Begriffsgeschichte und Konzeptualisierung des psychischen Traumas

In contrast to historical debates, which will be looked at in more detail below, it is common sense today that a traumatic experience must basically be considered the cause even for persisting mental disturbances. Nevertheless, the traumatic event as such remains a great conceptual challenge despite today??s definitions. Since the first investigations were made in the nineteenth century, the term trauma has gained an increasingly expanding scope. Today??s view has shifted more towards post-traumatic events, individual assessments, personal experiences and ways of coping. It is its expanded scope which exposes the term trauma to the danger of being trivialized once each subjectively felt misfortune or any sort of loss is defined as a trauma. A clear distinction must be made between a trauma and other difficult circumstances in life to establish and evaluate the individual extent to which people may be exposed to burdens or strain. Since the beginning of scientific debates about trauma and its consequences, the controversial subjects have always involved the question from which point on the term trauma is applicable and what the connection is between the type, intensity and duration of an encumbering event and the kind and intensity of a traumatically caused mental disturbance.     

Treating post-traumatic stress disorder among Vietnam combat veterans: An existential perspective

In the existential therapeutic approach the traumatic event is not divorced from the totality of one's life. The authors believe that finding some degree of meaning in the traumatic event is essential and that the recovery process begins when one feels that meaning and the sense of self are congruent.     

The Contextuality and Existentiality of Emotional Trauma

In this article I chronicle the emergence of two interrelated themes that crystallized in my investigations of emotional trauma during the more than 16 years that followed my own experience of traumatic loss. One pertains to the context-embeddedness of emotional trauma and the other to the claim that the possibility of emotional trauma is built into our existential constitution. I find a reconciliation and synthesis of these two themes—trauma's contextuality and its existentiality—in the recognition of the bonds of deep emotional attunement we can form with one another in virtue of our common finitude.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

The Comprehensive Resource Model®: Overview of basic affects in adversity & effective treatment for complex reactions to trauma

Much of the theoretical focus in post‐traumatic stress disorder has been on the role of the amygdala, the hippocampus and the prefrontal cortex. Crucially, in unresolved traumatic experiences that underlie clinical presentations, this focus misses the brain areas key to the defence responses of fight, flight and freeze—and the associated affects of anger, fear and grief. The periaqueductal gray in the midbrain, with the hypothalamus, is essential for these somatic and emotional responses to traumatic experiences. We argue that when treatment approaches thought to work at the higher brain levels have been ineffective, it is because they have failed to engage the midbrain and hypothalamic sources of the affective responses to the trauma and to the memory of it. Basic affects have been so overwhelming that dissociation, or a similarly protective neurochemical capping mechanism, has prevented full resolution of the affective content of the adversity. Treatment with the Comprehensive Resource Model^® (CRM) aims to clear the clinically relevant residues of adverse experiences by resolving the emotional responses accessed through the body memories. When the trauma has led to overwhelming distress, and/or dissociation, there is a necessity for robust resourcing to be in place before the emotional intensity of that distress is accessed. Resourcing needs to be as proximal to the re‐experience as possible to promote complete resolution and in some psychotherapy modalities, the supports provided are somewhat remote from the crucial moments of processing. Therefore, we describe how the CRM seeks to have robustly resourced states present concurrently with traumatised states to avoid overwhelming emotional distress. This allows safe entry into the deepest pain residual from the traumatic event so that it is not overwhelming during processing of the memory, and does not lead to further dissociation, allowing the individual to remain fully present throughout. This “stepping into the affect” can then be so rapidly effective that we also argue that CRM is not an exposure treatment; re‐orientation to the deepest content of the experience resolves the residual distress quickly and permanently through memory reconsolidation. Re‐learning at upper brain levels will then follow from the revoking of the affective power, which has previously driven stimulus/context and response learning in the amygdala, hippocampus and prefrontal cortex.     

Human time and dreaming

One characteristic of massive trauma is a persistent feeling that time is frozen, i.e., an experience impossible to integrate into a psychic reality. In this paper, the author sets out to explore the dimension of time in the psychoanalytical situation in an effort to shed light on this question. The infant acquires an immediate sense of time through the rhythm of frustration and satisfaction, and out of these encounters, a fundamental dialogue evolves. This primary dialogue is internalised and is regarded as an indispensable structure for psychic life. The child's existence is impregnated by unconscious desires or beliefs of the adult world—enigmatic messages that will constitute an unconscious source of the child's own psychic reality. Timeless desires and enigmatic messages urge on a dreaming in attempts to carry over the psychical sense of time and the implacable time of existence. When we infuse a time dimension through our dreaming and our narratives, we give shape to our timeless wishes. The psychoanalytic situation arouses the primary dialogue and an elementary experience of time. Traumatic experiences are tantamount to the absence of the primary object and thereby the death of time. Dreaming becomes an endeavour to create a psychic space, the aim of which is to restore the primary dialogue. If circumstances obliterate all hope of re-establishing the bond to the primary object, the sense of time is destroyed as well. The author concludes that the experience of time and elaboration of traumatic experiences are closely connected.     

Memory in dreams1

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.     

The nature of intrusive memories after trauma: the warning signal hypothesis

Individuals who had experienced a range of different traumas were asked to describe the quality and content of their intrusive memories. Visual intrusions were the most common, and thoughts were uncommon. Intrusion quality varied little with type of trauma. Intrusive memories commonly consisted of stimuli that were present immediately before the traumatic event happened or shortly before the moments that had the largest emotional impact (i.e., when the meaning of the event became more traumatic). It is suggested that intrusive memories are about stimuli that through temporal association with the trauma acquired the status of warning signals, i.e., stimuli that if encountered again would indicate impending danger. This explains why intrusive memories are accompanied by a sense of serious current threat. The warning signal hypothesis may be useful in guiding therapists in identifying the moments with the largest emotional impact that will need reprocessing in treatment, and in educating patients about the nature of reexperiencing symptoms.     

A longitudinal investigation of the reliability of memories for trauma and other emotional experiences

This study examined the relative consistency and characteristics of memories for trauma and other non‐traumatic emotional experiences over time. A community sample of 52 participants who reported a recent traumatic event were asked to recall both the traumatic and a positive emotional experience in two interviews separated by approximately three months (M = 105.39 days). The recollections were elicited with either a free narrative, cognitive interview, guided imagery, or written narrative approach. Results indicated that traumatic experiences were recalled more reliably over time than other emotional experiences. Traumatic memory imagery tended to persist in memory (with no apparent impairment), whereas features of positive memories were subject to considerable distortion, regardless of interview style. The findings contribute to the understanding of the impact of trauma on memory with the passage of time. Copyright © 2004 John Wiley & Sons, Ltd.     

On Being Annoyed

What is it that unites episodes of the emotion of annoyance? The paper considers possible analyses of the content of the state of annoyance, and concludes that this emotion should be understood to involve a negative construal of an object, event, or state of affairs as having failed to exemplify one of a suite of kinds of everyday quality or excellence. This account permits us to see what is common to a varied range of superficially‐disjointed emotional responses, and to make sense of the conditions under which annoyance is appropriate or inappropriate. Moreover, it reveals something of what we care about in everyday and social contexts, in our ordinary dealings with persons and artefacts.     

The minimal A-theory

Timothy Williamson thinks that every object is a necessary, eternal existent. In defense of his view, Williamson appeals primarily to considerations from modal and tense logic. While I am uncertain about his modal claims, I think there are good metaphysical reasons to believe permanentism: the principle that everything always exists. B-theorists of time and change have long denied that objects change with respect to unqualified existence. But aside from Williamson, nearly all A-theorists defend temporaryism: the principle that there are temporary existents. I think A-theorists are better off without this added commitment, but I will not argue for that in any great detail here. Instead, I will contend that a very tempting argument for temporaryism is unsound. In the first half of the paper, I will develop the Moorean ??common sense?? argument for temporaryism and dispute its central premise, namely that temporaryism is the best generalization from our ordinary beliefs about creation, destruction, coming to be, and passing away. I will argue that given the pervasive vagueness in our ordinary beliefs and the background commitments of all A-theories, temporaryists cannot claim to have the common sense view because no party can accommodate most of our common sense beliefs. In the second half of the paper, I will propose a permanentist A-theory that explains all change over time as a species of property change. I call it the minimal A-theory, since it dispenses with the change in existence assumption. As we??ll see, the permanentist alternative performs well enough in explaining our ordinary beliefs, and it has better prospects for answering three objections commonly levied against A-theories.     

创伤后应激障碍的双重表征理论及其进展

创伤后应激障碍(PTSD)的双重表征理论认为创伤引起了可回忆的言语记忆和可回忆的情境记忆两类记忆。这两类记忆能够解释PTSD,比如再现创伤和情绪加工。创伤的情绪加工可能合出现成功完成、慢性加工和过早抑制加工三个结果。最后本文讨论了该理论在研究设计、临床实践和解释实验数据方面的应用。     

Posttraumatic stress disorder in medically ill patients: what is known, what needs to be determined, and why is it important?

Can a medical illness or its treatment qualify as an emotionally traumatic event and can it cause posttraumatic stress disorder symptoms? If so, can the view of a medical illness as a traumatic experience enhance our ability to understand patients' adjustment to illness and their emotional reactions to it? Is it important to identify posttraumatic symptoms and try to address them in medically ill patients? These questions form the backbone for this review. Because many questions remain unanswered (or the answers are not definitive yet), we concisely summarize the issues and present our own view of the most pressing questions for further research.     

The Middle Passage,Trauma and the Tragic Re-Imagination of African American Theology

African American Christian consciousness developed in response to the traumatic field in which African American subjectivity took shape. The expression of the faith in the African American tradition is fundamentally tragic as a consequence. The Middle Passage is the existential and symbolic nodal point of this experience. There is a sense in which African Americans remain very much on the water; marginalized and suspended between worlds. There is a deeper sense in which the African American situation and response reflects the condition of modernity and post-modernity in the sense that it is hardly more than modernity becoming conscious of itself. A thorough examination and exploration of its significance is essential to developing a theology that adequately expresses African American Christian consciousness. This paper is an attempt to lay out, what I think, are some of the basic components of the experience and the bare outlines or orientation of such a theology grounded in it.     

Are memories for sexually traumatic events "special"? A within-subjects investigation of trauma and memory in a clinical sample

According to a long-standing clinical tradition, sexually traumatic experiences are processed and recalled differently from other experiences, often leading to memory impairment. In this study, we compared the characteristics of traumatic memories for sexual violence and two other types of emotional experiences. N=44 women recruited from a local sexual trauma agency were asked to recall and describe three autobiographical events: sexual abuse/assault, a non-sexual trauma, and a positive emotional event. The characteristics of the three memory types were compared on both subjective and objective measures. Further, the potential influences of level of traumatic impact and dissociation were assessed. Results indicated that memories for sexual trauma were not impaired or fragmented relative to other memories. Instead, memories for sexual trauma were associated with a remarkably high level of vividness, detail, and sensory components. Further, high levels of traumatic impact were not associated with memory impairment. Implications for the ongoing traumatic memory debate are discussed.     

Commentary on Paper by Philip A. Ringstrom

When we feel overwhelmed by an inescapable threat, we “identify with the aggressor” (Ferenczi, 1933). Hoping to survive, we sense and “become” precisely what the attacker expects of us—in our behavior, perceptions, emotions, and thoughts. Identification with the aggressor is closely coordinated with other responses to trauma, including dissociation. Over the long run, it can become habitual and can lead to masochism, chronic hypervigilance, and other personality distortions.

But habitual identification with the aggressor also frequently occurs in people who have not suffered severe trauma, which raises the possibility that certain events not generally considered to constitute trauma are often experienced as traumatic. Following Ferenczi, I suggest that emotional abandonment or isolation, and being subject to a greater power, are such events. In addition, identification with the aggressor is a tactic typical of people in a weak position; as such, it plays an important role in social interaction in general.     

Thanatos and massive psychic trauma: the impact of the death instinct on knowing,remembering, and forgetting

The connection between massive psychic trauma and the concept of the death instinct is explored using the basic assumptions that the death instinct is unleashed through and is in a sense characteristic of traumatic experience, and that the concept of the death instinct is indispensable to the understanding and treatment of trauma. Characteristics of traumatic experience, such as dissolution of the empathic bond, failure to assimilate experience into psychic representation and structure, a tendency to repeat traumatic experience, and a resistance to remembering and knowing, are considered as trauma-induced death instinct derivatives. An initial focus is on the individual, on how death instinct manifestations can be discerned in the survivors of trauma. Next the intergenerational force of trauma is examined; a clinical vignette illustrates how the death instinct acts on and is passed on to the children of survivors. Finally, the cultural or societal aspects of trauma are considered, with an eye to how death instinct derivatives permeate cultural responses (or failures to respond) to trauma. Because trauma causes a profound destructuring and decathexis, it is concluded that the concept of the death instinct is a clinical and theoretical necessity.     

Emplotting the traumatic self: Narrative revision and the construction of coherence

Abstract

In this article we provide a constructivist‐narrative conceptualization of the origins and psychotherapeutic methods for treating trauma. We believe that the experience of trauma ensues when lived events outpace peoples’ abilities to emplot or narrate these events from the perspective of dominant life narratives. The sights, sounds, and smells associated with traumatic events preclude such emplotment. The therapeutic objectives of narrative therapy include finding ways to develop meanings for the trauma and subsequently to integrate these with the dominant narrative. Two case studies are provided to illustrate our conceptualization and therapeutic approach.     

Vantage point in traumatic memory

Abstract— Persons with posttraumatic stress disorder (PTSD) spontaneously recalled the traumatic event that led to their condition from either a field or an observer vantage point. In the former case, participants recollected the event as if they were seeing it again through their own eyes; in the latter case, the event was recalled from the perspective of a detached spectator. Analysis of the two types of recollections revealed marked differences in their contents. Whereas field memories afforded richer accounts of the affective reactions, somatic sensations, and psychological states that participants experienced during the focal trauma, observer memories contained more information about participants' physical appearance and actions and the spatial layout of the traumatic scene. Observer trauma memories were also experienced as less emotional and anxiety provoking than field trauma memories. The discussion focuses on the clinical implications of these findings and prospects for future research on traumatic memory.     

The Normative Significance of Forgiveness

P.F. Strawson claimed that forgiveness is such an essential part of our moral practices that we could not extricate it from our form of life even if we so desired. But what is it about forgiveness that would make it such a central feature of our moral experience? In this paper, I suggest that the answer has to do with what I will call the normative significance of forgiveness. Forgiveness is normatively significant in the sense that, in its paradigmatic instances, forgiving alters the operative norms bearing on the interaction between the victim and the wrongdoer in certain characteristic ways. My project here is, first, to clarify the ways that paradigmatic cases of forgiveness alter the norms of interaction between victim and wrongdoer and to argue that it is in this respect that forgiveness is a normatively significant feature of our moral responsibility practices. Second, I show that most extant theories of forgiveness fail to explain the characteristic ways in which forgiving alters norms. Third, I offer a theory of forgiveness that accounts for this significant normative feature. I conclude by addressing two objections to my proposal.