Like so many psychological processes, the effect of trauma is characterised by dialectic tensions, of wanting to kill the pain with silence and denial, and of attempting to kill it by shouting it out from the top of one’s lungs and giving it a name. The attempt to make it go away by ignoring and burying it is rarely, if ever, successful - trauma usually finds its way out as a symptom, prolonging and repeating the horror in disguised form. Letting the unbearable unthinkable pain, shame, hopelessness and rage out can come at the cost of disintegration and retraumatisation. This dialectic tension emphasises the need for a combination of an empathic response as well as putting emotions into words, and Klein (1987) emphasises the latter, putting the ‘talk’ back into talking therapies.
The nature of the psychosomatic symptom in a sense follows the pattern in which we try to deal with traumatic experiences – it screams for the pain to be recognised, trying to drag attention to the story and memory of an atrocity, while at the same time distracting from it, silencing its real origin and nature, and deflecting attention from that unspeakable experience. This leads to an oscillating between feeling numb and having traumatic and retraumatising flashbacks and dissociation. Memories and feelings about the traumatic event often are fragmented, incoherent or absent from consciousness altogether, being the result of defensive mechanisms humans can use to help them survive events that are overwhelmingly atrocious, physically and/or emotionally.
Some of the processes involved in dealing with trauma are denial, repression, and dissociation. These operate at the social as well as at the individual level, and the ways in which we experience, frame and tackle trauma is always closely linked to the social context. In Germany, for example, during and after the Holocaust the traumatic reality of the atrocities was frequently denied and repressed, and only after years and decades did the working through and rediscovery of ‘Forgotten History’ (Herman 1992) take place. In German the term for this kind of process is ‘Aufarbeiten’, which literally translates as ‘working up’ – thinking, feeling, remembering, in order to push the repressed traumatic material, memory and emotional fragments up from the scary depths up into consciousness. Implied in the literal English translation is that one gets ‘worked up’ in such a process, which brings me back to the dialectical tension – psychotherapy, especially working with trauma, is often experienced as an opening of a can of worms.
Without ‘Aufarbeitung’, however, developing a coherent narrative facilitating healing is not possible. Similarly to ‘good enough’ psychotherapy, the German school system provided a safe place in which pupils were taught about the Holocaust and encouraged to face the facts, with all their emotional impact, and process it together, under the pastoral guidance of a teacher. This frequently involved facilitating a re-experiencing of events by remembering, reading accounts and watching films, which frequently was retraumatising. It brought the events that collectively had been repressed into the depths of the German unconscious back to the surface, where for the first time atrocities to an incomprehensible scale could start to be processed. For that generation of Germans this involved experiences that have not been actively experienced but have been passed down as vague and diffuse secondary experience, which probably has a similar nature to primary traumatic experiences that have been distorted by dissociation and fragmentation.
There is a distinction between trauma caused by natural disasters or accidents, and trauma caused by human design. The former is easily met with sympathy and empathy, but in the latter the outsider is caught in the conflict between victim and perpetrator, and has to choose sides. Herman (1992) points out that it might seem easy to side with the perpetrator, who only asks us one thing: to do nothing. In contrast to this, the victim asks us to feel their pain, to act, engage, take sides, protect, remember, and risk becoming subject to attack, ridicule and shame as well.
The perpetrator does all he or she can to promote forgetting, by silencing, ridiculing, denying, rationalising, manipulating, attacking one’s credibility, and arguably worst of all, attacking one’s trust in oneself and one’s perception of, and relationship with, reality. An additional danger is that the perpetrator’s account in isolation from the wider community can seem very convincing and bullet-proof to a bystander. The victim’s account and experience become both invalid and invalidated, and unspeakable. To speak about it makes one vulnerable to even more stigma, shame, disbelief and ridicule.
To hold traumatic events in consciousness requires the weaving of what I call a ‘healing canopy’, (similar to Peter Berger’s (1967) concept of the ‘sacred canopy’), a social context and community that affirms and protects the victim coherently, and that weaves together the victim, witness and bystander in a common alliance, co-creating a coherent and shared sense of reality. It is so immensely important for recovery that the victim, witnesses, friends and family together knit what I call a ‘post-traumatic narrative’, eventually leading to a ‘healing canopy’, which provides respite and a secure base from which to gradually start engaging with life, the world and people again.
Going back to the history of psychoanalysis, Charcot laid the groundwork in the 19th century, and by 1890 Janet, Freud and Breuer agreed that the so-called hysterical symptoms they observed were the result of psychological trauma which has caused an alteration of consciousness, a state of dissociation. They discovered that psychosomatic symptoms disappeared when traumatic events were called back into consciousness, together with the accompanying intense feelings, in what they called a process of ‘abreaction’ or ‘catharsis’, and what Freud later termed psychoanalysis, (also termed ‘the talking cure’ by Breuer’s client Anna O), by following back ‘the thread of memory’.
Interestingly, there seems to be a typo on page 13 in Herman (1992) ‘Trauma and Recovery’, spelling ‘thread’ with a ‘t’ in the end, which says it all - a parapraxis symbolising the paradoxical tension between wanting to remember and to speak about it, but also wanting to employ all sorts of defenses to cut off the thread/threat of memory, because it is so intolerably threatening, frightening and painful. Freud followed the thread of memory back to sexuality as possible origin of hysterical symptoms, and frequently more specifically childhood sexual abuse.
The nature of disorders and symptoms is closely connected with the social context in which they appear – for example the oppression of women and hysteria, war and shell-shock/PTSD and ‘the combat neurosis of sex war’ (Herman 1992), in which women’s reality and existence in the private sphere was denied, which made them vulnerable to all sorts of sexual and domestic abuse, and simultaneously robbed them of the opportunity to speak out about it without shame and facing disbelief. There was no concept or terminology for the abuse they often were subject to, which left them unable to name and identify the wrong-doings in the first place. Neither was there a social framework which would have enabled the moral calibration of their experiences.
American feminist Betty Friedan called a woman’s situation ‘the problem without a name’ – I believe that one of the most damaging things after a traumatic event has occurred is the fact that abuse robs a woman (or any victim) of a voice, making him or her literally and metaphorically suffer in silence. The feminist movement created therapeutic self-help groups practicing ‘consciousness-raising’, which again reminds of the term ‘Aufarbeitung’. Their codes are similar to psychotherapeutic relationships, based on intimacy, confidentiality and honesty. This enabled women to overcome barriers of denial, secrecy, shame, guilt, denied experience, denied feelings and denied reality, (which had prevented them from naming their injuries), and enabled them, often for the first time in their lives and maybe even history as a whole, to find and use a voice. In these groups, frequently in contrast to the consulting rooms of their time, women were surrounded by supportive women who believed them when they were talking about being raped, often sharing that very experience. The existence of these groups also led to consciousness raising at the social level, and gradually also towards a change in legislation, as well as a change in attitudes within the mental health profession. In 1975, as a direct result of feminist pressure, a centre for the research of rape was established within the National Institute of Mental Health in the USA. For the first time women were seen as informants, not just subjects; their emotional experiences were honoured and validated. The results confirmed what Freud had initially established but then repudiated (maybe itself as an act of defensive denial of traumatic reality): sexual assaults against women and children were pervasive and endemic, at least in Western culture.
For the first time this allowed women to define sex against their will as rape and atrocity, and maybe for the first time allowed them to realise the traumatic impact these experiences have had on them. This led to the discovery that men might have been ‘using their genitalia as weapons’ (Herman 1992), whether they were suffering from ‘combat syndrome’ or not, and that the different kinds of trauma, including the newly termed ‘rape trauma syndrome’ and ‘battered woman syndrome’, were all closely intertwined, in a destructive, dirty ‘abusive canopy’, passed down from generation to generation. This canopy has also become soiled by the abuse and silent pain that has been swept under the carpet. It is the difficult and delicate task of the therapist to help the traumatised client unpick the fabric of this old, dirty and fragmented canopy or carpet with holes, following back both the thread and the threat of the trauma, and together weaving a ‘narrative canopy’ to facilitate healing.
Berger, P. (1967) The Sacred Canopy: Elements of a Sociological Theory of Religion, Open Road Media
Berger, P., Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge, London: Penguin Books
Herman, J. L. (1992) Trauma and Recovery: From Domestic Abuse to Political Terror, London: Pandora
Klein, J. (1987) Our Need for Others and its Roots in Infancy, London: Tavistock Publications
Silke Steidinger - Psychotherapist writing about developments in psychotherapy