My main idea in this post: one reason the symptoms of trauma persist is because people become attached to their traumas. Symptoms serve as a locus of attachment in a world in which each and every attachment can vanish in a moment. It’s kind of like a small child clinging to an abusive parent.
Tom, a Vietnam veteran, went to see Bessel van der Kolk about his PTSD. Among his most disturbing symptoms were nightmares. Van der Kolk prescribed a drug that had been shown to be effective in reducing the incidence and severity of nightmares. Returning two weeks later, Tom said the medicine didn’t work because he wasn’t taking it. Why?
I realized that if I take the pills and the nightmares go away . . . I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam. (p. 10)
Van der Kolk writes that Tom’s answer led him to realize he would probably be spending the rest of his life trying to learn the answers to the mysteries of trauma. I’m not sure van der Kolk learned the right lesson.
For van der Kolk, trauma is a disorder in the brain that is expressed in and through the body. Thus, the title of his recent book, The Body Keeps the Score. However, if we take Tom’s answer seriously, it seems as if it is the meaning of the story that is important. It is the meaning of Tom’s trauma that keeps him locked in the past.
Trauma is attachment to our traumas
If we think about Tom’s trauma in this way, then his nightmares and other traumatic symptoms keep him attached to the only place that really counts in his life. The past is the most meaningful place he knows, as it is for many traumatized soldiers who fail to distinguish their attachment to their buddies from attachment to their trauma. If this were so, it would help to explain why traumatized people get stuck in the past. Considering the alternatives, it’s where they most want to be, or at least where they most need to be.
But while this explanation fits soldiers who have lost buddies at war, it could hardly apply to a victim of rape, or a terrible car accident. Or could it? Perhaps one sticks to the experience one survived in the place of the experience one did not. And what did the traumatized person not survive? The experience that everyone and everything that one values can be annihilated in a moment. This experience is a moment of madness, the sudden loss of attachment to everyone and everything that makes life worth living. Lindemann defines trauma as “the sudden, uncontrollable disruption of affiliative bonds.”
This disruption not only puts the severely traumatized back in the situation of the abandoned child, but in the situation of the abused child, whose trauma attaches him or her to the experience of trauma itself, much as an abused child is attached to the abuser. For both child and adult, nothing is worse than the loss of attachment to whom or whatever represents life and world. Trauma evokes a moment of madness, the sudden cessation of human bonds. The solution to this madness is in attachment to the trauma itself. The solution may sound ironic, but tragedy is based on irony.
Trauma as a moment of madness
We dissociate in order to remain with the traumatic experience in a way that is secret even from ourselves, but for that reason all the more powerful. We also dissociate to escape the experience. We dissociate to do both at once. That’s what dissociation is. (I am going to use the term “we” from this point not to pretend that I understand the traumatized, but because I am one. At some point I may write about my story, but for now this is as close as I get.)
Dissociation is not just “a sort of extraordinary flight reaction.” (Sachs, p. 27) From this point of view, the standard one, we dissociate when we cannot escape a threatening experience physically. And do we escape into the dissociated self, who stereotypically looks on from above, as though the dissociated self were an observer of the real self?
While this description is accurate, it neglects that dissociation is also the way we remain with an unbearable experience, because as unbearable as the experience was, it is more unbearable still to let go. Letting the experience go is to step into nothingness, to fall into total fragmentation. Abandoning the trauma is to lose the continuity of the self.
But isn’t it the trauma that disrupts the continuity of the self? Yes, but consider trauma from the perspective of D. W. Winnicott’s remark that the fear of madness or breakdown is a fear of an event that has already happened. It happened before the young child could metabolize the experience (p. 90). Something similar happens with trauma, in which the moment of trauma is itself a moment of madness, in which the inability to metabolize the experience leads to its sequester.
From a therapeutic perspective, this sequestration of trauma is bad, for it makes the traumatic experience unavailable to speech and narrative. But from the perspective of the traumatized person, sequestration serves another purpose, as we hold onto what would otherwise destroy us by letting it go. In letting go of the experience we would have to stand back and know it, and the destruction of attachment it represents, or rather simply is. It may be dangerous to ride the tiger. It’s more dangerous still to jump off and become its prey. Better traumatized than mad.
Dissociation is conventionally defined as a psychic strategy by which the self’s continuity is preserved, and madness avoided, by splitting off traumatic memories from conscious association. As Bromberg puts it,
Dissociation, the disconnection of the mind from the psyche-soma, then becomes the most adaptive solution to preserving self-continuity. (p. 273)
I’m arguing that self-continuity is preserved as much or more by the split-off part as by the conscious, for it is in the split-off part that trauma’s subjective value resides: the value to survival that is obtained by attaching the self to an otherwise unbearable experience of madness. To be attached to the madness is to own it, so to speak. Only when the madness of total loss becomes known is it able to destroy its subject. Attached but dissociated, madness can be contained.
The price of containment is severe, but it is not just about remaining stuck in the past. The symptoms of severe trauma all serve to connect the present to the past: flashbacks, nightmares, even the disturbing familiarity of hypervigilance remind us that there is something to be terrified of. This something is an alternative to madness, the loss of all attachment. Symptoms are attachments. Bad attachments, but better than no attachments at all. Like an attachment to an abusive parent. Or as Winnicott puts it, “what we see clinically is always a defense organization.” (p. 90) The symptoms of trauma are a defense against “primitive agony,” represented by fears such as disintegration, falling, and the loss of contact with reality. Traumatic symptoms are a defense not against the fear of such experiences, but against the experiences themselves.
Respect the symptoms of trauma
What does all this imply for the treatment of trauma? Take symptoms seriously, but not too seriously. Respect them. EMDR (eye movement desensitization and reprocessing), CBT (cognitive behavioral therapy), and PE (prolonged exposure) are all aimed at the rapid extinction of symptoms. As though the symptoms were the trauma. Eliminating symptoms is not the same as eliminating trauma.
Tom needs help with his nightmares and other PTSD symptoms. Drugs might help, and help comes first. My argument isn’t with short-cuts to treatment. If one is in despair, any short cut looks good. My argument is with the confusion of the symptoms of trauma with trauma.
Trauma is a meaningful experience that threatens all meaning, because it is a premonition of the destruction of meaningful attachment. Trauma is worse than death. Death is non-being. Trauma is a living death, life without attachment.
Long term treatment should aim at helping those who are traumatized grieve their losses, rather than hold on to them as though the losses were life itself. Any serious treatment of trauma combines short term relief from symptoms with long term grief work.
Another way to think about treatment is suggested by van der Kolk’s approach, which is to treat the body, relax the body, allow the self to inhabit the body, so that the embodied person can live in the present, not the past. Van der Kolk imagines that in treating the body one is changing the traumatized brain. Perhaps. But from Tom’s perspective, it is not his brain that is the problem. It is his mind, particularly the way he understands his trauma as a sacred duty.
From this perspective, treating the body will not change Tom’s mind, but it may make it easier for Tom to live with his trauma. His trauma need not rob him of so much of everyday life if he can just live in is body. His attachment to his trauma may not lessen, it may still remain the meaning of his life, but his will be a life that is easier to live with. For some that is probably as good as it gets.
References
Philip M. Bromberg, Standing in the Spaces: The Multiplicity of Self and the Psychoanalytic Relationship. Hillsdale, NJ: The Analytic Press, 1998.
Erich Lindemann, Symptomatology and management of acute grief. In American Journal of Psychiatry (1944), 101: 141–149.
Adah Sachs, Intergenerational transmission of massive trauma: the Holocaust. In Terror Within and Without: Attachment and Disintegration, ed. Janet Yellin and Orit Epstein (21-38). London, UK: Karnac, 2013.
Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking, 2014.
D. W. Winnicott, Fear of breakdown. In Psycho-Analytic Explorations, ed. Claire Winnicott, Ray Shepherd, and Madeleine Davis (87-95). London: Karnac, 1989.