The Concept of Cumulative Trauma

Unconscious Fantasy and The Priming Phenomenon

This paper is the third in a series of investigations into (1) the nature and development of unconscious fantasy, (2) its place in a contemporary model of mind that, parenthetically, suggests a possible solution to the problem of theoretical pluralism, and (3) its mode of operation in the mind. The aim of these investigations is to update the notion of unconscious fantasy, an indispensable construct in psychoanalytic theories that assume out-of-awareness mentation, and to situate that construct within contemporary views of mental functioning in disciplines such as philosophy of mind, cognitive science, and developmental psychology. At the same time, data accessible only through psychoanalytic work challenge these fields with findings that indicate the need for further investigation. This paper argues that experimental evidence on the phenomenon of "priming" lends support to one of the seminal claims in our field, one frequently attacked as an outmoded shibboleth: that is, that the past matters, whether encoded in declarative or in procedural memory. In common parlance, we are "primed" to respond to some situations in predetermined ways; the past primes us to experience the present in often unique and personal ways. There is evidence too that the priming mechanism and the encoding of subjective experience in declarative and procedural memory operate from very early in life.

Can Babies Remember Trauma? Symbolic Forms of Representation in Traumatized Infants

Three important areas of current inquiry concerning early trauma-the respective roles of reality and fantasy, age-related capacity for the symbolic representation of trauma, and attachment status-are approached through clinical case reports of three children seen initially at very early ages. The findings are relevant to the issue of whether preverbal infants can experience traumatic events that later are available to interpretation. The focus is for the most part on event traumas-single harrowing, life-threatening experiences-occurring at quite early ages. Three main points are emphasized. First, toddlers and infants (including neonates) can experience intense pain and show symptoms of traumatization. They are capable of experiencing an event as harrowing and life-threatening. Second, these events are capable of being memorialized or symbolically represented, that is, stored in memory in a way that can affect later behavior and learning. Third, how that traumatization resolves itself, or fails to, can be decisively affected by the functioning of the attachment system.

The Identity Formation of the Victim of 'Shunning'

This study investigates the concept of shunning, which can be differentiated from other types of bullying through focusing on the victimizing process. Shunning represents the collective exclusion of an individual by being ignored by their peers and it is the typical type of Ijime (bullying) in Japan. I present two brief cases that describe experiences of classmates being shunned. I examine the cases and then introduce four different positions of the victim's reaction to the experience of being shunned which correspond to four different identity statuses. Papadopoulos (1999) put forward the idea of'storied community' through his clinical work with refugees, which provides victims with coherent narratives and transitional space as a secure base. This concept seems to have useful applicability in the phenomenon of shunning. However, the devastating dilemma for shunned victims in Japan is that the most available storied community, which could offer them refuge, is the one of 'suicide as revenge on the tormentors'. In this way, the choice is impossible between finding refuge in that story or losing the sense of identity. The implications for the clinician to relate to the victim of shunning are discussed, within the context of this approach.

THE PSYCHOANALYTIC CONTRIBUTIONS OF MELITTA SCHMIDEBERG KLEIN. MORE THAN MELANIE KLEIN'S REBEL DAUGHTER

Compared to the impact of the work of Melanie Klein on the history of psychoanalysis, the contributions of her daughter, Melitta Schmideberg, passed almost unnoticed. At present, Schmideberg is solely remembered for having harshly attacked her mother at the start of the Controversial Discussions of the British Psycho-Analytical Society and for having coined the fitting expression "stable instability" in order to describe borderline and asocial personality disorders. However, the author discusses how the early groundbreaking discoveries of Klein with regards to primitive anxieties were the result of the joint work and thinking of Melanie and Melitta. Moreover, he argues that the conflict between the two, along with the subsequent polarization of their views, did not facilitate the development of psychoanalysis, neither did it help the analytic community to recognize the value of Melitta's contributions to psychoanalysis.

Where Is India in My Psychoanalytic Work?

Taking for granted that an analyst's ethnic and national origin can influence his or her theoretical and technical preferences, I have attempted to highlight the role of India in my psychoanalytic life. I have expanded the death instinct concept and sought to soften the impasse between psychoanalysis and religion from an Indian perspective. I have also demonstrated how aspects of Indian culture affect my clinical practice, including my office décor, my therapeutic attitude, my language, and my interventions with patients. By providing such details, I am hoping to establish my veracity for non-Indian psychoanalysts and to inspire Indian psychoanalysts towards greater authenticity. More importantly, my hope is to enhance dialogue between psychoanalysis and Indian thought since such discourse has the potential to enrich both disciplines.

The Effect of Trauma on the Conductor of the Group: A Type of Identificatory Countertransference

Trauma affects the conductor of the group as well as the group members. This identificatory countertransference of the group conductor is a resultant of the coming together of the conductor's internal and external worlds, the interplay of introjections, projections, and empathy. It is inconceivable that a conductor of a group can project a "blank screen" of technical neutrality when trauma impinges upon everyone. From a psychodynamic perspective, this article explores groups under the throes of trauma, the interplay of that trauma with the conductor's feelings, and the effects on his or her role in the group. The article also explores the effect of trauma upon the affective process within the group and upon the cognitive processes of the conductor and group members.

Repairing links: building attachments in the preschool classroom

A psychoanalytic model of preschool consultation is presented, born of the conviction that psychoanalysis has powerful tools with which to tackle some of our most difficult and entrenched community problems. Since trauma is known to impact our ability to think reflectively and symbolically (Fonagy, Moran, and Target 1993), the clinical methods of psychoanalysis-drawing on the ideas of container/contained, the capacity to hold alternate points of view, and the capacity to reflect empathically (here with teachers in the face of their at times harsh and insensitive treatment of students)-are crucial to success in work with cumulatively traumatized staff (Khan 1963). The strongest resistances to consultation arise from an anti-attachment system developed as a result of cumulative trauma and operating at multiple levels in the preschool. Consultation services are organized around an understanding of this anti-attachment system. At various levels of the system, including staff, parents, and children, consultants work to facilitate secure relationships in the preschool setting. These relationships foster recognition of children's emotional complexities and build cooperative links between staff and parents, in an atmosphere that otherwise might often push adults into fearful, self-protective states that interfere with their contact with children's states of mind.

Memory in dreams

In this paper the author discusses a specific type of dreams encountered in her clinical experience, which in her view provide an opportunity of reconstructing the traumatic emotional events of the patient's past. In 1900, Freud described a category of dreams--which he called 'biographical dreams'--that reflect historical infantile experience without the typical defensive function. Many authors agree that some traumatic dreams perform a function of recovery and working through. Bion contributed to the amplification of dream theory by linking it to the theory of thought and emphasizing the element of communication in dreams as well as their defensive aspect. The central hypothesis of this paper is that the predominant aspect of such dreams is the communication of an experience which the dreamer has in the dream but does not understand. It is often possible to reconstruct, and to help the patient to comprehend and make sense of, the emotional truth of the patient's internal world, which stems from past emotional experience with primary objects. The author includes some clinical examples and references to various psychoanalytic and neuroscientific conceptions of trauma and memory. She discusses a particular clinical approach to such dreams and how the analyst should listen to them.

Julie's museum: The evolution of thinking, dreaming and historicization in the treatment of traumatized patients

The author contends that, following Freud, trauma may be viewed as a disruption of the ego's 'protective shield' and that a central factor of this shield is an internalized relationship to a thinking-containing mother. Severe trauma destroy this inner connection, resulting in the reversal of a-function and the establishment of a rigid traumatic organization (ss-screen) that brings coherence to the shattered psyche. However, this is an 'organized chaos' in which concrete forms of thinking predominate. The patient's ability to think, dream and imagine is significantly curtailed and she is consequently locked in a traumatic world from which she is unable to evolve. He offers a detailed case history to illustrate these points and the vital role the analyst's imaginative capacities play in the analysis of such individuals. Finally, he addresses the development of the capacity to represent the trauma, starting with primitive, often somatically encoded experiences, and evolving toward the capacity for historicization.

A case history: from traumatic repetition towards psychic representability

This paper is devoted principally to a case history concerning an analytic process extending over a period of almost ten years. The patient is B, who consulted the author after a traumatic episode. Although that was her reason for commencing treatment, a history of previous traumatogenic situations, including a rape during her adolescence, subsequently came to light. The author describes three stages of the treatment, reflected in three different settings in accordance with the work done by both patient and analyst in enabling B to own and work through her infantile and adult traumatic experiences. The process of transformation of traumatic traces lacking psychic representation, which was undertaken by both members of the analytic couple from the beginning of the treatment, was eventually approached in a particular way on the basis of their respective creative capacities, which facilitated the patient's psychic progress towards representability and the possibility of working through the experiences of the past. Much of the challenge of this case involved the analyst's capacity to maintain and at the same time consolidate her analytic posture within her internal setting, while doing her best to overcome any possible misfit (Balint, 1968) between her own technique and the specific complexities of the individual patient. The account illustrates the alternation of phases, at the beginning of the analysis, of remembering and interpretation on the one hand and of the representational void and construction on the other. In the case history proper and in her detailed summing up, the author refers to the place of the analyst during the analytic process, the involvement of her psychic functioning, and the importance of her capacity to work on and make use of her countertransference and self-analytic introspection, with a view to neutralizing any influence that aspects of her 'real person' might have had on the analytic field and on the complex processes taking place within it.

The basic traumatic situation in the analytical relationship

The author attempts to develop a concept of psychic trauma which would comply with the nucleus of this Freudian notion, that is, an excess of excitations that cannot be processed by the mental apparatus, but which would also consider the functions and the crucial role of objects in the constitution of the psychism and in traumatic conditions, as well as taking into account the methodological positioning according to which the analytical relationship is the sole possible locus of observation, inference and intervention by the psychoanalyst. He considers as a basic or minimal traumatic psychoanalytical situation that in which a magnitude or quality of emotions exceeds the capacity for containment of the psychoanalytical pair, to the point of generating a period or area of dementalisation in the psyche of one or both of the participants, of requiring analytical work on the matter and promoting a significant positive or negative change in the relationship. Availing himself of Bion's theory about the alpha function and the metapsychological conceptions of Freud and Green concerning psychic representations, he presents two theoretical formulations relating to this traumatic situation, utilising them according to the 'altered focus' model proposed by Bion. He presents three clinical examples to illustrate the concept and the relevant theoretical formulations.