The Role of Helplessness in PTSD Symptoms and Other Disorders

Joseph Burgoin
Defense Mechanisms
·
Detours
·
Unbearable Emotion
31

As you may know, many people who experience traumatic events do not subsequently develop post-traumatic stress disorder (PTSD).  One of the determining factors seems to be the feeling of extreme helplessness at the time the trauma occurred:  people who don't feel helpless are able to process the experience in their usual way.  In language I've used elsewhere on this site, they are better able to "contain" their experience.  When someone is overtaken unaware by a traumatic event, however, they can't rely on their usual resources to process or contain the flood of fear, anxiety, pain, etc. aroused by the event.  To protect itself from this overwhelming experience, the mind erects a barrier against the memory, segregating it from other memories and emotions in a process of defense against it.  The defense fails as the memory can't be entirely excluded but continues to exert an extremely powerful effect.  The paradoxical result of this effort to ward off an overwhelming experience is to give it a lasting power to cause pain.

It was Sigmund Freud and Josef Breuer, of course, who first theorized about the power of unintegrated traumatic memories.  In their Studies on Hysteria (1895), the authors presented a theory that women who exhibited conversion (hysterical) symptoms suffered from "reminiscences" or memories -- and in particular, memories of childhood sexual abuse.  They believed that these memories retained a lasting effect because, at the time the trauma occurred, these children were helpless and unable to protect themselves from the assault or react to it in a normal fashion.  As a result, the memory of that traumatic experience becomes walled off, segregated from other experiences and memories; it "acts like a foreign body" in the mind because it hasn't been subjected to normal mental processing like other experiences (p. 6).

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Psychological Obstacles to Grief and the Grieving Process

Joseph Burgoin
Defense Mechanisms
·
Points of Departure
·
Rules of the Road
18

We tend to talk about grief and the grieving process as if it were a separate category of emotional experience altogether,  different somehow from all the others.  Because it means confronting death, mortality and ultimate loss, the grieving process does have a uniquely large and pervasive impact on our psyches; from another point of view, however, grief is but one of the  emotions and when it becomes unbearable, we will ward it off in our characteristic ways.  In other words, when people go through the grieving process, you will often see them resort to their habitual defenses.  As discussed in my post on the tenacity of defenses, as we grow up, our modes of warding off pain become entrenched; even when we've evolved and developed new ways of coping on a day-to-day basis, when confronted with a feeling as difficult to bear as grief, we may fall into the familiar rut of our oldest defenses.

We had to put our dog Maddy to sleep yesterday.  While it's not quite the same as losing a human member of our family, she has been a beloved part of our lives for the last ten years.  Her death has made me notice how we're all responding to our grief, reflective of our particular defenses, and in not such unusual ways, I believe.  It has also stirred a lot of memories from 20 years ago when, within the space of a few months, my dear friend Tom Grant died of kidney cancer at the age of 45 and my mother-in-law Eva, then in her late 50s, succumbed to metastatic breast cancer.  These untimely deaths -- Tom and his wife had two small children and my mother-in-law was fit, dynamic and vitally alive -- have been among the major losses in my life and on occasions such as Maddy's death, the feelings I had back then are still very much present to me.

Splitting and Projection

For the last year or so, Maddy has had a laryngeal problem common in older Labrador Retrievers; she was scheduled for corrective surgery on Monday.  In the four or five days leading up to the surgery, her condition had deteriorated badly and she basically stopped eating.  We thought it might have to do with her medications, but when we took her to the surgeon Monday morning, he immediately said, "This has nothing to do with her larynx problem."  Her lungs were so full of fluid he couldn't even read her X-ray.  He believed she had some fatal condition and presented euthanasia as an option, although he told us that congestive heart disease, a treatable condition, might also be to blame.

Maddy's loss of appetite had filled me with dread.  Both my friend Tom and my mother-in-law lost their appetites as their conditions worsened; I felt sure Maddy had some form of cancer and I wanted to have her put to sleep that day -- to prevent further needless suffering, I told myself.  The rest of the family felt otherwise and wanted to make sure of her condition first before taking such a step.  I felt very rational and level-headed but kept my opinions to myself.  This was my defense:  in order to evade the pain of loss, I split it off and projected it into the rest my family for them to carry; I became a bit detached and efficient, as I am wont to do at such a moment.  I'm good in crisis situations; my defenses help me put emotion aside and do what needs to be done, though in this case, it stopped me from feeling my own grief.

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On Everyday Narcissism

Joseph Burgoin
Points of Departure
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Shame/Narcissism
35

In several earlier posts, I've talked about different aspects of narcissism.  Using the film The Social Network as a case study, I discussed characteristics of narcissistic personality disorder displayed by the fictional Mark Zuckerberg; I've described narcissism as the primary defense against shame and used public rants by Charlie Sheen as a way to illustrate it; I've talked about the difference between narcissism and authentic self-esteem; and finally, I've complained about narcissistic behavior and the lost art of conversation -- the way people at social gatherings so often seem interested in talking only about themselves.  There's yet another aspect of narcissism I'd like to discuss, one most of us wouldn't view as pathological.  Let's call it everyday narcissism.

First, a little bit of history.  The term narcissism was coined by Paul Nacke in 1899 to describe someone who treated his or her own body as if it were a sexual object, in lieu of having sexual desires for other people.  Freud took up the term and eventually made a distinction between primary (normal) and secondary (pathological) narcissism.  Primary narcissism is the universal desire to protect ourselves from danger and to preserve our own lives; it has a sexual component that doesn't preclude desire for others.  People who suffer from secondary narcissism, on the other hand, "display two fundamental characteristics:  megalomania and diversion of their interest from the external world -- from people and things" (Freud, On Narcissism, p. 74).

Since then, the concept of narcissism has expanded beyond Freud's original view, enlarging on the elements of megalomania and giving only secondary emphasis to the element of sexual desire.  Merriam-Webster's primary definition for narcissism is "egoism, ego-centrism," relegating "love of or sexual desire for one's own body" to the secondary meaning.  When most people use the word today to describe someone else, they usually mean he or she has megalomaniacal tendencies:  "feelings of personal omnipotence or grandeur" (Merriam-Webster again).   Our use of the word often implies personal vanity, which suggests a sexual desire for one's own body, but it's not the primary meaning for most of us.  In general, what is written today about narcissism focuses on having a grandiose self-image and an excessive need for admiration to sustain it.

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When Is It Appropriate to Feel Shame?

Joseph Burgoin
Shame/Narcissism
·
Social Behavior
·
Society and Culture
22

In many of my earlier posts, I've written about the role shame plays in psychological and emotional difficulties.  I've discussed the fantasy flight into an idealized self in order to escape an unbearable sense of toxic shame; I've also tried to describe typical defenses against shame and frequently connect shame and narcissism, as I did in my post about Charlie Sheen .  In each instance, I've been discussing shame when it becomes toxic and thereby linked to different forms of mental illness; but is there a different type of shame, one that is non-toxic and in some sense "normal"?  Isn't it appropriate, sometimes, to feel shame?

It seems that every culture (including less developed and non-Western cultures) includes ideas and codes of behavior related to shame.  According to Rochelle Gurstein in her book The Repeal of Reticence (1996), shame is always connected to physical exposure and vulnerability; it also "threatens to engulf us at moments when our biological reality -- our 'animal' nature, as it is commonly called -- overwhelms our 'civilized' self; that is, when we are too directly confronted with the body in its most physical aspects."  She quotes Norbert Elias (1939), who held that "people, in the course of the civilizing process, seek to suppress in themselves every characteristic that they feel to be 'animal.'"  The origins of the word shame -- not only in English but French and German as well -- are linked to the idea of covering up.  You may recall that, in the Bible, shame was born when Adam and Eve ate from the Tree of Knowledge, realized that they were naked and covered themselves to hide their nakedness.

So (putting it baldly) if a stranger were to walk in while you were on the toilet or having intercourse, you'd want to cover up; the feeling that motivates you is shame.  (This does not imply that we feel those activities are "dirty" or "bad" -- a religious overlay -- but that they should not be witnessed by other people; they are private.)  Apparently this sort of feeling in connection with the activities of our "animal nature" is to be found in virtually all civilized cultures, even primitive ones.  As they become "civilized", human beings everywhere want to distinguish themselves from other animals on the planet, to believe we are on a different plane; when we have an experience that confronts us with the fact that we are not so different -- that we, too, are animals despite all the trappings of civilization -- we experience shame.

On the other hand -- and I may be anthropomorphizing here -- it seems to me that our dog Maddy on occasion feels shame, too.  Usually, she sleeps through the night without waking us and waits to relieve herself until morning.  But on several occasions when she was suffering some kind of digestive problem and couldn't wake us up to let us know, she peed on the floor.  In the morning when we awoke and saw what had happened, she hung her head and slunk off to the closet -- to me, the very picture of someone filled with shame.  This occurred without our saying a word to her, or attempting to humiliate her for losing control.  I've seen this with other dogs and heard similar stories from other dog-owners.  My theory is that Maddy feels shamed not of her animal nature but when she is unable to control her bodily functions.  Most human beings would also feel shame under those conditions.  Can you imagine how you'd feel if you lost control of your bowels in a public place?  This doesn't mean that you should feel ashamed but that you inevitably would.

As Gurstein notes in her book, ours has become a society where this type of shame scarcely exists any longer.  If you suggest that some behaviors actually are shameful (that is, should be kept private), you will be called "uptight" or labeled a "prude".  During graduate school, Gurstein studied with the historian Christopher Lasch, who famously wrote about The Culture of Narcissism (1979) and how individuals in modern American society, with a fragile sense of self, become obsessed with fame and celebrity.  Her own book shows how the "repeal" of social standards that used to preserve a realm of privacy around the transactions of our animal nature, particularly sex, has led to a debased public realm in which virtually nothing is held to be sacred and private.  She does not link the two themes -- shame and narcissism -- but I will do so now, expanding one of my central themes into the social realm.

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The Rise of Bipolar Disorder Symptoms and Treatment

Joseph Burgoin
Depression and Bipolar Disorder
·
Points of Departure
·
The Medicalization of Mental Health
70

If you've been around as long as I have, you may remember a time when the diagnostic label "Bipolar Disorder" was relatively unknown.  Although that term has been around since the 1950s, it came into common usage only in 1980 when the APA released its third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III); before then, mental health professionals discussed and wrote about Melancholia or Manic-Depressive Illness. It was considered quite rare.   As you may know, that revision to the prior version of the DSM sought to eliminate its psychoanalytic/psychodynamic bias and replace it with a supposedly more "scientific" approach, thereby embedding psychiatry within the medical model of treatment.

According to the 1969 book, Manic Depressive Illness by George Winokur of Washington University, Bipolar Disorder used to be fairly rare.  In 1955, only one person in every 13,000 was hospitalized for it.  Today, by contrast, according to the National Institute of Mental Health, Bipolar Disorder symptoms affect an astounding one in every forty adults in our country!!!  It's also worth noting that, before psychiatric medications were introduced, the long-term outcome for those patients was fairly good.  Only 50% of the people hospitalized for a first attack of mania ever suffered a second one.  Studies have found that, in the pre-drug period, 75-80% of hospitalized patients recovered within a year and only half of them had even one more attack within the next 20 years.  Today, Bipolar Disorder is a chronic illness, with patients spending years and years on psychiatric medications.  In other words, Bipolar Disorder was comparatively rare before 1980 and the prognosis for hospitalized patients was fairly good; today it's 325 times more common than it used to be and has become a lifelong illness.

How are we to account for this change, from a rare and acute illness to one that is pervasive and chronic?

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