Monday, March 12, 2012

Reducing Uncertainty

Doris Brothers spoke to the Tampa Bay Psychoanalytic Society, Inc on March 10, 2012 on uncertainty and trauma. Brothers notes that people are motivated to reduce uncertainty--despite there is no certainty in the world-- by simplifying experience, accomplished by dissociation. We think, feel, fantasize, and make decisions, all regulatory processes created to have a sense that we will go-on- being [WInnicott]…until trauma shatters this sense.

Brothers defines trauma as that which threatens our going-on-being, threatens us with the fear of annihilation. Trauma threatens us with uncertainty. While her formulations about trauma are ongoing, she says a few ideas about trauma persist for her:

1. Trauma is relational, that is, trauma always has a relational meaning.

2. We always make restorative efforts, however faulty, that give us a sense of certainty that we will go-on-being, and that the relational surround will be there so we can go-on-being. We restore ourselves by clinging to convictions (certainties), from which we cannot be dissuaded.

3. Trauma goes hand in hand with dissociation. Brothers says dissociation is a restorative effort to reduce uncertainty by simplifying that which is complex. For example, while others purport that feelings are often too intense to be born, Brothers says it is the range of feelings, often contradictory, that we cannot bear. (As a colleague noted, perhaps all defenses, and all symptoms, are restorative attempts.) I agree with Brothers that therapists need to respect symptoms, which Brothers says allow for safety and certainty that otherwise would not exist. Therapists ought not seek to take away prematurely what is necessary to the patient to stave off terror of annihilation.

4. Shame is an inevitable companion of trauma.
On a note of self disclosure, such as therapists admitting to failures of empathy brought to our attention by our patients, Brothers notes an implicit ‘Ah, you notice my humanity, it may be safe to show me yours.’

Brothers also spoke of trauma as having a before, during, and aftermath, and what’s more, the before can have occurred before conception, as in intergenerational transmission of trauma. As Winnicott noted in The theory of the parent–infant relationship (1960, NY, IUP) “If maternal care is not good enough, then the infant does not really come into existence, since there is no continuity in being…” Winnicott (1958, IJP: The capacity to be alone) also noted that when a mother is depressed or dissociated (perhaps from her own past trauma or that of her mother’s) and unable to provide mutual regulation of experience, the infant, in matching its mother’s state, is devoid of subjectivity at a time critical in development. An infant who has extreme fluctuations in subjectivity, a traumatically dissociated infant, experiences discontinuity and threats to its going-on-being.


Ernesto Vasquez said...

Although I had met Doris before and have read her work, March 10, I gained greater respect and appreciation for her personally and psychoanalytically for her superb exposition and her open and receptive attitude which permitted such a genuine exchange of ideas.

Steve Graham said...

I thought her talk was a wonderful and timely presentation! The notion of certainty built in as a result of disruptive trauma as a way of rebuilding a sense of security is quite an addition, at least for me, to the understanding and treatment of trauma as well as repetitive painful states. I'm looking forward to processing it in both of our classes on Wed. It also made sense to me that we would eschew sameness or difference as a result of trauma.

I did wonder, however, whether certainty/uncertainty may be posited in a binary way so as to foreclose the notion of more or less certain. We need not consider therapy mutative only if a patient completely abandons the after-trauma certitude position; rather, if he/she can even play with a possibility that it may not always be (or have to be) certain, that step, I think, is monumental.

I am also not entirely sure that I believe that all trauma is relational, at least as we were talking about it yesterday. It seems to me, both in my own personal experience as well as that of those I know personally and as patients, that it can be pretty traumatic to imagine that one will face annihilation/death per se. In those situations, the relational piece may be the absence of a connection -- existential aloneness -- that is so shattering. The traditional notion of hell (hotly --forgive the pun-- being debated/disputed throughout the ranks of Christendom) is only partly that of physical pain, but largely that of being cut off from connection.

A colleague and I were talking about the role of our Christian faith and the notion of certainty. By definition, faith (the substance of things hoped for, the evidence of things not seen) is not knowing, but it functions to diminish the sense of uncertainty for believers. Doubt is therefore included within the realm of faith, it seems.