The assumptive world theory of trauma

DSC00481This post is a review of The Loss of the Assumptive World: A Theory of Traumatic Loss, edited by Jeffrey Kauffman. The approach is popular among a group of clinicians, though I think its thesis is widely, if tacitly, held. It’s a good theory with a remarkable flaw.

The assumptive world

The assumptive world is the only world we know and it includes everything we know or think we know. It includes our interpretation of the past and our expectations of the future, our plans and our prejudices. (Tom Attig, quoting Parkes, p. 55)

Robert J. Lifton and Irvin Yalom play pretty big roles in assumptive world theory, which could be called existential crisis theory. Trauma happens when our basic assumptions about the world are shattered. These assumptions are as fundamental as “I will continue to live,” “I will not be alone and isolated for the rest of my life,” and “my life has meaning and purpose.”

Kierkegaard, dread, and the assumptive world

Some assumptive world theorists make a big deal out of the fact that assumptive world theory is based on cognitive models of the world, whereas the PTSD view of trauma rests trauma on fear. This is no longer the case in DSM-5 (see previous post on DSM-5), where PTSD has its own category among the dissociative disorders.

The best way to think about the assumptive world is to think of its loss as similar to what Søren Kierkegaard calls dread, “the presentiment of something which is nothing.” For Kierkegaard, we dread absolute freedom, and it is this that makes him the first existentialist. Kierkegaard writes of the fear of standing on the edge of a tall building. Suddenly one realizes that one has the freedom to simply jump off, and that freedom is terrifying.

Ordinarily we think of freedom as a good thing, the freedom to choose one’s vocation, one’s mate, one’s way of life. But absolute freedom is dreadful, because it means the loss of all the attachments we experience to people, places, and ideas. It is the freedom of the space walker who cuts his lifeline to the mother ship, and slowly drifts off into space.

Though trauma is not usually experienced as the lightness of being, but instead as a heavy burden, trauma is actually the loss of attachment to all the things that we value. Nothing means anything anymore because nothing can be relied upon because nothing is safe. Friends, family, love, work, the future can be taken from us in a second, and suddenly we know it in a way we only vaguely thought about before.

The value of seeing trauma as the loss of the assumptive world is that it makes the loss of meaning central to trauma. This is in some ways an obvious idea, but one that has proven difficult to integrate into trauma theory, in part because it has proven so difficult to measure.

Although psychiatrists and psychologists have sometimes declined to use the term meaning on the grounds that it cannot be defined scientifically, we must find a rigorous way of analyzing it because, without addressing this idea of meaning . . . we cannot understand post-traumatic stress disorder (p. 13).

I agree with Lifton, who is being quoted here, but would put the conclusion differently. Trauma is the loss of meaning, and the problem is not so much finding a rigorous way of analyzing meaning as understanding what we mean by meaning.

Betrayal

One way of understanding meaning is in terms of betrayal. Trauma is betrayal of our most fundamental assumptions about the world. Consider the experience of Muncie K. (T-503), a Holocaust survivor. Though she suffers flashbacks, this is not the experience that bothers Muncie most. What she cannot get over is how unbelievable it all was, even as she knows that every moment was true. “Absolutely unbelievable that they did this to us. Why? This is the question I always ask.” She repeats a version of her Why? question at least a half dozen times during her interview for the Fortunoff Video Archive for Holocaust Testimony. By “unbelievable,” Muncie doesn’t just mean what happened to her, but the fact that human beings could do it.

Humans betrayed Muncie, as they betrayed their own humanity. The great advantage of betrayal theory is that it makes trauma the outcome of a human relationship, not just one person’s pathology.

When questions are asked from a relational perspective, the pathology is not placed solely within the mind of the individual. Instead, both the individual and the context inform conceptualization of the survivor’s response to trauma. The context may include the traumatic events itself, the relationship to the perpetrator, the societal response to the event, and cultural influences on the individual, among many other critical variables. (76)

Putting it this way says to us “Don’t just look at what happened to the survivor. Look at what people did to her, and consider why someone would do this.” Why? Why? Why? Muncie asks. Do we have an answer? It doesn’t matter. The question has shifted from Muncie’s flashbacks, her individual trauma, to why the Germans would do such a thing. The question becomes their psychopathology, or let us just call it evil. Evil is an answer to why.

Muncie K’s experience was extreme, and so is the answer, evil. But betrayal on a far lesser level occurs every day, including the betrayal of marriages, friendships, and at work. It’s less traumatic, but the approach of betrayal theory, looking at the relationships involved, remains useful, if for no other reason than to remind us that trauma has not just victims, but executioners, even if they are called husbands, friends, employers, or bystanders.

It’s not about omnipotence

The primary flaw of assumptive world theory, and it’s a big one, is that it posits that our belief that the world is safe, meaningful, and good is not merely a fantasy, but a narcissistic one, stemming from infantile omnipotence.

The power of assuming is received from primitive omnipotence; the self receives the assumptive world, yet the giver is the self’s very own root omnipotence. (p. 206)

It makes sense to argue that these assumptions originate in an experience of infantile omnipotence, as when Donald Winnicott writes about the infant’s hunger, and as if by magic milk appears (p. 101). The parent has anticipated the infant’s hunger, met it, and the child knows nothing of need, just desire and satisfaction. That’s infantile omnipotence. But it doesn’t last, and the task of child-rearing is to break the illusion gradually. If that’s trauma, it’s the slow, ordinary trauma of growing up.

Assumptive world theory forgot its roots in attachment

Assumptive world theory has forgotten, or perhaps never fully understood, that it is a theory of attachment. The assumptive world is the world of attachments: to persons, places, things, ideas. Trauma is the failure of attachment. Assumptive world theorists liken the assumptive world to what John Bowlby (1973) called “internal working models.” (p. xi, 140) They forget that an internal working model is not an omnipotent fantasy, but the internalization of the individual’s relationships with others, so that these relationships become a framework for the self.

Bessie K. did not lose an omnipotent fantasy when she was in the concentration camp. She lost all connections to normal human relationships and the expectations we harbor for them. Similarly, a soldier traumatized in battle did not lose his fantasy of omnipotence. He lost his normal expectation that his comrades’ bloody body-parts would not besmirch his own. The same goes for a woman who is raped. She did not lose an omnipotent fantasy of safety. She lost the normal expectation that she could walk down the street without being horribly assaulted.

The psychiatrists who originally defined PTSD as an event outside the range of usual experience were not all wrong (DSM III). Why assumptive world theory rests its case on the shattering of infantile omnipotence is unclear to me. But the result is not. It rejects what is most valuable in assumptive world theory—that the assumptive world is a collective enterprise, maintained by us all. Trauma happens when this collective enterprise fails.

References

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (3rd Ed.). Washington, D. C.: American Psychiatric Association, 1985. (DSM-III) Also DSM-5 (2013).

John Bowlby, A Secure Base. New York: Basic Books, 1988.

Jeffrey Kauffmann, ed., Loss of the Assumptive World: A Theory of Traumatic Loss. New York: Brunner-Routledge, 2002.

Søren Kierkegaard, The Concept of Anxiety, trans. R. Thomte. Princeton, N. J.: Princeton University Press, 1980.

Robert Jay Lifton, “From Hiroshima to the Nazi doctors: The evolution of psychoformative approaches to understanding traumatic stress syndromes,” in J. P. Wilson & B. Raphael (eds.), International Handbook of Traumatic Stress Syndromes (pp. 11–23). New York: Plenum Press, 1993.

C. M. Parkes, (1971). “Psycho-social transition: A field of study.” Social Science and Medicine, 5, 101–115.

D. W. Winnicott, “Communication between infant and mother and mother and infant, compared and contrasted,” in Babies and Their Mothers, pp. 89-103. London: Free Association Books, 1987.

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Comment (1)

  1. Not Buying It

    Another simpleton trying to co-opt everything into a reductionistic attachment lens. You are emblematic of Maslow’s warning of possessing only a hammer and seeing all problems as nails.

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