Lecture 2

Question 1

Hermann on Trauma and Recovery

Answer 1

Tendency to discredit the victim or render her invisible. Whether her story is true or false etc. Removal of secrecy conceptualisation of trauma came from Hermann.

Question 2

Issue with trauma accounts

Answer 2

Often not told chronologically

Question 3

“Most” traumatic event

Answer 3

Not always what would be predicted; up to the patient/client.

Question 4

Important questions for trauma work

Answer 4

Do you have to talk about the details of trauma in order to do trauma work?

Question 5

Dissociative experience

Answer 5

E.g. “I don’t have any memory of how I got here.”

Question 6

Neuroscience symptoms

Answer 6

Heat, voices, dissociative experience, having a hard time coming down from stress - PNS, SNS.

Question 7

Mistrust

Answer 7

Space of distrust - emotional experiences can serve as triggers to memories. Physiological trigger for distrust. Triggers a trauma reaction.

Question 8

Hysteria

Answer 8

Previously, clustering of symptoms that seem all over the place. Dissociative, paranoid, emotionally dysregulated.

Question 9

Freud 101

Answer 9

Our minds are divided into conscious (fully aware), preconscious (can access with effort, by thinking), and unconscious (cannot access,. greatly influences how we think/behave/feel/our personality).

Freud places emphasis on childhood and relationships - psychosexual developmental theory.

the Id: pleasure principle - immediate gratification thru any means possible; primary process thinking.

Ego - reality principle; this is the real world, what you need to do, what will benefit me and lead to an advantage; secondary process thinking (adaptive).

Superego: opposite of id, internalisation of societal and moral values of society, conscience, parents. Moral conscience.

Ego defence mechanisms - ego deals with neurotic or moral anxiety thru irrational, protective measures; toolbox to minimise our anxiety, comes at cost.

Psychological presentation is the consequence of unconscious conflict.

Question 10

Psychoanalysis

Answer 10

The therapy that makes the “unconscious” conscious = mechanism of change. Free association, childhood experiences, therapeutic relationships (transference, countertransference).

Question 11

Freud’s influence on the diagnosis of PTSD in DSM

Answer 11

Conceptualisation of traumatic neurosis dominated thinking in the medical profession from late 19C up till 1960s/70s. Rewritten into DSMI in Gross Stress Reaction (now PTSD).

Question 12

Hysteria - presentation/symptoms

Answer 12

• Physical symptoms with no physical cause. Often described as dramatic and
  disturbing: Hallucinations, appetite changes, coughing, disturbed vision, etc.

“a strange disease with incoherent and incomprehensible symptoms. Most
physicians believed it to be a disease proper to women and originating in the
uterus.”

Question 13

Charcot and hysteria

Answer 13

Transformed asylum for “beggars, prostitutes, and insane” into ‘modern’ scientific facility.
Live demonstrations with “hysterical” women. Not interested in patients inner lives, more with their physical manifestations with psychological origins. Did a lot of work to validate/create recognition for the very real physical symptoms. Added that lens of objectivity.

Question 14

Aetiology of histeria - Breuer, Freud, Janet.

Answer 14

Breuer, Freud and Janet: Hysteria was a condition caused by psychological
trauma. Reactions to traumatic events produced an altered state of
consciousness which induced hysterical symptoms.

Janet called this “dissociation.” Breuer and Freud called it “double
consciousness.”

Solution to the mystery of hysteria could be found in the reconstruction of the
patient’s past.

Question 15

Aetiology of hysteria - Freud

Answer 15

Freud ventured specifically into the sexual lives of hysteric patients, hesitantly. Listened and then uncovered the traumatic events of childhood concealed
beneath more recent, often trivial experiences that had triggered the onset of
symptoms

Freud eventually viewed hysteria as related to the defense of repression.

Question 16

Freud and the traumatic theory of the origins of hysteria

Answer 16

Thesis - the bottom of every case of hysteria there are one or more occurrences of premature sexual experience. Link between childhood sexual abuse and trauma and adult presentation.

A year later, Freud privately repudiated the traumatic theory of the origins of hysteria due to the social implications of these findings. Hysteria was so common among women that if his theory were correct, he would be forced to conclude that what he called “perverted acts against children” were endemic across all socioeconomic groups and in large numbers.

Question 17

Seduction theory

Answer 17

Freud abandons the “Seduction Theory” as the root cause of Hysteria because it was not universal. In contrast, the Oedipal Conflict is universal and it is the traumatic event that triggers this unresolved and repressed conflict.

Shift away from external event of trauma and focus internal reaction / on disruption. Oedipal, electra conflict. ==> Invalidating.

Question 18

Pt Dora

Answer 18

A pivotal shift occurred in Freud’s work with his pt. Dora in which he focused on the eroticism of her sexual abuse. Dora terminated treatment.

Question 19

Hermann on Freud’s traumatic theory of hysteria

Answer 19

Herman: “On the ruins of the traumatic theory of hysteria, Freud created Psychoanalysis”

Question 20

Freud’s shift to psychical phenomena

Answer 20

Freud shifts the emphasis. Not reality and patient talking about trauma, focusing instead on fantasy. e.g. Shame and what shame does to your self concept.

Thought fantasy, imagery
and thoughts were more central to analysis than actual memories of early childhood
abuse.

Disavowed, minimized or recanted the role of external, event-based stressor
experiences that negatively impacted the process of psychosexual development.

Question 21

Addition of developmental history to “psychical phenomena”

Answer 21

Freud adds developmental history. Origin of these phenomena come long before the traumatic event. Rooted in dynamic between primary caregiver and child. Personality is rooted in your progression through these stages. Reaction to trauma rooted in this progression and abnormality in the developmental process with primary caregiver. == examine individual pretrauma.

Question 22

Prolonged hysteric symptoms and shift to psychical phenomena

Answer 22

• Examination of pre-morbid psychic functioning as a determinant of mental
  disturbances
• Traumatic impacts to the self-structure were acute and transient in nature.
• If symptoms were prolonged, they were not caused by the material reality but by the pre-morbid traits and psychodynamics of the individual.

Question 23

How Freud’s focus on fantasy and intrapsychic fantasy lives on today

Answer 23

Therapist: “What’s most important is your experience of what happened, not necessarily whether or not it actually happened.”

“It remains a fact that the patient has created these phantasies for himself, and the fact is of scarcely less importance for his neurosis than if he had really experienced what the phantasies contain. “

Question 24

Freud’s foreshadowing of DSM symptoms

Answer 24

Noted patients with trauma histories may be “stuck”. Unresolved conflict => trauma. Freud gives us hints of that.

Identified PTSD symptom clusters listed in DSMIII-R: instrusive imagery, physiological hyperactivity, active reliving as if the event were recurring.

Question 25

Trauma as Disequilibrium

Answer 25

Metaphor-”Protective shield of the ego” for the defensive mechanisms.

Traumatic events are external stressors, strong enough to break through the
“protective shield” and inflict injury or harm to the person.

Question 26

Freud elaborated the concept of trauma as involving

Answer 26

1. An external stressor event which overwhelms normal ego functioning.
2. A change in the steady state of the organism (i.e. disequilibrium)
3. A reduction of ego-defensive and coping capacity
4. The problem of mastery in that other stressors can take on traumatic proportion.
   Thus both the traumatic stressors and secondary ones can overwhelm the now
   depleted ego defenses, thereby setting up the possibility of long-term post traumatic
   stress disorder and comorbid conditions.