What would we do with a trauma so vague and vast that we have no name for it? I think there is such a trauma, and the British Psychoanalyst D. W. Winnicott identified it over half a century ago. Winnicott (1989) wrote specifically about trauma, but I’m not going to write about that. I’m going to write about the implications of his work in general.

The trauma identified by Winnicott doesn’t fit the definition of PTSD. Nor does it fit any of the categories by which experts think about developmental trauma, such as DESNOS (disorders of extreme stress not otherwise specified), C-PTSD (chronic or complex PTSD) or DTD (developmental trauma disorder).

All these categories, with the exception of PTSD, are traumas that primarily affect the developing child, though they may occur in any long term abusive situation, such as wife abuse. With children C-PTSD is generally the result of physical or sexual abuse or obvious neglect. A website explaining C-PTSD begins this way.

As a child, Olivia, who never knew the identity of her father, was consistently abused and neglected by her mother. Her mother’s emotional temperament was highly variable—shifting from dark moods during which she was verbally and physically abusive to her daughter, and manic periods during which she left Olivia to fend for herself for days at a time. (http://www.elementsbehavioralhealth.com/mental-health/what-are-the-symptoms-of-complex-ptsd/)

There are differences between C-PTSD and DESNOS, but they are primarily terminological (see my post http://traumatheory.com/?p=178).  DTD is identical to C-PTSD. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) does not officially recognize C-PTSD, but its new subcategories of dissociative and pre-school subtypes of PTSD come close. The International Classification of Diseases (ICD-11) will include C-PTSD.

A trauma so vague and vast we have no name for it

“In health the mind does not usurp the environment’s function.” (1992a, p. 246) What does Winnicott mean with such a cryptic statement? He means that the feeling of being a real, authentic human being depends on not having to constantly react to one’s world. He’s thinking especially about young children, but I think it applies to all.

To live an authentic existence is to experience a feeling of “going on being,” as those who write about Winnicott often put it. But that way of putting it could be misleading. For Winnicott the first task is not to go anywhere. Not going but being comes first. To be, and to be, and to be . . . without traumatic interruption. Not to feel this experience, not to have this experience, but to be this experience, is the meaning of life, for it involves the mind and body as a unity, as though they were one.

The opposite of feeling alive is not feeling dead. The opposite of feeling alive  is having to devote all one’s attention, time, and energy adapting oneself to others’ (originally mother’s) moods and expectations. The opposite of feeling alive is being a totally social self, reactive, compliant, and lacking in spontaneity.

The alternative to being is reacting, and reacting interrupts being and annihilates. Being and annihilation are the two alternatives. (Winnicott, 1990, p. 47)

Why does Winnicott put it so strongly? Why would he equate reacting with annihilation? Because he is thinking about what it takes to maintain a sense of the continuity of one’s existence. Trauma has the capacity to destroy even the most developed sense of the continuity of existence. In this sense, trauma induces madness.

To be sure, even the deeply traumatized person generally does not run around acting mad. The deeply traumatized person generally learns to use his mind to hold him or herself together. The result is a split between psyche and soma, mind and body, and hence the loss of vitality and spontaneity. This is no small thing, for it is the unity of psyche and soma that is the key to the meaning of life for Winnicott, what he calls “the feeling of real.” (1971, p. 80)

What’s this have to do with trauma?

Certainly this has little to do with PTSD as we ordinarily think about it, a singular event such as rape, a car crash, or even an extended event such as war. What Winnicott is talking about is the emotional environment in which we are brought up, and whether we have to spend our childhoods responding to the intrusions of others, who are never in rhythm with our own experiences, who never seem to understand us, who can never just let us be, or just be quietly with us.

Winnicott is referring to the subtle rhythms of childhood relationships during the time in which the psyche is formed. A child who has to fight off the intrusion of an overbearing parent, or the intrusion of having to hold himself together too long when the parent is psychologically or physically absent (absence is also an intrusion) has been impinged upon, and impingement is trauma.

Actually, this is not quite right. It is not impingement, but “the reactions to impingement happening over a period of time that cause damage to the personality and result in fragmentation.” (Abram, p. 163) Lots of impingement means lots of fragmentation of the psyche, as the experience of the continuity of being is constantly disrupted.

How is this related to adult trauma?

From a Winnicottian perspective, restricted affect, a prime symptom of PTSD, is not only about dulling all emotion so as to keep the most disturbing emotions at bay. Restricted affect also reflects the loss of vitality that comes from the disruption of going on being, and consequent use of the mind to manage soma, a type of self-holding. In this respect PTSD is a loss of the meaning of life.

Perhaps the biggest similarity between childhood and adult trauma is what we do with it. An “original experience of primitive agony cannot get into the past tense unless the ego can first gather it into its own present time experience.” (Winnicott, 1987, p. 91)

Winnicott’s idea is that unthinkable memories are “frozen,” in the hope that there will be an opportunity, a new more hospitable environment, in which to unfreeze the memories, which means to experience them for the first time.

One has to include in one’s theory of the development of a human being the idea that it is normal and healthy for the individual . . . to defend the self against specific environmental failure by a freezing of the failure situation. (Winnicott, 1992b, p. 281, author’s emphasis)

It is this hope, often unknown even to the sufferer, that allows him or her to continue: that someday there will be a chance to revisit the trauma in a safe environment.

The method of trauma treatment gets too much attention. Lots of methods help, including just talking. And all depend on this hope. Trauma sufferers commit suicide not when their symptoms get worse (many survive all their lives with terrible symptoms), but when they lose this hope.

Conclusion

If this way of thinking about trauma even comes close to the truth, then there are an enormous number of traumatized people living lives far less vital than need be, far more than the 3.6% of Americans who are estimated to experience PTSD in any one year (www.ptsd.ne.gov/what-is-ptsd.html). For a vast number of Americans (and of course other nationalities), an experience of trauma has followed them all their lives.

For every child brought up in a home that is dysfunctional enough to cause them to experience C-PTSD, there must be a dozen brought up in homes in which they were forced to react rather than just be. “And reacting interrupts being and annihilates. Being and annihilation are the two alternatives.”

This doesn’t mean that we are all traumatized. Most people aren’t. Nor does it mean that trauma is on a continuum. It means that trauma is more subtle and complex than our categories allow us to know, and perhaps more subtle than we want to know.

References

Jan Abram, The Language of Winnicott. Northvale, NJ: Jason Aronson, 1996.

D. W. Winnicott, Creativity and its origins. In Playing and Reality. New York: Routledge, 1971, pp. 65-85.

D. W. Winnicott, The concept of trauma in relation to the development of the individual within the family. In Psychoanalytic Explorations. Cambridge, MA: Harvard UP, 1989, pp. 130-148.

D. W. Winnicott, The theory of the parent-infant relationship. In The Maturational Processes and the Facilitating Environment. London: Karnac Books, 1990, pp. 37-55

D. W. Winnicott, Mind and its relation to psyche-soma. In Through Paediatrics to Psycho-Analysis. London: Karnac Books, 1992a, pp. 243-254.

D. W. Winnicott, Metapsychological and clinical aspects of regression within the psycho-analytical set-up. In Through Paediatrics to Psycho-Analysis. London: Karnac Books, 1992b, pp. 278-294.