Traumatic effects of political repression in Chile: A clinical experience1

The author examines psychic trauma resulting from human rights violations in Chile. Starting from trauma theories developed by authors such as Ferenczi, Winnicott and Stolorow, she posits the relevance of the subject's emotionally signifi cant environment in the production of the traumatic experience. She describes the characteristics of the therapeutic process on the basis of a clinical case. She emphasizes the need to recognize the damage that may be produced within the reliable link between patient and analyst, pointing out the risk of retraumatization if analysts distance themselves and apply ‘technique’ rigorously, leaving out their own subjective assessments. Therapists must maintain their focus on the conjunction of the patient's intersubjective context and inner psychic world both when exploring the origin of the trauma and when insight is produced. The author posits repetition in the transference as an attempt at reparation, at fi nding the expected response from the analyst that will help patients assemble the fragments of their history and achieve, as Winnicott would put it, a feeling of continuity in the experience of being.     

New interpretative styles: Progress or contamination? Psychoanalysis and phenomenological psychopathology1

Psychoanalysis has started to recoup, often quite implicitly, a more phenomenological stance, ever since psychoanalysts have started working with borderline and psychotic patients. As many of these patients have commonly been through traumatic experiences, psychoanalysts have been using an approach that questions the role of traditional psychoanalytical interpretation and pays more attention to the patient's inner conscious experiences; this approach is characteristic of a specifi c form of contemporary psychiatry: phenomenological psychopathology, founded by Karl Jaspers in 1913 and developed into a form of psychotherapy by Ludwig Binswanger, with his Daseinsanalyse. If what we could call a phenomenological ‘temptation’ has been spreading over psychoanalysis, so too has a psychoanalytical ‘temptation’ always been present in phenomenological psychopathology. In fact, even though this branch of psychiatry has led us towards a deeper understanding of the characteristics of psychotic being‐in‐the‐world, its therapeutic applications have never been adequately formalised, much less have they evolved into a specifi c technique or a structured psychotherapeutic approach. Likewise, phenomenological psychotherapy has always held an anaclitic attitude towards psychoanalysis, accepting its procedures but refusing its theoretical basis because it is too close to that of the objectifying natural sciences. Psychoanalytic ‘temptation’ and phenomenological ‘temptation’ can thus be considered as two sides of the same coin and outline a trend in psychoanalytic and phenomenological literature which points out the fundamental role of the patient's inner conscious experiences in the treatment of borderline and psychotic patients.     

The basic traumatic situation in the analytical relationship1

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 signifi cant 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.     

Los Degradados: Out,down, dead: Transmitted and inflicted trauma as encountered in the analysis of a 6‐year‐old girl1

The author presents the analysis of a precocious traumatized little girl, which reveals the ways in which historical trauma is transmitted and intrafamilial trauma is both disguised and represented. The play as it evolves is seen to simultaneously communicate what the child struggles with and to resolutely try to hide what has actually happened. Analyst and child together participate in play which utilizes displacement, enactment and interactive enactment, the latter play mode being the very hallmark of profound traumatic experience. Carlotta, the child, helps the analyst to follow her quest for meaning making even as the interaction between them adheres to and departs from the deepening pentimenti of traumatic experience, which needs to be unraveled and reconstructed in order that her own developmental progression can be rejoined. The analysis facilitates Carlotta's capacity to play in a more unfettered fashion and to assist her family's recovery as well.     

Pretrauma Neuroticism, Negative Appraisals of Intrusions, and Severity of PTSD Symptoms

Earlier studies found that self-reported posttraumatic stress disorder (PTSD) symptoms are correlated with negative appraisals of symptoms and with neuroticism. It is unclear whether the latter two are associated. Possibly, an overarching trait such as neuroticism mediates the relationship between PTSD symptoms and negative appraisals of symptoms. Data from a previous study (see I. M. Engelhard, M. A. van den Hout, M. Kindt, A. Arntz, & E. Schouten, 2003) were used in the present effort to address these issues. Neuroticism scores were obtained from 1,372 pregnant women. One hundred and twenty-six women experienced a pregnancy loss, and 117 of them were assessed for PTSD symptoms and negative appraisals of symptoms. The 3 variables of interest were all significantly correlated. The data indicate that negative appraisals of symptoms explain and predict PTSD symptoms independently of neuroticism.     

Black identity and workplace oppression

This paper is primarily aimed at counselling and psychotherapy practitioners who meet issues of workplace conflict in their practice and the resulting stress and trauma faced by their clients. I define workplace conflict as complex and enduring situations arising from diverse forms of harassment. These include bullying, scapegoating and other discriminatory and oppressive practices that affect health, esteem and work performance. This paper reports the findings from my doctoral research project which investigated and sought to understand the specific experience and nature of workplace conflict for black workers in three institutional settings: the National Health Service (NHS), education and social services. The inspiration for this research came from psychotherapy practice, where it was repeatedly observed that black workers appeared to be suffering significantly more negative and damaging effects of workplace stress and trauma than white workers. I describe these experiences as workplace oppression and differentiate them from other workplace conflicts.     

The Impact of Social and Political Changes on Survivors of Political Persecutions in Rural Russia and Ukraine

Differences in depressive symptoms and attitudes about political and social changes were examined for individuals with and without family histories of Stalinist persecution in several small villages in Russia and Ukraine. In a sample of 422 villagers, there were 37 family members of survivors of Stalinist purges. In comparison to villagers with no family history of persecution, those who had such history perceived their social life with other villagers and their life in general to be much improved in the late 1990s. They also reported much lower levels of depression than those without a history of persecution. Differences that were discovered could not be accounted for by demographic characteristics of the respondents. The results suggest that individuals with a history of family trauma related to political persecution may perceive their environment as more positive as a result of political changes and may cope with political transitions differently than persons who have no history of family persecution.     

灾后儿童心理创伤及危机干预

地震后,幸存下来的儿童可能比成人心理承受的压力更大,及时地对他们进行危机干预,帮助他们进行灾后心灵的重建是非常重要的。本文就儿童心理创伤反应、危机、危机干预、展开,针对儿童较成人的特殊性提出了对儿童进行危机干预的具体措施。     

The language of absence

This paper will focus on the concept of 'absence', which describes a continuum of non-responsiveness and misattunement of the environment in the stage of absolute dependence; it refers to concepts like lack, failure, non-recognition, impingement, neglect, tantalizing, ranging to mental, physical and sexual abuse. An extreme external absence causes shock and fear. The automatic survival response is an inner absence, an intrapsychic absence, a dissociation of parts of the self. The external and the inner absence are the negative image of each other. The concept of absence points to the synchronicity of outer and inner reality and portrays the non-responded-to needs of the self. This point of view of the development of psychopathology of the self on the basis of massive dissociation is inherently an intersubjective-field-theory. As the inner absence is created as a reaction to an absence of the other, in analysis - the analyst has an active role in reviving it. This paper will explore the language of absence, that is, the derivatives and consequences of these situations in the inner realm, and in the relations with the analyst. It is the author's contention that understanding and speaking this language has important clinical and technical implications. Understanding the language of absence enables the analyst to recognize its intersubjective and its intrapsychic presence, to provide an environment that allows for its revival, and to facilitate and regulate the annihilation anxiety that awakens when dissociated self-states are experienced. When the absence is present, i.e. when the traumatic experience and the dissociated reactions to it are experienced in an attuned relationship, it is rendered with meaning, symbolization, and validation, and enables the survival mode of dissociation to be relinquished.     

儿童创伤截肢

儿童意外伤害在国内外一直是受到普遍重视的问题,我国在这这方面的研究不多。严重肢体创伤的处理无论从专业理论还是在手术技巧上均要求很高,尤其对儿童肢体的毁损性创伤的治疗往往使临床医师常需在截肢与肢体挽救二者之间作出困难的选择。如何确定急诊截肢和保留肢体,国内外目前尚未有一个客观合理权威的标准。本文主要综述儿童截肢的标准和方法,以供参考。