PSYCHOTHERAPY - Psychoanalysis - Systemics - Pnl - EMDR

Trauma, anxiety and communication

Paper presented at the Sixth Conference of Gradiva, “On Anxiety and Other Emotions” held in Barcelona on the 9th and 10th of November 2007

Summary
All anxiety – ineffable, signal of alarm, objectless fear, not existing without an object, of birth, of castration, of separation or paranoid – insists on conveying its message through human links as well as in psychoanalytic theories. Anxiety always aims at desire, that engine for the projects of life. Here are some of its scenes and its possible places in reference to the dimension of trauma, aggression and violence.

A few years ago in Lacanian environments an adage circulated, which in its synthetic version stated that “if the analysand says he is anxious, then he is not.” For quite a while that was evident to me, and to some extent it still is, although much less so, primarily because I’ve seen enough patients in the throes of fully fledged anxiety attacks while being able to speak at the same time, and secondarily because I have seen others, under hypnosis or EMDR, who although they didn’t explicitly say they were anxious, their words and gestures expressed the same by no less expressive means, while vividly reliving scenes that showed the source of their distress.

Anyway, it is always amazing the lack of proportion between what is said and what is shown, the enormity of the affective expressions if compared with the poverty of verbal description. Something very serious within anxiety remains clearly unsaid in words.

A field that over the years I have been returning to singled itself out for me, namely the relationship between anxiety and communication in the therapeutic context. Later on, when I began to work on a frequent and consistent basis with children and adults who had suffered ill treatment, sexual abuse or negligence, this interest gained momentum in relating the anxiety to traumatic experiences.

This paper aims to share with you some thoughts that may not be worth much fortheir originality but for their closeness to a very specific practice, the care and treatment of the abused child,  of the grownup abusers (invariably former abused children) and with the task of restoring in the child’s  mental balance a narration of his experiences that allows him to overcome the emotional quagmires dooming his life as well as the mental defensive maneuvers he has had to appeal to in order to preserve the love he needs to feel to and receive from his caretakers.

For quite a number of years psychoanalysts of all schools have been recovering the notion of trauma. Indeed trauma never did disappear from our theories, but we had shifted from trauma as an event to the dimension of the traumatic as the basic condition of the original construction of subjectivity. In this general level the first and permanent task of mind would be, in Freudian terms, to transmute quantities of drive energies into representational qualities, a process which goes on by generating it seems unavoidable impacts on the mind.

Since the beginning of its construction and as the ground of its development the mental apparatus would develop and morph feelings, emotions and anxieties into symbolically useful elements. There are several ways to refer to this process (as Freud, Klein, Bion, Lacan, Winnicott, Fairbairn and others did) which, while keeping some differences according to the weight attributed to psychogenesis they all agree in depicting a process of translation along different language computational formats (as a cognitivistic may say) categorizing or failing to categorize emotions, feelings, thoughts and words, perceived as they may be: conscious, preconscious or unconscious.

But beyond this first level of the traumatic dimension we can also speak of trauma in its first version:  the event, with its excesses and its power to destroy the nascent processing capabilities of the mind, a trauma that can be caused by reasons ranging from pure heartbreak (the child who belongs to no one, meaning nothing to anyone) to the child victim of an utter intentional assault, that is, conversely, the child that is too loaded with meaning  for his attacker, in fact a victim of this latter’s projections.

If in the first case the mind’s primary task is to bring forth psychic representatives for the drives, developing links with the adult in order to allow the inscription of basic trust and satisfying experiences, both required for the normal use of fantasy and desire (under the pleasure principle), in the second we may talk of the difficult task of controlling annihilation anxieties, aiming at the survival of the relationship between body, mind and the best possible attachment to an adult. The surplus of excitation comes no longer from an instinctual source, and instead of having the mind binding  meaningfully energetic quantums and building up a psychic apparatus able to wish and imagine projects, we have the mind trying to process physical pain, fear and overall confusion.

Here’s an example.

In the first days after admission, George, about three years old, looks very distressed. He seems to live in his own movie, picks up some toys and harshly scolds them, ordering them not to move. He cries nonstop and keeps banging his head with his fists, also scratching his face furiously. Every night he has trouble sleeping. With a history of chronic neglect and recently cruel physical abuse that led him to lose several fingers burned on an electric stove at the hands of his mother’s friend, he seems to be reliving scenes of the violence he has been subjected to. When an educator addresses him in affectionate tone and takes his hand, subtly leading him to change the slap to a caress, he begins to subside without yielding entirely his self-harming inertia. For a few days he remains calm, and allows the educator to take him in his arms and comfort him but tries to conceal his pleasure in getting attention. He begins to tell apart all adults in the protection centre but not in the street, while holding the hand of the caregiver, he smiles and tries to seduce no matter whom, as if he were prepared to go off with any stranger. He seems to believe that delivering himself to another is the best resource to avoid shocks. He loves to play to “here he is!” and “he’s not here!” covering his face with a paper. Every day he utters more words.

This whole process will be seriously affected when after several months without any contact with his mother; she comes fresh out of jail. George only once at the beginning of his life in our centre had said the word “Mom”, weeping abundantly. Since then he had not mentioned her and you could think that her memory had been warded off somewhere in his mind, adequately covered by the idyllic relationship he had established with other adults, all of them having become Mom. With his mother his anxieties return, he poops his pants, talks about monsters in his room, falls suddenly asleep in class and cries. On the other hand, it seems that in the interval he had exorcised partially the image of the neglectful mother and her abuser partner. Now, whenever he feels hurt by something he threatens to “tattle to his mother”, now transformed into his principal, though scaring, protector. However, he carries on with his tendency to indiscriminate and fusional seduction.

Let’s see another case.

Anthony is a 10 year-old boy, whose mother left their country, leaving her child with a sister of hers and  being able to bring Anthony with her 5 years later, having in the meantime married a knight in shining armour.

Anthony, during those five years had told Mom several times on the phone that Aunt had wildly punished him, physically. The mother could not go to pick him up for fear of being unable to return, and could not take him seriously. When she finally brings the child, Anthony is a truly savage, has no limits, steals things from his stepfather, etc.

Mother, afraid of losing her husband punishes him severely, flogs him with a belt and has him hours on his knees, arms outstretched. The stepfather insists on making him a true Catalan, puts him hours nonstop studying the language, copying pages of the encyclopedia, etc. Finally the boy runs away and advised by a friend goes to the police for help. The administration commissioned an emergency report, declared his helplessness, took him under guardianship and Anthony is sent to our centre.

His behaviour is anxious and reckless. From the first moment shows all the signs of having suffered a very traumatic sexual initiation. Hyper-sexualized, very lewd gestures and language, he proposes sexual games to younger children and masturbates ostentatiously. He can’t suffer a baby crying and covers his ears. It is very easy for him to be provoked and he shoots blows in all directions, as someone might do fighting in the dark. Closely observed his behaviour is not active at all, rather looks to be of the reactive type. Smarter children quickly begin to use him as the scapegoat of more or less serious mischief or quarrels, pointing to him as the one who had started the trouble.

Interviewed, he appears calmer and is able to express great anger against his mother and against his stepfather, the former because she did not fulfill her promise to bring him for five years and left him in the hands of his cruel aunt and the secondly for reasons not very clear but dimly related to having been physically dominated. He says he’s making a lot of effort to forget terrible things that have happened. He shows concern faced with his coming pubertal change, which he expects with anxiety. He says he wants to have his emerging genital hair shaved. In the medical examination an anal fissure, of fairly recent origin, is found.

After a couple of weeks things have changed a lot. He keeps going onwith his sexual display but his fighting has almost faded away. He is reconciled with his mother, whom he now worships. She begins to reconnect with her lost child, tries to pamper him, looking somehow forced and artificial, both have lost five crucial years of relationship. Now it happens that the battering was not that painful and the past terror in front of his stepfather has given place to a strange eagerness to see him. He now loves him with madness and would rather forget everything ever said about his past. Sometimes he vaguely alludes to things that have happened, but the former gravity of the suffering has declined.  The child tries visibly to soften his story and join his mother in worshipping her husband. The story is not over yet.

I have brought these two cases to indicate the coincidence on the defensive strategy to which both draw on. The idealized loving fusion with the aggressor or negligent caregiver is a classically studied resource in the annals on abuse. Both children solve their troubles of losing their primary figures through idealization, through uncritical identification with the ideals of the other. Faced with a strange person they react in a globally seductive way, George with a surrendering exhibition that aims to disable preemptively any aggressive meaning and Anthony exhibiting dramatically his condition of abused child and later on his adoration for his mother and stepfather.  He has discovered that his mother depends on her husband and the way not to lose her is to incarnate the perfect immigrant character his stepfather demands.

During a session he candidly utters his wish to wear a Real Madrid football T-shirt with the printed name of the Barcelona’s player Ronaldinho and another one from the Barcelona with the name of the Real Madrid’s player Van Nistelrooy.  His angel-face while telling us this caused us quite some surprise but the boy is basically telling us he has no illusions on the chances of the matching of his mother with her prince, and disguises himself as an unlikely character, probably fearing that he is going to be the one to split them up.

This calling to identifying with the other’s ideal turns out to be useful in the short term but leaves things worse than before.  Such a huge alienation in the desire of their mothers, caught as they are in dependent idealization of their men, is maybe a survival strategy but leaves little doubt about what these children will do when they grow up: future revenges or abusing cycle repetitions –  time will tell. Luckily life is quite long, and we also hope that our help may have been of some service.

These children appeal to what we call, in Lacanian key, an imaginary capture with the loved adult’s image. They forget for their own sake the damage received and alienate themselves sacrificially within the adult project in order to keep in both cases the mother, although in George’s case there is luckily also a grandmother to whom he is related in a less burdensome way. If we assume that this alienation through identifying with the adult’s ideal image is the predominant defense, now we’ll have to ask what the hidden plot of the anxiety will be.

Anxiety is the feeling that cannot speak its name. “Anxious” is a screen name for what cannot be named. At the level of neurosis we may speak of a hidden desire inside a great fear, but we are not talking about this clinical dimension, and the constitution of fantasy and wish is but a hypothesis in both our cases. We are talking about the trauma, whose repetition is, as matter of fact, guaranteed in the future of these children if we can’t stop the consolidation of the fusional idealizing defense.

What cannot be named is the representation which produces the feeling that may end up as a distressing one. Feelings are judgments generated by the mind regarding the value of our perceptions, especially the inner ones. Anxiety is distressing, so to speak, because it expresses the painful assessment our mind makesof certain scenes printed in our memory. The distressing feeling becomes nameless because the mental scenes which it addresses are too terrifying to be accepted in consciousness. They are fantasies that unlike those proposed by daydreaming are monstrous, thus when we can see them in our patient communications we can easily understand the terror they convey.

Let’s come back to our children. If we ask about the inherent distressing feeling in their manifestations and the defense erected against them we would be inclined to consider it as a feeling between confusion and shame, shame perhaps as a solution to confusion: shame of being an object of such degrading aggression to their selves and dignity. In some cases (especially in cases of lasting sexual abuse) we may find shame as the backbone of the future construction of subjectivity.

Manifestations of poor Georgie scolding his toys or trying to tear his face to shreds, or Tony while imitating rabidly (before becoming a devotee of his stepfather), this latter’s words of contempt for his and his mother’s language and country suggest that these children have been shamed for some appalling reason in the eyes of the agent of humiliation and have reacted in turn feeling self-ashamed, assuming the identification entailed in the aggression undergone.

Do I have to be contemptible to be loved? The answer will be different for the victim of physical abuse, as George is or physical plus sexual abuse, as in Anthony’s case. You can escape from punishment: behaving, becoming valuable, obeying more and better and basically giving up childhood. The sexually abused, instead, faces up to the dilemma, and to keep the rapport with the needed (even abusive) adult he must remain negligible (Malacrea, 2000) [i].

I want to comment on two aspects that I consider of crucial value. One is the role of the gaze, in these and other children in similar cases.

Georgie and Tony are very sensitive to the gaze of others. They have history, implicitly but easy to make out in the case of the former, explicit and full of meaning in the case of the second. These are children who look down, have trouble raising their glances, as if they were convinced that their eyes are less than those of the other, or they convey the mark of stigma. Outrageously open and forcing a smile in the case of George and elusive and full of fear in Tony, to whom his stepfather used to dress him down shouting “look at me!”. Anecdotally (not so much of an anecdote) we may mention that on one occasion in which an educator had the misfortune to tell him to look into his eyes as he spoke, Anthony reacted very aggressively.

The other point, and I’m about to finish, refers to the verbal expression of traumatic distress, the relationship between anxiety and language.

Analysts tend to believe that until things can be properly expressed in words they cannot be properly remembered, conceived and elaborated. Perhaps this was the hidden meaning in the sentence which we began with. If when the patient says he is anxious then he is not, maybe when he can say it then he is not anxious anymore.

Anyway, our extended theoretical preference for the language, reaching sometimes to the point of believing that there is no thought without language cannot be today sustained. Since the cognitive revolution in psychological science we know that thought and languages are two different functions, although both improve with their interaction. What I mean, to get to the point, is that there are more ways to spell out memories and more memories than the verbal one, and treating patients with severe trauma is a good testing ground for many different possibilities to work on ways of memory.

Anxieties of annihilation, confusional states and overwhelming shame do not allow strictly verbal therapeutic approaches, namely empathic listening and interpretation, even in the broadest sense of the notion of interpretation. I have long experimented, very advantageously, with interventions in Ericksonian Hypnosis, NLP and recently also EMDR. These methods show that elaboration can be achieved with almost no talking, linking visual images or sensations during some exercises, or favoring translation between sensory representations, visual and verbal ones, in any order and appealing to the language as the tool for synthesis, if required. Or even appealing to the patient’s imagination to construct alternative narratives to the one coagulated in his symptoms.

This is not the time to go further, to talk in detail about these therapeutic resources, I just want to emphasize that using them requires extending the concept of communication, from verbal level down, if someone prefers to speak thus (even I would rather do it, carried on by that previously criticized inertia).We must do it in order to understand that  tearing his the skin of his face as poor Georgie used to, or delivering punches in the dark in broad daylight as Anthony used to, is also communication, encrypted messages being directed to someone who can understand them. Although I confess that in saying this I feel like saying a banality and we could all agree. Besides, Freud had already said it, while he watched Dora playing with the clasp of her purse.
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[i] Malacrea, M. (2000) Trauma y reparación.  Barcelona, Paidós.

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