Committee Freud, Colloque de Tel Aviv, on the 29/02/2016
I have come here today to share some thoughts about the subjective and social consequences of psychic trauma because throughout my psychoanalytic practice, both private and institutional, I keep being confronted with the problem of trauma, be it the psychic trauma common to all speaking beings, as Freud defined it, or all the clinical forms of real trauma: those of Holocaust survivors, of soldiers in the Israel Defence Forces traumatized by war, of victims of terrorist attacks, of children and adults who suffered sexual abuse, of victims of car accidents or work-place accidents, and so on.
Here in Israel, for historical and current reasons we are all aware of, we are very often called upon to provide immediate and suitable help to traumatized people.
As heirs to Freud's teaching, it is befitting that we listen to these people with humility, since working with trauma (just like doing analytic work with schizophrenic and autistic patients, for instance) requires that we "set aside" our theoretical certainties and our "well-established clinical know-how". I believe this is a prerequisite both for making therapeutic progress with our patients and for arriving at a better understanding of trauma treatment.
I insist on the term "humility", because since about the year 2000 — that is, just after the start of the Second Intifada and the brutal attacks upon our cities, followed by the threat of missile- delivered chemical warheads during the 2003 war in Iraq — our country has seen a proliferation of new methods of trauma treatment. These techniques contribute to disseminating a discourse of "therapeutic triumphalism" portraying itself as opposed to what is a very distorted image of psychoanalysis, and promoting its own virtues to the public and to Israeli medical, social and higher education institutions.
These new trauma psychotherapies have now become the favorite focus of hygienist and moralist ideologies which contribute to the globalization of forces of resistance against psychoanalysis.
I have called my presentation Transformations of Trauma in Analysis: from Alienating Identities to Structuring Disidentifications because this transformational path does not concern solely the traumatized patient's evolution in analysis, but also the analyst's identity, that is, the position held — or not held — by each analyst throughout the analysis of the traumatized patient, and even throughout his entire career as an analyst.
Whatever the nature of the traumatic events that affect people, each person has different subjective resources with which to face them and overcome them.
Psychoanalysis serves to provide individual answers — unforeseeable and unprecedented, to those who, due to their particular psychic structure, do not have the necessary symbolic points of reference to face that which is unbearable, untenable and unmanageable: the unrepresentable aspects of the sexual sphere and of death, that is, of the Real.
This means that in psychoanalysis there is no "standard therapy" suitable for traumatized subjects, contrary to currently fashionable therapeutic methods (inherited from 19th century psychiatry, that is, from hypnosis and suggestion) and contrary to the new cognitivism, which offer ready-made solutions designed for the "typical traumatized patient".
Although there are no "specializations" in psychoanalysis — such as there are in medicine —, certain practitioners identify themselves as specializing in trauma treatment. We leave it to them to justify this position.
As for me, I doubt that an analyst who claims "specialist" status of any kind can truly hold, in transference, the unique place attributed to him by each patient, one patient at a time, in every session and at every stage of analysis.
The specificity of the analyst consists in listening to the unconscious, as we well know. Psychoanalysis is the only field of human activity able to offer the subject a different type of listening to what his unconscious is saying in his own words about suffering, so that it is heard as a symptom, that is, "unprecedented speech", as Lacan so elegantly put it at the end of the nineteen fifties.
In fact, what is said and what is heard in the gradual unfolding of speech in analysis, with all patients — traumatized or not —, cannot be reduced to the expression of the deficiencies of a personal story as it took place in reality, nor to the unconscious libidinal history of an individual.
What is heard in the unfolding of the speech of each patient in analysis is at the same time what is said about the relation of each subject to his culture and, to go even further, what is traumatic in the very constitution of humanity, particularly its shortcomings: that which is deficient between human beings. No, it was not Jung who said this, it was Freud! Yes, Freud, who wrote about the murdered father of the primitive horde in Totem and Taboo, and about the prophet Moses killed by his people, in Moses and Monotheism.
But the fact that there is no specialization in psychoanalysis does not at all mean that our discipline cannot contribute a precise and relevant point of view about the modalities of psychic structuration and functioning of traumatized subjects. Far from it! Psychoanalysis makes it possible to identify inadequacies, points of fracture and breakage, moments of absence and silence in the flow of language, which occur in the unfolding of the speech of our traumatized patients. Psychoanalysis teaches us that it is, above all, the silences — particularly the silences transmitted from one generation to another —, which are extremely traumatizing and have devastating effects on the structuration of normative subjectivity, even before the birth of the little human.
Working with so-called traumatized patients puts us to the test because it forces us to confront in a blunt, violent and brutal manner the unrepresentable... the unbearable, the horrific and inhuman: Auschwitz.
I admit that to conduct an analysis in these difficult cases, it is best for the analyst to have ample clinical experience (not necessarily in the field of trauma). This is so because the clumsiness of those who, for example, provide the patient with intelligent interpretations coming right out of the therapist's neatly organized toolbox can send the patient — in just a few seconds — into the deepest despair: into the black hole of depression, causing him to have delusions or hallucinations, or to commit suicide or criminal acts.
It can be a young girl raped for years by her own father, or survivors of Dr. Mengele's experiments, or people tortured in Syrian prisons; or the Israel Defence Forces commander haunted by the noise of heads of terrorists being crushed under tank tracks on the road to Beirut, or the valiant policeman dumbfounded by the angelic expression of the dead child pulled out of the water, drowned by his own mother...
In all these cases, and others like them, the analysis is conducted "on the razor's edge" and the analyst must demonstrate humility, sensitivity, tact and, above all, great courage.
This having been said, our purpose is not to compare psychoanalytic therapy of traumatized patients to other methods of therapy whose benefits are not disputed.
The comments Freud made in the summary of Dora's case about different psychotherapies, when he said that it was not a matter of disputing the effectiveness of the various methods in fashion at the time (hypnosis, suggestion, etc.) are surprisingly timely in this context. But he added that in his opinion the results of these therapies were unsatisfactory, either because the symptoms return later in an intensified form, or are displaced and return in another guise, unfamiliar to the patient and therefore less controllable and more intolerable to him.
Sometimes, these therapies can be beneficial to a degree; Freud believed that this is due not so much to the method itself, but rather to the therapist's benevolence, that is, to the good feelings established between him and the patient: this is what he called positive transference.
In contrast, the effectiveness of psychoanalysis and the permanent resolution of symptoms is due to the fact that analysis essentially involves negative transference, that is, the lengthy and painful mechanisms of transference — as is made clear by our clinical work with traumatized subjects.
I feel that today it is particularly important to point out the value of psychoanalysis and its approach to trauma: not only in order to clarify its clinical and therapeutic contribution, but above all because we live in an era in which medical, psychiatric, mental health and education authorities in our countries — supported by spokesmen for all these so-called modern methods and techniques of trauma treatment (as well as the treatment of attention deficit disorders and CBT, etc.) — are attempting to impose a hygienist morality that not only aims at delegitimizing psychoanalysis and its tradition — that goes without saying! — but also tries to eliminate the place of the desiring subject in society. In short, the "psychiatric State" attempts to establish its dominance over its citizens! Claiming to possess knowledge about the well-being of others, this State tries to control the minds, behavior, desires and even the symptoms of our fellow citizens, regardless of the diagnosis they have been given.
But the imposed or voluntary effacement of the individuals behind the "new nosographic identities" proposed by mental health or education authorities (particularly to those diagnosed with PTSD, autism or ADHD) cause individuals to give up their place as desiring subjects in society. That is, they abandon the fight for life, for that which stimulates desire, in short, for that which constructs, creates and makes it possible to maintain the subject's dignity as an individual among others.
The question that remains to be answered is: can the psychoanalyst accept a request for analysis from someone who describes himself in advance as suffering from PTSD (whether he is a war hero, a victim of the Holocaust, etc.), and who, holding on to various imaginary benefits — narcissistic, social or economic — does not want to lose his identity as a trauma victim?
In my view, a request for analysis formulated in this manner is not admissible. I do not believe that analysis can take place in these circumstances, in other words, that the psychotherapeutic results which can be expected from a true analytic process can be achieved.
This, of course, raises an important question I will not attempt to answer here: that of the suitability or unsuitability of analysis in different circumstances.
Of course, it is not the analyst's role to confirm or invalidate the imaginary representations announced in advance by different individuals, or to promise those who request analysis tangible therapeutic results. Some people identified as "traumatized" come to see us and quickly leave when they learn that we do not use CBT or EMDR therapy, and that we do not promise that "they will go back to the way they were before the trauma" suffered in war, in a motorcycle accident, etc., as they often ask us to do.
Other people, to whom analysis is recommended by former patients, by friends or by acquaintances, do not even come to a first appointment after being warned by their physicians or psychiatrists that analysis is ineffective, counter-indicated and even dangerous for people with post- traumatic stress disorder.
But more and more often there are people for whom things happen the other way: after having tried a number of psychotherapy or rehabilitation centers — where the above-mentioned methods, and some others, are used —, they decide to enter a psychoanalyst's office (sometimes secretly, that is, without the knowledge of their psychiatrist or their physician), and they embark on the work of analysis, which is difficult, uncertain, less disappointing than their previous therapies, and certainly more enriching...
Indeed, it is the traumatized subject's ability to recognize himself as a suffering subject which allows him to forget or repress his identity as a trauma victim, making it possible to unknot something, so that something new can take the place of the traumatic representations fixed in his imagination: other representations, other forms of more common psychic suffering, more tolerable and therefore easier to live with than those which were alienating for the patient before analysis.
Thus, little by little, the unique and liberating speech of each patient, his traumatic memories, lose their pathogenic power, are pushed back by signifiers that refer to other stories, to other dramas, to other forbidden joys... the ones Freud taught us to decipher in dreams, slips of the tongue and everyday language, which is the language of psychoanalysis.
Guido Liebermann