‘There is no greater agony than bearing an untold story inside you’ Maya Angelou
‘Conventional treatment, we know is no longer sufficient when working with complex trauma.’ These were the opening words of Ralf Vogt, the chief organizer of this most outspoken and brave conference.
The Leipzig event felt like the blindfolds have come off and enabled us to examine the reality of peoples’ most unmet needs, as a result of denial, attachment betrayal and slander. This was due to the courage and determination of all the speakers. Going forward, our understanding of complex trauma is gathering pace and current research is developing a deeper understanding of the root causes of human suffering.
From body therapy, child therapists, forensic evidence, philosophical and historical contributors this fast-paced conference was so rich and dense with material that I’m not able to cover all the insights and facts that were presented by all speakers in this review.
‘What happens when people talks about betrayal?’: In her poignant presentation Jennifer Freyd talked about her research on Betrayal trauma theory where victims of sexual abuse are likely to forget and dissociate, particularly when the abuse is done by a family member or a care-giver. So, why is it that we forget? Apart from the simple fact that sexual abuse often happens at night in the dark where it is hard to see the abuser, it’s also too dangerous to remember what is then forgotten. When we are young and very dependant, we need to make sure that our needs are met and the attachment system is meant to protect us. Our needs for attachment tend to override everything else in life. An abused child therefore will risk further mistreatment. The more betrayal, the more memory impairment hence forgetfulness will occur, particularly if the abuse ‘that cannot be discussed’ happens within the family and becomes the core of ‘betrayal trauma.’
Freyd then went on to demonstrate institutional betrayal: she drew evidence from her research laboratory at the University of Oregon and found that those who experienced institutional betrayal suffered from PTSD, depression, anxiety and dissociation. The parallels between familial betrayal and institutional betrayal are more often than not interconnected. Freyd’s research on the issue of sexual trauma was conducted within schools, universities and military institutions. The disclosure of trauma which we don’t talk about tends to harm us most. A bad response to trauma disclosure is where the victim is blamed. Statements such as: ‘don’t walk alone at night’ or ‘don’t wear seductive clothes’ can feel highly demoralising to a rape victim. Also when trauma is disclosed, people often change the subject simply because they don’t know how to respond to such disclosure. So, what is a good response? Studies show that psychological education and teaching people how to listen to traumatic disclosure has proven to be highly effective and is easy to correct. Jennifer and her research team conducted an experiment by sending an email to all university staff and members challenging their perception that the rape myth is associated with loose behaviour. The results were very quick and very effective and reduced the rape myth endorsement. She concludes: “institutions need to appreciate the whistle-blower rather than silence them”.
Ralf Vogt took us through a psycho-educational journey, outlining Germany’s history of sexual violence. A law against incest and sexual violence was only passed in Germany in 1871. In 1895 Freud came up with his seduction theory but was discredited as mad. In 1907 Ferenczi and Jones denounced the Oedipus complex. It was Anna Freud who was highly protective of anyone slandering her father’s drive theory. Until 1973 men in Germany could still be sexually forceful on their wives. In 1997 a new era of Slander and Betrayal emerged but only in 2000 was corporal punishment against children banned. Even today at the heart of slander and betrayal lies a strong ambivalence towards the victim where the power dynamics lead to exploitation. Similarly, we see these same dynamics among dissociative patients who, living under threatening conditions, have their introjected parts taken over and thus often sabotage the therapy. This is when the therapist ends up feeling powerless. We need to work with these parts as they live in two worlds: 1. their families and 2. the world of therapy. This is when therapy needs to slow down. Slander & betrayal need to become conscious to the patient. The SPIM 30 model is meant to help overcome this problem, not so much dwelling on what happened in the past but what is happening right now within the therapeutic relationship.
Like a chess master, Eli Somer gave us a very informative account on how to battle a doubting court (most relevant to the justice systems in Israel and the USA) where the defence often accuses the DID witness that they were over-diagnosed, that hypnosis cannot be used in court and that the memories are iatrogenic (born in therapy). As challenging as the court can be towards individuals with DID, we can now assert that:
- Traumatic amnesia does exist and is legitimate.
- The FMS (False Memory Syndrome) is no longer a valid argument.
- The DSM & ICD-X are enforced by law to determine a violation of psychology and medical neglect.
- The issue of anthropological possession can be used in court.
DID is a valid condition, but what do we do if DID is used as a defence for murder and diminished responsibility? This is a tricky subject. DID is not a defence, it may support though a case of insanity or in positive circumstances may help provide therapy in prison. Dissociative amnesia is not freeing the patient from a sentence (anyone can simulate amnesia). PTSD and delayed reactions are included in the DSM and can be used in court.
In helping in a case of sexual crime, where the survivor has had a long history of mental conditions, Somer emphasises the cautious measures needed for defending them. Always confer with an attorney, come to court rested and relaxed and take your time in answering the opposing attorney. As well as being prepared for such an exhausting task, the need for law reform covering the legitimacy and existence of dissociation as a valid diagnosis in court cases is becoming increasingly apparent.
In his harrowing and most revealing talk, Harald Requardt presented ‘The incredible but true – the abyss of betrayal’ a most chilling account of the evidence and documentation he has collected about mind control and other criminal activities in post-Nazi Germany. These activities were supported by the CIA and promoted war criminals such as Josef Mengele, Klaus Barbie and other Nazis. Not only did they get away with murder but they carried on their previous work under the Nazi regime by mentoring CIA agents and used the results of human experiments on children for Cold War purposes in various countries around the world. In working with these survivors today, we need to be more prepared to face their introjected parts, where the parts are programmed at different levels. Just as we have finished one level, we enter another layer.
With clarity and conviction Ellert Nijenhuis shed light on the history of medical psychology from the 17th century onward around the diagnosis of what was originally called Melancholia and hysteria. For many years it was not accepted that unexplained physiological symptoms found in soldiers and women were caused by intense fear and powerful emotions. For the first time during the 18th century there was some acknowledgement that emotions were at the root of people who displayed extreme sensitivity. Swiss soldiers used to fear nostalgia (home sickness) which was then known as the Swiss disease. The irritable heart condition called ‘Da Costa syndrome’ was also found in American Civil War soldiers who displayed a psychosomatic anxiety disorder. In 1859 Briquet wrote that abuse is the main component of hysteria and was rejected. Janet & Charcot believed Briquet. Janet went on developing his writings on the experience of hysteria and described it as the incapacity to integrate bad experiences. H. Oppenheim (1889) wrote about somatoform dissociation and later Charles Myers (1940) saw traumatised soldiers who were disconnected from themselves. Some soldiers feigned death: this was not supposed to be termed hysteria as the term still belonged to women and therefore it was renamed as shell shock. Similarly the term PTSD showed symptoms of depersonalisation and de-realisation, hyper/hypo arousal. Hysteria, PTSD, Dissociation are all traumatic unintegrated experiences, when they are treated the symptoms can be alleviated. PTSD was classified as an anxiety disorder but there was some debate about whether it should be classified as dissociative disorder. Today PTSD includes: anger, irritability, agitation and anxiety. Complex PTSD includes not only flight but also the fright reaction; still many responses of rage are not included. What is neglected in our field is how easily people forget that often trauma causes people’s experiences from the past to live in the present. As members of society we would like to have an objective that we want to control things not through ignorance but through realisation.
The huge effort and efficiency put into this impressive conference was much appreciated, however the intensity and sheer number of the lectures meant that we had little time to digest and reflect upon much important material. Also as a non-German speaker, my wish for the next conference would be to improve the quality of translation. The clown show led by Irina Vogt and her team was fun. Finally, Winja Lutz’s effortless multi-tasking from presenting, to translating and overseeing the conference as a whole, helped make this a unique event in the world of trauma and psychoanalysis.