The Pains of Psychological Trauma

Understanding the Pains of Psychological Trauma post 1

Introduction to Trauma

Aside from those caused by brain disorders or by genetic inherited conditions–most mental problems are caused by some form of psychological trauma.  The word ‘Trauma’ was adapted from Medicine into psychiatry and psychology.

In psychology, “Trauma” is a deeply distressing or disturbing experience. The experience is of such an intensity that leaves a psychological scar in our minds. These highly emotionally-charged memories affects us later on in our lives. They make us feel anxious and/or gives us symptoms without our understanding why we feel the way we feel.

An example of psychological trauma would be the death of a very closed family member, such as a parent in childhood or a child in adulthood. An example of “symptom” would be the recurrent nightmares that take place at around the anniversary of the person’s death.

The history of Trauma

Freud was the first physician in giving Trauma its place and importance in the field of psychiatry.  We can say that Trauma gave origin to the creation of psychoanalysis.  Until Freud’s time, at the end of the 19^th century, psychiatry did not pay much attention to psychological trauma as a source of mental illness.  Psychiatrists of that time believed that mental illness was the product of the then called “degeneration” or sheer inheritance. 

Charcot and Janet in France noticed that patients that suffered from hysteria had a history of traumatic situations in their past.  But they did not take it much further than noticing this fact. This finding, however, led to the possibility that neuroses were not inherited but acquired.

Freud investigated the matter exhaustingly and realized that patients who suffered from hysteria actually had a history of trauma in their lives. Some of the traumas had happened in their recent past–but the most significant ones dated back all the way to their childhoods.  He then went on to discover the importance of Trauma in general–and of childhood trauma in particular–in the development of mental illness.  

The Freudian discoveries: Trauma, Psychoanalysis, and the first Freudian model of the mind

Using his then new technique of psychoanalysis, Freud discovered that these neurotic patients “suffered from reminiscences.” This means that they suffered from the effect of memories of forgotten traumas that had become “repressed” (forgotten). These emotionally charged painful memories had been blocked off from their consciences because they were disagreeable memories. 

For this reason–and in order to avoid psychological suffering–people preferred not to remember them. Accordingly, they made stringent efforts to forget them.  But, in spite of all their best efforts, these memories did not disappear completely from the mind. They were just pushed to the back of the mind. They went into a reservoir of ideas he came to call “the Unconscious.”  And eventually they came back. This return Freud called “The return of the repressed”. This returned was usually triggered by some incident and would determine the outbreak of the neurosis.

The first Freudian tripartite model of the mind

Freud posited that the mind had three compartments:

1-The conscience (that part of the mind that kept us in touch with reality in the here and now)

2-The preconscious (the memories that were not in our immediate consciousness but that could be retrieved by making an effort of recall)

3-The Unconscious (the part of the mind that worked as the depository of early and traumatic memories). This deeper part could not be easily accessed. It required the lifting of repression using hypnosis or psychoanalysis. 

These were the types of memories that still affected his patients as “reminiscences.” From the Unconscious, these emotionally charged memories had the power of creating physical symptoms he called “conversions.” “Conversions” happened predominantly in hysterical patients. They were physical symptoms that replaced the forgotten traumatic memories. They were symbolic “body memories” of past traumatic situations, so to speak. 

For instance, a person might experience a paralysis of her arm of unknown origin with all her nerves and muscles being intact. These patients baffled the neurologists of those times. This phenomenon of conversion in hysterics had no explanation for the neurologists and psychiatrists. Thus they believed that these individuals were born with some form of inherited brain “weakness.” And therefore, they had nothing to offer these patients in terms of treatment.

Trauma and the advent of hypnosis

In the late 19^th century, Charcot in France found out that he could hypnotize these patients and remove their physical symptoms through hypnosis. In the hypnotic state, he suggested these neurotic patients that they would be free of their paralysis upon coming back from the hypnotic state–and they did!

When he was young, Freud spent time with Charcot in La Salpetriere (the main neuropsychiatric hospital of Paris at that time). And he marveled at the new hypnotic technique used by Charcot and at its effectiveness to remove neurotic symptoms.  He learned hypnosis himself and started applying it to his patients upon his return to Vienna where he established his private practice.

The problem was, as Freud noticed, that the symptom might go away after a hypnotic session, but later would come back; or the symptom would move to another part of the body and reappear over and over again later on. So, hypnosis helped, but was not the panacea. With this form of treatment, the patient had to be seen by the doctor regularly in hypnosis sessions to remove her symptoms over and over again. He then realized that Hypnosis was a palliative but not a curative method.  And he was looking for a method that could achieve more.

From suggestive hypnosis to “the cathartic method“

It is by that time that he met an older colleague in Vienna, Joseph Breuer, who had been practicing hypnosis for years with success.  Breuer was a family doctor, not a neurologist or a psychiatrist. He told Freud about a modification of the hypnotic method he had come up with.  This new method did not use direct suggestions like Charcot’s, but rather sought to relax the patient enough to remember forgotten–traumatic memories. 

Breuer had applied this new technique for the first time in 1881 on a young woman who came to be known as Anna O.  She was a twenty-five-year woman at the time. Anna told Breuer to “let her tell her story of her trauma without interruption.” In a way, Anna O created the basis of what would later become the psychoanalytic method.  She called the treatment “the talking cure” or “chimney sweeping.” And Breuer called this new psychotherapeutic procedure “Abreaction”(a form of psychological “Catharsis” which literally means purging emotions). 

Breuer also noticed that if Anna told the whole story of a certain traumatic scene from her past, her symptoms would disappear for good. They did not return or displace to another part of her body. Freud then dropped suggestive hypnosis and started using Breuer’s “cathartic method” instead with some success.  

The creation of Psychoanalysis and the new classification of the neuroses by Freud

Freud’s next step was to remove the hypnosis from the cathartic method thus creating what we now know as “psychoanalysis.”

So, psychoanalysis is a method of treatment and of investigation of the mind. It is based on the notion that past traumatic memories that have been forgotten still can impact us from their place in the Unconscious causing us to have unexplainable symptoms in the present. 

The three most common presentations of those symptoms are:

1-Phobias (severe fears that are out of proportion with the magnitude of the threat)

2-Obsessions and compulsions (now known as OCD)

3-Conversions (body memories expressed as physical symptoms)    

As a result, he created a classification of trauma that defined what he called the “psychoneurosis”. These are the three original trauma related neuroses caused by past trauma memories that became unconscious.  

The origin of the psychoneuroses

Following the main symptom presentation, he came up with a classification of three psychoneuroses according to the symptoms that predominated in them:

1-Phobic or “Anxiety Hysteria”

2-Obsessive Neurosis (a new condition described originally by Freud himself)

3-Conversive Hysteria (what is today known as “Conversion Disorder” in the DSM 5)   

All of these conditions, however, had one central symptom in common: Anxiety. But the intensity of anxiety varied in each neurosis. It was high in Obsessional and Phobic neuroses and minimal in Hysterical neurosis.

“Neuroses” were then different modalities of dealing with anxiety in ways that made them more tolerable to the individual.  Anxiety was the cardinal symptom present in all forms of neurotics. This cardinal affect was part of the other neurotic symptoms. But psychological symptoms were created to avoid its generation at all costs. 

Anxiety is a very disagreeable feeling. It is a form of intense fear without an object.  Anxiety is to the mind what pain is to the body. For this reason, people come up with strategies to fend off anxiety as best they can. These “strategies against the development of anxiety” Freud called the “Mechanism of Defense”.

The partial abandonment of Trauma as the main cause of neurosis in Freud

By the early 20^th century, Freud had lost trust in some of the trauma stories his patient told him.  He could not come to believe the massive numbers of sexual childhood abuse in Victorian society related to him by his patients. He then realized that sometimes these stories of childhood trauma were not factual. However, patients related them as if they had actually happened to them.

Freud then concluded that–besides factual trauma situations there were also traumatic phantasies in childhood.  And from that time on, he deemphasized factual trauma as the cause of the neuroses in favor of traumatic psychical phantasies. 

However, Freud never abandoned completely his trauma theory as the origin of neurosis.  This discovery led him to the realization that there were two different types of reality:

 1-Factual, objective, external reality 

2-“psychical reality” (how the person perceives her own reality regardless of what actually happens).

In the next post I will continue examining trauma, its history, its later developments–and the current methods used in psychoanalysis, psychology, and psychiatry to treat these all too frequent conditions in the postmodern world.   I will also make useful suggestions and recommendation as to what to do if you suffer from Trauma issues.

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Till then,

Dr T