Lecture 2 Flashcards
Hermann on Trauma and Recovery
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.
Issue with trauma accounts
Often not told chronologically
“Most” traumatic event
Not always what would be predicted; up to the patient/client.
Important questions for trauma work
Do you have to talk about the details of trauma in order to do trauma work?
Dissociative experience
E.g. “I don’t have any memory of how I got here.”
Neuroscience symptoms
Heat, voices, dissociative experience, having a hard time coming down from stress - PNS, SNS.
Mistrust
Space of distrust - emotional experiences can serve as triggers to memories. Physiological trigger for distrust. Triggers a trauma reaction.
Hysteria
Previously, clustering of symptoms that seem all over the place. Dissociative, paranoid, emotionally dysregulated.
Freud 101
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.
Psychoanalysis
The therapy that makes the “unconscious” conscious = mechanism of change. Free association, childhood experiences, therapeutic relationships (transference, countertransference).
Freud’s influence on the diagnosis of PTSD in DSM
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).
Hysteria - presentation/symptoms
- 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.”
Charcot and hysteria
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.
Aetiology of histeria - Breuer, Freud, Janet.
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.
Aetiology of hysteria - Freud
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.
Freud and the traumatic theory of the origins of hysteria
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.
Seduction theory
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.
Pt Dora
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.
Hermann on Freud’s traumatic theory of hysteria
Herman: “On the ruins of the traumatic theory of hysteria, Freud created Psychoanalysis”
Freud’s shift to psychical phenomena
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.
Addition of developmental history to “psychical phenomena”
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.
Prolonged hysteric symptoms and shift to psychical phenomena
- 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.
How Freud’s focus on fantasy and intrapsychic fantasy lives on today
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. “
Freud’s foreshadowing of DSM symptoms
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.
