing a trauma, or after a ‘short period of working-out [or] “incubation”’ (ibid.: 96; 131). Further, in Freud’s initial description of the case of Frau Emmy von N., he notes that ‘however these motor symptoms may have originated, they all have one thing in common […] an original or long-standing connection with traumas’ (ibid.: 95).

Breuer is the more explicit of the two in reflecting on the significance and prevalence of interpersonal...