[chapter: Roads and Boundaries]
Trauma is psychic or emotional wounding. In the general discourse it is used most often to describe the results of systematic wounding either one person perpetrates on another – as in sexual or emotional abuse; or in the context of war and other forms of collective – usually political – aggression where usually one ethnic group inflicts all forms of violence on to another.
From the earliest scientific investigations of the psyche and the resulting theoretical formulations, psychic dissociation –- that is: a loss of experiential (subjective) and/or observable (objective) psychic unity has been seen as a response to trauma and linked to pathology. Much of the writing on dissociation has focused on the functioning of memory, usually in one of two ways. The first, where there seems to be an inaccessible set of memories: body memory that has not been able to be expressed in terms of narrative memory, and which instead expresses itself in a range of symptoms, some of which are psychic (with a splitting or splintering of the personality in the most serious cases), and others that are somatic (i.e. conversion symptoms). In the second group the memories are disturbingly present, especially in the forms of repetitive trauma dreams at night and recurring and unbearably intrusive affect during the day. In both cases, what is lost is a full functioning personality.
Therapeutically, it therefore follows, what is necessary is a framework within which the various parts of the personality can be linked up again, in other words: to heal the dissociation.
As a psychoanalyst and a anthropologist – as, in other words, an observer of the functioning of the human personality in its various environments – I understand any person to simultaneously live in three different realities: an inner world; a social world made up of various overlapping (and sometimes concentric) circles; and a metaphysical (or transpersonal) world, that is: ideas (often inchoate and assumed, and by definition ‘received ideas’ from the culture into which each of us is born) about cause and effect and meaning. The first is dependent on – though not identical with – relations with the second two.
A traumatized person, in this way of looking at things, is one who lives too much in a private, inner world, and who is (or feels) cut off from the other two. Healing would come in terms of a linking up – a reconnection – of the inner world to the various circles of the social and metaphysical (and transpersonal) world. And as a psychotherapist, I see it as my responsibility to help mediate (by which I mean: accompany, support, guide, if possible) this reconnection of the inner world of my clients with the various social and metaphysical (transpersonal) worlds in which they live. This is only possible if and when a relationship – and a very specific relationship, it is called a therapeutic alliance and its main ingredients are trust and hope – has been established between us.
In the summer of 2000, I was part of a small research project on trauma dreams at a clinic for people suffering from the effects of war and collective violence in the Netherlands (Ventevogel, et. al.).
The people I spoke with were all refugees from the long list of conflagration zones the world knows: Angola, Sierra Leone, Kurdish Iraq, Chechnya, the former Yugoslav Republic, Afghanistan. What they had in common is that they had fled their country, their extended and sometimes immediate families, and their culture. That they had survived bloodshed and brutality, and carried with them experiences of atrocity that can be summed up but not really shared. And that, once admitted to the clinic, they had received the diagnosis of post-traumatic stress disorder (PTSD), of which the symptom of repeating nightmares was what they said they suffered the most from, and in fact was the thing that drove them to seek help.
We learned that such dreams were rarely exact video-like replications of their traumatic experiences. Instead, while the feelings of usually overwhelming fear, despair, horror, nearly always recurred in a soul-searing sameness, the images seemed to differ, sometimes with subtle distortions of actually lived-through situations, and at other times fully symbolic representations. Quantitative research conducted concurrently seemed to confirm such findings, in which only 14 per cent of the dreams were reported to be exact repetitions.
I was responsible for exploring the subjective experience of the nightmares. In my conversations, there were three recurring messages in our conversations, I will paraphrase them here:
- What I experienced can not be shared. I will never be able to tell you, or anyone, about my horrors. There are no words for that.
- My dreams? Those are exactly the same, every single night. I dream what I experienced. No, I don’t want to talk about that, I want to forget everything.
- I am no longer really alive, I can no longer be helped. But if I can help you to help others by telling you my story, even what I see in my dreams, then of course I will do that. But my life is over.
One man, a doctor from Chechnya, explains as follows: Dreams and memories … even though it concerns the same images, still it is different because what I see in my dream, the way it feels is that it is happening all over again, in reality. Then I wake up with racing heart, bathed is sweat because at the moment, it seems as if it is really happening. Yes. Dreams are more real than the thoughts about it. The dreams are as if it is reality.
The dream as experience
The dream, in other words, is not a ‘re-‘experience, as is referred to in the PTSD diagnosis and trauma literature. It is a category of experience. The autonomous nervous system is fully activated in reaction to an inner event that is felt and processed the same way as if it concerned something occurring in the phenomenal world, the world of the senses and the world of time passing sequentially. In what follows I will consider repetitive traumatic nightmares from the psychoanalytic perspective, because this allows room for both a subjective and eventually an intersubjective interpretation, thereby staying close to the experience of the teller of the dream as personal story and the listener.
These dreams, or experiences, can be seen as a sort of intrusive remembering, and is to be distinguished from a normal state of dynamic equilibrium where remembering is an active ego-function and forgetting, as Jung says, is a process in which, ‘certain conscious contents lose their specific energy through a deflection of attention. When interest turns elsewhere, it leaves former contents in the shadow just as a searchlight illuminates a new area by leaving another to disappear into the darkness. This is unavoidable for consciousness can keep only a few images in full clarity at one and the same time, and even this clarity fluctuates.
But it is as if those who suffer from these collective traumatic experiences cannot turn their attention elsewhere, as if the searchlight returns again and again, unbidden and without control, to the horrors they have suffered and then often gets stuck there. As if, what remains outside the range of vision, what is, in other words, forgotten, are the motion and emotion of everyday life, the present. And because they cannot meet the present, because they seem to be stuck in an endless sameness, there seems to be no future. In this they feel disconnected from their social world, and, often enough, from humanity at large.
Jung says, ‘Isolation leads to panic, and that is only to often the beginning of a psychosis. The wider the gap between conscious and unconscious, the nearer creeps the fatal splitting of the personality, which in neurotically disposed individuals leads to neurosis, and in those with a psychotic constitution, to schizophrenia and fragmentation of the personality. The aim of psychotherapy is therefore to narrow down and eventually abolish the dissociation by integrating the tendencies of the unconscious into the conscious mind’ (Jung, 1921). (Emphasis mine). It is not only the content of the unconscious that Jung talks about here, but rather the dynamics between consciousness and unconsciousness.
Both Jung and Freud lived through the First World War and its aftermath, when the precursor of PTSD was first described as ‘war-neurosis’ or ‘shell-shock’, and both wrote about the phenomenon of recurring nightmares. For Freud the puzzling repetitive character of something causing pain contributed to him making a fundamental revision in his meta-psychology, that of the addition of the controversial death-instinct as a primary motivating factor for human behaviour, next to, or along with, the pleasure principle. His death-instinct forms the basis for what were later called the ‘ego-instincts’, and Freud postulated that repetitive trauma dreams, which he compared to transference neurosis, were ‘endeavouring to master the [traumatic] stimulus retrospectively. Both were part and parcel of what we now know as the ‘repetition compulsion’. (Freud, 1920)
Jung said something similar. He described repetitive nightmares as a traumatic complex of highly charged affect, and the intrusion of this complex into consciousness as ‘abreaction’. ‘Abreaction,’ he said, ‘appears as an attempt to re-integrate the autonomous complex, to incorporate it gradually into the conscious mind as an accepted content, by living the traumatic situation over again, once or repeatedly. ‘But Jung also added something that gave me a crucial bit of understanding. ‘Mere rehearsal of the experience does not itself possess a curative effect; the experience must be rehearsed in the presence of the doctor.’
So Jung holds that it is important to experience the traumatic affects together with another. Jung is not talking about the experience itself, but about the affects, the emotionally-charged complex that arose as a result of the traumatic experience. There is no basic distinction possible for the patient who feels caught in the grip of the re-experience, but as therapist I can make this differentiation. My hypothesis here is that the nightmare is not a needless repetition but an act of communication. And that telling of the traumatic nightmare to another, to the therapist, is an example of–or rather: can stand as a model for–what Jung means when he talks about ‘rehearsing [the experience] in the presence of the doctor.’ Because, Jung says, ‘The patient’s conscious mind finds in the doctor a moral support against the unmanageable affects. The therapeutic effect comes from the doctor’s efforts to enter into the psyche of the patient, thus establishing a psychologically-adapted relationship. For the patient is suffering precisely from the absence of such a relationship.’
I would like to briefly restate my understanding of what Jung says here. Traumatic experience can lead to dissociation, nearly all writing about trauma in the past century is in agreement about this point. One symptom of dissociation is repeating of the traumatic complex in the form of nightmares during sleep and re-experiences during the day, the so-called ‘repetition compulsion’. The therapeutic problem is not the abreaction, but how to bridge the dissociation. And the healing effects, says Jung, comes from an experience of relationship. Such feeling can only result if the doctor finds a way to allow the patient to experience having been understood or having been wholly seen.
Still, what everyone who has suffered through deep trauma says, it is a lament that echoes through all the literature: You will never understand what I have experienced. I am completely alone. This is true, of course. Trauma is not general. It is specific. There is nothing like losing a child or watching a comrade die be or being raped or tortured. There is only the death of this child or this unbearable pain. The argument I would like to advance in this article is that it is the image of the affects in the recurring trauma dream, if these can be told to another in a therapeutic or transitional space is an attempt to create a relationship. And that, accordingly, the function of a recurring nightmare –Jung writes about this as the transcendent function–is not only intra-psychic but also inter-personal, or: psycho-social.
Discussion
By considering the recurring dream or nightmare as an experience in the here and now, one lets go of the notion that we already know what it is about, this ‘knowing’ or omniscience is implicit in the term re-experience. I believe this ‘knowing’ stance is a defensive reaction on the part psychiatric framework and therapeutic practice in the face of the often overwhelming feelings of helplessness when confronted by inhumane and dehumanising acts of savagery and destruction. It then becomes possible, first, to open oneself up to share the experience with the patient, and secondly to notice subtle changes and to be able to explore the symbolic meaning of them. What I heard was that:
– the affect that was brought up with the nightmare was always and endlessly seeming the same: paralyzing fear, pain, humiliation, desperate grief, and a sense of overwhelming powerlessness
– but that the images that arose with those affects, could and did change, sometimes in small details, sometimes fundamentally.
As a result, dreams, even (or perhaps especially) those that repeat and work through some of the most painful experience that can be told and heard, can offer a way out of the impasse of loneliness and disconnection, and contribute to the establishment of a therapeutic relationship. And that relationship can lead back to life.
References
Freud, Sigmund (1920), Beyond the Pleasure Principle. In (1944) Standard Edition, Volume 18. London: Hogarth Press
Jung, C.G. (1921) The Therapeutic Value of Abreaction. Collected Works, Volume 15. London: Routledge
Vysma, M. (2001) Trauma Dreams and Reconnection. Unpublished Thesis as part of the Amsterdam Masters in Medical Anthropology, University of Amsterdam
Ventevogel, Peter, et. al. Dream Content in Refugees with PTSD, unpublished article