The "Adualistic" Representation of Trauma: On Malignant Internalization
Meares, Russell, American Journal of Psychotherapy
This paper suggests that traumatic memories are represented in a way that is qualitatively different from nontraumatic memories. The argument depends upon a concept of self, derived from Hughlings Jackson and William James, which is double, involving not only mental life but reflection upon it. Trauma is seen as causing an uncoupling, or dedoubling, of consciousness.
The traumatic diminishment of the subject-object distinction in psychic life has several main effects. First, there is a change in the form of consciousness to a state which is focussed on the present and on immediate stimuli. Secondly, the memory system in which the traumatic events are recorded is nonepisodic, lacking the reflective component. In this way, it is unconscious. Thirdly, the traumatized-traumatizer dyad is represented not as two persons in relation but more nearly as a fused monad. This representation is not integrated into the system of self as the stream of consciousness but remains relatively sequestered. This sequestration is "unstable, " determining rapidly oscillating, and opposite, forms of relatedness, termed "reversals." Finally, in an ,uncoupled" state, the interpretation of the "meaning" of the traumatic event is impaired. Its construction is determined by affect.
TRAUMA AND THE BRAIN-MIND SYSTEM
Recent evidence showing that abuse of various kinds is typical of the childhood of those with severe personality and related disorders has created renewed interest in the clinical impact of traumata. As yet, however, little attention has been paid to the way in which these traumata are represented in memory, and how these representations differ from that which are nontraumatic. These subjects provide the main themes of this paper.
The ideas concerning representation of trauma outlined here are based on observations of borderline patients (1,2). The central conceptualization. is based on the theories of the British neurologist Hughlings Jackson (1834-1911) (3) and upon modern memory research. The main argument rests on the notion that trauma results in an "uncoupling" of consciousness.
An understanding of the effects of psychological trauma must begin with a conception of what is being traumatized. This notional entity, which is frequently neglected in discussions of trauma, lies between the event and the resultant symptomatic changes. It can be called the "self."
JACKSON'S CONCEPT OF SELF
The problem of defining self is considerable. However, Hughlings Jackson, who was an early and important influence upon Freud, outlined a view of "self" that helps to guide an exploration of the consequence of noxious environmental circumstances. Although Jackson's fame rests upon his neurological investigations, particularly as they concerned epilepsy and aphasia, he was also a pioneer theorist in the sphere of mental illness. A large and neglected part of his opus concerns this subject. He believed himself to be the first person in the medical literature to use the word "self" (3, 11, p.96).
Jackson conceived self as double, made up of subject and object poles. Like William James, he called the pole of "subject unconsciousness" the "U' James knew and corresponded with Jackson and may have been influenced by him. James added a necessary elaboration of Jackson's double self. The cardinal feature of the self, as he saw it, was an awareness of the stream of consciousness. This other pole of self, "object consciousness, "James called the "me."
Jackson believed that self as double, that is, involving the capacity for introspection (3, 11, p.95), was something that arrived late in evolutionary history. It depended upon brain development. Although Jackson saw mind, or self, as a function of the brain, he warned that the two must not be confused. One should not mistake the psychical for the neural, nor vice versa (3, 11, p.9). They exist in "parallel concomitance" (3, 11, p.42). This doctrine was quoted with approval by Freud (4) in his paper on aphasia. Jackson's viewpoint strikingly resembles the approach to the brain-mind problem currently influential in the field of neuroscience (5).
Jackson suggested---once again anticipating modern work (6)-that the emergence of self involves maturation of the prefrontal cortex (3, 11, p.393). This is not to say that self is located in the prefrontal cortex. Rather, this development allows a higher or more complex coordination of the basic elements of the nervous system to come into operation. Self, he believed, is simply a "co-ordination." It does not represent anything that had been newly built into the nervous system. There is no "autocratic mind at the top" (3, 11, P.98) that directs affairs.
Jackson's concept of self has two main implications. The first arises from his view that, in a broad sense, developmental history replicates evolutionary history Thus, it will be predicted that the self appears relatively late in childhood. This has recently been confirmed by Flavell and his colleagues (7) who found that the child does not discover the stream of consciousness until four, five or six years of age.
The second implication of Jackson's concept of self is that neural tracts connecting the prefrontal cortex with other parts of the brain are needed for the higher coordination upon which the self depends. Put another way, their function is necessary to the capacity to reflect upon the movements of "inner life." Recent neurophysiological evidence suggests that these tracts are involved in the higher-order aspects of attention, and in monitoring, evaluating, and modulating current experience (8).
Jackson's concept of "dissolution" is the third aspect of his theory upon which my approach to the representation of trauma is based. An insult to the central nervous system causes, so his observations led him to conclude, a retreat down the evolutionary and developmental pathway (3, 11, p.3956). Those functions, which appear last in evolutionary history, as well as in human development, are the most fragile and the first to be lost. Greater intensity of assault upon the mind-brain system causes a larger retreat down the evolutionary path. This effect, the reverse of evolution, Jackson termed dissolution.
Parallel concomitance implies that what affects the brain also affects the mind; similarly, a disruption of mental function has its counterpart in the cerebral sphere, Seen in this way, any noxious assault upon the mind-brain system, be it electrical, toxic, or psychological, will produce dissolution of some kind, however minor.
I This idea is consistent with the viewpoint of Lenore Terr, a leading
Lenore Terr, a leading
figure in the field of psychological trauma. Terr considers that a psychologically traumatic event has an effect analogous to a blow on the head or to a toxin (9, p.201), I will be arguing that the most salient and important aspect of this effect is an uncoupling or "de-doubling" of consciousness.
MEMORY AND TRAUMA
The effect of trauma is particularly salient in the sphere of memory@ Current memory research offers a means of understanding this effect.
Memory is no longer conceived as a unitary phenomenon, rather, it is made up of a number of "modules" of function which may, to some extent, operate independently of each another. One or more may be lost, while others continue to function. One of these types of memory function was ignored by mainstream memory research for much of this century. It was described by William James.
James wrote of the common experience of memory. It has two main aspects. 1. Remembering a particular event with something of its sensory aliveness, as a scene or an episode that can, in a metaphoric sense, be viewed. 2. Knowing that this experience comes from another time in one's own past (10, 1, p.650). Hughlings Jackson had also remarked upon the doubleness of this form of memory (3, 11, p.361).
Interest in this form of memory was revived by Endel Tulving (11). He distinguished between two forms of memory expressible in words. In this sense, both are "declarative." One of these kinds of memory corresponds with the first aspect of jamesian description. Tulving called it "episodic." The second form simply concerns facts, or knowledge of the world. This memory is "semantic." Unlike episodic memory, it involves no additional awareness of remembered events in one's personal history. One simply knows, for example, what happened in 1066, or 1776, the names of trees, and the form of their leaves. Relative to episodic memory, semantic memory is "adualistic." In order to highlight this difference, Tulving (12) called the former "autonoetic", i.e., self-understood, and the latter "noetic" (purely intellectual) .
In addition to these forms of memory, other, nondeclarative, forms are recognized. They include procedural memory, which concerns motor repertoires, and perceptual memory representation, which records sensory impressions. These memory systems are conceived as "anoetic" in the sense that consciousness and cognition are not necessary to them.
Although it is likely that a fairly large number of memory modules will eventually be identified, Tulving (13) posits that current data support the existence of five modules: episodic, semantic, procedural, perceptual representation systems, and an additional "working memory." It is important, in terms of the main thesis of this paper, to keep in mind that these different systems do not develop all at once, but serially throughout childhood, forming a kind of hierarchy (see Table 1) .
Perceptual representation is evident at the beginning of life. The sound of the mother's voice, the smell of her milk, the shape of her face are all recognized 7-10 days after birth (see review (2)). Procedural memory also emerges early. However, semantic memory, which depends upon recall in the absence of the thing remembered, does not appear until the end of the first year (14,15), when a child may crawl to a cupboard where he or she knows something is kept. This memory becomes "declarative" with the development of language during the second year.
Episodic memory emerges during the third year (16). The child can describe events in the fairly recent past. However, the episodic memory that James and Tulving described concerns the recall in adult life of events in the remote past. This form of memory is now distinguished from memory for recent events and called autobiographical memory. It does not develop until the fifth year of life (17). It is not unreasonable to suppose that the emergence of this form of memory is related to the child's discovery of the stream of consciousness since both experiences depend upon the capacity for reflection and since both appear in human life at about the same age.
Hughlings Jackson's "dissolution" postulate suggests that the episodic and autobiographical memories, which appear late in developmental history, will be more fragile than earlier developing forms of memory. They will be more easily overthrown by insults to the brain-mind system. Where psychological traumata are sufficient to disorganize and to disrupt the operation of the reflective processes, the traumatic memory will be stored in a memory system that is different to that related to ordinary consciousness, i.e., not in the episodic memory system but in a memory system that, although usually verbal, is earlier or more primitive than the episodic system. This system is presumably the "semantic" (18). The traumata are not recorded as incidents, but as a form of "knowledge" of negative selfcharacteristics (18). The individual is as though unconscious of the origins of these attributions, which tell the subject, in the manner of a script (19), that he or she is bad, stupid, ugly, incompetent, etc., in the presence of someone who is critical, shaming, controlling, cruel, etc.
The re resentations of trauma can be understood, accordinQ to Tacksonian theory, as having an organization of a hierarchical kind. The lesser traumata or those occurring later in life, will be recorded in memory systems, such as the semantic, which are closer to ordinary consciousness than those which are more severe and/or experienced earlier in life. They will reflect the work of more mature processing systems than severe/early trauma does.
Earlier or more severe traumata will be recorded in "anoetic" memory in a way that is wordless, but probably involves images. At the earliest or most severe level, the traumatic memories will be wordless and perhaps imageless, recorded in a largely bodily way, as affects and impulses to act.
FEELING CREATEs REALITY
The doctrine of parallel concomitance allows us, as previously remarked, to assume that psychological trauma has an effect analogous to cerebral disruption caused by physical or toxic means. Jackson described cases of disruption of cerebral function in which there was a transient loss of reflective consciousness and of episodic memory. The main thesis of this paper is that a similar uncoupling, or de-doubling of consciousness is a principal consequence of psychological trauma. This possibility is suggested by the particularities of the traumatic experience.
A traumatic event impacts on the psychic system like a loud noise. The stream of consciousness is lost. There is a diminution in the reflective process so that one is no longer aware of memories or imagining, but only the immediate present. In this sense, there is an uncoupling of consciousness. The individual is functioning in a state that Edelman (20) might call "primary consciousness," which he distinguished from "higher order consciousness." There is an awareness only of the traumatizer, the affective state, and sensations in the body, such as a beating heart, constricting gut, etc.
This trauma, if repeated, is likely to be recorded in a memory system, such as semantic which is adualistic rather than in the autobiographical form of memory (Repeated traumata are typically less available to consciousness than those that have occurred on a single occasion (9). When contextual cues trigger this aggregation of memories of similar traumatic events, the individual is not aware that they are memories (18). They are experienced as present events.
It must be supposed that the uncoupling due to trauma affects not only the reflective capacity upon which autobiographical memory and the stream of consciousness depend, but also a related series of monitoring, tracking, evaluating, and modifying functions that follow the maturation of certain tracts emerging from the prefrontal areas. These tracts are outlined by Schore (8).
Failure of this complex monitoring system allows the feeling the core of the traumatic memory to determine its "meaning," In this state, an attentional process, which compares inner and outer, is inadequate. Unencumbered by a higher level of evaluation and monitoring, the powerful affect creates its own psychic reality. Most importantly, this includes the attributes given to self and other during this experience.
An example of such a failure is provided by an incident during the therapy of a young woman, L.T., who had a severe borderline condition that was complicated by an eating disorder. She was intelligent and had read fairly widely about the latter disorder.
The therapist, also a young woman, was soon to go on vacation. L.T.'s developmental history involved severe separation anxiety related to her mother's repeated use of threats of abandonment and emotional distancing as a means of exerting control over her child. Sensitive to this background as the core of a traumatic system, the therapist began to prepare L.T. for the problem of separation during her vacation by giving her the dates of its occurrence. Although the therapist tried to explore the response, L.T. merely shrugged off the news as if it were inconsequential.
Following the session, L.T. wandered for hours. She told the therapist about it in the next session. She was not clear precisely where she had gone. However, she did remember walking through a large cemetery some miles from the hospital. There, she made a curious discovery. She found a gravestone bearing the name of the therapist. The adjoining grave was that of the dead person's mother. Her name resembled that of a psychiatrist well known in the field of eating disorders.
After this session, the therapist, her interest piqued, telephoned the custodians of the cemetery to inquire about these gravestones. They did not exist. Nobody who had the therapist's surname had been buried in that cemetery. Yet, it seemed the patient was not lying, in the ordinary sense of the word. There was no point in such a lie. A plausible explanation of her story is as follows:
The shock of the therapist's impending departure triggered the traumatic memory system, at the same time causing an effect equivalent to trauma. This engendered a period of altered consciousness in which there was an uncoupling or de-doubling of consciousness. The reflective process was lost and, with it, the episodic memory, which depends upon reflection. Put another way, her wandering was fuguelike, and her mental state dissociated (see Schacter (21), re memory and fugue states).
In her changed state of consciousness, L.T. could not, as it were, view her experience. She was sunk within it, precipitated into the traumatic system that had been triggered by the news of what felt like abandonment. In this state, the therapist was dead. The experience was presumably associated with rage of a murderous kind. The revengeful wish that the therapist should die produced the thought that this death had already occurred. In her uncoupled state, the fantasy of her therapist's death was now a reality, and constructed in terms of a "false" memory of the therapist's grave.
The therapist, however, is not only hated but also idealized. This is manifest in the name of her mother, which, on the gravestone, resembled that of the famous therapist.
This incident is determined, according to the main thesis of this paper, by a system of traumatic memories that are not stored in the memory system which involves the reflective capacity but in an earlier, nonreflective system, presumably the semantic. Circumstances that resemble the original trauma trigger the traumatic memory system, including the attributions and meanings that the affective experience generated. These original attributions are "transferred" to the current event. Lenore Terr gives an example of such "transference" that had arisen in a traumatic situation.
Terr interviewed 25 children who had been kidnapped from their school in a small town called Chowchilla and kept captive while their kidnappers sought a ransom. One of the girls had argued with her mother before the kidnapping. She gave a description of one of her kidnappers that matched that of her mother (9). However, her kidnappers were male.
A speculative understanding of the reason for this girl to give an incorrect description is similar to that for L.T. and the gravestones. The child's fight with her mother was presumably typical of previous fights that made up a traumatic memory system in which the powerful maternal figure is controlling and frightening. The same feelings, magnified, are associated with the kidnappers, so that the system is triggered. However, the girl is now in a state of terror. This has a compounding effect upon the disorganization of consciousness, the doubleness of which is impaired and with it the higher-order monitoring system that matches current experience against models of the past stored in memory. A coarser matching system is now dominant, lacking the fine discrimination of the later-evolved mechanisms. Since the feelings relating to the kidnapper match those recently felt for her mother, they are aggregated within the same miniature complex of meaning. The features of the mother are "transferred" to one of the kidnappers.
These anecdotes suggest the contents of a traumatic system, as judged by disinterested observers, will include "distortions" of those who inflicted the traumata. These attributions will be linked to related self-attributions.
The attributions may be beyond those of weakness, badness, or stupidity. The patient may experience himself/herself as repulsive, verminlike, dismembered, or deformed. These images reflect the terror, alienation, and sense of personal disintegration that form the core of memories of severe trauma. They are linked to images of the other as a monster, devil, or witch with hideous destructive powers. These images are not the products of dreams, but arise in waking life. They may be taken into the session as actual perception, so that the face of the therapist is changed and terrifying.
Since monstrous attributions are created in a state in which the reflective process is inoperative, as in early childhood, they are likely to be recorded in a memory system that is unconscious. This nightmare world of powerful and frightening feelings, revengeful and forbidden wishes, mingled with bodily and facial representations is portrayed in myth, fairy tales, and religious imagery
The malignant attributions that are the consequence of traumata have a structure different from normal identifications. The pathological identifications are adualistic.
Normal identification is exemplified by the little boy of two or three who swaggers around with his hands in his pockets like his father. This child is playing a double game. While he pretends to be his father, he is also himself. Two models are held in his mind. One is matched against, and reverberates with, the other. An essential aspect of this behavior is the child's positive feeling towards the father. He also wants to be like him. Although this experience is partly illusory, his father is also a real person.
In a traumatic situation, the opposite of these two features is found. The dualism is lost, and the other is experienced as alien, not-like-me. This comes about through the traumatic event arousing high anxiety that wipes out all sense of a world going on within. There is nothing else but the figure of the traumatizer, the terror, and the bodily sensations, such as a rapidly beating heart, a sense of constriction. In severe states, since there is very little sense of inner life remaining, the only experience of a person is of the other. In this situation, the other comes to inhabit the victim. In the traumatic state, the space between self and other is lost, so that self and the traumatizer are represented as fused. The traumatic system will be triggered by contextual cues and by high anxiety. During these states, the subject may experience themselves as the other who is alien. The "it," one patient called it. The experience may be of being demonized. One patient described it:
It was as if it were subconscious, like I was being controlled by something out of my power. It was like being demonized. Like having someone in your body making you speak and making you act, even though you're fighting it the whole time. Like your body's not your own. You don't have control of your body or your speech.
This representation of self, fused with the alien other, produces oscillations in self-state, in which, at times, the individual appears as the frightened and helpless victim and at others, perhaps a few seconds later, as the traumatizing other. These switches might be called reversals (21, 22, p.87-100).
The fused representation of traumatizer and the traumatized is sometimes represented in paintings created by abused patients. A female patient might paint herself as a creature made of two parts, one of which is male (23). This apparent fusion of the traumatizing other with the self representation, as if the former were impacted into the latter, is found in some borderline patients. For example, one woman, who had been badly physically abused by a violent father, took on a quasi-male persona and dressed in the black leather of a biker. At times, during the session, her voice was loud, harsh, and menacing. At other times, she took on the reverse pole of the representation so that her voice was the whisper of a frightened child.
The malignant internalizations described here are not integrated into the self system. In a metaphoric sense, they are "loose" or unstable. In Piagetian terms they are unassimilated. They determine relationships that shift rapidly, and in which the subject takes on one or other poles of the traumatic relatedness.
The oscillation between the self-other poles of traumatic memory is sometimes understood in terms of projective identification. However, since this term includes a wide number of mechanisms, and also normal states (24, p.98), it is preferable to use the word "reversal" which has a specific technical meaning and which was introduced by Freud in his later work (25).
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RUSSELL MEARES, M.D.*
* Professor of Psychiatry, Department of Psychological Medicine, University of Sydney, Westmead Hospital, Westmead NSW 2145, Australia.…
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Publication information: Article title: The "Adualistic" Representation of Trauma: On Malignant Internalization. Contributors: Meares, Russell - Author. Journal title: American Journal of Psychotherapy. Volume: 53. Issue: 3 Publication date: Summer 1999. Page number: 392+. © American Journal of Psychotherapy 2008. Provided by ProQuest LLC. All Rights Reserved.
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