Thursday, April 15, 2010

Emotional Trauma in Review - Part 1

A - The Complexity of Emotional Trauma
Judith Herman’s (1992) synthesis of psychological trauma remains, in my opinion, unsurpassed. It is the standard to which I return time and again.
“Psychological trauma is an affliction of the powerless. At the moment of trauma the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning.”
In other terms, traumatic events shatter what Stolorow (2007) refers to as ‘the absolutisms of everyday life’: “When a person says to a friend, “I’ll see you later” or a parent says to a child at bedtime, “I’ll see you in the morning,” these are statements whose validity is open for discussion. Such absolutisms are the basis for a kind of naïve realism that allow one to function in the world, experienced as stable and predictable. It is in the essence of emotional trauma that it shatters these absolutisms, a catastrophic loss of innocence that permanently alters one’s sense of being-in-the-world.” (emphasis added).
In Herman’s view, “[t]raumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life…They confront human beings with the extremities of helplessness and terror, and evoke responses of catastrophe…the salient characteristic of the traumatic event is its power to inspire helplessness and terror.”
According to Jones (1995), “If trauma is limited to what is “shattering” and “devastating” –war neurosis, concentration camp phenomena, massive physical and/or sexual abuse- then we are likely to miss the more subtle manifestations of traumatic states. What is needed is an operational definition of traumatic states. I suggest that our behavioral response points toward a definition…affects are presymbolic signals that convey information; the organism uses these affective signals to appraise the situation and take effective action. Defined operationally, a traumatized state occurs when a person is unable to respond appropriately and effectively to a situation; in turn, this inability to respond is signaled by anxiety-panic… If we reserve the term trauma for those situations that evoke anxiety-panic, then we have defined both in operational terms. This is the definition of traumatic anxiety that Freud (1926) proposed, but which has been lost due to the shifting meanings of “trauma.”’
The varied manifestations of emotional trauma can be grouped into three main categories: hyperarousal, intrusion, and constriction. “Hyperarousal reflects the persistent expectation of danger; intrusion reflects the indelible imprint of the traumatic moments; constriction reflects the numbing response of surrender.” (Herman, 1992)
“People subjected to prolonged, repeated trauma develop an insidious, progressive…[condition]…that invades and erodes the personality. While the victim of a single acute trauma may feel after the event that she is “not herself,” the victim of chronic trauma may feel herself to be changed irrevocably, or she may lose the sense that she has any self at all.”
I will consider physiological and psychological hyperarousal in post number 2 of this series.
Intrusive symptoms after a single acute trauma tend to abate in weeks or months. In survivors of prolonged, repeated trauma these symptoms persist for many years with little change. The traumatic experiences become encoded in memories which break spontaneously into consciousness, both during waking hours as well as during sleep. Small, seemingly insignificant occurrences can also evoke these memories which are experienced with their original vividness and emotional force.
Traumatic memories are encoded as vivid sensations and images, and lack verbal narrative and content, thus resembling the memories of young children. The intense focus on fragmentary sensation, on image without context, gives the traumatic memories a heightened reality. Lacking symbolic content, these memories are expressed in action. This is most apparent in the repetitive play of children. Commonly, traumatized people find themselves reenacting some aspect of the damaging experience in disguised for, without realizing what they are doing. Some reenactments put the survivor at risk for further harm. According to Herman, “There is something uncanny about reenactments. Even when they are consciously chosen, they have a feeling of involuntariness. Even when they are not dangerous, they have a driven, tenacious quality. Freud named this recurrent intrusion of traumatic experience the ‘repetition compulsion’.”
There is general agreement in the field, that the repetitive reliving of traumatic experiences are spontaneous, unsuccessful attempts at healing. The driving force of the reenactments is the emotional rather than the cognitive experience of the trauma. What is reenacted are the overwhelming, crushing emotional experiences in an attempt, however unsuccessful, to integrate them. In treatment, in Herman’s words, “[b]ecause reliving a traumatic experience…[entails]…such intense emotional distress, traumatized people go to great lengths to avoid it. The effort to ward off intrusive symptoms, though self-protective in intent, further aggravates the {emotional trauma], for the attempt to avoid reliving the trauma too often results in a narrowing of consciousness, a withdrawal from engagement with others, and an impoverished life.”

“When a person is completely powerless, and any form of resistance is futile, she may go into a state of surrender. The system of self defense (see post number 2) shuts down entirely. The helpless person escapes from her situation not by action in the real world but rather by altering her state of consciousness. Analogous states are observed in animals, who sometimes “freeze” when they are attacked … These altered states of consciousness are at the heart of constriction or numbing … “
In a superbly crafted paragraph, Herman goes on to say, “Sometimes situations of inescapable danger1 may evoke not only terror and rage but also, paradoxically, a state of detached calm, in which terror, rage, and pain dissolve. Events continue to register in awareness, but it is as though these events have been disconnected from their ordinary meanings. Perceptions may be numbed or distorted, with partial anesthesia or loss of particular sensations. The sense of time may be altered, often with a sense of slow motion, and the experience may lose its quality of ordinary reality. The person may feel as though she is observing from outside her body, or as though the whole experience is a bad dream from which she will shortly awaken. These perceptual changes combine with a feeling of indifference, emotional detachment, and profound passivity in which the person relinquishes all initiative and struggle. This altered state of consciousness may be regarded as one of nature’s small mercies, a protection against unbearable [emotional] pain.”
Herman explains further, “These detached states of consciousness are similar to hypnotic trance states. They share the same features of surrender of voluntary action, suspension of initiative and critical judgment, subjective detachment or calm, enhanced perception of imagery, altered sensation, including depersonalization, derealization, and change in the sense of time. While heightened perceptions occurring during traumatic events resemble the phenomena of hypnotic absorption, the numbing symptoms resemble the complimentary phenomena of hypnotic dissociation.”
The features of emotional trauma that become most pronounced in chronic trauma are avoidance or constriction. Herman suggests “[w]hen the victim has been reduced to the goal of simple survival, psychological constriction becomes an essential form of adaptation. This narrowing applies to every aspect of life –to relationships, activities, thoughts, memories, emotions, and even sensations– …this constriction…also leads to a kind of atrophy in the psychological capacities that have been suppressed and to the overdevelopment of a solitary inner life.”
She continues, “The constrictive symptoms of [emotional trauma] apply not only to thought, memory, and states of consciousness, but also to the entire field of purposeful action and initiative. In an effort to create some sense of safety and to control their pervasive fear, traumatized people restrict their lives.”
And concludes, “In avoiding any situations reminiscent of the past trauma, or any initiative that might involve future planning and risk, traumatized people deprive themselves of those new opportunities for successful coping that might mitigate the effect of the traumatic experience. Thus, constrictive symptoms though they may represent an attempt to defend against overwhelming emotional states, exact a high price for whatever protection they afford. They narrow and deplete the quality of life and ultimately perpetuate the effects of the traumatic [experiences].”
Nevertheless, if as therapists, we keep in mind the ‘incomparable power of human recognition’, then we can acknowledge to our patients their countervailing efforts to reintegrate a fragmenting world and restore a sense of continuous and coherent being, thus providing one more opportunity for healing (Stolorow, Atwood, & Orange, 2002).
In closing, I would like to offer an important question that Stolorow, Atwood, & Orange (2002) address. “Why does one person respond to trauma with a successful act of dissociation, leaving the organization of his or her world otherwise relatively intact, whereas another react with an experience of self- and world dissolution?”
They begin to provide an answer pointing out that intersubjective systems theory as a “post-Cartesian psychoanalytic theory, while not denying the existence of an individual’s strengths, recognizes that anyone ‘s resources only come into play within specific intersubjective fields. In addition, the nature of trauma itself is understood to vary as a partial function of the relational and historical context in which it occurs (Stolorow & Atwood, 1992). The trauma experience that leads to annihilation, embedded in its own distinctive context, is likely to differ markedly from the one in which dissociation takes place.”
Then, they conclude: “The trauma that annihilates subverts the person’s whole way of making sense of his or her life and attacks sustaining connections to the human surround at their most fundamental level; the trauma that can be dissociated, although also a threat to existing organizations of experience, leaves sustaining ties intact to some degree, so that a stable platform of selfhood and worldhood survives for the encapsulation and dissociation of the traumatic event.”
B - Affective-Symbolic Disintegration
Jones (1995) defines the sense of self as “the personal organization we experience when we are able to effectively integrate our affective experience with what we think in a relatively stable internal relationship. In other words, it is the ability of the individual to create a relationship between his feeling core and his thinking “I” that is at the heart of selfhood. It is the affective-symbolic integration that leads to the creation of a sense of self.”
Jones holds that affects are our primary process because they are our first and only information processing system until the arrival of thought at about 10-12 months of age. He conceptualizes affects as “the experiential representation of a nonsymbolic information-processing system that can serve as the central control mechanism for all aspects of human behavior, including the control of physical movement, memory, and all interactions with the environment... affects, and affects alone, serve as the primary control signals for all animals and presymbolic infants.” The developmental task during this period is learning to use our body.
Thought is our second information-processing system. “At some specific point in time, perhaps as early as eight to ten months of age, the program that will eventually lead to speech is activated… Consequently, symbolic functioning –what we usually call thinking- must be layered upon and eventually integrated into the smooth, presymbolic affective information processing system of infancy. These two discrete ways of processing information form the substrate of the “divided mind”; the necessity of integrating them results in the rapprochement crisis…” The developmental task with the arrival of thought becomes learning to use our mind, that is, “effectively [integrating] our affective experience with what we think in a relatively stable internal relationship.” I try to capture the essence of this process with the metaphor of ‘learning to think with our heart.’
Jones describes an example of affective-symbolic integration in his discussion of the attainment of object constancy as cognitive development: “At somewhere around 10 to 12 months, the infant begins to acquire the ability to use symbols, a process crowned by the first spoken word at approximately 18 months; the ability to attach names to things leads to the formation of concepts. Nouns are the first type of speech the infant uses; typically, they describe phenomenologic objects in the world-out-there (Mama, Daddy, cat, etc.). As used in the psychoanalytic literature, the term internal object must refer to these first concepts; otherwise, the term is simply redundant for a presymbolic schematic representation or has no meaning at all. Similarly, the term object relations does not refer to the infant’s first experience of relationship, but, rather, to his first attempts to symbolize or conceptualize that experience. If one holds to this definition of object, object constancy occurs when the infant achieves the ability to maintain the concept of his mother in his mind even when experiencing high-intensity negative feelings –rage, hatred- directed toward her. In other words, object constancy (or its equivalents, libidinal object constancy and emotional object constancy) implies conceptual stability despite the presence of intense affectivity.” (emphasis in original)
I believe the relative stability of the reciprocally -regulating affective-symbolic network is the crucial factor, too much or too little of each component can cause a disruption. Thought can act as a brake on emotions to keep us from acting impulsively; we call the outcome of this exercise will power. Emotions enliven our intellectual life, rendering it colorful and creative; intense affectivity, however, can cause conceptual instability. These assumptions parallel our everyday observations about ourselves and others; we experience greater difficulty in maintaining our integrated state –“keeping our shit together”- when experiencing intense negative emotions.
In Herman’s (1992) view, “[t]raumatic events are extraordinary, not because they occur rarely, but rather because they overwhelm the ordinary human adaptations to life…They confront human beings with the extremities of helplessness and terror, and evoke responses of catastrophe…the salient characteristic of the traumatic event is its power to inspire helplessness and terror.”
Extreme helplessness and terror (intense affectivity) cause affective-symbolic disintegration; that is, the disintegration - characteristic of a traumatized state of mind- of our world of experience at the center of which is our sense of self, our enduring center in relation to which the totality of our experiences are organized. This is truly a psychological catastrophe (Stolorow, Atwood, & Orange, 2002). I examine the physiological aspects of this catastrophe in post #3.
Ernesto Vasquez, MD
April 11, 2010

Jones, J. Affects as Process. Northvale, NJ, The Analytic Press, 1995.
Herman, J.L. Trauma and Recovery. New York, NY, Basic Books, 1992.
Stolorow, R.D., Atwood, G.E., & Orange, D.M. Worlds of Experience. New York, NY, Basic Books, 2002.
Stolorow, R.D. Trauma and Human Existence. New York, NY, The Analytic Press, 2007.

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