Affiliated member of the WPA – World Psychiatric Association

Abstract Hashemzadeh, Mona; Shakiba, Shima

Symposium
A return to the theory of trauma and it’s victims

Many scholars believe that emotions and attitudes of individuals about themselves and others are all influenced by their childhood experiences. Among the most important childhood experiences is the early childhood experience with the primary caregiver who is in most cases a mother (Arnes et al., 2012). Every year millions of children are exposed to trauma worldwide, although It is well known that exposure to trauma can lead to a wide range of mental health problems. Trauma can indirectly increase the risk of mental disorder by increasing the sources of chronic daily stress. Childhood trauma can have a profound effect on adolescent mental health. Systematic reviews show that child abuse predicts anxiety and depression in one’s life (Lindert et al., 2014; Norman et al., 2012). Growing evidence suggests that childhood traumas to the developing brain of children and adolescents have devastating effects. One of these effects is emotional disorders. Childhood abuse and neglect may lead to chronic disability and emotional fluctuation, resulting in an increase in emotional disorders such as depression (Bryko Hays et al., 2010). Mental trauma is a unique experience that an individual experiences an event or endures a difficult situation in which the individual is fragile in the integration of his or her emotional experience and personal experience (internal or mental) is a threat to life, physical and intellectual integrity. People may understand this fragility emotionally, cognitively and physically. Jan Allen emphasizes that there are two factors to a traumatic experience. Internal experience and external experience. Subjective experience is an external event that constitutes trauma. The more you believe you are at risk, the more traumatic the person will be (Violens, 1999). trauma is whatever outstrips and disrupts the psyche’s capacity for representation or mentalization. Absent the potential for mental representation, these events and phenomena are historical only from an external, third-person perspective. Until they are mentalized, they remain locked within an ahistorical, repetitive process as potentials for action, somatization, and projection( fonagy et al.2008). the psychological consequences of trauma, in an attachment context and perhaps beyond, entail a decoupling of mentalization and a reemergence of nonmentalizing modes of representing internal reality. This situation is pernicious because the immediacy of a memory experienced in the nonmentalizing mode of psychic equivalence has the capacity to retraumatize again and again, further decoupling mentalization and making the experience ever more real. Trauma in the attachment context is most pernicious because the biological basis of attachment assumes trust, and part of this rests on the safety of not having to mentalize . Trauma inevitably activates the attachment system. This activation (probably for evolutionary reasons) temporarily inhibits areas of the brain concerned both with remembering and mentalization. This is why mentalization comes to be so readily abandoned in the face of trauma, particularly attachment trauma. Unmentalized trauma endures and compromises mental function. Of course it also interferes with new relationships. When the self is experienced as being destroyed from within through identification with the aggressor, projective identification is felt to be imperative. In order to escape from the grip of trauma, the individual needs help to recover mentalization. Of course remembering in the context of an enduring psychoanalytic relationship is one such means, but not the only one (Gabard, 2018).

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Trauma: history and its relation with loss and mourning

According to Freud the first traumas in a development of every individual are birth trauma, weaning, birth of a sibling, loss of the feces in anal psychosexual stage and the most important one is castration. All of them are a kind of loss. Any other loss in adulthood reactivates these primitive losses and the helplessness inherent in them. The importance of loss in the experience of trauma is also emphasized in object relation theories. There is a loss of the good internal object and its protective function in every loss. So, the process of mourning and its pathologic counterpart melancholia is essential in the final outcome of trauma in victims.

References

  • Kirshner Lewis A. (1994). Trauma, the Good Object, and the Symbolic: A theoretical Integration. Int. J. Psycho-Anal.
  • Garland C. UNDERSTANDING TRAUMA A Psychoanalytical Approach. The Tavistock Clinic Series, Second Enlarged Edition

Mona Hashemzadeh, MD

 

Unmentalized trauma and reenactment

Unmentalized experiences and fragmented somatic or emotional experiences that are not symbolically represented are the critical elements for a theory of pathogenesis and mental functioning. Freud’s definition of “actual neurosis” (1895), Klein’s description of primary unconscious fantasy (1932), and Bion’s (1962) notion of unmetabolized beta elements all are the understanding of whether, or to what extent, the raw data of existential experiences is transformed into subjective experience (Fred Alford, 2018). Consequently, trauma is everything disrupts the psyche’s capacity for representation or mentalization. Until they are mentalized, they remain locked within an affective memory with repetitive processes as potentials for actions, somatization, and projection (Levine, 2014).

Reenactment is an essential feature in patients experiencing trauma-related pathology and refers to the generalization of previous relationships. Fonegy (2019) distinguished three types of reenactment of trauma. Revictimization, the most common form of reenactment refers to looking for relationships characterized by physical, emotional and sexual abuse, often involving rejection, abandonment or neglect. Another best-known form of reenactment involves reenactment of neglect. The patient detects any signs of neglect and prefers to interpret interpersonal situations in terms of neglect and becomes convinced that others are indeed neglectful. Sometimes the patient identifies with aggressor and treats him/herself neglectfully. Finally, reenactment of attachment trauma in parenting is also common in victims of childhood maltreatment. They are “ghosts in the nursery” that are unconscious effects of their past in the relationship with their children.

In fact, even single traumas could urge a pressure in the victim to reenact what has happened or to project the traumatic experience to others who have no choice to feel what the victim of trauma feels.

References

  • Bateman, A. W., & Fonagy, P. (2019). Handbook OF Mentalizing in Mental Health Practice. New York: American Psychiatric Publishing.
  • Fred Alford, C. (2018).  Trauma and psychoanalysis: Freud, Bion, and Mitchell. Psychoanalysis, Culture & Society 23, 43–53.
  • Levine, H. (2014). Psychoanalysis and Trauma. Psychoanalytic Inquiry, 34:214–224, 2014.

Shima Shakiba, PhD

 

A case Study

The lecturer is going to present a case of a childhood trauma.

Amin Solhi, MD

 

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