The Unbearable and the Unsayable
I was recently speaking with a noted psychiatrist and psychoanalyst, and he told me that clinicians generally don’t understand something important about the impact of trauma - that it changes the structure of a person’s brain, permanently. According to this idea, he further explained, certain pathways of excitation and reaction are laid down “in the neurological substrate” by very severe trauma, and once this has occurred the person is altered biologically and the central nervous system responds differently forevermore. It was implicit in his thinking that psychoanalytic exploration would never be capable, in itself, of affecting these supposedly permanent alterations. If such an idea is true, it would appear to set limits on the applicability of psychoanalysis to those many conditions in which severe trauma plays a role. I decided to ask my brilliant friend Dr. E., also a psychiatrist, what he thought of this view. Our talk branched out into a wide-ranging discussion of the nature of the experience of trauma.
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Part 1
G.A. So, old friend, tell me what you think of this idea that trauma may create irreversible changes in the structure and functioning of a person’s brain.
Dr. E. It is difficult to see how one would substantiate an idea like this. It is very crude, and actually is more of a fantasy than a scientific hypothesis: a neurological fantasy .
G.A. So you don’t think it has any significance?
Dr. E. I didn’t say that – the fantasy does have a meaning. The image of irreversible changes in the brain is probably a reification of certain feelings that lie at the heart of trauma.
G.A. What are the experiences that are being reified in such imagery?
Dr. E. It is apparent what the experiences are, G.A.: it is a matter of a person’s sense that he or she has been irrevocably changed by what has occurred. It is the feeling that one will never be the same again. A person undergoing such a feeling might have a dream of his or her brain having been permanently damaged or modified, but taking such an image literally, as your medical colleague seems to have done, is not anything one should become terribly serious about. It may be that this reification serves in part as a means of neutralizing the devastating power of trauma. Is your friend by any chance himself a trauma victim?
G.A. Yes, early physical and emotional abuse in his family, and multiple illnesses later that devastated his whole childhood.
Dr. E. Somehow that does not surprise me.
G.A. What exactly do you mean by the term, ‘reification,’ Dr. E., and how is it that this is used to neutralize the pain of trauma?
Dr. E. Reification in this instance is the transformation, in imagination, of a subjective experience into a material thing, It is the symbolization of something felt in a concrete image, and then simultaneously the loss of the sense of the symbolic as the image is recast as existing in physical reality. The feeling of having been irrevocably altered is replaced by a compelling vision of an irreversible physical change in the nervous system. There you have it. By concretizing an otherwise terrifying experience of no longer even being the same person one has been, the feeling of personal disruption and discontinuity is diminished and encapsulated to some extent. People like to nail down such things that happen to them in specific, localized physical images, and that is exactly what is occurring here. It is kind of sad though when one sees these processes unconsciously giving rise to supposed psychological and physiological theories. Such ‘theories’ never take us anywhere, except away from the intensity of the experiences they are presented to explain.
G.A. Tell me more of your thoughts regarding trauma, and about the changes through which a person passes in the wake of this experience.
Dr. E. I don’t even know where to begin, G.A.. You have a way of asking impossibly general questions, and leaving a person with the impossibly difficult task then of answering them.
G.A. Okay – how about this? Tell me your ideas about dissociation, about the nature of the change that occurs when a person passes through a traumatic experience but then seems not to know that he or she has done so. Tell me how it comes to pass that someone develops an amnesia for an event that has transpired.
Dr. E. Not a good question, G.A. It doesn’t lead to anything interesting. A person who has amnesia for some emotionally traumatic event just has the amnesia, and that is it. He or she doesn’t remember it. In fact, as far as that person is concerned, it never occurred. The person becomes someone in whose life the event did not happen. That is what dissociation is.
G.A. Yes, Dr. E., but how is that possible? How can a person become someone something did not happen to? Can it be said that this involves a splitting of consciousness?
Dr. E. Consciousness does not and cannot split. It is not a material thing. Only material objects, like diamonds, can split. The person becomes someone for whom the incident did not take place, and nothing more.
G.A. But what about the whole tradition in our field that pictures consciousness as undergoing such splits: vertical splits, horizontal splits, dissociations that segregate one nucleus of experience from another.
Dr. E. Those images are all concretizing reifications, rather like the supposed brain changes you began this interview with; they refer to nothing objectively real and they explain absolutely nothing. They are symbols we use to represent and attempt to master experiences that are beyond our capacity to assimilate.
G.A. Well, you say the person becomes someone for whom the event did not occur – but obviously the event did occur, and the person is not someone whose life was unaffected. So how does one understand this sort of thing?
Dr. E. I told you there isn’t anything more to it! Are you deaf? Something happens in someone’s life. It is too much for the person to bear, so it is not borne. It is too much to be put into words, so nothing is said. It is too much to even be aware of, so awareness vanishes. The person has become someone for whom it did not occur. Of course the person is nevertheless affected by the incident, whether he or she knows of its existence or not. The events of our lives have all kinds of effects on us, regardless of whether those events are accessible to our conscious recollection. Please stop asking these bad questions.
G.A. You may find the questions bad, Dr. E., but I find your answers to them interesting anyway. So bear with me, my friend. Let’s go more deeply into the things that happen to people in the context of very severe trauma. What are your views on the problem of multiplicity and so-called dissociative identity disorder?
Dr. E. What do you mean ‘What are my views’? That is like asking what are my views on the moon. I have no ‘views’ on multiplicity – it is a phenomenon one encounters from time to time, and that is it. I warned you to stop with such questions.
G.A. But surely you are aware that there is a controversy in our field about the very existence of this disorder, that is, the reality of multiple personality. Some people say it is real and is generated by severe childhood trauma, most often including sexual abuse; other people say it is a fiction, created by zealous therapists working with suggestible, compliant patients.
Dr. E. I don’t waste my time with such discussions.
G.A. Tell me anyway something about your experience in this area. Have you had a chance to observe and/or work with such patients?
Dr. E. Many. So what is your question?
G.A. Well this appears to mean you are one who believes dissociative identity disorder is a real phenomenon rather than being something that is induced.
Dr. E. You just won’t let go, will you? I am not a believer in any “real” phenomenon of multiplicity, if I understand what you mean by this; nor do I subscribe to the oversimplified notion of anything being “induced.” These are false and useless alternatives: the first assigning the essence of so-called dissociative identity disorder exclusively to the patient, and the second to the influencing therapist. Multiplicity comes into being, in all its glory, at the interface of patient and analyst and both make their contributions. It is neither independently real, nor is it unilaterally induced. A person with a history of unbearable, unsayable trauma comes into a developing connection with someone – perhaps an analyst, but it could be anyone - and depending on the kind of response this person encounters, the trauma history may begin to emerge in the form of a flowering of seemingly autonomous alters. It is also possible no such emergence will take place and the history will remain mute.
I had an experience many years ago with one such patient that taught me much about this matter. A 45 year-old woman called me for a consultation regarding her ongoing psychotherapy. She had been in analysis for 8 years with a well known figure in our field. She said she was unhappy with the results of her treatment and needed advice on what to do about it. I asked her to tell me about her relationship with her analyst as well as about her background. As a child she had been the victim of profound sexual abuse by her mother, who had used her relentlessly during her early years as a masturbation toy. She said that there had once been “some boys.” A question came into my mind, and I decided to voice it. I asked her what the names of the boys were. She said she did not recall, and also the boys were gone and it was all a long time ago. Then another thought came to me, and again I decided to express it. I told her I thought it wasn’t a very nice thing to forget a person’s name. She was quiet for a moment, and then she said:
“I think you are a mother. That is the whole problem in my analysis – my analyst is only a father. He always wants me to be grown up and reasonable.”
As we spoke about her dilemma, the names of the boys began to come back to her. Finally she told me that the boys had not disappeared; it was rather that they had gone into hiding because they believed her analyst hated children. I asked her where the boys had hidden themselves. She answered that they had hidden in her stomach. She had suffered for many years with difficult gastrointestinal symptoms.
I telephoned her analyst and advised him to speak to her about the fact that “the boys” believed he hated children. He tried to raise the issue with the patient, but was unable to avoid giving her the impression that he still hated children. He told her he wanted to know where she had gotten such a strange and incorrect notion. Their so-called treatment ended at this point. I knew this analyst well, and the boys were right in thinking that he hated children. The child he hated most of all, however, was the one he carried within himself. It was the traumatized child he had once been, whose painful experiences had been wholly disavowed. He was a very grown-up person, too much so, a highly cultured gentleman who prided himself on his maturity and sophistication. If an analyst is not on friendly terms with the child within, there is no chance for there to be successful clinical work with patients such as the one I am describing. The world of ancient trauma simply cannot manifest itself, and if there are alters that have begun to crystallize, they will vanish in the face of the analyst’s intolerance and hatred. An analyst who can bear his or her own childhood feelings, by contrast, will tend to respond maternally to any signs of such experiences in a patient, and the stage is then set for the coming forth of the trauma. Boys long forgotten come out of hiding, and the memories they hold have a chance to be more fully remembered and disclosed.
Having terminated her therapy, the patient began to see me instead. Her analyst reacted by accusing me of unethical conduct in stealing his patient. I do not believe it is possible to steal anyone’s patient, since patients are not possessions, but his behavior made the new treatment she and I were undertaking more stressful than it needed to be.
G.A. So tell me what happened with this patient.
Dr. E. It worked out pretty well and there is not a lot to tell. The horrors of her early life were more completely explored, the boys were able to leave their hiding place and be recognized, and eventually, after many years, there were signs of a more complete wholeness than had been possible before.
G.A. What signs of wholeness did you see?
Dr. E. At a certain point, she ceased to speak of boys, or of the little girls who were also included among the 5 alters that I met in this case. I did not ask where they had gone, knowing that they were not in hiding but rather that some important growth process was taking place. Finally, the patient developed a love for gardening. She planted an enclosed, beautiful flower garden arranged in a pentagon, where 5 different kinds of flowers would bloom simultaneously. It was implicit that the 5 areas of flowers corresponded to the 5 alters, and that the planting, nurturing, and enclosing of the garden enacted aspects of the coming together of the previously separated parts of herself. She and I never discussed this, however. Sometimes silence can be a fine and golden thing.
G.A. So are you telling me that the phenomena of dissociation are embedded in what is sometimes called an intersubjective field?
Dr. E. Yes, as is all psychopathology, of every form and degree. But I don’t much care for philosophical terminology. Let us just say that people are what they are, feel what they feel, and do what they do in part because of how they have been and are being responded to by others. This is the human condition, for better and for worse. Dissociation itself can only occur in certain kinds of contexts, generally ones that deny a child the opportunity for his or her feelings to be recognized and validated in any way. A dissociative person lives in a relational world that contains no room for the events that have vanished from recall. If any sign of the disappeared history shows itself, the child encounters reactions of incomprehension, hostility, and/or agonizing pain. Sometimes the child is marginalized or even excommunicated from the family. Once the space for those events materializes on the other hand, perhaps in the patient finding someone to listen who can be a mother, they begin to reappear, along with the children to whom they happened. Eventually it all comes together and is really not all that complicated.
G.A. Give me an instance of how dissociation arises and is maintained within such a relational world.
Dr. E. The examples are abundantly available to any clinician who works in this area. The one that comes back to me at this moment concerns a 30 year-old woman who, as a child, had been horrifically abused by her grandfather. He had repeatedly raped and tortured her from when she was 4 years old until she was 11 or 12. All memory of the events had vanished as she grew into adulthood, the family system as a whole being one of consistent denial. At the age of 28, however, she began to have conversations with one of her cousins, a woman who, like herself, had been attacked by the grandfather. In the dialogue between the two of them, fragments of the lost memories began to reappear. The grandfather was an iconic figure in the family, revered and honored by all. Although his demonic side had victimized a number of family members, this was erased from the family system’s conscious history. Finally the grandfather died and a great funeral and memorial service took place, an occasion for mourning the loss but also celebrating what everyone saw and needed to see as the greatness of his life. The woman I am speaking of chose this opportunity to break the silence, as she stood before the mourners and tried to give an account of how her grandfather had raped and tormented her. She bravely, or foolishly, was insisting that this was an occasion on which the truth could no longer be buried. Before the first sentences escaped her mouth, however, her brothers and uncles rushed up to her and carried her out of the meeting hall, throwing her into the street. She was told that what she had tried to do was unforgivable and that she was crazy.
G.A. So what happened to this woman then?
Dr. E. She killed herself shortly after this incident.
G.A. She killed herself? What is your understanding of the suicide?
Dr. E. I think this was her way of trying to raise the stakes with her family, by staging an event, as she probably imagined it, so dramatic that they could not deny it. Sometimes the truth is much more important to a person than even life itself. This story is very sad and very depressing though, because her plan did not work out at all. The family looked at her suicide and saw it as a confirmation that she was crazy. Denial systems such as this one cannot be broken down by direct confrontations with the truth. A space for that truth first has to be created. You are tiring me out again, G.A. Come back tomorrow.
G.A. Just one more question, please. If you were working with the woman you just told me about, wasn’t there a way for you to intervene to avert the suicide?
Dr. E. I was seeing her cousin, not her, and only found out about the whole story after the death. See you tomorrow.
Part 2
G.A. Good morning Dr. E! I want to return to a discussion of the experience of trauma itself, and the challenges we face as psychoanalytic therapists working with patients whose lives include such experiences. Is it the case that some things that may occur are simply, plainly just ‘too much’? In other words, are there events that transpire in human lives that cannot be faced, that are, because of their magnitude, literally impossible to integrate into our sense of who we are? And if there are, then what do we do as clinicians in the face of these circumstances?
Dr. E. There are events that feel unbearable. But are you asking whether sometimes certain events are literally beyond anyone’s capacity to deal with? I don’t see how one could answer a question such as this, and I am afraid, once again, you have raised an issue that isn’t worth discussing. You are good at that, G. A., and I suppose it is commendable to be good at something, but I ask you nevertheless to stay with questions that can be answered.
G.A. Let’s talk about specific personal experiences though. I spoke to someone recently who told me he felt Mt. Everest had fallen upon him. The specific context was the eruption of long-dissociated pain relating to the deaths of his parents and a number of siblings and cousins when he was a boy. This person had had an earlier psychiatric consultation and antidepressants had been recommended by the doctor he spoke to. He was so flooded that the psychiatrist deemed it advisable to contain and reduce the intensity of his suffering with a drug. I know such treatment is not your favorite, Dr. E., but talk to me about what we can and should do in the face of such overwhelming pain. Many in our field recommend the use of medications based on the idea that many aspects of the experience of such severe trauma are intrinsically destructive and impossible otherwise to manage.
Dr. E. I agree it is tough to manage Mr. Everest falling on one. But I would ask, what if Mt. Everest did fall on a person? What if the experience of the catastrophic pain is in exact proportion to the magnitude of the disaster that did indeed occur? You mentioned someone that lost both parents and other family members as well during his childhood. Are you aware of how such losses can accumulate and amount to the ending of a child’s world? Are you asking me how we, as clinicians, can respond to this pain?
G.A. Yes, please.
Dr. E. It will obviously vary with the specific situation, but in the case of your man who lost his family as a boy, how about simply empathizing with the magnitude of the loss? How about making every effort to stay with the intensity of his experience?
G.A. But how does one do that? The experience is one that is impossible to bear.
Dr. E. Then that is what you stay with, the very impossibility of the unbearable pain. You see, G.A., if you somehow get lost in the concreteness of it all, and perhaps agree the person faces something impossible to withstand, then the only solution is to numb the pain, with medications, alcohol, or maybe it would come up that suicide would be very effective as well. Such literality takes us nowhere we want to go. Resist the literalizing impulse, and stay with the feeling that is present in the moment. If that feeling is one of Mt. Everest crashing down on one’s head, so be it. Actually in this story I would understand the patient’s use of the metaphor of Mt. Everest as his way of trying to express the experience of his whole world having been crushed and destroyed. Maybe I could say exactly that to him.
G.A. That sounds good, but how does that reduce the person’s pain?
Dr. E. It probably would not, but that is not a goal worth pursuing. The goal is to let the suffering be expressed, to let the emotional truth of a life finally have a chance to be put into words and images. A space is then being created for that pain that has not existed before. It might even be that the person’s agony would increase in consequence of the sort of discussion I am suggesting, but he or she would then be more in the truth. This is all kind of obvious again, so please raise more interesting questions. Why do I have to keep asking you to do this?
G.A. As you know perfectly well, Dr. E., I am asking the sorts of questions people generally might ask, and I want your thinking disseminated to them to others in our discipline. If you will be a little more tolerant, I will endeavor to deepen the questions I am asking.
Dr. E. The problem with “disseminating” my thinking, G.A., is that the professionals in our field generally don’t want to hear about it because they think they have it all figured out. They have made up their minds about such matters, and you can’t get through to them; only to the young that still have an openness, and for them, the questions need to be better ones.
G.A. Why do you think it is, then, that so many clinicians, including trained psychoanalysts, are occupied with the alleviation of suffering as their primary concern? If the real goal and power of analysis lies in the articulation of a life’s truth, then the whole emphasis on the taking care of people in pain has a wrongheadedness about it.
Dr. E. There is nothing wrong with wanting to reduce another person’s pain, and one always hopes someone can find ways of living that are satisfying rather than full of suffering. A problem arises though when the analyst has a driving need to alleviate pain, when he or she cannot tolerate what may be a natural experience by the patient of intense negative affect. The reason so many psychotherapists are compelled to reduce their patients’ pain has to do with the lives of the therapists themselves, with the family constellations in their histories that set them on a path toward their careers. It is almost always the same story: a sensitive child is enlisted by a parent to provide the emotionally sustaining, soothing nurturance that was missing in the parent’s own developmental background.
G.A. Is this what Alice Miller called The Drama of the Gifted Child?
Dr. E. Yes it is, but the original title of that book was Prisoners of Childhood, which was much better. The analyst is captive to his mother and/or father, in the sense that he or she, unconsciously, is always drawn to alleviating the parents’ (and patients’) pain, and the grip of this mission is an imprisoning death camp for the analyst’s soul, if you think about it. If the child, fated to become a psychotherapist later in life, breaks away from the role of soothing and otherwise supporting the parent, he or she catapults that parent into an agony state and is attacked and/or emotionally abandoned. This theme then plays out in the psychotherapy practice, where the real power of analysis – to address the truth of a life – becomes subverted by the ancient agenda of relieving parental pain. All kinds of strange collusions and evasions then begin to structure the analytic dialogue, defeating its potential to achieve its most important goals. This is a worthy topic, but I am not interested in discussing it any further with you.
G.A. How about this as a question then: What are the greatest challenges facing our field in the area of the understanding and treatment of survivors of extreme trauma?
Dr. E. Some issues come to mind that create great difficulty for many of the clinicians in our field, but I don’t know if you would be referring to such things in what you are calling challenges facing our field. These are issues pertaining to the heart of the trauma experience and to what can and cannot be achieved in a psychotherapy process. They include the dream of purifying the soul of the effects of trauma, the freezing of time as a consequence of trauma, and the infinite isolation and loneliness created by trauma. Do you want me to talk about all this?
G.A. Please do.
Dr. E. The term ‘trauma recovery,’ if you think about it, is almost an oxymoron. Trauma, as I use the term anyway, is not just a terribly painful or shocking occurrence in a person’s life – it is an event or series of events that is too much to bear, too much to take in as even having happened. The idea of recovery is about getting over something. I think there is no getting over real trauma. This sounds like a message of hopelessness, but it is not, so give me a moment to explain. Belief in the possibility of ‘recovery’ from trauma, understood as a nullifying of the devastation, is a form of denial. Most analysts, and especially those that are animated by an unconscious goal of nurturing and healing a wounded parent, cannot understand this. Their commitment is to radical healing, a transformation that undoes the traumatic wound once and for all. Such clinicians encourage their patients’ dreams that their terrible life histories can be transformed and purified, that the pain can be permanently removed and supplanted by a healing experience of joy and love. Such expectations are inevitably dashed as the enduring reality of the traumatic injury continues to haunt the person’s existence. There is no pot of gold at the end of the road of the psychotherapy of trauma. Under the best of conditions what one does find there is a release from captivity as dissociation gives way to wholeness, and then abiding sadness.
G.A. I am not understanding how can you say there is no hope for trauma survivors. If you tell someone there is no hope of recovery and that all they can look toward is sadness, that person, if he or she believed you, might just want to die.
Dr.E. There you go again. Do you deliberately not listen to what I am trying to say? I did not say there is no hope. What I said was that there is no hope of a recovery that purifies a person’s life and does away with the trauma. It belongs to the events we are speaking of that they will affect the person down to the moment of his or her last breath. There is however hope for the person, for his or her life and future – generally there is profound hope, and I would always seek to communicate a sense of that as someone is beginning to bear the unbearable and say the unsayable. But that future for which one can and should hope is not to be one free of the pain of the past; it will be a future that contains that pain, one that includes the events that formerly could not find a home anywhere. It will be a future of wholeness, as I said.
G.A. So how does the analyst dispel someone’s hope and expectation for what you are calling ‘purification’ and ‘recovery’? Also, is sadness all someone can then hope for? That sounds like a pretty depressing goal to be reaching for.
Dr. E. The wholeness of a person is not empty and is not depressing. It means that the individual becomes wholly present, and is no longer having to pour effort into being someone various things did not happen to. Good things flow from such a transformation, but the erasure of trauma is not one of them. Among the blessings that come with wholeness is the freedom to be who one is
It is generally very difficult for a survivor of significant trauma to accept that there will be no purification, for this situation often includes all manner of curative fantasies that carry the hope of undoing the injuries of a traumatic past. Sometimes those fantasies are the only thing that has helped the person avert a suicide, so the realization of the irreversibility of trauma may be fraught with danger. A binary opposition has crystallized: absolute emancipation versus everlasting imprisonment. Anyone dwelling within the terms of this binary will tend to hear what I am saying as a message of despair, and I emphasize again that survivors of trauma are people for whom there is genuine hope. The role of the analyst is to work, in concert with the patient, to establish a setting that will come to include the unbearable and unsayable. The patient will fall, sometimes devastatingly, into despair in the course of this process, feeling there is no hope for survival at all. At such times the analyst must connect to that despair and reflect his developing understanding of its original and contemporary emotional sources. If he does this, he contradicts the expectation that there is no place for the suffering that is felt, and a third way out of the binary choice between freedom and captivity is found. The unbearable can begin to be borne and the unsayable can begin to be said. This is the pathway toward wholeness, and it can be a very long one.
G.A. How about another example to clarify what you are describing?
Dr. E. Okay. After a number of years of analytic work, a 25 year-old patient told me she had begun to remember having been sexually assaulted by her father as a small girl. The memories began slowly, with faint impressions of something bad having happened, something terrible that her father did. She begged me to tell her it was a matter of sick fabrications on her part, false memories, but I was unable to comply. Then the recall accelerated. There was a nightmare that occurred at the time, symbolizing the eruption of a long-buried history. In the dream the patient was walking along a country road and encountered an outhouse. She opened the door and looked down into the toilet. She saw dark foaming liquid swirling about, going around and around. Then the motion of the liquid intensified and its level began to rise. Gurgling, foaming, it finally spewed forth in a violently explosive geyser. A torrent of dark memories afflicted her, including dozens of times in her early life when her father had come to her in the night and forced himself upon her sexually. She could not bear the recollections.
“I can’t live with this. It will kill me. I will kill myself. I have been killed. I am already dead so I want to be dead.”
G.A. So, how in the world do you make something impossible possible? She is telling you life has become unlivable in consequence of the remembering.
Dr. E. Exactly, and that is what one tries to stay with. You see, she didn’t believe there could be any human understanding of what she had been through. It was her conviction, like that of every abuse victim I have ever known, that she was irredeemably bad, and by virtue of that badness, no one would respond to her suffering with anything except revulsion and hatred. That is a core aspect of the battle: to defeat such expectations.
G.A. Tell me then what happened between you and this young woman.
Dr. E. She and I talked to each other for 30 years.
G.A. But what happened in her life?
Dr. E. She eventually did well – she became an exceptionally creative person, developed close friendships, married and raised two beautiful sons.
G.A. Well that sounds like recovery if anything is!
Dr. E. She did not ‘recover,’ in the sense of erasing the pain of her childhood history. The incest imposed on her remained an enduring source of pain. She did however remember her whole history, and although it continued to be a source of suffering for her, she was not captive to it and did not repeat it. Abuse histories that are not remembered are always repeated upon the next generation or its surrogates; histories that are emotionally recalled, in contrast, are transformed into dangers one protects the next generation from.
G.A. What occurred between this woman and her father? Was he still alive through the long course of her therapy?
Dr. E. Yes he was, and she was always polite with him, outwardly. She remained painfully aware, however, that he had committed unforgivable crimes against her.
G.A. Is there a place for forgiveness in the journey of such a trauma survivor?
Dr. E. Do you mean a place for the victim of abuse forgiving his or her perpetrators?
G.A. Yes, exactly. There is a body of opinion in our field affirming the desirability of forgiving those who have hurt us as a way of healing old wounds.
Dr. E. Do you think a holocaust survivor who has lost her entire family to the Nazis should forgive those who murdered all her loved ones? Some crimes are simply unforgivable, and anyone who claims to have achieved forgiveness in such a situation seems to me to be moving into a strange and impossible place. I would say the sexual attacks against the person I am describing fall within the group of such crimes. I have little patience with the proponents of forgiveness, who, if you think about it, are the merchants of denial.
I was actually present at a conversation between my patient and her aging father in which he said he was sorry about what had happened and begged her to forgive him. This talk occurred several decades after the original assaults. The father’s request, passionately presented, was itself another crime committed against my patient, and it caused her great pain at the time. He seemed to be implying that if only she could accept his heart-felt apology, they could all move on and the terrible events of the past could be left behind. In other words, they could all recover. Such an idea is preposterous because there is no moving on from such crimes. There is however a freeing of a person from captivity, and such emancipation requires a journey into the truth of what has transpired. Nothing else will do. It would have helped my patient if her father could have said he knew what he had done was unforgivable, but he was unable to make such a statement. People capable of committing horrific crimes against children are generally unable to assume the human responsibility one would like to see.
G.A. You said you and this patient spoke to each other for 30 years. What happened after that?
Dr. E. The patient died.
G.A. What killed her?
Dr. E. A cardiac infarction, suffered at age 56. It was very sudden and very sad. She did however get to see her sons grow up and led a very good life. She did not feel she had ‘recovered’ from the traumas of her early years, nor should she have. She knew the truth of her own history and was able to do beautiful things with that knowledge. If more people had an equal level of understanding and awareness, this world would be a better place. I need another break, G.A. You are exhausting me.
G.A. I will be back tomorrow, Dr. E. Rest yourself my friend, and thank you for your thoughts.
Part 3
G. A. Well, here we are again! Good morning! I trust you are rested. The sun is shining, the birds are singing, and it is a great day for more conversation!
Dr. E. Spare me the hypomania, Atwood.
G.A. Thank you for the feedback, grumpy old man. Anyway, what I want to do is to pursue the other two challenges or issues you mentioned regarding the understanding and therapy of trauma, one about what you referred to as the ‘freezing of time,’ and the other about ‘infinite isolation’ experiences. Tell me first about the effects on time.
Dr. E. Time comes to a stop for a person subjected to extreme trauma, even as time continues to pass for that very same person. It is hard for a great many people to understand how this could be the case. It happens because something is impossible to go on with. I will give you a story in illustration.
I once met a woman whose husband had been killed by a drunk driver one evening, while he was on an errand for his family to pick up Italian bread for a spaghetti dinner. The tragedy had taken place 20 years before I met this person. She told me about all manner of difficulties in her life, and at the end of our discussion added that she never thought about her husband. I expressed amazement at this, and she responded:
“Well, never, except for in my dreams. I have the same dream about him every night. I dream every night that I am sitting at my kitchen table and my husband walks in with a loaf of bread. I have no idea why I should have such a dream. Do you think dreams mean anything?”
Time stopped for this woman on the day of her husband’s death. She had been sitting at her kitchen table, waiting for him to return with the Italian bread so the family could have its dinner. Eventually a policeman came and informed her that her husband had been killed. Her repeating dream shows that she was still sitting at that table, waiting for her husband to return for the next two decades. Time had ceased to flow, and although in one respect clocks kept ticking and years kept passing, in another respect they did not. And strangely, she seemed not to know that a freezing of time had taken place. When I remarked about the apparent significance of her dreams, I thought I saw tears begin to form in her eyes. But then they receded.
Even sadder than what happened to her, however, was what she told me about the fate of her daughter, 12 years old at the time of the husband’s awful death. The girl had loved her father above all others in heaven and on earth. She showed no disturbance in her life in consequence of the tragedy; if anything, her level of functioning seemed to rise over the course of the next years. She became a straight-A student in school, participated very actively in sports and social life, and eventually went on to an excellent college with full scholarship support. After graduating with a degree in architecture (her father had been in the construction industry), and looking toward a very bright professional future, she met a young man and fell in love. They decided to marry. Everything in her life seemed to be coming up roses. The disaster occurred when she and her young man announced their engagement and set a wedding date. She collapsed into a profound, unexplained depression. Suddenly she refused to get out of bed in the morning, saying she was paralyzed.
“ I feel there is something horribly heavy resting on top of me. Something is closing in on me. I can’t live and I can’t move and I can’t breathe.”
The mother called a psychiatrist in order to get help for her daughter’s sudden deterioration. She was referred to a medical group in a local university that was investigating and treating depressions in young adults having a sudden onset without identifiable precipitants. These doctors thought they had discovered a distinct mental illness that had not been recognized in psychiatry up to that time. They called it: ‘acute endogenous depression of young adulthood.’ Their idea was that this illness, organic in origin, related to subtle neurochemical changes in the brain, and they hoped to infer the nature of these changes by studying the effects on the depressions in their patients of various experimental cocktails of drugs. The young woman became their guineapig. Vast numbers of drugs and combinations of them were tried on her in the ensuing period, with mixed and unreliable results. She would briefly improve from the most severe extremes of her so-called depression, but then fall back into it and once again become unable to function.
I asked the mother had she considered the possibility that her daughter’s unexplained breakdown might be related to her father’s sudden death that had taken place 10 years before. I added that since there had been no signs of emotional disturbance during the interim, it was likely the child’s grief had been buried. The experience of the traumatic shock of the father’s having been killed and then the pain of the mourning seemed nowhere evident in her history, and so I suggested she had saved these reactions up and now was being flooded by them. I added that her experience of a heavy weight on top of her might reflect an identification with her father, whom she was picturing as being crushed under six feet of earth. The feelings of being closed in and unable to breathe equally could be her way of being with him within the coffin, in his state of death, not moving, not breathing. Here too one sees an arrest in the passage of time, a resistance against moving forward in life, to building and embracing a meaningful future and a family of her own. Such progressive developments, in the context of this young woman’s life, would mean departing forever from her beloved father and leaving him permanently behind. Inasmuch as he had been the center of this woman’s life and his loss could not be grieved, this was not possible for her. I urged the mother to seek some sort of psychological help for her daughter, focused on the buried grief and the factors interfering with it. To my surprise, she rejected this advice and said both she and her daughter had faith in the biological psychiatrists. A sick feeling came over me at this point, and later that day I became physically ill. I do not ordinarily express my emotional reactions to distressing events in bodily reactions, but in this instance I was tremendously disturbed by the mother’s refusals to even consider the possibililty in her daughter’s life of an arrested grief reaction. I did not speak to the woman again for many years. Almost two decades later, she developed a metastatic cancer, and returned to me for a single consultation. This presented an opportunity to ask about what had happened to her daughter. It was so sad. For all the years that had elapsed in the meantime, the drug trials continued, the daughter had been in and out of psychiatric hospitals, and her planned marriage and career and really her whole life lay in ruins. Her fiancée had left her, she never worked as an architect, and she had become massively obese.
G.A. That is a depressing story about depression, Dr. E. I am left with one question about it. Why could the daughter not grieve the loss of her father? Granted his violent death is a trauma and a shock that is off the scale; and yet, still and all, other daughters manage to come to terms with such tragedies without destroying themselves and their lives.
Dr. E. I have wondered about that very question. The story, if I have read it correctly, is of a family in which there was no possibility of mourning the loss, and the daughter’s so-called illness – her ‘acute endogenous depression of young adulthood,’ as her doctors wished to think of it – was her way of preserving contact through an identification with her father in his state of death. The mother also maintained a tie to her lost husband, as reflected in her repeating dreams of him returning home with the bread. You will recall the mother refused to consider the possibility that her daughter was captive to an arrested grief reaction – I think for her to have accepted this would have required her to confront her own mourning, something her dreams suggest was not possible for her as well. Why it was no mourning could occur I just don’t know, but there have to have been reasons.
G.A. Speculate for me about what those reasons could have been.
Dr. E. First, the daughter - let us imagine that something went terribly wrong early in her life between herself and her mother, something that meant no real relationship between the two of them could continue. There were some signs in the mother of an enveloping narcissism, and she may have been one of those who invite their children on an emotional journey from which there will be no return. Imagine further that the tie to the father then became the foundation of the daughter’s life and being. To grieve the loss of the father then would have meant giving up the one in relation to whom her very existence as a person was sustained. Under such circumstances mourning cannot occur and the lost parent remains as an enduring presence to the surviving child. I would assume the father’s existence was maintained somehow throughout her adolescence, perhaps in part by her molding herself into a duplicate of him in a female body. Whatever the path of keeping him alive was, it could not continue once she entered into her own anticipated marriage. Perhaps the wedding plans triggered her collapse, when she began to think about the part of the ceremony in which the father gives away the bride. Her identity as a person being contingent on feeling connected to him, a more dramatic symbol of that closeness then broke into being: her deathlike depression. The clinical work in a case such as this consists in the exploration of the tie to the lost parent, of its foundational function in sustaining the child’s being, and of all the circumstances and events that played a role in magnifying that function. One hopes such an exploring will set the stage for a more productive form of mourning that will not cost the young woman her life. No attempt along this line was made.
Second, the mother – she too evidently held the husband at the center of her existence, and she continued her relationship with him in her dreams, forever awaiting his return home from the trip to the store to buy bread. It could be that her story is the mirror of her daughter’s: that she too had been exclusively tied to her own father and dependent on him for her sense of being. Maybe her husband inherited this function in her life, and as a consequence there was no possibility of accepting the death and mourning the loss. I never came to know her well enough to be sure that this was the general story, but I have known many such cases over the years.
The tragedy in this family, involving both mother and daughter in an arrest in the passage of time, is associated with a death, but extreme traumas of other kinds also freeze time. The reason is not complicated: it is always a matter of something happening that one simply cannot make into a part of one’s history. It remains in an eternal now, perhaps hidden away in a persistent amnesia. There is a terrible aloneness in that frozen moment, a sense of having become limitlessly cut off from the whole human community. The loneliness is possibly the most unbearable aspect of the entire experience.
G.A. The clinical story about the woman and her daughter is interesting, tragic, depressing - - but it is mostly conjecture. Can you give another story illustrating the freezing of time more directly?
Dr. E. Yes, I can, and it involves my first clinical case of so-called dissociative identity disorder. The events I will describe happened 40 years ago. I had been working with a woman, then 24, for perhaps two years. She was suffering with some fairly serious depressions that came and went, and my understanding of her at the time centered around a lasting loneliness she seemed to feel and that traced back into her childhood. It did not occur to me that she might be a multiple until one night something happened that indicated it unequivocally. I received a telephone call from someone speaking in a high, falsetto tone. I asked her who she was, not recognizing that it was this patient. The answer coming back was:
“This is little girl … I am four years old…..she…doesn’t know about me…I want to tell you where I come from.”
I realized at this point that this was my patient, and that I was speaking to an alter. I asked her to go ahead and tell me where she came from
“I am in a room full of grownups. It’s a party. A door opens and someone comes in carrying a platter. There is a baby boy on the platter. They put it down on the table. Then a tall man with a beard comes in. He is carrying a knife. He goes over to the baby and takes the knife and cuts the baby’s penis. The baby screams and blood spurts out of his penis. All the people in the room clap and hug each other and are happy. I don’t want to be like these people. They think it’s fun to hurt babies. I don’t ever want to grow up. I will never grow up.”
Time froze for this little girl and thenceforth she did not age, like Peter Pan, remaining just 4, although chronologically the patient was 24. She – the 4 year-old – had lived in the meantime in a secret playground, but was now coming out to make contact with me.
G.A. Obviously this was a Bris.
Dr. E. No, it wasn’t. It was an inexplicably joyful attack on the most vulnerable part of an infant’s anatomy. That is how it was held by the alter for the next two decades, and it was many more years before the events could begin to be reinterpreted as a Bris.
G.A. So tell me what then happened in this case.
Dr. E. What happened was what generally happens in such cases: the tragic story of trauma and abuse is gradually told, the alters that have been generated emerge in this process, and, eventually, an integration takes place. The 4 year-old turned out to be one of 6 alters in all. They came together after a number of years, and I don’t feel like describing that process right now. You asked for a more direct example of the freezing of time – I just gave it to you, so let’s move on.
G.A. Okay - Is this case though in any way relevant to what you referred to earlier as infinite isolation?
Dr. E. Yes it is. The little girl had lived in a place of the most terrible isolation, cut off from all communication with other human beings. Her only contact was with ghostly entities she saw in the secret playground. The loneliness of the trauma victim is of the most extreme kind that one can imagine: a loneliness that has as its most essential feature that it is felt as absolute, never to be relieved.
G.A. So say some more things to me about this loneliness, this isolation. How does it typically play out? What does it give rise to? Why is it so widely misunderstood by clinicians working in our field?
Dr.E. The loneliness is cosmic, rather than terrestrial. It extends throughout the universe and seems, to the person suffering it, to be eternal. It is not conceivable that it can ever be addressed, diminished, soothed, escaped. It is damnation.
G.A. Are you telling me that a person is somehow literally damned by these experiences?
Dr. E. There is such a thing as an experience of being damned, of being forever in darkness with no possibility of being released. That experience is not the same thing as actually, literally, metaphysically being condemned to hell for all eternity, which is an idea I do not subscribe to. It is instead a feeling a person may have, one that may become more compellingly true than any other. We must understand how such a feeling can lead someone to very extreme acts, sometimes acts of great destructiveness.
G.A. You must explain further; what you are talking about.
Dr. E. I was asked to consult on a most terrible case some years ago, that of a man who had taken it upon himself to murder a number of little girls. He had killed himself after ending the lives of the children, by shooting them. The question I was asked to address by the authorities was the motive of the killer. His crime seemed not to be anything anyone could understand. Why kill innocent little girls? I offered a theory, based on a few details of the case, but my thinking was ignored by those investigating the incident.
My theory was that he had attacked and killed out of a sense of eternal isolation.
G.A. How does the feeling of isolation, no matter how intense it becomes, turn into an impulse to kill? And why in the world would that killing be of little children?
Dr. E. There is a principle that applies to pretty much all these atrocities. One reads about serial murders, but there is always one additional death that does not appear in the news reports: the original murder of the killer’s own soul, generally a crime that has taken place long, long before. The serial killing of children is a restaging of an original murder, spiritual rather than physical in nature. It is history being reenacted, but with the original victim now recast as the active controlling agent in the drama. The powerlessness of the early victimization is thereby replaced by godlike control over the life and death of the other. Sometimes this reversal is enhanced by becoming suffused with sexual intensity.
G.A. How does any of this relate to loneliness?
Dr. E. There were a few facts in the case that directed me to that theme. This man had access to children of both sexes, but chose to kill girls, not boys. Secondly, he had a history of chronic anguish over the loss of his own firstborn child, a girl, who died shortly after her birth. He agonized over a period of many years about the death of this child, saying he was unable to accept the fact that her life had ended before it had a real chance even to begin. His loss of her seemed to be more important to him than his later children, all boys, who survived. This initial baby girl was someone the man could not have come to meaningfully know – her life was too short - and yet she seems to have been the most important person in the world to him.
I asked the question: What is going on here? An idea then floated down from a cloud: his firstborn child was a symbol of this man’s own original innocence. She was his inner, essential child-self, reincarnated, only to die immediately having been given a second chance at life. He must have himself been killed as a small boy by something that happened in his family, in a murder of the soul. Perhaps that soul was that of a girl from the beginning. The circumstances, again suggested by details about his fantasies and obsessions that we don’t need to go into, almost certainly involved a series of traumatic sexual attacks or their equivalents against him.
G.A. How is it that he could have had the soul of a girl from the beginning? What are you talking about?
Dr. E. What I mean is that as a very young person, he might have felt he was, in his essence, female rather than male. This generally comes about when there are events and circumstances in a child’s world that lead to an active disidentification with those of one’s own gender.
Anyway, the sexually violated child is catapulted into a realm of suffering that feels, to that child, at an infinite remove from human contact. It is a searing, emotionally disfiguring sort of thing that leaves one believing life has ended and one has been cast into the darkness. This is where the loneliness sets in, for the experience is so extreme that it is unimaginable that anyone will be able or willing even to approach it. This is what generally causes the wall of silence to appear. And yet such an exclusion from participation in the community of others is itself not bearable for a person. A driving desire arises to close that infinite gap, to somehow draw the world of the light and the world of the darkness back together again.
My idea was that this man’s core life experience had originally been the violation and utter destruction of his own childhood soul: the most precious of all precious things to a little boy or little girl. He had lived, thenceforth, in a damnation state, alone with this terrible emotional reality. By killing a series of female children, the most treasured things in the lives of their families, I think he imagined a drawing down into the darkness of the grieving parents, maybe also of the girls themselves, and therefore a relieving of the infinite loneliness by which he had been afflicted. The man wanted some companions in the cavern, and he killed in order to get them. One sees this sort of thing often enough.
G.A. What a terrible story. Is there anything that could have been done for this man, before he committed the murders? Or would this be a case that was hopeless, the traumas and injuries being too deep and beyond the reach of meaningful human response?
Dr. E. We will never know. But my thought was that it was his experience that he was beyond the reach of the human world , and that his terrible actions were direct responses to that felt reality. It is at least imaginable that a different outcome could have been achieved if there had been someone deeply involved with this man who was trying to find him. Maybe that person could have communicated that he understood the drive to kill defenseless children as borne out of the need to make others feel as he did, so that someone else would know something comparable to the agony of his losses. Maybe it could be said that if he carried out the terrible crimes, then the shattered families would know what it means when everything you believe in and hope for is murdered. It would be worth a try, but I have no illusions as to how difficult such an intervention might be. It would require a massive commitment, extending over a great many years. Our field places little value on such things. People want quick fixes, and if they cannot be accomplished, then move on. As you know, G.A., it is my experience and my belief that the journey of psychotherapy can only be a slow one.
G.A. I don’t think you would want to leave those who read this interview with the idea that trauma victims are prone to commit murders.
Dr. E. No, and if you think anything I have said even remotely suggests such a thing, you need help. What I said was that the consequences of the solitude experience can be deadly – among the destructive things that can happen, suicide is much more common than becoming a killer of others. But sometimes the opposite altogether occurs, especially when the human environment of the trauma survivor is a favorable one. It can be that great creative expressions flow out of experiences of trauma, expressions that themselves also relate to the solitude of the darkness.
G.A. Could you give us an example of such a creative response?
Dr. E. Almost every truly creative act I have ever studied might constitute such an example. To take just one, consider the great poet Maya Angelou, author of I Know Why the Caged Bird Sings.
During her middle childhood years, she was repeatedly molested and then violently raped by her mother’s boyfriend. He told her he would kill her beloved older brother if she spoke about the sexual attacks. She tried to hide what had occurred, but it was discovered by her family and finally the truth came out. Although the boyfriend was arrested and charged, he was murdered, possibly by Maya Angelou’s own relatives, before he could serve his prison time for his crimes. For the next years, she remained almost completely mute, locked in a cage of silence. It is understandable that she stopped talking, in view of the boyfriend’s threats against her brother and also the fact that he was murdered, by being beaten to death. But even in the absence of such threats and violence, a wall of silence materializes. Finally, helped by her brother, her grandmother, and a teacher who encouraged her interest in literature, she began to speak again. And then later, after long struggle, the caged bird began to sing … and sing … and sing. I listened to her at Bill Clinton’s 1993 inauguration, reading a gorgeous poem entitled, “On the Pulse of Morning.” Drawing on her own lonely journey into the darkness, she has given hope to all those who are lost that they might be found.
G.A. Is there anything more you would care to add on the theme of infinite isolation in the world of the trauma survivor?
Dr. E. Just this: the isolation experience is one of estrangement from all things human. That is the challenge for the clinician: to extend the reach of his or her empathy to precisely this subjective state, in a way drawing the feeling of having been cast into the cavern of darkness back into the community of others as something humanly recognizable. It is a paradox of psychotherapy that it can sometimes render the unbearable bearable and the unsayable sayable – this occurs, however, not by diminishing the pain one encounters in the world of the trauma survivor, which is impossible, but by including that pain within the circle of human understanding.
G.A. Thank you Dr. E. I hope to have another chance to talk to you sometime soon.
Dr. E. Have a good day, G.A., and I hope you will work on your questions a little more before you come back.
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Part 1
G.A. So, old friend, tell me what you think of this idea that trauma may create irreversible changes in the structure and functioning of a person’s brain.
Dr. E. It is difficult to see how one would substantiate an idea like this. It is very crude, and actually is more of a fantasy than a scientific hypothesis: a neurological fantasy .
G.A. So you don’t think it has any significance?
Dr. E. I didn’t say that – the fantasy does have a meaning. The image of irreversible changes in the brain is probably a reification of certain feelings that lie at the heart of trauma.
G.A. What are the experiences that are being reified in such imagery?
Dr. E. It is apparent what the experiences are, G.A.: it is a matter of a person’s sense that he or she has been irrevocably changed by what has occurred. It is the feeling that one will never be the same again. A person undergoing such a feeling might have a dream of his or her brain having been permanently damaged or modified, but taking such an image literally, as your medical colleague seems to have done, is not anything one should become terribly serious about. It may be that this reification serves in part as a means of neutralizing the devastating power of trauma. Is your friend by any chance himself a trauma victim?
G.A. Yes, early physical and emotional abuse in his family, and multiple illnesses later that devastated his whole childhood.
Dr. E. Somehow that does not surprise me.
G.A. What exactly do you mean by the term, ‘reification,’ Dr. E., and how is it that this is used to neutralize the pain of trauma?
Dr. E. Reification in this instance is the transformation, in imagination, of a subjective experience into a material thing, It is the symbolization of something felt in a concrete image, and then simultaneously the loss of the sense of the symbolic as the image is recast as existing in physical reality. The feeling of having been irrevocably altered is replaced by a compelling vision of an irreversible physical change in the nervous system. There you have it. By concretizing an otherwise terrifying experience of no longer even being the same person one has been, the feeling of personal disruption and discontinuity is diminished and encapsulated to some extent. People like to nail down such things that happen to them in specific, localized physical images, and that is exactly what is occurring here. It is kind of sad though when one sees these processes unconsciously giving rise to supposed psychological and physiological theories. Such ‘theories’ never take us anywhere, except away from the intensity of the experiences they are presented to explain.
G.A. Tell me more of your thoughts regarding trauma, and about the changes through which a person passes in the wake of this experience.
Dr. E. I don’t even know where to begin, G.A.. You have a way of asking impossibly general questions, and leaving a person with the impossibly difficult task then of answering them.
G.A. Okay – how about this? Tell me your ideas about dissociation, about the nature of the change that occurs when a person passes through a traumatic experience but then seems not to know that he or she has done so. Tell me how it comes to pass that someone develops an amnesia for an event that has transpired.
Dr. E. Not a good question, G.A. It doesn’t lead to anything interesting. A person who has amnesia for some emotionally traumatic event just has the amnesia, and that is it. He or she doesn’t remember it. In fact, as far as that person is concerned, it never occurred. The person becomes someone in whose life the event did not happen. That is what dissociation is.
G.A. Yes, Dr. E., but how is that possible? How can a person become someone something did not happen to? Can it be said that this involves a splitting of consciousness?
Dr. E. Consciousness does not and cannot split. It is not a material thing. Only material objects, like diamonds, can split. The person becomes someone for whom the incident did not take place, and nothing more.
G.A. But what about the whole tradition in our field that pictures consciousness as undergoing such splits: vertical splits, horizontal splits, dissociations that segregate one nucleus of experience from another.
Dr. E. Those images are all concretizing reifications, rather like the supposed brain changes you began this interview with; they refer to nothing objectively real and they explain absolutely nothing. They are symbols we use to represent and attempt to master experiences that are beyond our capacity to assimilate.
G.A. Well, you say the person becomes someone for whom the event did not occur – but obviously the event did occur, and the person is not someone whose life was unaffected. So how does one understand this sort of thing?
Dr. E. I told you there isn’t anything more to it! Are you deaf? Something happens in someone’s life. It is too much for the person to bear, so it is not borne. It is too much to be put into words, so nothing is said. It is too much to even be aware of, so awareness vanishes. The person has become someone for whom it did not occur. Of course the person is nevertheless affected by the incident, whether he or she knows of its existence or not. The events of our lives have all kinds of effects on us, regardless of whether those events are accessible to our conscious recollection. Please stop asking these bad questions.
G.A. You may find the questions bad, Dr. E., but I find your answers to them interesting anyway. So bear with me, my friend. Let’s go more deeply into the things that happen to people in the context of very severe trauma. What are your views on the problem of multiplicity and so-called dissociative identity disorder?
Dr. E. What do you mean ‘What are my views’? That is like asking what are my views on the moon. I have no ‘views’ on multiplicity – it is a phenomenon one encounters from time to time, and that is it. I warned you to stop with such questions.
G.A. But surely you are aware that there is a controversy in our field about the very existence of this disorder, that is, the reality of multiple personality. Some people say it is real and is generated by severe childhood trauma, most often including sexual abuse; other people say it is a fiction, created by zealous therapists working with suggestible, compliant patients.
Dr. E. I don’t waste my time with such discussions.
G.A. Tell me anyway something about your experience in this area. Have you had a chance to observe and/or work with such patients?
Dr. E. Many. So what is your question?
G.A. Well this appears to mean you are one who believes dissociative identity disorder is a real phenomenon rather than being something that is induced.
Dr. E. You just won’t let go, will you? I am not a believer in any “real” phenomenon of multiplicity, if I understand what you mean by this; nor do I subscribe to the oversimplified notion of anything being “induced.” These are false and useless alternatives: the first assigning the essence of so-called dissociative identity disorder exclusively to the patient, and the second to the influencing therapist. Multiplicity comes into being, in all its glory, at the interface of patient and analyst and both make their contributions. It is neither independently real, nor is it unilaterally induced. A person with a history of unbearable, unsayable trauma comes into a developing connection with someone – perhaps an analyst, but it could be anyone - and depending on the kind of response this person encounters, the trauma history may begin to emerge in the form of a flowering of seemingly autonomous alters. It is also possible no such emergence will take place and the history will remain mute.
I had an experience many years ago with one such patient that taught me much about this matter. A 45 year-old woman called me for a consultation regarding her ongoing psychotherapy. She had been in analysis for 8 years with a well known figure in our field. She said she was unhappy with the results of her treatment and needed advice on what to do about it. I asked her to tell me about her relationship with her analyst as well as about her background. As a child she had been the victim of profound sexual abuse by her mother, who had used her relentlessly during her early years as a masturbation toy. She said that there had once been “some boys.” A question came into my mind, and I decided to voice it. I asked her what the names of the boys were. She said she did not recall, and also the boys were gone and it was all a long time ago. Then another thought came to me, and again I decided to express it. I told her I thought it wasn’t a very nice thing to forget a person’s name. She was quiet for a moment, and then she said:
“I think you are a mother. That is the whole problem in my analysis – my analyst is only a father. He always wants me to be grown up and reasonable.”
As we spoke about her dilemma, the names of the boys began to come back to her. Finally she told me that the boys had not disappeared; it was rather that they had gone into hiding because they believed her analyst hated children. I asked her where the boys had hidden themselves. She answered that they had hidden in her stomach. She had suffered for many years with difficult gastrointestinal symptoms.
I telephoned her analyst and advised him to speak to her about the fact that “the boys” believed he hated children. He tried to raise the issue with the patient, but was unable to avoid giving her the impression that he still hated children. He told her he wanted to know where she had gotten such a strange and incorrect notion. Their so-called treatment ended at this point. I knew this analyst well, and the boys were right in thinking that he hated children. The child he hated most of all, however, was the one he carried within himself. It was the traumatized child he had once been, whose painful experiences had been wholly disavowed. He was a very grown-up person, too much so, a highly cultured gentleman who prided himself on his maturity and sophistication. If an analyst is not on friendly terms with the child within, there is no chance for there to be successful clinical work with patients such as the one I am describing. The world of ancient trauma simply cannot manifest itself, and if there are alters that have begun to crystallize, they will vanish in the face of the analyst’s intolerance and hatred. An analyst who can bear his or her own childhood feelings, by contrast, will tend to respond maternally to any signs of such experiences in a patient, and the stage is then set for the coming forth of the trauma. Boys long forgotten come out of hiding, and the memories they hold have a chance to be more fully remembered and disclosed.
Having terminated her therapy, the patient began to see me instead. Her analyst reacted by accusing me of unethical conduct in stealing his patient. I do not believe it is possible to steal anyone’s patient, since patients are not possessions, but his behavior made the new treatment she and I were undertaking more stressful than it needed to be.
G.A. So tell me what happened with this patient.
Dr. E. It worked out pretty well and there is not a lot to tell. The horrors of her early life were more completely explored, the boys were able to leave their hiding place and be recognized, and eventually, after many years, there were signs of a more complete wholeness than had been possible before.
G.A. What signs of wholeness did you see?
Dr. E. At a certain point, she ceased to speak of boys, or of the little girls who were also included among the 5 alters that I met in this case. I did not ask where they had gone, knowing that they were not in hiding but rather that some important growth process was taking place. Finally, the patient developed a love for gardening. She planted an enclosed, beautiful flower garden arranged in a pentagon, where 5 different kinds of flowers would bloom simultaneously. It was implicit that the 5 areas of flowers corresponded to the 5 alters, and that the planting, nurturing, and enclosing of the garden enacted aspects of the coming together of the previously separated parts of herself. She and I never discussed this, however. Sometimes silence can be a fine and golden thing.
G.A. So are you telling me that the phenomena of dissociation are embedded in what is sometimes called an intersubjective field?
Dr. E. Yes, as is all psychopathology, of every form and degree. But I don’t much care for philosophical terminology. Let us just say that people are what they are, feel what they feel, and do what they do in part because of how they have been and are being responded to by others. This is the human condition, for better and for worse. Dissociation itself can only occur in certain kinds of contexts, generally ones that deny a child the opportunity for his or her feelings to be recognized and validated in any way. A dissociative person lives in a relational world that contains no room for the events that have vanished from recall. If any sign of the disappeared history shows itself, the child encounters reactions of incomprehension, hostility, and/or agonizing pain. Sometimes the child is marginalized or even excommunicated from the family. Once the space for those events materializes on the other hand, perhaps in the patient finding someone to listen who can be a mother, they begin to reappear, along with the children to whom they happened. Eventually it all comes together and is really not all that complicated.
G.A. Give me an instance of how dissociation arises and is maintained within such a relational world.
Dr. E. The examples are abundantly available to any clinician who works in this area. The one that comes back to me at this moment concerns a 30 year-old woman who, as a child, had been horrifically abused by her grandfather. He had repeatedly raped and tortured her from when she was 4 years old until she was 11 or 12. All memory of the events had vanished as she grew into adulthood, the family system as a whole being one of consistent denial. At the age of 28, however, she began to have conversations with one of her cousins, a woman who, like herself, had been attacked by the grandfather. In the dialogue between the two of them, fragments of the lost memories began to reappear. The grandfather was an iconic figure in the family, revered and honored by all. Although his demonic side had victimized a number of family members, this was erased from the family system’s conscious history. Finally the grandfather died and a great funeral and memorial service took place, an occasion for mourning the loss but also celebrating what everyone saw and needed to see as the greatness of his life. The woman I am speaking of chose this opportunity to break the silence, as she stood before the mourners and tried to give an account of how her grandfather had raped and tormented her. She bravely, or foolishly, was insisting that this was an occasion on which the truth could no longer be buried. Before the first sentences escaped her mouth, however, her brothers and uncles rushed up to her and carried her out of the meeting hall, throwing her into the street. She was told that what she had tried to do was unforgivable and that she was crazy.
G.A. So what happened to this woman then?
Dr. E. She killed herself shortly after this incident.
G.A. She killed herself? What is your understanding of the suicide?
Dr. E. I think this was her way of trying to raise the stakes with her family, by staging an event, as she probably imagined it, so dramatic that they could not deny it. Sometimes the truth is much more important to a person than even life itself. This story is very sad and very depressing though, because her plan did not work out at all. The family looked at her suicide and saw it as a confirmation that she was crazy. Denial systems such as this one cannot be broken down by direct confrontations with the truth. A space for that truth first has to be created. You are tiring me out again, G.A. Come back tomorrow.
G.A. Just one more question, please. If you were working with the woman you just told me about, wasn’t there a way for you to intervene to avert the suicide?
Dr. E. I was seeing her cousin, not her, and only found out about the whole story after the death. See you tomorrow.
Part 2
G.A. Good morning Dr. E! I want to return to a discussion of the experience of trauma itself, and the challenges we face as psychoanalytic therapists working with patients whose lives include such experiences. Is it the case that some things that may occur are simply, plainly just ‘too much’? In other words, are there events that transpire in human lives that cannot be faced, that are, because of their magnitude, literally impossible to integrate into our sense of who we are? And if there are, then what do we do as clinicians in the face of these circumstances?
Dr. E. There are events that feel unbearable. But are you asking whether sometimes certain events are literally beyond anyone’s capacity to deal with? I don’t see how one could answer a question such as this, and I am afraid, once again, you have raised an issue that isn’t worth discussing. You are good at that, G. A., and I suppose it is commendable to be good at something, but I ask you nevertheless to stay with questions that can be answered.
G.A. Let’s talk about specific personal experiences though. I spoke to someone recently who told me he felt Mt. Everest had fallen upon him. The specific context was the eruption of long-dissociated pain relating to the deaths of his parents and a number of siblings and cousins when he was a boy. This person had had an earlier psychiatric consultation and antidepressants had been recommended by the doctor he spoke to. He was so flooded that the psychiatrist deemed it advisable to contain and reduce the intensity of his suffering with a drug. I know such treatment is not your favorite, Dr. E., but talk to me about what we can and should do in the face of such overwhelming pain. Many in our field recommend the use of medications based on the idea that many aspects of the experience of such severe trauma are intrinsically destructive and impossible otherwise to manage.
Dr. E. I agree it is tough to manage Mr. Everest falling on one. But I would ask, what if Mt. Everest did fall on a person? What if the experience of the catastrophic pain is in exact proportion to the magnitude of the disaster that did indeed occur? You mentioned someone that lost both parents and other family members as well during his childhood. Are you aware of how such losses can accumulate and amount to the ending of a child’s world? Are you asking me how we, as clinicians, can respond to this pain?
G.A. Yes, please.
Dr. E. It will obviously vary with the specific situation, but in the case of your man who lost his family as a boy, how about simply empathizing with the magnitude of the loss? How about making every effort to stay with the intensity of his experience?
G.A. But how does one do that? The experience is one that is impossible to bear.
Dr. E. Then that is what you stay with, the very impossibility of the unbearable pain. You see, G.A., if you somehow get lost in the concreteness of it all, and perhaps agree the person faces something impossible to withstand, then the only solution is to numb the pain, with medications, alcohol, or maybe it would come up that suicide would be very effective as well. Such literality takes us nowhere we want to go. Resist the literalizing impulse, and stay with the feeling that is present in the moment. If that feeling is one of Mt. Everest crashing down on one’s head, so be it. Actually in this story I would understand the patient’s use of the metaphor of Mt. Everest as his way of trying to express the experience of his whole world having been crushed and destroyed. Maybe I could say exactly that to him.
G.A. That sounds good, but how does that reduce the person’s pain?
Dr. E. It probably would not, but that is not a goal worth pursuing. The goal is to let the suffering be expressed, to let the emotional truth of a life finally have a chance to be put into words and images. A space is then being created for that pain that has not existed before. It might even be that the person’s agony would increase in consequence of the sort of discussion I am suggesting, but he or she would then be more in the truth. This is all kind of obvious again, so please raise more interesting questions. Why do I have to keep asking you to do this?
G.A. As you know perfectly well, Dr. E., I am asking the sorts of questions people generally might ask, and I want your thinking disseminated to them to others in our discipline. If you will be a little more tolerant, I will endeavor to deepen the questions I am asking.
Dr. E. The problem with “disseminating” my thinking, G.A., is that the professionals in our field generally don’t want to hear about it because they think they have it all figured out. They have made up their minds about such matters, and you can’t get through to them; only to the young that still have an openness, and for them, the questions need to be better ones.
G.A. Why do you think it is, then, that so many clinicians, including trained psychoanalysts, are occupied with the alleviation of suffering as their primary concern? If the real goal and power of analysis lies in the articulation of a life’s truth, then the whole emphasis on the taking care of people in pain has a wrongheadedness about it.
Dr. E. There is nothing wrong with wanting to reduce another person’s pain, and one always hopes someone can find ways of living that are satisfying rather than full of suffering. A problem arises though when the analyst has a driving need to alleviate pain, when he or she cannot tolerate what may be a natural experience by the patient of intense negative affect. The reason so many psychotherapists are compelled to reduce their patients’ pain has to do with the lives of the therapists themselves, with the family constellations in their histories that set them on a path toward their careers. It is almost always the same story: a sensitive child is enlisted by a parent to provide the emotionally sustaining, soothing nurturance that was missing in the parent’s own developmental background.
G.A. Is this what Alice Miller called The Drama of the Gifted Child?
Dr. E. Yes it is, but the original title of that book was Prisoners of Childhood, which was much better. The analyst is captive to his mother and/or father, in the sense that he or she, unconsciously, is always drawn to alleviating the parents’ (and patients’) pain, and the grip of this mission is an imprisoning death camp for the analyst’s soul, if you think about it. If the child, fated to become a psychotherapist later in life, breaks away from the role of soothing and otherwise supporting the parent, he or she catapults that parent into an agony state and is attacked and/or emotionally abandoned. This theme then plays out in the psychotherapy practice, where the real power of analysis – to address the truth of a life – becomes subverted by the ancient agenda of relieving parental pain. All kinds of strange collusions and evasions then begin to structure the analytic dialogue, defeating its potential to achieve its most important goals. This is a worthy topic, but I am not interested in discussing it any further with you.
G.A. How about this as a question then: What are the greatest challenges facing our field in the area of the understanding and treatment of survivors of extreme trauma?
Dr. E. Some issues come to mind that create great difficulty for many of the clinicians in our field, but I don’t know if you would be referring to such things in what you are calling challenges facing our field. These are issues pertaining to the heart of the trauma experience and to what can and cannot be achieved in a psychotherapy process. They include the dream of purifying the soul of the effects of trauma, the freezing of time as a consequence of trauma, and the infinite isolation and loneliness created by trauma. Do you want me to talk about all this?
G.A. Please do.
Dr. E. The term ‘trauma recovery,’ if you think about it, is almost an oxymoron. Trauma, as I use the term anyway, is not just a terribly painful or shocking occurrence in a person’s life – it is an event or series of events that is too much to bear, too much to take in as even having happened. The idea of recovery is about getting over something. I think there is no getting over real trauma. This sounds like a message of hopelessness, but it is not, so give me a moment to explain. Belief in the possibility of ‘recovery’ from trauma, understood as a nullifying of the devastation, is a form of denial. Most analysts, and especially those that are animated by an unconscious goal of nurturing and healing a wounded parent, cannot understand this. Their commitment is to radical healing, a transformation that undoes the traumatic wound once and for all. Such clinicians encourage their patients’ dreams that their terrible life histories can be transformed and purified, that the pain can be permanently removed and supplanted by a healing experience of joy and love. Such expectations are inevitably dashed as the enduring reality of the traumatic injury continues to haunt the person’s existence. There is no pot of gold at the end of the road of the psychotherapy of trauma. Under the best of conditions what one does find there is a release from captivity as dissociation gives way to wholeness, and then abiding sadness.
G.A. I am not understanding how can you say there is no hope for trauma survivors. If you tell someone there is no hope of recovery and that all they can look toward is sadness, that person, if he or she believed you, might just want to die.
Dr.E. There you go again. Do you deliberately not listen to what I am trying to say? I did not say there is no hope. What I said was that there is no hope of a recovery that purifies a person’s life and does away with the trauma. It belongs to the events we are speaking of that they will affect the person down to the moment of his or her last breath. There is however hope for the person, for his or her life and future – generally there is profound hope, and I would always seek to communicate a sense of that as someone is beginning to bear the unbearable and say the unsayable. But that future for which one can and should hope is not to be one free of the pain of the past; it will be a future that contains that pain, one that includes the events that formerly could not find a home anywhere. It will be a future of wholeness, as I said.
G.A. So how does the analyst dispel someone’s hope and expectation for what you are calling ‘purification’ and ‘recovery’? Also, is sadness all someone can then hope for? That sounds like a pretty depressing goal to be reaching for.
Dr. E. The wholeness of a person is not empty and is not depressing. It means that the individual becomes wholly present, and is no longer having to pour effort into being someone various things did not happen to. Good things flow from such a transformation, but the erasure of trauma is not one of them. Among the blessings that come with wholeness is the freedom to be who one is
It is generally very difficult for a survivor of significant trauma to accept that there will be no purification, for this situation often includes all manner of curative fantasies that carry the hope of undoing the injuries of a traumatic past. Sometimes those fantasies are the only thing that has helped the person avert a suicide, so the realization of the irreversibility of trauma may be fraught with danger. A binary opposition has crystallized: absolute emancipation versus everlasting imprisonment. Anyone dwelling within the terms of this binary will tend to hear what I am saying as a message of despair, and I emphasize again that survivors of trauma are people for whom there is genuine hope. The role of the analyst is to work, in concert with the patient, to establish a setting that will come to include the unbearable and unsayable. The patient will fall, sometimes devastatingly, into despair in the course of this process, feeling there is no hope for survival at all. At such times the analyst must connect to that despair and reflect his developing understanding of its original and contemporary emotional sources. If he does this, he contradicts the expectation that there is no place for the suffering that is felt, and a third way out of the binary choice between freedom and captivity is found. The unbearable can begin to be borne and the unsayable can begin to be said. This is the pathway toward wholeness, and it can be a very long one.
G.A. How about another example to clarify what you are describing?
Dr. E. Okay. After a number of years of analytic work, a 25 year-old patient told me she had begun to remember having been sexually assaulted by her father as a small girl. The memories began slowly, with faint impressions of something bad having happened, something terrible that her father did. She begged me to tell her it was a matter of sick fabrications on her part, false memories, but I was unable to comply. Then the recall accelerated. There was a nightmare that occurred at the time, symbolizing the eruption of a long-buried history. In the dream the patient was walking along a country road and encountered an outhouse. She opened the door and looked down into the toilet. She saw dark foaming liquid swirling about, going around and around. Then the motion of the liquid intensified and its level began to rise. Gurgling, foaming, it finally spewed forth in a violently explosive geyser. A torrent of dark memories afflicted her, including dozens of times in her early life when her father had come to her in the night and forced himself upon her sexually. She could not bear the recollections.
“I can’t live with this. It will kill me. I will kill myself. I have been killed. I am already dead so I want to be dead.”
G.A. So, how in the world do you make something impossible possible? She is telling you life has become unlivable in consequence of the remembering.
Dr. E. Exactly, and that is what one tries to stay with. You see, she didn’t believe there could be any human understanding of what she had been through. It was her conviction, like that of every abuse victim I have ever known, that she was irredeemably bad, and by virtue of that badness, no one would respond to her suffering with anything except revulsion and hatred. That is a core aspect of the battle: to defeat such expectations.
G.A. Tell me then what happened between you and this young woman.
Dr. E. She and I talked to each other for 30 years.
G.A. But what happened in her life?
Dr. E. She eventually did well – she became an exceptionally creative person, developed close friendships, married and raised two beautiful sons.
G.A. Well that sounds like recovery if anything is!
Dr. E. She did not ‘recover,’ in the sense of erasing the pain of her childhood history. The incest imposed on her remained an enduring source of pain. She did however remember her whole history, and although it continued to be a source of suffering for her, she was not captive to it and did not repeat it. Abuse histories that are not remembered are always repeated upon the next generation or its surrogates; histories that are emotionally recalled, in contrast, are transformed into dangers one protects the next generation from.
G.A. What occurred between this woman and her father? Was he still alive through the long course of her therapy?
Dr. E. Yes he was, and she was always polite with him, outwardly. She remained painfully aware, however, that he had committed unforgivable crimes against her.
G.A. Is there a place for forgiveness in the journey of such a trauma survivor?
Dr. E. Do you mean a place for the victim of abuse forgiving his or her perpetrators?
G.A. Yes, exactly. There is a body of opinion in our field affirming the desirability of forgiving those who have hurt us as a way of healing old wounds.
Dr. E. Do you think a holocaust survivor who has lost her entire family to the Nazis should forgive those who murdered all her loved ones? Some crimes are simply unforgivable, and anyone who claims to have achieved forgiveness in such a situation seems to me to be moving into a strange and impossible place. I would say the sexual attacks against the person I am describing fall within the group of such crimes. I have little patience with the proponents of forgiveness, who, if you think about it, are the merchants of denial.
I was actually present at a conversation between my patient and her aging father in which he said he was sorry about what had happened and begged her to forgive him. This talk occurred several decades after the original assaults. The father’s request, passionately presented, was itself another crime committed against my patient, and it caused her great pain at the time. He seemed to be implying that if only she could accept his heart-felt apology, they could all move on and the terrible events of the past could be left behind. In other words, they could all recover. Such an idea is preposterous because there is no moving on from such crimes. There is however a freeing of a person from captivity, and such emancipation requires a journey into the truth of what has transpired. Nothing else will do. It would have helped my patient if her father could have said he knew what he had done was unforgivable, but he was unable to make such a statement. People capable of committing horrific crimes against children are generally unable to assume the human responsibility one would like to see.
G.A. You said you and this patient spoke to each other for 30 years. What happened after that?
Dr. E. The patient died.
G.A. What killed her?
Dr. E. A cardiac infarction, suffered at age 56. It was very sudden and very sad. She did however get to see her sons grow up and led a very good life. She did not feel she had ‘recovered’ from the traumas of her early years, nor should she have. She knew the truth of her own history and was able to do beautiful things with that knowledge. If more people had an equal level of understanding and awareness, this world would be a better place. I need another break, G.A. You are exhausting me.
G.A. I will be back tomorrow, Dr. E. Rest yourself my friend, and thank you for your thoughts.
Part 3
G. A. Well, here we are again! Good morning! I trust you are rested. The sun is shining, the birds are singing, and it is a great day for more conversation!
Dr. E. Spare me the hypomania, Atwood.
G.A. Thank you for the feedback, grumpy old man. Anyway, what I want to do is to pursue the other two challenges or issues you mentioned regarding the understanding and therapy of trauma, one about what you referred to as the ‘freezing of time,’ and the other about ‘infinite isolation’ experiences. Tell me first about the effects on time.
Dr. E. Time comes to a stop for a person subjected to extreme trauma, even as time continues to pass for that very same person. It is hard for a great many people to understand how this could be the case. It happens because something is impossible to go on with. I will give you a story in illustration.
I once met a woman whose husband had been killed by a drunk driver one evening, while he was on an errand for his family to pick up Italian bread for a spaghetti dinner. The tragedy had taken place 20 years before I met this person. She told me about all manner of difficulties in her life, and at the end of our discussion added that she never thought about her husband. I expressed amazement at this, and she responded:
“Well, never, except for in my dreams. I have the same dream about him every night. I dream every night that I am sitting at my kitchen table and my husband walks in with a loaf of bread. I have no idea why I should have such a dream. Do you think dreams mean anything?”
Time stopped for this woman on the day of her husband’s death. She had been sitting at her kitchen table, waiting for him to return with the Italian bread so the family could have its dinner. Eventually a policeman came and informed her that her husband had been killed. Her repeating dream shows that she was still sitting at that table, waiting for her husband to return for the next two decades. Time had ceased to flow, and although in one respect clocks kept ticking and years kept passing, in another respect they did not. And strangely, she seemed not to know that a freezing of time had taken place. When I remarked about the apparent significance of her dreams, I thought I saw tears begin to form in her eyes. But then they receded.
Even sadder than what happened to her, however, was what she told me about the fate of her daughter, 12 years old at the time of the husband’s awful death. The girl had loved her father above all others in heaven and on earth. She showed no disturbance in her life in consequence of the tragedy; if anything, her level of functioning seemed to rise over the course of the next years. She became a straight-A student in school, participated very actively in sports and social life, and eventually went on to an excellent college with full scholarship support. After graduating with a degree in architecture (her father had been in the construction industry), and looking toward a very bright professional future, she met a young man and fell in love. They decided to marry. Everything in her life seemed to be coming up roses. The disaster occurred when she and her young man announced their engagement and set a wedding date. She collapsed into a profound, unexplained depression. Suddenly she refused to get out of bed in the morning, saying she was paralyzed.
“ I feel there is something horribly heavy resting on top of me. Something is closing in on me. I can’t live and I can’t move and I can’t breathe.”
The mother called a psychiatrist in order to get help for her daughter’s sudden deterioration. She was referred to a medical group in a local university that was investigating and treating depressions in young adults having a sudden onset without identifiable precipitants. These doctors thought they had discovered a distinct mental illness that had not been recognized in psychiatry up to that time. They called it: ‘acute endogenous depression of young adulthood.’ Their idea was that this illness, organic in origin, related to subtle neurochemical changes in the brain, and they hoped to infer the nature of these changes by studying the effects on the depressions in their patients of various experimental cocktails of drugs. The young woman became their guineapig. Vast numbers of drugs and combinations of them were tried on her in the ensuing period, with mixed and unreliable results. She would briefly improve from the most severe extremes of her so-called depression, but then fall back into it and once again become unable to function.
I asked the mother had she considered the possibility that her daughter’s unexplained breakdown might be related to her father’s sudden death that had taken place 10 years before. I added that since there had been no signs of emotional disturbance during the interim, it was likely the child’s grief had been buried. The experience of the traumatic shock of the father’s having been killed and then the pain of the mourning seemed nowhere evident in her history, and so I suggested she had saved these reactions up and now was being flooded by them. I added that her experience of a heavy weight on top of her might reflect an identification with her father, whom she was picturing as being crushed under six feet of earth. The feelings of being closed in and unable to breathe equally could be her way of being with him within the coffin, in his state of death, not moving, not breathing. Here too one sees an arrest in the passage of time, a resistance against moving forward in life, to building and embracing a meaningful future and a family of her own. Such progressive developments, in the context of this young woman’s life, would mean departing forever from her beloved father and leaving him permanently behind. Inasmuch as he had been the center of this woman’s life and his loss could not be grieved, this was not possible for her. I urged the mother to seek some sort of psychological help for her daughter, focused on the buried grief and the factors interfering with it. To my surprise, she rejected this advice and said both she and her daughter had faith in the biological psychiatrists. A sick feeling came over me at this point, and later that day I became physically ill. I do not ordinarily express my emotional reactions to distressing events in bodily reactions, but in this instance I was tremendously disturbed by the mother’s refusals to even consider the possibililty in her daughter’s life of an arrested grief reaction. I did not speak to the woman again for many years. Almost two decades later, she developed a metastatic cancer, and returned to me for a single consultation. This presented an opportunity to ask about what had happened to her daughter. It was so sad. For all the years that had elapsed in the meantime, the drug trials continued, the daughter had been in and out of psychiatric hospitals, and her planned marriage and career and really her whole life lay in ruins. Her fiancée had left her, she never worked as an architect, and she had become massively obese.
G.A. That is a depressing story about depression, Dr. E. I am left with one question about it. Why could the daughter not grieve the loss of her father? Granted his violent death is a trauma and a shock that is off the scale; and yet, still and all, other daughters manage to come to terms with such tragedies without destroying themselves and their lives.
Dr. E. I have wondered about that very question. The story, if I have read it correctly, is of a family in which there was no possibility of mourning the loss, and the daughter’s so-called illness – her ‘acute endogenous depression of young adulthood,’ as her doctors wished to think of it – was her way of preserving contact through an identification with her father in his state of death. The mother also maintained a tie to her lost husband, as reflected in her repeating dreams of him returning home with the bread. You will recall the mother refused to consider the possibility that her daughter was captive to an arrested grief reaction – I think for her to have accepted this would have required her to confront her own mourning, something her dreams suggest was not possible for her as well. Why it was no mourning could occur I just don’t know, but there have to have been reasons.
G.A. Speculate for me about what those reasons could have been.
Dr. E. First, the daughter - let us imagine that something went terribly wrong early in her life between herself and her mother, something that meant no real relationship between the two of them could continue. There were some signs in the mother of an enveloping narcissism, and she may have been one of those who invite their children on an emotional journey from which there will be no return. Imagine further that the tie to the father then became the foundation of the daughter’s life and being. To grieve the loss of the father then would have meant giving up the one in relation to whom her very existence as a person was sustained. Under such circumstances mourning cannot occur and the lost parent remains as an enduring presence to the surviving child. I would assume the father’s existence was maintained somehow throughout her adolescence, perhaps in part by her molding herself into a duplicate of him in a female body. Whatever the path of keeping him alive was, it could not continue once she entered into her own anticipated marriage. Perhaps the wedding plans triggered her collapse, when she began to think about the part of the ceremony in which the father gives away the bride. Her identity as a person being contingent on feeling connected to him, a more dramatic symbol of that closeness then broke into being: her deathlike depression. The clinical work in a case such as this consists in the exploration of the tie to the lost parent, of its foundational function in sustaining the child’s being, and of all the circumstances and events that played a role in magnifying that function. One hopes such an exploring will set the stage for a more productive form of mourning that will not cost the young woman her life. No attempt along this line was made.
Second, the mother – she too evidently held the husband at the center of her existence, and she continued her relationship with him in her dreams, forever awaiting his return home from the trip to the store to buy bread. It could be that her story is the mirror of her daughter’s: that she too had been exclusively tied to her own father and dependent on him for her sense of being. Maybe her husband inherited this function in her life, and as a consequence there was no possibility of accepting the death and mourning the loss. I never came to know her well enough to be sure that this was the general story, but I have known many such cases over the years.
The tragedy in this family, involving both mother and daughter in an arrest in the passage of time, is associated with a death, but extreme traumas of other kinds also freeze time. The reason is not complicated: it is always a matter of something happening that one simply cannot make into a part of one’s history. It remains in an eternal now, perhaps hidden away in a persistent amnesia. There is a terrible aloneness in that frozen moment, a sense of having become limitlessly cut off from the whole human community. The loneliness is possibly the most unbearable aspect of the entire experience.
G.A. The clinical story about the woman and her daughter is interesting, tragic, depressing - - but it is mostly conjecture. Can you give another story illustrating the freezing of time more directly?
Dr. E. Yes, I can, and it involves my first clinical case of so-called dissociative identity disorder. The events I will describe happened 40 years ago. I had been working with a woman, then 24, for perhaps two years. She was suffering with some fairly serious depressions that came and went, and my understanding of her at the time centered around a lasting loneliness she seemed to feel and that traced back into her childhood. It did not occur to me that she might be a multiple until one night something happened that indicated it unequivocally. I received a telephone call from someone speaking in a high, falsetto tone. I asked her who she was, not recognizing that it was this patient. The answer coming back was:
“This is little girl … I am four years old…..she…doesn’t know about me…I want to tell you where I come from.”
I realized at this point that this was my patient, and that I was speaking to an alter. I asked her to go ahead and tell me where she came from
“I am in a room full of grownups. It’s a party. A door opens and someone comes in carrying a platter. There is a baby boy on the platter. They put it down on the table. Then a tall man with a beard comes in. He is carrying a knife. He goes over to the baby and takes the knife and cuts the baby’s penis. The baby screams and blood spurts out of his penis. All the people in the room clap and hug each other and are happy. I don’t want to be like these people. They think it’s fun to hurt babies. I don’t ever want to grow up. I will never grow up.”
Time froze for this little girl and thenceforth she did not age, like Peter Pan, remaining just 4, although chronologically the patient was 24. She – the 4 year-old – had lived in the meantime in a secret playground, but was now coming out to make contact with me.
G.A. Obviously this was a Bris.
Dr. E. No, it wasn’t. It was an inexplicably joyful attack on the most vulnerable part of an infant’s anatomy. That is how it was held by the alter for the next two decades, and it was many more years before the events could begin to be reinterpreted as a Bris.
G.A. So tell me what then happened in this case.
Dr. E. What happened was what generally happens in such cases: the tragic story of trauma and abuse is gradually told, the alters that have been generated emerge in this process, and, eventually, an integration takes place. The 4 year-old turned out to be one of 6 alters in all. They came together after a number of years, and I don’t feel like describing that process right now. You asked for a more direct example of the freezing of time – I just gave it to you, so let’s move on.
G.A. Okay - Is this case though in any way relevant to what you referred to earlier as infinite isolation?
Dr. E. Yes it is. The little girl had lived in a place of the most terrible isolation, cut off from all communication with other human beings. Her only contact was with ghostly entities she saw in the secret playground. The loneliness of the trauma victim is of the most extreme kind that one can imagine: a loneliness that has as its most essential feature that it is felt as absolute, never to be relieved.
G.A. So say some more things to me about this loneliness, this isolation. How does it typically play out? What does it give rise to? Why is it so widely misunderstood by clinicians working in our field?
Dr.E. The loneliness is cosmic, rather than terrestrial. It extends throughout the universe and seems, to the person suffering it, to be eternal. It is not conceivable that it can ever be addressed, diminished, soothed, escaped. It is damnation.
G.A. Are you telling me that a person is somehow literally damned by these experiences?
Dr. E. There is such a thing as an experience of being damned, of being forever in darkness with no possibility of being released. That experience is not the same thing as actually, literally, metaphysically being condemned to hell for all eternity, which is an idea I do not subscribe to. It is instead a feeling a person may have, one that may become more compellingly true than any other. We must understand how such a feeling can lead someone to very extreme acts, sometimes acts of great destructiveness.
G.A. You must explain further; what you are talking about.
Dr. E. I was asked to consult on a most terrible case some years ago, that of a man who had taken it upon himself to murder a number of little girls. He had killed himself after ending the lives of the children, by shooting them. The question I was asked to address by the authorities was the motive of the killer. His crime seemed not to be anything anyone could understand. Why kill innocent little girls? I offered a theory, based on a few details of the case, but my thinking was ignored by those investigating the incident.
My theory was that he had attacked and killed out of a sense of eternal isolation.
G.A. How does the feeling of isolation, no matter how intense it becomes, turn into an impulse to kill? And why in the world would that killing be of little children?
Dr. E. There is a principle that applies to pretty much all these atrocities. One reads about serial murders, but there is always one additional death that does not appear in the news reports: the original murder of the killer’s own soul, generally a crime that has taken place long, long before. The serial killing of children is a restaging of an original murder, spiritual rather than physical in nature. It is history being reenacted, but with the original victim now recast as the active controlling agent in the drama. The powerlessness of the early victimization is thereby replaced by godlike control over the life and death of the other. Sometimes this reversal is enhanced by becoming suffused with sexual intensity.
G.A. How does any of this relate to loneliness?
Dr. E. There were a few facts in the case that directed me to that theme. This man had access to children of both sexes, but chose to kill girls, not boys. Secondly, he had a history of chronic anguish over the loss of his own firstborn child, a girl, who died shortly after her birth. He agonized over a period of many years about the death of this child, saying he was unable to accept the fact that her life had ended before it had a real chance even to begin. His loss of her seemed to be more important to him than his later children, all boys, who survived. This initial baby girl was someone the man could not have come to meaningfully know – her life was too short - and yet she seems to have been the most important person in the world to him.
I asked the question: What is going on here? An idea then floated down from a cloud: his firstborn child was a symbol of this man’s own original innocence. She was his inner, essential child-self, reincarnated, only to die immediately having been given a second chance at life. He must have himself been killed as a small boy by something that happened in his family, in a murder of the soul. Perhaps that soul was that of a girl from the beginning. The circumstances, again suggested by details about his fantasies and obsessions that we don’t need to go into, almost certainly involved a series of traumatic sexual attacks or their equivalents against him.
G.A. How is it that he could have had the soul of a girl from the beginning? What are you talking about?
Dr. E. What I mean is that as a very young person, he might have felt he was, in his essence, female rather than male. This generally comes about when there are events and circumstances in a child’s world that lead to an active disidentification with those of one’s own gender.
Anyway, the sexually violated child is catapulted into a realm of suffering that feels, to that child, at an infinite remove from human contact. It is a searing, emotionally disfiguring sort of thing that leaves one believing life has ended and one has been cast into the darkness. This is where the loneliness sets in, for the experience is so extreme that it is unimaginable that anyone will be able or willing even to approach it. This is what generally causes the wall of silence to appear. And yet such an exclusion from participation in the community of others is itself not bearable for a person. A driving desire arises to close that infinite gap, to somehow draw the world of the light and the world of the darkness back together again.
My idea was that this man’s core life experience had originally been the violation and utter destruction of his own childhood soul: the most precious of all precious things to a little boy or little girl. He had lived, thenceforth, in a damnation state, alone with this terrible emotional reality. By killing a series of female children, the most treasured things in the lives of their families, I think he imagined a drawing down into the darkness of the grieving parents, maybe also of the girls themselves, and therefore a relieving of the infinite loneliness by which he had been afflicted. The man wanted some companions in the cavern, and he killed in order to get them. One sees this sort of thing often enough.
G.A. What a terrible story. Is there anything that could have been done for this man, before he committed the murders? Or would this be a case that was hopeless, the traumas and injuries being too deep and beyond the reach of meaningful human response?
Dr. E. We will never know. But my thought was that it was his experience that he was beyond the reach of the human world , and that his terrible actions were direct responses to that felt reality. It is at least imaginable that a different outcome could have been achieved if there had been someone deeply involved with this man who was trying to find him. Maybe that person could have communicated that he understood the drive to kill defenseless children as borne out of the need to make others feel as he did, so that someone else would know something comparable to the agony of his losses. Maybe it could be said that if he carried out the terrible crimes, then the shattered families would know what it means when everything you believe in and hope for is murdered. It would be worth a try, but I have no illusions as to how difficult such an intervention might be. It would require a massive commitment, extending over a great many years. Our field places little value on such things. People want quick fixes, and if they cannot be accomplished, then move on. As you know, G.A., it is my experience and my belief that the journey of psychotherapy can only be a slow one.
G.A. I don’t think you would want to leave those who read this interview with the idea that trauma victims are prone to commit murders.
Dr. E. No, and if you think anything I have said even remotely suggests such a thing, you need help. What I said was that the consequences of the solitude experience can be deadly – among the destructive things that can happen, suicide is much more common than becoming a killer of others. But sometimes the opposite altogether occurs, especially when the human environment of the trauma survivor is a favorable one. It can be that great creative expressions flow out of experiences of trauma, expressions that themselves also relate to the solitude of the darkness.
G.A. Could you give us an example of such a creative response?
Dr. E. Almost every truly creative act I have ever studied might constitute such an example. To take just one, consider the great poet Maya Angelou, author of I Know Why the Caged Bird Sings.
During her middle childhood years, she was repeatedly molested and then violently raped by her mother’s boyfriend. He told her he would kill her beloved older brother if she spoke about the sexual attacks. She tried to hide what had occurred, but it was discovered by her family and finally the truth came out. Although the boyfriend was arrested and charged, he was murdered, possibly by Maya Angelou’s own relatives, before he could serve his prison time for his crimes. For the next years, she remained almost completely mute, locked in a cage of silence. It is understandable that she stopped talking, in view of the boyfriend’s threats against her brother and also the fact that he was murdered, by being beaten to death. But even in the absence of such threats and violence, a wall of silence materializes. Finally, helped by her brother, her grandmother, and a teacher who encouraged her interest in literature, she began to speak again. And then later, after long struggle, the caged bird began to sing … and sing … and sing. I listened to her at Bill Clinton’s 1993 inauguration, reading a gorgeous poem entitled, “On the Pulse of Morning.” Drawing on her own lonely journey into the darkness, she has given hope to all those who are lost that they might be found.
G.A. Is there anything more you would care to add on the theme of infinite isolation in the world of the trauma survivor?
Dr. E. Just this: the isolation experience is one of estrangement from all things human. That is the challenge for the clinician: to extend the reach of his or her empathy to precisely this subjective state, in a way drawing the feeling of having been cast into the cavern of darkness back into the community of others as something humanly recognizable. It is a paradox of psychotherapy that it can sometimes render the unbearable bearable and the unsayable sayable – this occurs, however, not by diminishing the pain one encounters in the world of the trauma survivor, which is impossible, but by including that pain within the circle of human understanding.
G.A. Thank you Dr. E. I hope to have another chance to talk to you sometime soon.
Dr. E. Have a good day, G.A., and I hope you will work on your questions a little more before you come back.