Amuse-Bouches IV – What Makes a Trauma Traumatic? (Part I)
Trauma often appears to be a very broadly-spread notion in psychotherapy. Its urgency in clinical settings seems to outpace the theoretical rigour we can give it, leading the label ‘trauma’ to have been been ascribed to all kinds of experience, from birth, to sex, war, and even to love.
Moreover, it sometimes seems that the only access we can get to an account of personal trauma is through its link with a collective trauma. The experiences of slavery, colonisation, and persecution all leave behind both victims and survivors, with the implication that the effects of these collective traumata are in some way ‘transmitted’ to later generations. Even if descendents lack a personal experience of the traumatic event themselves, its collective memory binds the group – constituting it as a group – whose distinctive identity is rooted in that shared historical trauma. This in turn bleeds into personal narratives of trauma among the group’s individuals, perhaps echoed in later symptomatology to which they might be connected but bear no obvious resemblance.
Indeed, almost all the theories of intergenerational transmission are based on models of trauma; and almost all the examples of intergenerational transmission involve an experience of trauma. Is trauma therefore a precondition for transmission? Conversely, does something need to be transmitted in order for a trauma to be felt as ‘traumatic’?
This interplay between collective and individual experiences of trauma generates some confusing repercussions. ‘Trauma’ as a label can come at the expense of a proper investigation into the complexities of an individual’s life. It becomes far too easy to simply declare ‘it’s trauma: case closed’ and avoid the inconvenience of having to probe into the specificity of an individual case. Psychoanalysis, by contrast, is a one-by-one practice. Its approach is to scrutinise, challenge, and perhaps de-stabalise such labels. In practice, this takes a long time and is painful psychotherapeutic work. When the alternative on offer is to comfort, empathise, and seek immediate relief from suffering, psychoanalysis can seem deeply unattractive as a treatment option.
But we have to stop and think about what ‘trauma’ actually is. To label an experience as ‘traumatic’ only begs the question. Worse, it can function as a way not to have to think about the particularities of each case. What made an experience traumatic for this individual but not that one? Why does the trauma manifest in this precise form rather than another, and at this time in a person’s life, perhaps years after a precipitating event? The paradox is that the label of ‘trauma’ can function to mask a subjective narrative – the very thing that many psychotherapies aim to bring to realisation.
To start with therefore, we can point to two problems that any theory of trauma has to have good answers for.
Problem 1: The Event
Often we find ourselves trying to locate a single event, and one of a specific magnitude, at the aetiology of a trauma. And yet we sense that this choice is always somewhat arbitrary if we cannot account for how that event was inscribed, metabolised, or worked-through by the individual. Why this event? Why is the same event not traumatic for everyone? Why does an event only take on a traumatic colouring years after it happened – and what might have triggered or re-activated it? The danger is that our in search for ‘The Event’ we end up with what Ruth Leys calls a ‘literalist’ reading of trauma: the event is presumed to have had a ‘direct’ impact that is in no way subjectively mediated. Even though we know it always is.
Likewise, an appeal to a single catastrophic event usually relies in turn on an appeal to external reality. For psychoanalysts however there is no such thing as ‘shared’ reality. So we have to ask what kind of reality is being proposed here? Furthermore, if an external event is presumed to have a certain magnitude we might be led to wonder: why can’t the absence of an event be traumatic?
Problem 2: Affective Weight
What gives a particular experience its measure of affective ‘weight’? That is, the level of psychical investment or emotional charge that is felt – in the end – as suffering? The ‘experience’ in this instance need not be an event. Even if we acknowledge the importance of a psychical reality over a material one, why should this particular experience carry or engender an affective investment over that one for a particular subject? When all is said and done the affect – even if displaced – has an origin, and is ‘felt’ by the subject in a certain way. Therefore we have to account for it.
The easy recourse would be to link inextricably the event to the affect it produced. The death of a loved one or a terrorist atrocity are deemed to carry sufficient explanatory force to draw a straight link between the event and the experience of the event. But this only moves the question back one step – we could easily ask what it was in particular about a certain event that granted it affective weight, and in any case it is not always so easy to identify an event which would qualify. Indeed, as modern criteria for PTSD deem exposure to a trauma-producing situation to be sufficient in producing the trauma itself, it might make us question whether we can be sufferers or victims of a trauma without knowing it. The alternative recourse, especially where the link between the event and its affective impact is less clear, is to neuroscience. Imbalances of brain chemistry or faulty neuronal wiring are ventured as explanations, exploiting the opacity generated when we are unable to justifiably locate the cause of trauma in the event. Cum hoc, ergo propter hoc.
The History of Trauma Theory
Now that we know the problem, let’s look back through history to see what different theories of trauma have been proposed. This won’t be a purely psychoanalytic history – and especially not a solely Lacanian one – because the field is much wider. Neither will it be an exhaustive history of that wider field. But it will allow us to pause at certain points here and there to comment on the parts that are of interest to psychoanalysis, and how it has – or should – engage with them.
At its inception, theories of psychical trauma were modelled on what was known about physical trauma. When John Erichsen proposed the term ‘railway spine’ in 1860 he was attempting to account for patients who had been involved in accidents on the newly-invented (and almost comically dangerous) railroads. Many complained of nervous injury, but presented no obvious physical signs. Erichsen hypothecated that the collision caused a physiological shock to the spine, resulting in tiny lesions affecting the nervous system. This proposal of an organic lesion at the origin of a psychical trauma was taken up by Hermann Oppenheim in 1889 under the label ‘traumatic neurosis’. Around the same time, on the opposite side of the Atlantic Jacob Mendes Da Costa had noticed that American Civil War soldiers showed signs of a post-combat anxiety disorder appearing in the form of breathing difficulties and palpitations, which he labelled ‘soldier’s heart’.
By the 1890s many illustrious names at the cutting edge of neuroscience were interested in this problem. Charcot, Janet, Binet, Morton Prince, Freud, and Breuer all made contributions to the problem of what was now seen as a psychical wound, beginning its conceptual divergence from the physical disturbances to which it had been held in parallel.
Freud and Breuer based their view of trauma on their research into hysteria. The common currency between the two was the idea of a psychical economy, and in trauma this was marked by “the incapacity of the psychical apparatus to eliminate excitation in accordance with the principle of constancy” (The Language of Psychoanalysis, Laplanche & Pontalis, p.467). The ‘cathartic method’, via hypnosis, was proposed as therapy on the assumption that the traumatic experience could be worked-out, worked-through, and physically abreacted in line with the economic model of the mind the pair had suggested.
Theories of trauma moved very quickly around this time. It was an exciting field, led by Freud and Breuer’s work on hysteria. By the late 1890s there were three possible models of trauma.
- 1. Trauma is the result of a single external event. For example, an experience of sexual abuse. Therapeutically we have to find this event because with it we will find the point of aetiology and work it through. For Freud at this time, there was always a sexual aetiology to trauma; for Janet, not so much.
- 2. Trauma is not the result of a single external event. Or at least, the traumatic event is not the sole aetiological agent. There could be a multitude of events at the same time that contribute to the effect of trauma, but there has to be a predisposition of some kind. Even if the magnitude of a certain event (for example, the death of a loved one) meant that it could never be fully psychically abreacted, the different ways it can be processed psychically pointed to some other determinative factor. Hysteria presented three options for how this could happen:
- a) Hypnoid hysteria – Breuer’s idea, presented in the Preliminary Communication to the Studies on Hysteria, was that what makes a trauma traumatic depends on there being a split in consciousness, a particular altered state of consciousness at the time of the event. He called this a ‘hypnoid state’ (SE II, 12).
- b) Retention hysteria – a short-lived idea of Freud’s from 1894 that trauma embeds itself when there is no opportunity in the moment to react in the proper way – perhaps due to social niceties or other circumstances at the time not permitting it – and so the affect it is ‘dammed up’. The job of therapy is thus to help abreact it (SE III, 94).
- c) Defence hysteria – by the time the Studies on Hysteria was published in full in May 1895, the dominant idea shared by both Freud and Breuer is that a traumatic experience is one which cannot be assimilated in the same way that an unpleasant idea is usually dealt with (most usually, through repression). A defensive mechanism is triggered, often taking the form of a conversion of the trauma onto the body. This becomes hysteria proper and the two earlier ideas are dropped.
- 3. The traumatic event is actually two events, or more precisely two moments (as we will see in Part II). This means that you can never identify a single traumatic event – it needs a later one to set it off. Initially (pre-Sept 1897) Freud had looked for a scene of ‘seduction’ (child sexual abuse) as the single event. Then (post-Sept 1897) he accepts that the search for this scene would be fruitless, and pens his famous “I no longer believe in my neurotica” letter to Fleiss (Letter 69, SE I, 259-60). But Freud never fully gave up his quest for the original scene. As we will, throughout his career he was always trying to look back, further and further, to find the original scene or event in the past which could account for the trauma he saw in the present.
When ‘shell shock’ emerged in World War I it was clear psychoanalysis had to have a view on this phenomenon. It was also a time of intense development in Freud’s own views. The economic model of the mind was revised, amended, but never abandoned. In 1916, Freud used it to explain trauma in these terms:
“Indeed, the term ‘traumatic’ has no other sense than an economic one. We apply it to an experience which within a short period of time presents the mind with an increase of stimulus too powerful to be dealt with or worked off in the normal way, and this must result in permanent disturbances of the manner in which the energy operates” (SE XVI, 275).
This idea seems very neat and all-encompassing. So much so, does it mean we can align trauma with neurosis, and claim that everyone who is neurotic must have experienced some kind of trauma? Freud isn’t so sure. Firstly, he thinks, it’s too broad – we would have to believe that everything and anything could be classed as traumatic, even the most mundane of early-life experiences. Secondly, where is the evidence that there was anything traumatic about most neurotic’s early-life experiences? Most of his patients were reporting fairly unremarkable childhoods growing up in middle-class homes, it was only later they sought his help (SE XVI, 275-6). If trauma was an accidental contingent experience, it had to be coupled with a certain disposition, Freud thought. It was a fixation of the libido (either from an infantile experience, or from some kind of hereditary of even prehistoric experience) that would lead to a sexual constitution capable of producing neurosis.
Just before the end of the First World War, all the leading voices in psychoanalysis were brought together at the Fifth Psycho-Analytical Congress in Budapest, in September 1918. As the ‘war neuroses’ were the hot topic of the day, they were joined by representatives from the Central Powers – the military coalition of Germany, Austria-Hungary, and the Ottoman Empire – who sat and listened as papers were delivered and proposals put forth that psychoanalysts should be able to set up new clinics to study shell-shock and test out psychoanalytic treatments for it (SE XVII, 207). Of course, that idea came crashing down when Germany and her allies lost the war just a couple of months later, but it remains one of the only points in history where governments have given a shit about psychoanalysis. This was, of course, not motivated by the claims of psychoanalysis to scientific interest. Military officials were more interested in the possibility that psychoanalysis could challenge the notion that it was the war per se that had traumatised their soldiers.
Were governments and their militaries wholly bought in to the idea that shell shock was the result of a disturbance in libidinal economy? Of course not. And here Freud notes that the opponents of psychoanalysis think they have him on the run. Where is the evidence of a psycho-sexual aetiology in cases of shell shock, they would demand? Freud’s reply initially appears a little evasive:
“If the investigation of the war neuroses (and a very superficial one at that) has not shown that the sexual theory of the neuroses is correct, that is something very different from its showing that that theory is incorrect” (SE XVII, 208, Freud’s emphasis).
Instead, Freud thinks that the war has caused another conflict in the soldier, between a warlike ego and a peaceful one. But then he comes to a remarkable conclusion: it’s not the war itself that has brought this about, it’s conscription:
“Thus the precondition of the war neuroses, the soil that nourishes them, would seem to be a national [conscript] army; there would be no possibility of their arising in an army of professional soldiers or mercenaries” (SE XVII, 209, my emphasis).
Conscription is the active ingredient in what makes a war trauma traumatic. In other respects, Freud thought, they do not differ from the traumatic neuroses we see during peacetime and which are not due to the conflict in the ego that conscription brings about. From a Lacanian perspective Freud’s conclusion is very interesting because it introduces the idea that an invocation or desire from the other is the precondition for trauma – exactly the kind of hypothesis Lacan would later develop in his theory of anxiety as the sensation of the desire of the other.
But Freud has a better answer to the challenge that the war neuroses disprove the sexual theory of trauma: the theory of narcissism. With this elegant solution, he was able to circumvent the simplistic ego-libido duality and argue for “an amount of sexual energy attached to the ego itself and finding satisfaction in the ego just as satisfaction is usually found only in objects” (SE XVII, 209-210). This gives us another very neat cut between the transference neuroses of peacetime (in which the ego defends itself from the claims of the libido) and the war neuroses (in which the ego defends itself from the threat of external violence).
Freud’s followers had quite a time with the theory of narcissism.
In 1916, Victor Tausk was one of the first to deploy it in arguing – against the military establishment of the time – that these men were not malingerers or deserters, but had fallen ill due to unconscious conflicts, resulting in a ‘flight into illness’ in order to avoid combat.
Abraham then proposed the theory that it was an over-developed narcissism which had led to trauma in some men rather than others. They were already unfit to fight by the time they reached the battlefield. In a now rather dated-sounding passage he writes:
“It is found with great regularity that war neurotics were even before the trauma – to call it for the time being by the common name – emotionally unstable, especially with regard to their sexuality…. Many war neurotics had, already before the war, shown poor or limited potency. Their relationship to the female sex was disturbed, by partial fixation of the libido in the developmental phase of narcissism to a greater or lesser extent. Their social and sexual functioning was dependent on certain concessions to their narcissism” (Abraham, ‘Psycho-analysis and the War Neuroses’, 1923, in Clinical Papers and Essays on Psycho-analysis, p.61).
Ferenczi however asked the obvious question – why shouldn’t an over-developed narcissism actually make you a better soldier? Wouldn’t it give you a greater lust for glory, honour, and blood? What was in fact happening, Ferenczi thought, was that when they reached the battlefield these men realised the horror that confronted them and were dealt an immediate blow to their honour. The problem therefore was an over-estimation rather than an over-development of their narcissism.
But importantly, neither Tausk, Abraham, Ferenczi, nor Freud were blaming these men or characterising them as malingerers. They were the victims of unconscious psychological conflict rather than a pathology of the will. We can notice as well that in all their theories it is not the event itself that is the determining factor – otherwise why wouldn’t all soldiers suffer the same fate? But neither are they taken as ‘witnesses’ to horrific events beyond their control. As Fassin and Rechtman point out in their excellent, careful study Empire of Trauma, “Their illness was not the product of historical circumstance but of their own tendencies” (p.63). Sufferers, yes; witnesses, no.
To some extent then, those government representatives and military psychiatrists who attended the 1918 Congress got what they came for. Yes, Freud would put the finger of blame on conscription as the precondition for the traumas of war. But on the other hand, it was no longer the event (the war) alone which was responsible. Moreover, it was still possible to for the military to see psychoanalysis as a method of extracting a ‘confession’ of weakness – if psychoanalysis had succeeded in humanising the treatment of shell-shocked patients by removing the need for electrotherapy, so much the better. Already, an important shift was underway. As Fassin and Rechtman note,
“Self-confession came to represent the central motif of the trauma narrative. The event features in this narrative only as the pretext for intimate revelation, for the trauma is already present, within the individual history of each patient, and it is this preexisting – structural – trauma that will ultimately explain the impact of the event” (Empire of Trauma, p.64).
With Beyond the Pleasure Principle in 1920 Freud had reasserted the fundamental economic model of trauma, but now with the addition of ‘repetition compulsion’ – the attempt by the psyche to bind a quota of excitation by mastering the original experience through repetition (SE XVIII).
A further and more radical twist came in 1926 with the publication of Inhibitions, Symptoms and Anxiety. Anxiety as a signal (of what to be afraid of) protects us against automatic anxiety (in which we are completely helpless). The consequence however is that the psyche comes under attack not just from the outside but from the inside (SE XX).
It is exactly this problematisation of inside versus outside, internal worlds versus external worlds, that topological models like the torus and Mobius strip beloved by Lacanians show so well. Put your finger on top of the Mobius strip and try to trace it along, from the topside to the underside, and you will soon realise that this is impossible. The torus as a category always precludes this inside-outside distinction. We will look at this more in Part II.
So by the 1930s, psychoanalytic views were the primary reference point for psychiatrists and any other medical professional working in the field of trauma. There was a recognition that trauma had to be detached from the event, and the question of what counted as ‘traumatic’ subsumed under a general theory of psychopathology. In short, it was widely-accepted that there was a lot more going on.
That all changed in 1945. With the extent of the Holocaust becoming clear it soon became apparent that this was the defining trauma of the age. Whilst no new classification of ‘trauma’ followed as a direct result, the debate about its nature continued but with a very different experience of tragedy to confront. Unlike the shell-shocked soldiers emerging from the battlefields of the First World War these victims were ordinary civilians with stories to tell. Stories, indeed, of what was meant to be kept secret.
Some of these stories were not told until many years later. It was as if the collective trauma exhibited the same latency that characterised personal trauma. As we have seen previously on this site, by 1979 the effort to collect and record these narratives – such as through the Holocaust Survivors Film Project at Yale – had led to a greater dialogue with psychoanalysis that continues to this day through the work of trauma theorists like Shoshana Felman and Cathy Caruth.
Yet over the intervening period, the large number of Holocaust survivors spread across both sides of the Atlantic allowed trauma as a category to get greater public attention, in turn bringin psychoanalytic ideas on trauma to a broader audience. Many of the survivors were themselves first-generation psychoanalysts – unsurprising given the large number of Jewish analysts and the perception fostered by the Nazis that psychoanalysis was a Jewish pseudo-science. One such refugee from the diaspora was Bruno Bettelheim.
Bettelheim had been in the Dachau and Buchenwald concentration camps from 1938-1939 before escaping to the US, where he wrote about his experiences in the collection Surviving, first published in 1952. It’s a telling title, as Fassin and Rechtman note, because it marks the start of a gradual move from ‘traumatic neuroses’ (or ‘war neuroses’) to ‘survivor syndrome’. They pick up on two important changes that Bettelheim’s collection heralded:
- Trauma is reframed as the experience of the ‘unspeakable’ and ‘communalised’ through an imperative. Survivors become guardians of this communal trauma, and it becomes their responsibility to testify on behalf of those who did not survive.
- The event comes back to the fore. For Bettelheim, what made a trauma traumatic depended on whether or not the event was sufficient to cause a breakdown in the most vital aspects of the psyche. Bettelheim had wondered what exactly had helped some to survive and others not. Were they stronger, physically or mentally? Or were they perhaps neurotic or psychotic already? The latter possibility raised the question as to whether it was this very psychical structure that had given them what he called the “will to survive”, where in normal circumstances it would have been taken as a mental deficiency. On returning from the camps the survivors seemed to occupy the space of both victims and heroes, a purgatorial status which only contributed to the ‘survivor’s guilt’ they reported.
Fassin and Rechtman comment that:
“The hypothesis of survivor guilt offered practical confirmation of the recast image of victims as witnesses…. With the survivors of the camps, testimony to trauma – more even than the testimony of the trauma victim – was gradually recognised as offering ultimate truth about the human condition” (Empire of Trauma, p.75-6).
Two major factors in the years leading up to 1980 resulted in a pivotal turning point in trauma theory. In the wake of the anti-psychiatry movement the psychiatric field needed to demonstrate the legitimacy of its diagnostic criteria. At the same time, the aftermath of the Vietnam war had produced huge political pressure from veterans’ groups and psychiatrists for recognition of the long-term damaging effects of what came to be seen as an unjust war.
Enter Robert Spitzer. Spearheading the American Psychiatric Association’s task force which since 1974 had sought to create a classification of mental disorders which could plug this legitimacy gap, the DSM-III was finally published in 1980. In it was a new classification: PTSD (‘post-traumatic stress disorder’). The huge controversy at the time over its inclusion is now largely forgotten. But in re-describing ‘traumatic neurosis’ as ‘PTSD’ it granted legitimacy to the new classification, and shed the stigma of ‘neurosis’ from the old label.
The introduction of PTSD effectively killed the debate about the nature of trauma that had until then so interested generations of psychiatrists, psychologists, and psychoanalysts. The Event was back as the sufficient aetiological agent. The very first criterion for the new diagnosis was simply exposure to an event that was deemed to be traumatic:
“A. The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.”
All of a sudden there was no need to figure out anything about the subject’s personality or the depths of their psyche – you just look for the event, and if the magnitude of the event is deemed to be sufficient then trauma would be the normal reaction. How much simpler life became:
- No need to worry about how the event was processed psychically by the individual;
- No need to worry about whether or not there might have been an underlying predisposition for trauma (and the stigma this could lead to);
- No need to worry about the ‘gain from illness’ that was so important to Freud and his contemporaries (and the suspicion this could engender);
- No need to worry about whether you’ve got the right interpretation of unconscious material;
- No need to worry about looking for an ‘original’ trauma that might lie behind the event itself.
The specificity of an individual’s psychology, the particularities of their case, their history, and what they actually said were obliterated. All that was needed for trauma was the event. Moreover, you could even be traumatised without knowing it, just as it would be possible to be a victim without knowing it. ‘Trauma’ now came at the expense of the self.
This produced some perverse outcomes. Robert Lifton could argue in his 1973 book Home from the War: Learning from Vietnam Veterans that US army atrocities were due to “atrocity-producing situations”. Extraordinary events allowed for extraordinary outbursts of violence. Atrocities thus became re-transcribed survivor guilt, and their perpetrators re-imagined as victims. As Allan Young noted, this provided the perfect solution for US politicians looking for a way to navigate around the inconvenient truth that some soldiers had committed horrific acts of barbarism: they were put in this situation in the service of their country so really, they were patriots. What’s the difference between these and the atrocities committed by the Nazis, we might wonder? The laughable assertion was that, unlike the Nazis, American soldiers suffered too.
But for sufferers of trauma, it was not as simple as being recognised as victims of an experience that overwhelmed them. As Freud had realised, clinical intervention had to do more than just identify the event. Alongside this there developed a gradual shift from finding the traumatic event to bearing witness to the unspeakable. As the founding motto of aid agency Médecins du Monde articulates it, the task was both “to care for and bear witness”. But the witness was not always the traumatised subject. On the assumption that an unspeakable event may require special expertise to find words, often this meant such words were provided second-hand through the proxy mouthpieces of pressure groups and humanitarian organisations, not through the voices of sufferers themselves. The opportunity to re-open the investigation into unconscious meaning was foreclosed once again. This of course generated its own problems, and questions of victimhood, witness, and testimony became condensed into the ‘memory wars’ of the 1980s. Its most infamous articulation as far as psychoanalysis is concerned came in 1985 with Jeffrey Masson’s The Assault on Truth and the start of the ‘Freud Wars’.
We will touch on just a few areas over the last 30 years and the major contributions to the debate in that time.
The seminal tragedy which has provided a consistent reference point for scholarship – at least in the West – is 9/11, and the impact of the post-PTSD conceptualisation of trauma made its impact keenly felt. To have ‘experienced’ 9/11 it was not necessary to have been there on the ground in Manhattan. Two studies cited by Fassin and Rechtman reported rates of PTSD a month after 9/11 of 7.5% among Manhattanites and 4% in the US population at large (based on representative samples). That 4% however was the expected rate of ‘background’ trauma pre-9/11, and it did not rise after the attacks… except among those who had watched the events unfold on TV (Empire of Trauma, p.3).
The latest edition of the DSM (DSM-V from 2013) now lists its ‘Criterion A’ for a diagnosis of PTSD not as a trauma but as a ‘stressor’ for which it is only necessary that the person is “exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence” either directly or indirectly (as a witness, first responder, or merely learning that a trauma had befallen a loved one). With this definition ‘victims’ proliferate and proximal distinctions matter less than political ones when it comes to deciding how a particular group has been affected by a ‘traumatic’ event. The status of victim is not always accepted by those who are alert to this. Meanwhile, although clinical interventions by aid agencies in disaster-hit regions over the past 30 years have often been classed under the banner of ‘humanitarian psychiatry’, Fassin and Rechtman make a persuasive case that these were more humanitarian than psychiatric. Many responders, even psychiatrists, treated psychological suffering in the broadest sense without regard for trauma theory or needing a reference to PTSD. Fassin and Rechtman argue that it was not trauma that prompted the call to help – in the beginning was humanitarianism (Empire of Trauma, p.174).
Several voices from the neurosciences have made their own contributions to trauma theory more recently. Bessel van der Kolk is one such major figure in the study of psychotraumatology, returning the field back to an organic model by suggesting that trauma is a different kind of memory – one that is ‘implicit’ or ‘nondeclarative’. This fits in nicely with notions of trauma as ‘unspeakable’ that were popularised in the post-Holocaust age. For van der Kolk, trauma is about dissociation. He believes that a failure of the integrative function of the brain (a function he ascribes to the thalamus) to on the one hand assign emotions (the job, he believes, of the amygdala) and on the other locate sensations in time and space (the hippocampus) produces ‘reactions without context’ which are taken as marks of trauma in PTSD. Therapy should aim to restore this integration. He is careful to say that traumatic experiences do not literally etch or imprint themselves on the brain, but the effect of indelibility is created due to damage of this integrative function when combined with the inability to extinguish external stimuli.
There are a few reasons to be sceptical about van der Kolk’s model. For one, it may be subject to the reification fallacy, but more fundamentally it doesn’t help us answer why some experiences are ‘etched’ or ‘imprinted’ more than others, given the external stimuli van der Kolk’s theory relies on are often not of a level that would suggest the integrative functions of the brain would be damaged or substantially altered by their occurrence. We would still need to explain how certain experiences lead to the inability or hindering of this function in the way he believes.
His position marks a contrast – thought not necessarily a conflict – from that of Laub, Felman, and other post-Holocaust theorists who privilege the ‘communal duty’ to testify to a trauma. Indeed, we might sometimes wonder whether they believe testimony is more important as a communal duty than as a way to treat or understand trauma. A distinction therefore needs to be made between the individual trauma and the communal impact. After all, are we analysing the person or the culture?
Moreover, testimony-based theories of trauma make it very difficult for us to distinguish between historical witness and dissociation. They oblige us – for good reasons – to take the testimony at face value, but how do we know what we are hearing isn’t a narrative marked by all the psychical defences of the primary process? We find the same ability to speak about a traumatic experience taken as proof of the effectiveness of more recent treatments, such as Shapiro’s EMDR therapy.
There are other interesting theories of trauma proposed within the last 10-15 years by the likes of Cathy Caruth, Ruth Leys,and Mikkel Borch-Jacobsen. But to do them justice would take us well outside the world of psychoanalysis and need a much more thorough exposition.
So in Part II we are going to look at five possible answers that psychoanalysis offers to the question ‘what makes a trauma traumatic’?
An early version of this article was delivered in a talk to the North West Regional Psychotherapy Association, Manchester, UK, February 2019.
By Owen Hewitson, LacanOnline.com
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