Trauma and the impossible to say

Some people argue that we now live in a ‘culture of trauma’.1  Generally that would appear to be a ‘bad thing’, although there is an interesting article in The Independent by Simon Usborne which refers to a new book by Stephen Joseph, a professor of psychology, who has collected evidence since 1987 (the Herald of Free Enterprise disaster) regarding how people respond to traumatic events.2  His studies show that, contrary to what might be expected, for a significant number of people, such events actually make them stronger.

Generally though, trauma tends to be viewed negatively, especially in the context of traumatic events and their link to psychological problems such as post-traumatic stress disorder.3   But what exactly do we mean by trauma?  The psychiatric profession seems reasonably clear about this: in the DSM-IV entry for PTSD, for example, a traumatic event is defined in terms of:

…..an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

This seems straightforward enough.  But what makes such events traumatic in the first place?  In other words, what makes trauma traumatic?   This is precisely the question that Verhaeghe and Vanheule pose at the beginning of their paper on PTSD.4  Verhaeghe and Vanheule cite two major review articles whose authors conclude that trauma is a necessary but insufficient condition for the development of PTSD. This is also something I refer to in my posting on PTSD   This leads Verhaeghe and Vanheule to develop their first hypothesis:

Whether PTSD develops is not so much determined by the trauma in itself; rather, there must be mediating factors of vulnerability and resilience. (p.494, emphasis in original)

The authors cite research that such mediating factors may include a genetic predisposition to developing a number of psychological problems, including PTSD, but also refer to other research which places much greater emphasis on environmental factors – which in turn leads them to conclude that:

…it is the ever-complex interplay between nature and nurture that determines the final result. (p.495)

They then go on to cite the findings of neuropsychological research which suggests that patients with PTSD are unable to process traumatic incidents in a normal, associative way.  There is a failure in symbolic processing, and the representations of the traumatic event cannot be stored in declarative or narrative memory (a form of long-term memory).  Instead they are organised in what is called procedural memory, which, although also long-term, is unconscious.  In other words, such memories are not directly accessible to the individual, but rather have to be constructed retroactively.

Essentially, what Verhaeghe and Vanheule are getting at is that a traumatic experience is one that cannot be symbolised and given meaning.  The trauma doesn’t ‘fit’ into the individual’s subjectivity, it makes no sense.  Instead it just keeps repeating itself in the form of flashbacks, nightmares, panic attacks and so on.  Another way of saying this that trauma is outside of symbolisation and representation.  And in Lacanian terms, this means it is in the domain of the Real, the impossible to say.

  1. This is actually the title of the last chapter of Ben Shephard’s book, which I have referred to previously, on trauma, conflict and psychiatry: Shephard, B. (2000) A War of Nerves. London, Jonathan Cape. []
  2. http://www.independent.co.uk/hei-fi/entertainment/what-doesnt-kill-us-7630329.html?printService=print []
  3. Or as a Russian women quoted in the above chapter by Shephard would have it, ‘post-dramatic stress’ – an interesting choice of words perhaps []
  4. Verhaeghe, P. & Vanheule, S. (2005) Actual Neurosis and PTSD: The Impact of the Other. Psychoanalytic Psychology, 22 (4), pp.493–507. []

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