The image is that of a dream. You might have had it too in one of its multiple forms. The image is dark and blurry. It is overwhelmed by the scream of a revving engine. You are pressing, desperately, on the pedal but the car does not move. Danger approaches, you feel helpless. Your desperation grows as you press on the pedal. Another dream, this time you manage to start the car, the chaser loses ground, exhilaration overwhelms you. You are safe. Then you see, at the same time as only you can in dreams, the horrendous grin on their face behind you and the obstacle in front, then the impact. You wake up distressed. Maybe you ask yourself what all this means, but you are soon reassured that it was “just” a dream. Now, imagine it was not. You might then begin to form an idea of the nature of flashbacks and intrusive memories of traumatic experiences. They are not just dreams.
- See also: 'An introduction to post-traumatic disorders'
What is psychic trauma?
Post-Traumatic Stress Disorder (PTSD) is one of the most diagnosed mental health difficulties in the UK. According to the 'International Classification of Diseases' (ICD-11), PTSD symptoms include “1) vivid intrusive memories, flashbacks, or nightmares … accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations; 2) avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event(s); and 3) … hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. The symptoms … cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”
The word “trauma” in Greek refers to a wound to the body, a cut, a laceration. Sigmund Freud used the term to describe how the metaphorical skin protecting the mind is lacerated by traumatic events. Unprotected by its broken envelope, the mind struggles to keep its unity and to make sense of both our internal reality and the world around us.
Trauma is often linked to direct devastating experiences, physical assault, neglect and emotional cruelty, the loss of a job or a dear relationship, natural disasters or accidents, bullying, harassment. There are also more insidious traumatic experiences. Social discrimination, related for instance to class, gender, and race, is indeed doubly traumatic as it is both experienced in the present and received through the generations. The intergenerational transmission of trauma is less commonly acknowledged than direct experiences, but it is just as poignant.
Parents’ unresolved traumas are passed onto children when the nursing relationship is not grounded in solid emotional foundations, when it is depressed, avoidant, chaotic. This does not always, or even most of the time, imply abuse or neglect so it is hard to identify. Well-meaning and loving carers are sometimes unable to provide the infant with the reliable holding it needs. The lack of emotional care can be experienced by the infant in just the same way as abuse and neglect. It leaves traumatic scars in the young skin of the growing mind, or it makes it thin and fragile.
Whereas the relation to a nurturing, loving, parent is crucial in developing the ability to contain anxiety, its absence prevents the development in the infant of self-care capacities. This, in turn, leaves it in a state of constant alertness, which prevents the development of essential brain structures. Early psychological trauma is also neurological trauma and developmental trauma. These circumstances will contribute to heightening the adult’s difficulties in coping with trauma and loss, making it harder on the adult’s mind to repair itself.
Even the most adjusted parental relationship is bound to generate traumatic experiences in the child. Indeed, in his book 'Inhibitions, Symptom and Anxiety', Freud indicated the infant’s experience of impotence and helplessness as paradigmatic of all traumatic situations. Unable to move and provide food and care to itself, the infant is utterly dependent on its carers for physical and emotional nourishment. The desperate cry of an infant perfectly illustrates the sense of utter despair that envelops the mind when it feels abandoned and uncared for. Subsequent life traumas evoke past ones and can originate the debilitating condition of PTSD.
Finally, important transitions in life can make unresolved trauma reappear. At those junctures in life, we must act both in the external world, to face its challenges, and in our internal one to work-through earlier experiences of helplessness that may make it harder for us to respond to the world out there. This is a lot when, for instance, we enter adolescence or we become parents, and we must face both the changes in our body and social circumstances, and the often enormous pressures to conform and perform.
Mending Wounded Minds
Imagine now, and maybe you do not have to imagine it at all, that you are told that, whatever your predicaments, they are minor events compared to this or that other tragedy which this or that other person has withstood successfully. Maybe you tell yourself this much. Where does that leave you? Perhaps, unseen or dismissed. Ashamed? Maybe guilty? Perhaps unable to take the help that may be available. It is perhaps surprising, but almost universal, that traumatised people are also crippled by agonising guilt. They might believe, unconsciously perhaps, that their predicament is their fault, that they called it upon themselves.
Heinz Weiss, a German psychoanalyst, noticed in his work with traumatised patients that many suffer the attacks by a part of their personality that Freud called the Super-Ego. These attacks from the inside can generate repetitive and escalating cycles, like that revving engine perhaps, without resolution or reparation. Unable to repair itself, the mind is unable to thrive, perhaps even to live at all. In his recent book 'Trauma, Guilt and Reparation', Weiss writes evocatively about the cycle of traumatic repetition and about how psychoanalysis can help break it,
“Trauma knows neither time nor space, it is everywhere and nowhere. It overwhelms the present with a past that never ended and fails to have a future because it is an endless repetition of the same. … [T]he individual can only re-find his or her history when internal processes of reparation begin to emerge.”
This is what psychoanalysis can offer to mend a wounded mind. It can help mobilise the individual’s internal resources to repair the damage inflicted by trauma. Those “internal processes of reparation” also account for the different outcomes of traumatic experiences. When faced with arguably comparable experiences, individuals respond in a range of different ways, some are unable to live rewarding lives, or live at all, while others are somewhat able to cope, and others still are able to repair their trauma and live fulfilling lives.
What does it mean to repair a psychological wound? How can it be achieved? The psychic work of reparation is a symbolic process attempting to make sense of the traumatic experience. It does not aim at concrete reparations, compensation or revenge. It “only” aims to install in the suffering mind an acknowledgement of loss, a recognition that what has happened cannot be undone and, as it were, things will never be again as they were.
Successful reparation makes the trauma thinkable by giving it symbolic values that can be thought of alongside the other symbolic constructs that make our mind. In doing this, the action of reparation transforms the trauma from a black hole-like entity separated from our mind and draining our mental vitality, into a part of who, against our wishes and control, we are. In her classic book, 'Understanding Trauma', Caroline Garland explains what that symbolic reparation of a traumatised mind entails. For traumatised individuals,
“To get better, the knowledge and the memory of the events they have suffered may need to become part of, and integrated into, the individual's conscious existence, through being worked through instead of being walled-up in some avoided area of mental activity. Their meaning for the individual has to be discovered, even achieved, so that the individual's response makes sense to him or her, and can be thought about, rather than the trauma's being dismissed as bad luck, a meaningless 'accident', or fate.”
If we believe with Freud, Garland and Weiss, that traumatic experiences live in us, as it were, everywhere and all the time, then we can appreciate that trauma becomes re-enacted in the clinical relationship with the psychoanalyst. It is, therefore, possible for the psychoanalyst to observe what the person does in those moments and how she thinks, and provide the emotional containment needed to mobilise her “internal processes of reparation”. Exploring in psychoanalysis how our minds contribute to the way in which we process our experiences, can help us avoid narratives of despair in which the victim has no agency. This can give us, in time, a sense that what we feel is not inevitable and that it can change.
In the chorus of Aeschylus’ Agamemnon, in Anne Carson's translation, we read, "Zeus put mortals on the road to wisdom when he laid down this law: By suffering, we learn." If we can experience this as true, if pain does not manage to destroy us, perhaps it can accompany us on our way to who we will become.
To know more about psychoanalysis, good places to start are the British Psychoanalytic Council, the British Psychoanalytic Association, and the Institute of Psychoanalysis. This last, in particular, the oldest society in this country, offers introductory lectures on psychoanalysis that provide a wide overview of the main concepts and practices of psychoanalysis. Much educational material is available on its website. Also of note, is that all psychoanalysts apply sliding scales to their fees to allow those who wish to have an analysis to find one they can afford. Moreover, both the British Psychoanalytical Association and the Institute of Psychoanalysis offer very low fees for psychoanalyses.