People come here to die: Winnicott and the the trauma of old age
This essay draws on my experience with a continuing care retirement community (CCRC). It is an essay on trauma–the trauma of old age and impending death. The CCRC serves as what D. W. Winnicott calls a transitional object. Only in the case of the CCRC, it’s a transitional object in reverse. That’s good and bad. Mostly it’s interesting, especially for me, since I live in one.
People come here to die. A CCRC, of which there are over 2,000 in the United States, provides independent living, assisted living, and nursing home care under one roof in the smaller communities. The larger CCRCs often occupy a campus, but the same principle applies. I live in one of the smaller CCRCs, with about 200 residents in independent living.
My wife died close to five years ago now. I lived alone in a big house for about two years. Keeping up the house and living alone became too much, and I moved to the CCRC. I’ve lived here now for almost three years.
The CCRC as transitional object in reverse
I’ve thought a lot about the psychology of living in a CCRC. What set me off was the remark by my first friend here. He said people don’t make close friendships in retirement communities because they know their friends will soon die. My friend died about a year after I met him (he was in his 90s), and I think what he said was only partly true.
The CCRC serves as a transitional object. What’s unusual about the CCRC is that it’s a transitional object in reverse. The infant and young child’s use of the transitional object serves to help him or her separate me from not-me, and so move from dependence to relative independence. The CCRC is the opposite, helping the residents move from independence to relative dependence.
The flipper is a good example, the first step in this move. The flipper is a little tear-drop-shaped piece of wood that swings on the outside of the independent living resident’s door. A worker pushes it against the door late at night, and it flips to a down position when I open the door in the morning. If the door isn’t opened by about 11am, the flipper stays up, and someone checks to see if I’m dead or seriously ill.
The flipper is the first step in a series of events—call them care—that usually eventuate in the resident dying in the nursing facility in an adjacent building.
Aftermath
I’ve rarely devoted a post to criticizing one book. But there are aspects of Aftermath that highlight all that’s wrong with the adoption of trauma theory by literary critics, a recurring theme of this blog.
What makes Aftermath different is that it is engaged with an actual trauma. Instead of using trauma theory to explain a text, it uses the literary imitation of trauma, above all the experience of fragmentation, to explain a genuinely traumatic experience, a double murder. It doesn’t work.
A highly regarded book
Preti Taneja, a British author of Indian descent, received the Gordon Burn Prize for Aftermath. The prize honors the year’s most dazzlingly daring and avant-garde work of English-language fiction and non-fiction. Her first book, We That Are Young, a version of King Lear, set in a modern-day Indian business family, received the Desmond Elliott Prize, and was short-listed for several others. I found it hard to find critical reviews. Critical comments yes, here and there, but no critical reviews.
The most critical comments were reserved for Goodreads, a reader response website sponsored by Amazon. Many readers stated that large parts of the book were incomprehensible due to its stylistic peculiarities: absent punctuation, large gaps between words and phrases, incomplete sentences, and so forth. One reader says rip out 80 pages, presumably the ones written in an attempt to represent the traumatic experience as a textual one, and the book makes sense as a history and critique of the Muslim experience in India and England. I agree. The book gets better toward the end.
The Atrocity and its background
Though the book often reads as though Taneja was in the midst of the double murder, she wasn’t. She didn’t learn about it until the next day when her partner read the newspaper to her over breakfast, and Taneja realized she knew the name of the attacker, Usman Khan. The 28-year-old had taken the creative writing course Taneja led at a high-security prison two years earlier. The attack took place at a reunion of the program. The newspaper reported that he had been shot dead by police, after stabbing five people, two fatally. One was her colleague, Jack Merritt. Darkly amusing to some was the fact that Khan was initially subdued by a participant using a Narwhal tusk fastened to the Cambridge conference room wall.
Taneja had been invited, but stayed home, preparing for a literary festival. She says she feels both relieved and guilty to have missed the horror and has been left wondering how to make sense of her peripheral connection to the atrocity.
She tells me she has now come to call it “disenfranchised grief … for those who had known the perpetrator, it was something unspeakable”. She is now, she notes in Aftermath, writing “in the wreck”. (Guardian, November 27, 2021) *
“Astro-city”: the attempt to represent trauma in a text
The simplest way to convey the narrative style is to point out that “atrocity” is spelled “astro-city” every single time, I estimate well over one-hundred times throughout the book. It took me 88 pages to figure out what she was trying to say with this affectation. The state did it, creating the conditions that led to the atrocity. One problem with this use is that it denies Khan his autonomy. Furthermore, at other points she presents a nuanced account of the question of where the responsibility began and ended. The narrative portion of the book is capable of subtleties the stylistic portion can’t capture.
Taneja uses fractured form to reproduce in the text the experience of trauma. Trouble is, actual trauma becomes confused with textual trauma, as when she refers to “the atro-city, this prison of narrative and counternarrative.” (p 60) Elsewhere she states that “prison is a palace made of narrative . . . nothing in there but narrative.” No, prison is a place made of concrete and steel. It’s hard and its real. “Concrete Mama” it’s called by some prisoners (McCoy and Hoffman). It’s hard and its cold but it’s always there, always waiting to take you back. To be sure, prison is alive with stories. I listened to prisoners’ stories for more than a year (Alford,1997). But no one tells stories in solitary confinement (“administrative segregation”), and confined lives lead to confined stories, lacking in imagination. Dreams, a realm of freedom, are the exception, and prisoners generally keep dreams to themselves.
Literary theory is not trauma theory.
It may come as a surprise to some, but trauma theory has become a leading analytic framework through which to analyze literary texts. Of course, literary theorists can and should use any framework they find useful. The problem is the confusion that has developed between literary trauma and psychic trauma. Theories of psychic trauma derived from literature have been applied to real trauma in an attempt to make sense of the suffering of real people. The result is confusion and misunderstanding about how real trauma might be healed. Trauma is healed through care and love, values that have no place in literary trauma theory.
My account of this phenomenon draws heavily on a book edited by Roger Kurtz, Trauma and Literature, a reader that Amazon markets as a textbook. Offering few new ideas, the book represents the state of the discipline and its players.
Cathy Caruth, a major player, is a literary critic who, drawing on the work of the litterateur Paul de Man, has influenced many who have sought to understand trauma in real life. Often overlooked is that Caruth’s claims are not just literary, but empirical. They can be tested against real trauma. I conclude with an example drawn from the testimony of Holocaust survivors. Some of this testimony was given in 1946, some twenty-five years later. The testimony given shortly after the liberation of the concentration camps was as narratively competent as that given a quarter-century later. Knowing this makes a difference in how we use literary theory to understand psychic trauma.
What Caruth claims
Caruth argues that traumatic events are unavailable to the conscious memory of the traumatized in the normal form in which memory operates, as narratives about events. Instead, trauma is experienced in terms of flashbacks, overwhelming feelings of anxiety, nightmares, physical tension, and physical illness. Trauma is experienced in symptoms rather than stories. These symptoms repeat themselves, as though the original trauma can never be put into the past.
Trauma is experienced as symptoms because it is too intense, and generally too sudden, to be understood as though it were an ordinary experience. Absent understanding, it can only be experienced and re-experienced, time after time. In this regard, trauma is like language, which according to poststructuralists, as they are called, claim that the signifier (the word) is always unable to properly designate the signified, that is the world.
For poststructuralists, there is a break between word and world; for trauma theorists, there is a break between word and wound . . . . For Caruth, the nonreferential quality of words and wounds renders the former appropriate for communicating the latter: “On this view, language succeeds in testifying to the traumatic horror only when the referential function of words begins to break down.” (Kurtz, p 100; internal quote from Leys, p 268)
Words can’t capture an overwhelming experience that lies beyond or beneath words. The words that come closest are the tropes of literary fiction, representing absence, indirection, and repetition. In both traumatized memory and narrative, lacunae serve as markers of traumatic experience (Kurtz, p 101).
More recent criticism of Caruth et al.
What if literary critics spent less time on modernist and postmodern texts, such as Caruth’s writing on Resnais and Dorfman, or Shoshana Felman’s on Celan? (p 106). Consider instead, says Stef Craps, Aminatta Forna’s Memory of Love, a realist trauma narrative.*
Peter Levine goes further than Bessel van der Kolk on the importance of body memory.
Peter Levine’s work on body memory of trauma has a devoted following. His is a more practical, methodical, and focused version of Bessel van der Kolk’s speculations about trauma’s embeddedness in the body. Van der Kolk wrote the forward to Levine’s Trauma and Memory: Brain and Body in a Search for the Living Past. It reads,
For well over a century we have understood that the imprints of trauma are stored not as narratives about bad things that happened sometime in the past, but as physical sensations that are experienced as immediate life threats — right now. (loc 90)
Or as Levine puts it,
It is crucial to appreciate that emotional memories are experienced in the body as physical sensations. (p 22)
The practice
Levine works by observing the position and attitude of the body, seeing where the tension lies, and working on that body part almost like a physical therapist, helping it to relax. “Expand” is his term. The difference is that Levine does this body work while talking with his patient about the trauma he or she experienced. It’s a good idea: talk about your trauma while your therapist works on your body to help it relax. In this way, psyche and soma and integrated. In practice, it doesn’t work so well, primarily because Levine focuses entirely on trauma confined to a single event manifested in a particular bodily contraction, as he calls it.
“Tell Me Why It Hurts: How Bessel van der Kolk’s Once-Controversial Theory of Trauma Became the Dominant Way We Make Sense of Our Lives,” is a strikingly good article on the appeal of The Body Keeps the Score (New York Magazine, July 31, 2023). It’s not long, and you can read it for yourself (the web address is given in the references). The article, and my comments, are not about whether van der Kolk (vdK) is right or wrong, but why his book has become so extraordinarily popular, spending 248 weeks on the New York Times paperback-nonfiction best-seller list and still counting. It’s sold 3 million copies and has been translated into 37 languages. It’s made vdK the world’s best-known psychiatrist.
The book’s thesis is that post-traumatic stress disorder (PTSD) is not just something that happens on the battlefield. It happens in childhood, and for many of us throughout our lives. PTSD is the intrusion of experiences that cannot be emotionally or cognitively assimilated, in many cases because we are too young or overwhelmed to make sense of them. Instead, these experiences are stored in a special type of memory he calls somatic memory that is based in the body, not the mind. Because these memories are stored in the body, they can’t be reached by talk therapy or reflection. Body work is necessary, by which vdK means virtually any therapy that involves the body and its movements. Yoga and massage are exemplary, but dance, play therapy, and psychodrama, in which people replay traumatic experiences with others, also count. Indeed, almost any therapy counts that isn’t just talk, but involves the body (I’m not quite sure why vdK includes psychodrama; it’s almost all talk).
But why did the book become so popular?
The book has been so influential because it says that you are emotionally ill not because of something in you, or about you. You are in a state of anxiety, depression, and despair because of what was done to you by others, frequently parents who paid insufficient attention to your needs, or responded inappropriately.
We know what good depression treatment looks like. You probably won’t get it.
Approximately half of people with post-traumatic stress disorder (PTSD) also suffer from Major Depressive Disorder (MDD) (Flory). That is my justification for treating depression in a blog primarily devoted to PTSD. Depression usually follows some of the earliest symptoms, such as anxiety and flashback but there are no fixed rules (https://www.ptsd.va.gov/understand/related/depression_trauma.asp).
As I’ve posted recently, it has become almost commonplace today, at least among those impressed by the latest results of neuroscience, to say that Descartes got it backward. Not “I think therefore I am,” but “I am therefore I think.” The mind is composed of body. Brain makes mind possible.
Yet, this is not how we experience ourselves. “I feel therefore I am” is probably the first and fundamental experience of self, or at least the experience that makes life worth living. It is the feeling of being alive. Depression is the opposite. It robs existence of vitality and pleasure. That’s the cardinal symptom of major depression; it can make life not worth living. Depressed people are about twenty times more likely to commit suicide (Gotlib and Hammen).
“Depression is the flaw in love”
A couple of recent books that take the neurological basis of depression seriously, also see love and its loss as central to the experience of depression. Because the mechanism of depression takes place in the brain, and because medication and other treatments that work on the brain help, doesn’t mean that our experience of the world is unimportant. Most important is loss, above all the loss of love: of being loved, of a loved one, as well as the loss of values crucial to one’s identity, such as the loss of religious belief.*
Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection. It is the aloneness within us made manifest.
Love, though it is no prophylactic against depression, is what cushions the mind and protects it from itself. Medications and psychotherapy can renew that protection, making it easier to love and be loved, and that is why they work. (Solomon, p 15)
Medication and therapy make love possible. For what is the good of a more balanced mind if one has nothing of value to do with it? Generally, this love is of another person, but it can be love of one’s work, or faith.
Stress causes depression among the vulnerable. Surprisingly, humiliation is the greatest stressor, loss is the second. (Solomon, p 61). But perhaps they are not so different. Though we seldom think about it this way, loss is shaming. After loss we are exposed to the world, naked and alone. Once you experience a shaming loss, you will never be the same, for you will have learned something about your vulnerability that you may have sensed but never known.
Mourning and Melancholia: narcissism or object relations?
Freud’s “Mourning and Melancholia” is mistaken, it seems to me, in drawing such a sharp distinction between the two experiences. What Freud called melancholia is today called depression. It generally refers to major psychotic depression and is no longer a useful label (Quinodoz, p 181). Still, it seems best to stick with Freud’s term, remembering that we are always talking about depression, and not some more exotic state.
Vamık Volkan introduces the category of the perpetual mourner, one who cannot, as Freud puts it, be “persuaded by the sum of narcissistic satisfactions it derives from being alive to sever its attachment to the object that has been abolished.” (M&M, p. 255) These mourners retain an intense tie to the lost object without slipping into melancholia (Volkan, p 199). It’s a simple point, but a powerful one. It fits more people than severe depression. Many of us know someone like this.
For Freud, melancholia is narcissism
For Freud, melancholia is marked not only by a refusal to give up the lost object (as people and occasionally ideas are called) but identification with it. As Freud puts it, “the shadow of the object” falls upon the ego. “In mourning it is the world which has become poor and empty; in melancholia it is the ego itself.” (M&M, p 246) The lost object becomes a part of the ego, the nucleus of an unforgiving superego that judges the one who mourns so harshly that he becomes depressed, melancholic.
This is the key distinction between the mourner and the melancholic for Freud. Both suffer from the loss of the beloved object but only the melancholic blames himself for being such a miserable person. Both withdraw their interest from the world, but only the melancholic experiences a drastic
lowering of the self-regarding feelings to a degree that finds utterance in self-reproaches and self-revilings, and culminates in a delusional expectation of punishment. (M&M, p 246).
This is accompanied, Freud continued, by a lack of concern with the one who is actually lost, as though there was never any real connection. In a sense, there wasn’t. The narcissist, for it seems that it is only narcissists who develop melancholia, always saw the other as an extension of himself, never existing in his own right. In melancholia, the narcissist, whom Freud compares with an amoeba, withdraws his pseudopod engulfing the object into himself, possessing the devalued object all to himself. He has lost nothing.
Striking is the harshness with which Freud condemns the melancholic narcissist.
When in his heightened self-criticism he describes himself as petty, egoistic, dishonest, lacking in independence, one whose sole aim has been to hide the weaknesses of his own nature, it may be, so far as we know, that he has come pretty near to understanding himself; we only wonder why a man has to be ill before he can be accessible to a truth of this kind. (M&M, p 246)
The melancholic really is a poor excuse for a human being, for he cares about no one but himself. He has not lost another. The other always existed primarily within himself, a possession of his ego that in loss has turned against him.
Kandel, The disordered mind. Or was Descartes wrong?
It’s become almost commonplace today, at least among those impressed by the latest results of neuroscience, to say that Descartes got it backward. Not “I think therefore I am,” but “I am therefore I think.” The mind is composed of body. The brain makes mind possible.
This is the argument of Eric R. Kandel, author of The Disordered Mind and Nobel Prize winner for his research on memory storage in neurons. The reader need not be intimidated. Kandel clearly explains recent developments in neuroscience for the non-specialist. He tries, but fails, to put together the neuroscience of the injured brain with the experience of emotional distress. He knows one is incomplete without the other, he calls for a “new scientific humanism,” but all he ever says is that both brain and experience need to be taken into account. Sometimes that’s enough, but about some experiences, such as PTSD, he cannot get out of the brain.
I feel therefore I am
It’s absolutely true that brain makes mind, and yet this is not how we experience ourselves. “I feel therefore I am” is probably the first and fundamental experience of self, and it would not be wrong to say that feeling is at least as body-based as it is mind-based. The fundamental experience, or at least the experience that makes life worth living, is the feeling of being alive, filled with the vitality of existence.*
Neuroscience doesn’t capture the feeling of being human. It’s about neurochemical events responsible for this feeling, but it doesn’t capture the experience of being alive, sad, happy, depressed, in love, etc. The question is how much this matters, and how the neurological explanation can be made useful without diminishing the experience of life.
Thus, we now know that psychiatric illnesses, like neurological disorders, arise from abnormalities in the brain. (p 41)
It’s not true, at least not when stated like this. These “abnormalities,” which exist, may be the brain’s normal reaction to an abnormal environment. What goes on in the brain is caused by the environment we live in, not just autonomous neurochemical events in the brain itself. Everything I experience changes my brain. But that doesn’t mean that all, or even most, psychiatric diseases arise from abnormalities in the brain. Some do, some don’t, and many are a mix. Besides, the term “arise” is too vague.
Kandel talks about PTSD at some length, and I’ll get to that shortly. His treatment of the topic is disturbing, but the scope of the book is broader and worth considering.
A “new scientific humanism”?
As research into the brain and mind advances, it appears increasingly likely that there are actually no profound differences between neurological and psychiatric illnesses and that as we understand them better more and more similarities will emerge. (p 43)
This convergence will contribute to the new, scientific humanism. (p 43)
I have only a scant idea of what Kandel means by “the new scientific humanism.” It would have helped had he defined “humanism” to begin with. I think he means that experience still matters, particularly one’s own experience of events such as depression.
Stephanie Foo went through hell, finally coming to terms with C-PTSD.
Stephanie Foo is not a trauma theorist. She is a radio journalist and author of an account of her journey through C-PTSD, What My Bones Know. Not always well-written, it is a horrifying story of her childhood, her encounter with at least a dozen unavailing therapies, and finally finding one that worked. It includes her account of intergenerational trauma in general and her family in particular. Her use of intergenerational trauma theory is deeply touching and theoretically unsophisticated.
In another post I’ve discussed the definition of C-PTSD. Complex PTSD refers to long-term exposure to trauma, usually beginning in childhood and continuing for years. Often it involves sexual abuse, but not always. Almost always there is no escape. Dissociation is a predominant coping mechanism. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM 5tr) does not recognize C-PTSD. The International Classification of Diseases (ICD 11) does but limits it to those already suffering from PTSD, a compromise that has never made sense to me. The psychiatric community generally seems less interested in the diagnosis than do those who suffer from it. Foo, like so many, was relieved to find a diagnosis that helped make sense of her experience.
A childhood in hell
It’s worth spending a little time with her story in her own words. Her abuse was spectacularly awful, becoming worse as she entered puberty.
A few times a year, my mother would get so tired of me that she decided God should take me back forever. She grabbed my ponytail at the top of a flight of stairs and used it to hurl me down. She raised a cleaver above my wrist, or she pulled my head back and pushed the blade into my neck, its cold edge pressing into the softness of my skin. I’d apologize frantically, but she’d scream at me that I didn’t mean it, to shut up before she sliced my jugular open. I’d fall silent, but then she said I was never repentant. So I’d start to apologize again, and she said my apologies were worth nothing, plus now my tears made me so ugly she was certain I had to die. So I stayed quiet until she screamed at me to speak again. We’d sit there, trapped in a senseless loop for hours. (p 13)
How did I feel about the fact that my mother blamed her suicide attempts on me? I couldn’t tell you. Those would be some very big feelings for a very little girl. But I do know this — that every night before bed, I kneeled and said the same prayer over and over like a mantra. “Please, God — let me not be such a bad girl. Please let me be able to make Mommy and Daddy happy. Please make me into a good girl.” (p 15)
Her father was no help.
“It’s not her [mommy’s] fault. It’s just that I’m bad, I’m awful, I’m evil,” I told him, and he believed me. “Why do you have to be like this,” he’d ask. “Why can’t you just be better?”
Worse was what she calls her father’s car terrorism.
My father didn’t hit me once after my mother left, but he was a fan of car terrorism.
“It’s time for both of us to die,” he’d sing, smiling. “I’m going to kill myself because I’m tired of this life, and you’re a fucking bitch so you’re coming, too.” He almost killed us a dozen times; each time, I’d beg and plead and placate him, feeding him reasons why we needed to live. (p 34}
How did she survive?
Though she doesn’t linger on it, Foo seems to attribute her survival to her hatred. (p 30) Hatred that she put into practice after her mother left, and her father took over her abuse.
Then I heaved the ax up above us in a graceful arc that would end on his balding skull. And I started to scream . . . . “ How do you like it? ” I said quietly, in that same chilling, deadpan, serial-killer tone I knew so well, and it felt delicious in my own mouth. “How does it feel to be on the other side of things? To be inches from death? How does it feel when someone wants to kill you?” (p 35)
“Okay, then let’s get one thing straight. You are never going to threaten my life again. NEVER. Do you understand me? ” “Yes.” “I SAID. DO. YOU. UNDERSTAND. ME. “Yes!” “You will never grab me. You will never touch me. You will never go over the fucking speed limit. You will drive right. You will never use your car to punish me. Do you have any idea what growing up with a constant fear of death has done to me? It has turned me into the fucking monster you see right now. This is happening because you did this to me.” (p 35)
Her anger, I believe, saved her from psychosis. She cossetted her nascent self in rage. “My anger was my power.” But her rage only bought her time. It didn’t heal; it only protected her fragile, broken self from obliteration. That was no small thing.
Judith Herman’s new book, Truth and Repair is disappointing
A review in the New York Times calls Judith Herman’s recently published Truth and Repair, “a beautiful, profound and important book.” (Kenneally) In some ways that may be true. What it’s not is a “blazing bookend” to Trauma and Recovery (1992). Not only is this just about the silliest phrase I’ve ever read in a review, but it’s wrong. Truth and Repair never deals with the internal changes necessary to overcome the wounds of trauma, above all the experiences of dissociation and the constant presence of the past. The books between the bookends never touch. The inner world of trauma is lost to reflections on tyranny, enlightenment, and justice.
Recognition and justice, what truth and repair look like to Herman, may help the traumatized woman integrate her inner self. But it’s also possible that this integration will remain superficial, social not psychological. Social integration may drive psychological disintegration further underground. Herman fails to address this complexity.
Trauma isolates
Because trauma isolates and shames, says Herman, recovery must be social.
If traumatic disorders are afflictions of the powerless, then empowerment must be a central principle of recovery. If trauma shames and isolates, then recovery must take place in community. These are the central therapeutic insights of my work. (p 7)
Tracing the recovery of survivors over time a large body of research has now documented facts that make intuitive sense: social support is a powerful predictor of good recovery, while social isolation is toxic. People cannot feel safe alone, and they cannot mourn and make meaning alone. (p 8)
Herman is concerned with only two types of trauma, the sexual abuse of children and the domination of women by force. This is no criticism, and it allows her to see trauma as continuous with tyranny, and tyranny as continuous with patriarchy, the original tyranny. But these are political categories, and while the trauma of sexual and marital abuse takes place in a political environment, its suffering is not necessarily resolved by rendering it social. I worry when psychic trauma is seen from a political point of view. Not because trauma isn’t political, but because a political point of view tends to treat the inside as a mirror of the outside.
A remarkable recent book, Caste: The Origins of our Discontents, by Isabel
Wilkerson, suggests a new way of thinking about the trauma experienced by
large groups in stratified societies. Wilkerson calls these groups “castes,” and her examples are Blacks in the United States, Jews in Germany, and Dalits (“untouchables,” but literally “broken people”) in India. I’ll focus on the United States, as she does.
While the subtitle of Caste suggests that Freud’s Civilization and its Discontents might have been an inspiration, there is little that is psychoanalytic about Wilkerson’s book. Nevertheless, her psychological insight is often keen, and she helps makes sense of the difficult question of how very large groups of people could experience trauma. Through their shared experience of belonging to a particular caste is her answer. Hers is not the whole answer, but it’s a neglected part.
Caste
Caste, writes Wilkerson, sets the supremacy of one group against the inferiority of other groups based on ancestry and other immutable traits, such as skin color (p 40). Caste is the bones, race is the skin. Caste is the institutional structure that keeps people in their place. Race is the marker, and is fluid and superficial. Above all, race is a social structure, not a biological one. We are all descended from the same group of tribes that migrated out of Africa in the last 100,000 years.*
Though she never quite says it out loud, Wilkerson seems to hold that the division of humans into a higher and lower status is a natural human tendency, shared with other primates and pack animals such as wolves. What’s optional is whether race is the identifier. In India it’s jati, or kinship group, generally rendered as caste.
Also optional is whether this hierarchy is built upon the humiliation, devaluation, and exploitation of those at the bottom, as it generally is, at least among humans. That’s not the rule among primates and wolves.
So where’s the trauma?
Consider the most horrendous humiliation and devaluation of those at the bottom, the lynching festival, the last of which was carried out by the KKK in 1981 in Mobile, Alabama. Unless that is, you consider the spate of police murders of Black men a type of socially sanctioned lynching. Wilkerson seems to believe it is (pp 400-403).
Lynchings were part carnival, part torture chamber, and attracted thousands of onlookers who collectively became accomplices to public sadism. Photographers were tipped off in advance and installed portable printing presses at the lynching sites to sell to lynchers and onlookers like photographers at a prom. They made postcards out of the gelatin prints for people to send to their loved ones. People mailed postcards of the severed, half-burned head of Will James atop a pole in Cairo, Illinois, in 1907. They sent postcards of burned torsos that looked like the petrified victims of Vesuvius, only these horrors had come at the hands of human beings in modern times. Some people framed the lynching photographs with locks of the victim’s hair under glass if they had been able to secure any. . . .
This was singularly American. “Even the Nazis did not stoop to selling souvenirs of Auschwitz,” wrote Time magazine many years later. Lynching postcards were so common a form of communication in turn-of-the-twentieth-century America that lynching scenes “became a burgeoning subdepartment of the postcard industry.” (p 123)
The euphoria of hate
Wilkerson titles her description of lynching “the euphoria of hate.” (p 304). Lower-caste whites, who suffer their own relative devaluation in the caste system, need a Black sacrifice to reassert their superior status. For Wilkerson, even rumored violations of caste are so profoundly threatening as to fuel evil and hate.
Author’s note: I could not write this post until after Trump was defeated; I’m not sure why. But he will be with us in one form or another for some time.
There is no cult of Trump. He is a skilled politician who allows others to share in his narcissism and his rage. To suggest that Trump has a cult-like following suggests that his appeal is extraordinary in some way. It’s not. Trump is an extremely clever politician, adept at manipulating nativism, racism, and rage. He gives voice to what is already out there. To treat Trump as a cult leader risks mystifying the appeal of authoritarian leaders.
What’s this have to do with PTSD?
Submerged deep inside the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a category that designates the victims of cults, labeled Other Specified Dissociative Disorders, 300.15.
Identity disturbance due to prolonged and intense coercive persuasion: Individuals who have been subjected to intense coercive persuasion . . . by sects/cults . . . may present with prolonged changes in, or conscious questions of, their identity.
In The Dangerous Case of Donald Trump: 35 Psychiatrists and Mental Health Experts Assess a President, Jennifer Panning describes what she calls “Trump Anxiety Disorder,” a “unique postelection anxiety syndrome that has emerged as a result of the Trump presidency.” It is characterized by “increased worry, obsessive thought patterns, muscle tension and obsessive preoccupation with the news.” (p 229) In the same volume, Betty Tang (p 215) writes of the “parallels between the anxiety reactions suffered by increasing numbers of concerned Americans and the symptoms of PTSD.”
Certainly, there is/was much to worry about with Trump as President; indeed, as long as he remains on the national stage. However, to refer to “PTSD-like symptoms” that afflict not only soldiers and other victims of terrible trauma, “but many of the rest of us as well” (Tang, p 215), risks trivializing PTSD and misunderstanding Trump.
Nevertheless, it makes sense to look at Trump from a psychological and psychoanalytic perspective. On the other hand, looking at Trump from only this perspective risks ignoring the power of ordinary politics to exploit our anger and fear.
Using Psychoanalysis to Understand #MeToo Memories
This is not an original post. It is from The New York Review, but it seems so important and relevant I decided to reprint it here because it helps explain how events that were not experienced as traumatic in the past can become traumatic many years later. This is the reason some women have waited decades to report their experiences. Elapsed time does not invalidate trauma; it helps make it. Subheads and emphases are my own.
Using Psychoanalysis to Understand #MeToo Memories, Avgi Saketopoulou
New York Review of Books, New York Review Daily, Oct 11, 2018
As the #MeToo movement has gathered momentum, we’ve seen a proliferation of allegations of sexual harassment and sexual assault. In some instances, one or two accusations are followed by a series of others, as happened during the course of Brett Kavanaugh’s Supreme Court confirmation hearings. Although Kavanaugh’s supporters, including Republican senators on the Judiciary Committee, professed respect for the demeanor of his main accuser, Christine Blasey Ford, even as they dismissed the allegations of others, they also called into question the integrity of her testimony. One of the main objections was the length of time, thirty-six years, that had passed before Ford had gone public with her report of his alleged sexual assault. Why would someone who has been hurt, they wanted to know, not speak at the time the injury was inflicted? Isn’t this very delay, as President Trump recently said, itself evidence that the claims are suspect? These questions are not new or specific to Kavanaugh, but they became especially urgent when a Supreme Court nomination is at stake.
Much trauma doesn’t fit PTSD
Part of the disconnect in appreciating how and why allegations arise as and when they do has to do with our culture’s understanding of trauma. We are accustomed to thinking about only one of the ways that trauma works. Here is the clinical definition most generally familiar: something is traumatic when it overcomes the subject’s capacity to cope, and it interrupts the self’s ability to absorb and process distressing or painful events. Such trauma can bring about feelings of helplessness and produce long-lasting disturbances in the subject’s life. This type of trauma is understood to happen in real time; the harm itself occurs at the time of the scarring event. This is the most widely held understanding of how trauma works, but psychoanalysis offers an alternate conception of trauma: specifically about how a traumatic experience can mean quite different things for the same individual over time.
Can psychoanalysis explain why people can be so cruel? Klein and Mitchell
This post a little different. Not the experience and treatment of psychic trauma, but psychoanalytic accounts of why people seem so eager to hurt each other is its focus. If most studies of psychic trauma are concerned with the experience of being traumatized, this account is about why people traumatize others. Aimed at people with a little knowledge of psychoanalytic theory, its main point is available to anyone. That’s why I post it here. You can read my view on Mitchell’s contribution to trauma theory in another post on this blog.
When I look around the modern world, I see progress, such as the toppling of the Berlin Wall in 1989, and the peaceful end of apartheid in South Africa in 1994. But for me, at least, it is the genocides that stand out: The Holocaust, the Cambodian genocide, genocide in Bosnia and Herzegovina, the Rwandan genocide, and the genocide in Darfur. The list is incomplete, and not up to date, but the point is simple: people seem to be driven to hurt and kill each other. Is there any hope that psychoanalysis could help us understand why people do such horrible things to each other? (https://genocideeducation.org/resources/modern-era-genocides/)
Melanie Klein
The only psychoanalytic theory that might possibly make sense of all this is the psychoanalytic theory of Melanie Klein. But here’s the problem: while Klein helps us understand the terrible things people do to each other, hers is not really a very good way to help people in psychological pain. I would hate to be treated by a traditional Kleinian analyst, of whom few remain. Nonetheless, traditional Kleinian theory makes the best sense of the larger world. Do we need two theories, one to explain the world, another to help people who suffer psychic pain? Maybe.
Epigenetics: of mice and men and women.
This is the second of two posts on epigenetics. In the first I was critical of using epigenetics to explain the transgenerational transmission of trauma. In this post I am less critical, but the epigenetics of trauma remains a research project in its early stages. The ACE test (adverse childhood experience), available now, is a better use of epigenetics.
The epigenetic scaffold
It used to be thought that the chemical scaffold that surrounded the DNA double-helix was unimportant. Today scientists recognize its importance. This scaffold is called the epigenome (epi from the Greek for above), and is composed of proteins and other chemicals. The scaffold chemically tells a gene whether to turn on or off. A gene that is turned off is like no gene at all. Experience in the world effects the epigenome, which means that the experience of trauma, or more accurately susceptibility to trauma, can be genetically transmitted in the same way other traits, such as hair color, are genetically transmitted.
Two mechanisms are particularly important for gene silencing. DNA methylation and histone modification. DNA methylation is the best-known example of a mitotically (referring to cell division) heritable epigenetic modification. (Ennis, loc 354). Unlike DNA methylation, most scientists thought that histone modification patterns weren’t copied directly to the new chromosomes produced during mitosis (cell division). However, a study by Susan Strome showed that some of the original strand’s modified histones are passed to the newly forming strand during DNA replication (Ennis, loc 354, 422). Other studies have confirmed this result.
It seems clear that epigenetic changes brought about by experiences such as trauma may be transmitted to subsequent generation during the process of reproduction. Whatever else is discovered about the epigenome, it is no longer makes sense to distinguish sharply between nature and nurture. Still, we should not become overenthusiastic. Strome’s study was done with worms; most are done with mice or rats.
PTSD is torture.
The most obvious thing to say about the relationship between torture and severe psychic trauma is that psychic trauma is often the result of being tortured. That’s true, but the relationship is closer than that. Severe psychic trauma is torture. PTSD has many of the same features as the pain intentionally inflicted by torture. (PTSD is a narrower category than severe trauma. I use PTSD only for convenience, not as a diagnostic category.) In other words, the relationship between torture and PTSD is not simply sequential. In many respects, PTSD is torture.
My authority for the pain of torture is the well known work by Elaine Scarry, The Body in Pain: The Making and Unmaking of a World. All page references are to this work unless otherwise noted. Others have written thoughtful works on torture, including Jean Améry, who was himself tortured. I have written about Améry elsewhere (Trauma and Forgiveness), but Scarry’s description of the experience of torture seems more relevant.
Trauma is the disruption of the ability to maintain relationships. Psychoanalysis can help. Stephen Mitchell tells how. Unfortunately, the cure takes time and money. A lot of time and money. Here I’m going to lay out what I think it would take, and roughly how it would work. Those uninterested in psychoanalysis may be tempted to skip this post, but I think laying out an ideal, a utopian treatment plan, shows us how far we are from an ideal, as well as directing our next steps, even if the pathway is currently blocked for most people.
Trauma is the loss of relationality
Trauma is the loss of relationality to self and to others. By relationality I mean the ability to participate in relationships. Trauma is the loss of access to sources of vitality deep within oneself, sources that are brought to life in spontaneous and authentic relations with others, from families to strangers.
Is it time to drop the diagnosis of PTSD?
CAUTION! The material in this post was rejected by the “Proceedings of the Listening to Trauma Conference: Insights & Actions.” The reason: “Its tone is too contentious for a collection with positive studies of the physiological underpinnings for trauma and meaningful emerging clinical treatments.” Proceed at your own risk.
In many respects post traumatic stress disorder (PTSD) has been an extraordinarily fruitful diagnosis. It connected the politics of the Vietnam War with the suffering of hundreds of thousands of veterans (Alford, pp 9-13). As the authors of The Empire of Trauma, Didier Fassin and Richard Rechtman, put it, trauma today is not a clinical but a moral judgment. Its advantage is that it has given us “this unprecedented ability to talk about—and hence experience—the violence of the world.” (p 276) In addition, trauma has given us a new perspective on contemporary history, up close and from the ground up. History written from the perspective of trauma is history written from the perspective of the victims.
Reliability versus validity
And yet I think PTSD has come to an intellectual dead-end for all the reasons discussed in this blog over the last two years.
Dori Laub has a bad trauma theory, but he has still made a contribution.
Laub concludes an autobiographical essay, “On leaving home and the flight from trauma,” with the following lines.
Perhaps it is only through resisting the temptation and the pressures of becoming the same that he [the therapist] can listen to the patients as they really are, without succumbing to the generalizing effects of theory and the homogenizing produced by fashion and by political correctness. (2013a, pp 579-580)
Laub has adopted some of the most fashionable theories of trauma. At the same time, it is hard to imagine that he is not a good therapist to the traumatized. I conclude this from the way he writes about his patients, as well as having seen him interview survivors for the Fortunoff Video Archive for Holocaust Testimony at Yale University.
Are PTSD and C-PTSD dissociative disorders? Yes, but it’s more important to remember that they are first of all about terror.
It appears that PTSD and C-PTSD may be grouped under the dissociative disorders in the next edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders). As Matthew Friedman points out, the new DSM-5 category of trauma and stress related disorders was intentionally placed next to the dissociative disorders in order to suggest their similarity (p. 549). Whether this is a good direction to be heading is another question.
A quick definition: dissociation is the division of parts of the self. Dissociation occurs when the parts of the self that know and feel traumatic experience no longer communicate with the rest of the self. Dissociation is generally seen on a continuum, more or less.
What’s dissociative about PTSD and C-PTSD?
I’ll get to C-PTSD (complex PTSD) in a minute.
It’s easy enough to interpret the leading symptoms of PTSD in terms of dissociation. The flashback is a dissociative symptom, a failure to prevent intrusion of unwanted and painful experience.
PTSD criteria read like a short laundry list of dissociative isolative and exclusionary processes (intrusion, numbing, and avoidance). (Chefetz, p. 28)
The dissociation associated with PTSD is characterized by an alteration between hyperarousal and numbing or constriction. The dialectic of trauma moves between intrusion and numbing.
Judith Herman (pp. 47-49) and others have argued that the experience of trauma generally moves from early hyperarousal to later numbing and constriction. Others, such as Richard Chefetz see no progression, just the dominance of one position or another.
Some people with PTSD present with flooding, and others are so emotionally shutdown that they present as emotionally flat, detached, with active dissociative process. (p. 80)
It’s time to stop letting the stressor define PTSD. Not doing so makes the new categories of C-PTSD and DESNOS largely irrelevant.
I’ve been posting on this blog for about eighteen months now, a total of fifty-two posts. Though I’ve written a couple of books on trauma (my latest is Trauma, Culture, and PTSD), I still feel like a newcomer to the field. In this post I want to talk about what still puzzles me about trauma theory. The experience of writing this blog has led to more questions than answers.
I’ve been able to reconstruct to my own satisfaction the origins of PTSD in the Vietnam War. The new diagnostic category served political ends, pointing out what war does to the people who fight it. The introduction of the disorder called PTSD was progressive politics. It was also a humane diagnosis, helping to explain to those who suffered from it what was happening to them, giving both soldiers and their families a vocabulary for their pain.
PTSD in DSM-5
At almost the same time as DSM-5 was being released, the National Institutes of Mental Health was refusing to fund any more research based on the DSM.
National Institute of Mental Health (NIMH) announcement
By Thomas Insel on April 29, 2013Patients with mental disorders deserve better. . . . That is why NIMH will be re-orienting its research away from DSM categories . . . . The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.
If the DSM were the model for physical medicine, then a heart attack would be defined as “chest pain disorder,” a symptom without a cause.
Henceforth, the NIMH research goal is to fill in the “Draft Research Domain Criteria Matrix,” which links 5 basic natural formations, such as “systems for social processes,” including attachment and fear, with eight columns of units of analysis, such as genes, molecules, and cells.
The goal is to move from mind to brain, so that there will no longer be any need to talk about mind at all. It’s all about electricity and meat, as Gary Greenberg puts it. And electricity and meat can be measured. Not, however, in the language of human suffering.
American psychiatry and psychology have been cut off from the official world of science, but not from VA funding (over 100 million dollars since 2012 for PTSD). This has consequences. One, I believe, is the failure of more trauma specialists to object to the VA’s endorsement of cognitive behavioral therapy (CBT), including exposure therapy, as the treatment of choice, the only “evidence based treatments.”
These treatments are short-term, can be learned from a manual, and administered by lesser trained persons. CBT is quick and cheap compared to long term therapy by well trained persons. But consider CBT’s difference not only from traditional talk therapy, but also from the rap groups that sprang up in the Vietnam War era, in which veterans could exchange experiences. CBT discourages “cross talk,” as people talking with each other is called (Tasman et al., p. 1928). The potential of PTSD to help sufferers explain to each other the varieties of torment and relief has been lost.
This does not mean we should abandon the diagnosis of PTSD. Indeed, when this is proposed it is often sufferers who object most strenuously, for the diagnosis has helped many people make sense of their disrupted lives. It does mean that we should rethink the category.
The best trauma narrative I know is Aftermath: Violence and the Remaking of the Self, by Susan Brison. It’s an account of her rape and attempted murder. I call it the best trauma narrative because it combines philosophy, trauma theory, and narrative. Alice Sebold’s Lucky, probably the most well known rape narrative (reviewed in this blog), is better written, and makes a more compelling story. But Susan Brison is a distinguished philosopher, and she approaches her trauma, and trauma theory in general, from a perspective that combines philosophy and experience.
Actually, Brison doesn’t think being a philosopher did her much good. Rape and trauma challenge philosophy because they reveal how embodied we all are. Before we are minds, even before we are body-minds, we are body. Philosophy is generally not comfortable with bodies. Philosophy is practiced by questioning the obvious, asking questions such as “what is time?” But when confronted with an experience that is overwhelmingly obvious, her rape and near murder, Brison found no comfort in philosophy.
But now, when I was confronted with the utterly strange and paradoxical, philosophy was of no use. (p. x)
Testimony can create the trauma it discovers.
Trauma theory and testimony grew up together, beginning in about 1980. By this I mean that trauma theory and Holocaust testimony emerged as socially and historically significant at about the same time. It’s worthwhile thinking about their relationship. If we take the limits of testimony seriously, then much of current trauma theory, especially Cathy Caruth’s account of the “missing moment,” is mistaken.
It is, of course, not literally true that trauma theory emerged in 1980. Freud built much of psychoanalysis on his reinterpretation of his patients’ trauma almost a hundred years earlier. Shell shock, as PTSD was then known, emerged with the First World War. What happened beginning in the early 1980’s was the inclusion of PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III) for the first time. The introduction of PTSD coincided with the “narrative turn” in the humanities and social sciences. At about the same time, the Fortunoff Archive for Holocaust Testimony was established at Yale University.
I have come to believe that Holocaust testimony leads to a misunderstanding of trauma, especially if one does not understand testimony’s limits. I have published three books on trauma that draw on Holocaust testimonies in the Fortunoff Archive. I think I understand the limits of testimony better now. My instructor, so to speak, is Henry Greenspan, author of On Listening to Holocaust Survivors. I also draw on some more recent papers of his. In place of testimony, Greenspan has engaged in extended conversations with survivors. Some of these conversations have lasted decades. Out of these conversations comes a different way of thinking about testimony and trauma.
Trauma escapes language, but so does life.
Trauma theory has a problem with language. Leading trauma theorists such as Cathy Caruth hold that the mark of a traumatic experience is that it escapes language. This is the primary reason that Caruth and others have been attracted to the work of Bessel van der Kolk, and neuroscience generally. Van der Kolk holds that traumatic experience is so sudden and overwhelming that it cannot be put into words. Ruth Leys addressed the problem in a 2010 interview. I don’t believe the intellectual situation has changed much since then, other than the increasing influence of affect theory: the claim that there is an autonomous neurological system that experiences not just trauma, but life, in such a way that language is always playing catch-up.
It is my claim that a major reason for the popularity among postmodern theorists of non-cognitive theories of trauma and affects is that there is a deep coherence between the views of cultural critics and those of the scientists to whose work they are attracted. . . . Van der Kolk [a psychiatrist and neuroscientist] believes that the literal nature of the traumatic flashback or memory means that it belongs to a system of traumatic memory different from that of ordinary memory and as such is cut off or dissociated from ordinary recollection, symbolization, and meaning. In the case of Caruth the same argument takes the deconstructive form of claiming that the aporia or gap in consciousness and representation that van der Kolk and others believe characterizes the victim’s traumatic experience stands for the materiality of the signifier in de Man’s sense, that ‘moment’ of materiality that simultaneously belongs to language but is aporetically cut off from the speech act of signification or meaning. (p. 666)
An aspect of this argument that does not get a lot of attention is how language normally develops. The answer seems to be that language is always cut off from experience, not just among the traumatized, but among us all. If so, then traumatic experience is continuous with ordinary experience. Trauma does not operate in a parallel neurological or linguistic universe. The difficulties the traumatized experience putting words to their experiences are exaggerated versions of everybody’s experience with language. Trauma is uniquely painful, but the way traumatization happens is not unique, but is shared by all who speak.
Trauma destroys meaning, and psychoanalysis is not the best way to understand how this happens. Destructiveness, Intersubjectivity and Trauma: The Identity Crisis of Modern Psychoanalysis, by Werner Bohleber helped me reach this conclusion, which is not his. Bohleber is a former president of the German Psychoanalytic Association, and editor of Psyche.
Bohleber holds that the psychoanalytic theory of trauma needs two models:
- the Freudian psycho-economic model, and
- the hermeneutic object relations model, as he calls it.
The “economic” model captures the experience of being overwhelmed by an excess of violence, anxiety, and stimulation that cannot be mentally bound, largely because the ego was unprepared. The term economic, in this context, refers to currency of mental energy, or libido.
The object relations model explains the feelings of abandonment, including the destruction of emotional bonds with others, as well as the inability to connect with good objects, or feelings, in oneself, associated with trauma. (pp. 97-98)
But even using both models, the psychoanalytic account faces a fundamental problem, “the almost complete separation of psychic and external realities within psychoanalytic reality.” External reality is often devalued by psychoanalysts because it challenges the primacy of unconscious experience (p. 102). The most important thing to know about trauma, says Bohleber, is that it is a “brute fact” that takes place in historical time (p. 109).
Affect theory is coming to trauma theory. In fact it’s already here. The best account I’ve read is Ruth Leys “Trauma and the Turn to Affect.” A historian of science, Leys is the author of the highly regarded Trauma: A Genealogy. This post is indebted to her work.
The main thing to understand about affect theory is that it has nothing to do with affect–that is, feeling and emotion. According to affect theorists, affect is a
pre-subjective force that operates independently of consciousness or the phenomenological concept of subjectivity. (Leys, 2012)
Affect is a mental state, separate from belief and desire, the affect program system as it is called. Affect is the body acting on itself, free of cognition and emotion on the one hand, the quality of the stimulus, or stressor, on the other. If this sounds weird, stick with me.
As Patricia Clough puts it,
Trauma is the engulfment of the ego in memory. But memory might be better understood not as unconscious memory so much as memory without consciousness and therefore, incorporated, body memory, or cellular memory. (p. 6)
The transference is always active between the scholar and what he or she studies. This is especially so when the subject is trauma. So Dominick LaCapra argues, and I think he’s right. What does the transference mean in the case of trauma? For LaCapra it means that “at some level you always have a tendency to repeat the problems you are studying.” (p. 142)
More generally,
by transference I mean primarily . . . the tendency to repeat in one’s own discourse or practice tendencies active in, or projected into, the other or object [of study]. (P. xv)
In the case of trauma, those writing about it often write as though they have been traumatized. The writing of Cathy Caruth and Shoshana Felman is frequently in “unmodulated, orphic, cryptic, indirect allusive form” that is designed to transmit the disorientation of trauma. (LaCapra, p. 106) This may be suitable for trauma fiction, as it is sometimes called (though I have questioned that in another post), but it is unnecessary and counterproductive when trying to explain trauma.
There’s lots of talk these days about the transgenerational transmission of trauma (TTT). Some of it focuses on epigenetic changes in the chemical environment of the genes that make people more or less susceptible to trauma. I find this topic incredibly complicated and difficult to understand. I’ll try to explain it the best I can, but the reader should be clear that as far as PTSD is concerned, the epigenetic transmission of trauma is still up in the air, a hypothesis with no established empirical (scientific) basis. As two of the leading researchers put it in the Journal of Traumatic Stress,
There have been no empirical demonstrations of epigenetic modifications per se in association with PTSD or PTSD risk. (Yehuda and Bierer, p. 430)
This reality has done little to dampen speculation, including that of Yehuda and Bierer, as we shall see. I’m not sure if this is bad or good. Mostly I think it’s irrelevant.
Robert Stolorow’s Trauma and Human Existence represents the kind of book trauma theory needs more of, a book that connects the psychology of trauma with a philosophy of human existence. Connecting trauma to the philosophy of existence is at least as useful as connecting trauma to neuroscience, the current wave. In this sense, Stolorow’s is an old fashioned book, and that’s a compliment.
The trouble is the philosophy Stolorow chooses, that of Martin Heidegger. For Heidegger does not fit well with Stolorow’s relational account of trauma. For Stolorow, trauma is the loss of attachment, particularly the inability of parents and others to attune themselves to their children’s moods. His case studies are mostly about patients who experienced troubled childhoods. He uses a well-known quote from D. W. Winnicott as an epigraph to his second chapter, “there is no such thing as an infant.” There is only the relationship between mother and child.
His book could have been just about what is called today developmental trauma disorder (DTD). Except that he bravely writes at length about his horror at finding his wife of many years dead in bed beside him, so cold and alien he couldn’t touch her.
