In the afternoon of Saturday, January 9, 2010, Robert Stolorow, PhD spoke to the Tampa Bay Psychoanalytic Society, Inc on “Contextual and Existential Dimensions of Trauma,” allowing us to experience why he is sometimes called ‘the prince of darkness.’ In his talk, Stolorow noted the contextuality and embeddedness of emotional life, and of emotional trauma, in particular.
A child requires affective attunement from another to assist in tolerance of emotion. Affect tolerance, then, is a property of a relational system. In fact, intolerance of an affect state or of a trauma is unrelated to the quantity or intensity of that affect or trauma, but instead it is the absence of emotional attunement that renders affects or traumas unassimilatable.
Painful emotional experience becomes enduringly traumatic in the absence of emotional attunement, i.e. trauma is context sensitive. Death, and finitude (our limitations), are constitutively relational. It is “the incomparable power of understanding” (George Atwood) that mitigates the finitude of relationality.
Existentially, trauma shatters absolutisms and exposes the fragility of illusions of invulnerability with which we move through the world. Unassimilated trauma leads one to feel dreadful alienation and estrangement and exposes us to the randomness and unpredictability of life. Stolorow expands what Heidegger wrote about the authentic being toward death by adding being toward loss.
He noted that, while trauma produces feelings, there also exist feelings about these trauma-induced feelings. Clinically, it is the secondary feelings that often must be explored first, as patients may feel shame about exposing the trauma-induced feelings. Retraumatization may occur when an experience closely replicates the original trauma; when it confirms the organizing principles established by the traumatic experience; or when there is loss of the bond that served to counteract the trauma.
Lycia Alexander-Guerra, MD
photo by John Lambert, LCSW
Sunday, January 10, 2010
A Day with Stolorow, Part II
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5 comments:
Lycia,
I felt the Stolorow seminar was stimulating and thought provoking. However, I am reminded of a paper that I wrote in college on neuroscience and behavior. In that paper I used “The Brain Book” by Peter Russell, Copyright 19779, as a reference. I thought the reference was significant because the book indicates the relationship of brain functioning and behavior. The response that I received from the teacher was that if I wanted to state an opinion then I should use a more current reference. My explanation then was that the information was not new information but had been cited decades for ago.
My feelings for the Stolorow presentation were provocative. His experience and understanding of trauma was more than verbalization, it was genuine. His presentation of the reality of trauma in general and his trauma in specific was made very “in the moment”. Freud’s observation of infantile amnesia was that children had a hard time with conscious memory before age 3. With the advent of neuroscience, it is noted that the part of the hippocampus, associated with memory, does not finish developing until about 3, although the amygdala, emotional part of the brain, develops earlier. That may account for why children and adults can react to stimuli but not remember it. We can also look at development of the frontal cortex which does not finish developing until around age 25. Possibly development of the brain could be delayed if there are delays due to stress and life style. With these neurological happenings Stolorow’s Intersubjective-Systems Theory has more meaning. Neurology supports Stolorow’s conclusions. There are also several studies that indicate that changes in environment, past understandings, and relationships enhance behavior.
Stolorow’s reference to the snake that eats itself for food is also a character in Rosicrucian Literature. The Polyps that eats itself for food generates a new beginning and re-generates itself again. This may be similar to Winnicott’s idea of child development and Potential Space as a shifting in the holding environment and maturation.
Stolorow’s lack of interest in the neurological role of interactions robs the essence of verification of The Intersubjective-Systems Theory. Every thought and emotion pass through the brain and nervous system first.
Lycia, thanks for summarizing what Stolorow had to say, I found, in the area of trauma, the clinically most helpful pearl the concept of dealing with secondary feelings engendered by the trauma before attempting to deal directly with the feelings of the trauma per se. A word of caution to all, it is wonderful to try to join in with the patient and understand, but we must always be open to consider what is best for the patient. I am not sure that Stolorow could do that for himself let alone a patient. A training analyst shared with us a sobering experience when a patient of 8 years attempted suicide by getting in the bathtub with an electrical cord. He phoned him after he'd been discharged from the hospital and had gotten relief from antidepressant medication and asked him why he hadn't suggested this to him. He said: "that's not what I do". When the only tool you have is a hammer, all you see are nails. Jessica.
The concept of dealing with the secondary affects of trauma first is an excellent idea, since the first ones are attached with such shame. That may be the most helpful pearl of the day. One cautionary note for him and the non medical people is “ When the only tool you have is a hammer, all you see are nails”. I had a training analyst in Philadelphia share with us the story of how his long-term patient phoned him to tell him he had been hospitalized following a serious suicide attempt where he had gotten in a bath tub and tried to electrocute himself.
He had found in the hospital that he was severely depressed and was given antidepressants that relieved the depression. The analyst said, he was glad he felt better, but this was not part of what he did. It did not occur to him that he had any responsibility for suggesting that maybe the patient was in need of just that.
The tension between the different parties was ridiculous. It was silly to try to educate people on psychopharmacology there-- it wasn’t the proper forum-- but
it was a bit of a point after all. I believe I heard him say that he is still grieving the death of his first wife, and that he did treat it wit Stolishnaya which I guess he thought was superior to considering proper medication. There I must disagree. I guess this allows him to write on trauma and philosophize.
Stolorow is certainly an interesting and controversial figure in our field. He does have the effect of a lightning rod at times... It was interesting that he was confused and confounded by his emotional impact on the group. In spite of the mixed reaction to his lecture, I admire him immensely for his sizable body of work and original thinking. His theory appears as more philosophical than prescriptive in terms of technique or even framework.
I would also add that the mounting research from diverse fields, including neuropsychology, have done much to bolster and lend credibility to psychoanalysis through the empirical demonstration of the differences in how conscious and unconscious processing occurs. For example, research on subliminal perception, selective attention, cortical evoked potentials and visual phenomena involving perceptual processing, has empirically validated the existence of complex, psychological processes carried on unconsciously, and the active interplay between these unconscious processes and conscious ones, which affect a patient's behavior; a central tenet of psychoanalysis. Stolorow did not feel the need to include neuroscientific research or commentary into his lecture, though in practical terms and from an ethical standpoint, as a clinician, deepening one's understanding of related fields buttresses psychoanalytic theory with a usable secondary framework and serves as preparation for emerging exigencies and opportunities for insight and relatedness in the therapeutic moment.
Laurie Phillips
Well, I thoroughly enjoyed Stolorow... though it is always boring to me when someone reads a paper. I found his perspective refreshing, as I share his aversion with all things neuroscience... an odd predicament for an inpatient psychiatrist - I readily admit.
I loved his statement about the "tools of analytic inquiry" which I believe the first one was something about empathy, and the second was introspection. And his comment about "driveness" versus drive. I found that when he shared his clinical material, he seemed to have a deep empathic connection with his patients that seemed to border on love (a good thing in my book). He does have a bit of ruthlessness with his audience, which I imagine could be quite off-putting if one doesn't share his views. But I could go on and on.... I loved it!
I left invigorated, and renewed in my search for "analytic inquiry" during my sessions with patients...
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