Over trauma: “wounded healer”

Over trauma: “wounded healer”[1].

Presentation on Estonian-Latvian Psychoanalytic Association meeting on April, 7^th 2018, in Tallinn.

Wounded healer[2] is a term created by psychoanalyst Carl Gustav Jung. The idea of “wounded healer” is about vulnerability of psychoanalyst as a person. In psychoanalysis, psychoanalysts will be involved into complicated situations, because of treating people with serious mental disorders. Additionally will quality of the psychoanalytic work be influenced by psychoanalysts’ unrecognized personal traumatic experiences. Even the analyst might be consciously aware of his own personal wounds, these wounds might be activated unconsciously in certain situations, especially if the analyzed wounds are similar to his own. I mean here collective traumas[3] shared between Estonian people.

“The occurrence of traumatic events in Estonia dates back to August 23, 1939, when Germany and the Soviet Union signed the Molotov-Ribbentrop pact in Moscow. Soon Poland was divided; Estonia, Latvia, and Lithuania lost their independence; and the Soviet Union began war with Finland. After occupation of the Estonian Republic on June 17, 1940, by the Soviet army, arrests of people not loyal to the newly established Soviet Estonia began.

Finally, on June 14, 1941, many of the most influential people of the Estonian Republic, including the president of Estonia, the commander of the Estonian army, and members of parliament and their families, were deported to

Siberia. When the Second World War began, the actions of special destruction battalions of the Soviet army[4], voluntary self-defense units[5], and the Soviet and German armies brought about massive destruction of buildings, bridges, factories, farms, and homes as well as death or harm to people. Germany established concentration camps on Estonian soil, and many Estonian people who were loyal to the Soviet Union, together with Jews and gypsies, were brought there and killed. In turn, after the Soviet army once again occupied Estonia, the Soviet Secret Service began repressive actions against people, who were defined as enemies of the Soviet Union. These actions, which targeted former members of the German army and self-defense units, religious people, and those who belonged to the so-called Forest brothers[6], as well as the relatives of these individuals, had a tragic and traumatic impact on victims and their relatives.

In March 1949 the next wave of deportation began, which included mainly people from the countryside (over 20,000) who were taken to Siberia to break down the resistance of the Forest brothers; these people were forced to abandon their individual peasant lives and join collective farms. After the war, a new social life began under the Soviet totalitarian regime, dominated by the last decade of the great Stalin terror (Conquest, 1990).” (Parktal, 2012, pp. 350). Latest collective trauma for Estonians was September 28^th, 1994, when MS Estonia sank and 852 person died (only 95 bodies were find) and 137 were rescued. This trauma touched almost every Estonian.

The analyzed wounds in psychoanalysis might affect the wounds of the analyst. The analyst either consciously or unconsciously might to pass this awareness back to his patient, be the cause an unconscious relationship to take place between psychoanalyst and patient. Danger for psychoanalytic situation to sink into oceanic feeling of unconscious past trauma situation might happened, with following repetition of traumatic situation for both participants. But here is also another side of the problem: from Monty Python – “Always look on the bright side of life…”[7] Netherlands Catholic priest Henri Nouwen (1979) thinks that this woundedness can also serve as a source of strength and healing when counseling others. By his religious approach, ministers must be willing to go beyond their professional role and leave themselves open as fellow human beings with the same wounds and suffering — in the image of Christ. In other words, we heal from our own wounds. We can speculate for example about career choice, how much our own traumatic experiences have played the role in wish to be a psychoanalyst and to heal the other people and healing ourselves also at same time.

In this presentation I will keep in my mind wounds made by destruction of Estonian Republic on 1940, Soviet and German occupation during Second World War and Soviet annexation following colonization of Estonian Republic over forty five years. Those dramatic events let for Estonian people wounds we share by my understanding and observations in clinical work also today.

1. Past. Psychoanalysts as also ordinary human beings (surprise, surprise!) are also vulnerable from influences of the external world. On the last century, there has been taken place many wars in human history and the most devastating two of them First and Second World War partly on territory of Europe where we all are born.

Wars in Europe (PowerPoint). Absence of phallus refers not only to the woman’s sexual equipment but also to death[8]. Wars usually leads societies into new symbolic order. Same happens in child’s development, when he painfully recognizes the difference of the sexes, by observing the presence or absence of the phallus. He is not the phallus anymore, mother has no phallus, and father has the phallus, which is not the phallus. Phallus as symbol has arrived in child’s mind and then the penis as an anatomical organ will be substituted by the phallus as a symbol, symbol of sexual power of both sexes. Child is leaving mothers imaginary (l’imaginare) world and will enter fathers symbolic (le symboliyue) world. By Bion we may add, that recognized absence by child creates chance for him to think about his body and sexuality.

We are touched by previous wars indirectly, through wordless communication with parents and older relatives, through so called transgenerational transmission of trauma previous generations.

“What the traumatized generation has not digested will be deposited into subsequent generations in the form of traumatic object relations. Those relations will be recreated because the communication process in relationships with the traumatized generation was distracted. Extreme trauma causes destruction of the communicative dyad in the traumatized generation’s internal psychic world. Relations between the internal self as object and the good internal object[9] will be distracted, and communication breakdown will lead to ‘‘absolute internal isolation and the most intense desolation. The internal good object falls silent as an emphatic mediator between self and environment’’ (Bohleber, 2007). Emphatic understandings between individuals from different generations will be not possible because the good internal object is lost.” (Parktal, 2012, pp. 353).

And here we can find enough room for additional personal traumas to make from us as psychoanalysts “wounded healer”, with specific personal and social differences in us as healers.

By my understanding, based on reading and observations of communication with colleagues from west side of continent, that there was and is essential difference in process of recovering from trauma of Second World War between West and East Europe. People in Western part of Europe (it is political dividing) began their recovery from war and mourning soon after end of the war. In Eastern part of Europe people didn’t have chance for recovery and mourning in social level. War trauma got addition by trauma from soviet terror and lost freedom by living under Soviet occupation and annexation in Baltic States under the auspices (aegis) of Soviet Union.

Wounded healer in east side of continent is not only different from colleague from west side, but by my understanding much more hidden and secretive, even hypocritical (silmakirjalik). For western colleagues this side in our mind will be most often not seen or understood. Post war time has changed us deeply, and it seems that for us it is so hard to leave such a familiar and safe paranoid-schizoid society in our minds.

Occupation (PowerPoint). Phallus has no counterpart but its absence. During the Soviet occupation and annexation, the difference between previous life and present, was felt as total absence. Lost state, lack of freedom, destruction of property, death and loss of beloved people – a world too much, made painful and enormous wounds for people in Estonia. Because of intensity of trauma, this kind of absence, was too much for creation of thinking about days gone over. “Lacan admits, as does Freud (…), a phallic stage, where the phallic-castrated alternative – that is, the presence or absence of the phallus – is what will determine the difference of the sexes.”(Etchegoyen, 2005, pp. 123). In the moment of castration, when child painfully recognizes the difference (he is not the phallus, mother has not the phallus) mystery of appearance of phallus as symbol can happened. During intense trauma with enormous pain difference will be not seen and symbolic meaning of change will not take place. This is the time and place, when colonization of nation begins.

Great Stalin – symbol of nation’s friendship (PowerPoint). The subject (who is) supposed to know. By Lacan the function of the analyst is to disappear as person, as I, as ego, because not to allow imaginary relation to dominate in analytic situation. “However, each time scientific progress creates signifier[10] as a new invention, we are led to think it was always there, and then we project it in a subject supposed to know.” (Etchegoyen, 2005, pp. 128). Like analyst who can become to the patient the subject (who is) supposed to know, so for colonized nation Great Stalin stands for the subject who is supposed to know, and he know very well and very good almost everything for us and about us. Mourning and recovery in Eastern Europe was mainly possible only in families and secretly. How to mourn your father, when he died as solder of German army or uncle, who died in fighting against soviet regime in occupied country, both as enemies of Soviet State, criminals now? And even more – at the same time, you can mourn your another uncle, who was fighting in Soviet Army and now is kind of hero.

Living in Soviet society (PowerPoint). Zero is a blank that makes the lack (absence) visible. In “A seventh man[11]”, John Berger describes a passport photograph of a young boy belonging to a migrant worker (Berger and Mohr, 1975). To us the photo suggest a presence, but to his father it represents the absence. The dialectic between presence and absence here is about how meaning is created. In Lacan, language is representation. What is represented is not present in language, but only re-presented. The subject is no exception: it is only presented, never present. The subject is absent from language: as a kind of zero. (A demonstration: how many numbers on a blank page? None. Write ‘0’. How many now? One. Write ‘1’. How many now? Two. And so on.) Even losses accepted by Soviet state, were not mourned because of demand politically correct way of mourning, state mass rituals, which didn’t leave no space for personal feelings. Zero stays zero and blank page stays blank, when meaning as number one was not added to the trauma.

Memorial to victims of political repression in St. Petersburg (PowerPoint). Art makes absence visible. Lacan has said, that mother presence is possible only then, when child is able to bear absence of her. In traumas, we can see the opposite situation. Recognition for absence is possible when loss has found its meaning or zero has meaning as number and got additional number one. Alexander Etkind professor of Russian literature and cultural history at the University of Cambridge named his book about mourning theories in the context of Soviet terror sharp (teravmeelselt) as: “Warped mourning: stories of the undead in the land of the unburied.” Etkind (2013) is referring in the book’s title to Freud, “When the dead are not properly mourned, they turned into undead and cause trouble for living” (p.17).

2. Thinking in present about the past. How I as psychoanalyst, who is experienced social trauma by transgenerational transmission, will experience others experiences and traumas?

Trauma is waiting for psychoanalyst (PowerPoint). Knock, knock, who is behind the door? How I will be able to share with you my experiences around the trauma happened in past, but still present today? Does the Other (symbolic order or father in triangular situation) exist at all for me around the trauma? Does the world of knowledge exist or has disappeared or dissociated from feelings and body?

Beloved Stalin – happiness of nations (PowerPoint). The subject (who is) supposed to know. Will the analytic third appear or not in analytic space? Or will I still stay in mental dyadic imaginary relationship like with mother. The most popular Russian journalist Oleg Kashin said that Stalin was “The third person sleeping in every one of our beds (Etkind, 2013, p.11), and he knows very even your intimate mental world.

Dreams come true (PoverPoint). Demands for presence or absence are demand for love. In dyadic situation between the mother and child, child discovers his ego mirrored in her: the subject discovers his ego in his reflection in the mother, because the first notion of the ego comes from the other. As we see the ego substance (põhiolemus, aines, tõeline sisu) by Lacan is eccentric (tavatu, veider), because the child acquires the first notion of his ego upon seeing himself reflected in the mother, that is to say in the other (Etchegoyen, 2005, pp. 121). Does this world of knowledge about trauma exist, or has disappeared into dreams or dissociated from feelings and body? Can the soviet fathers’ relationship with children also be imaginary?

The red flags of socialism (PowerPoint). Death came true. Words are hard to find for explain myself, when pain and sorrow with feelings of helplessness and archaic pleasure, will be taking over my observing mind. “People did not want to talk about the painful past because they had lost trust in others’ world. Lost close and intimate relationships deprived people from the pleasures of life. Left alone with their restricted understandings about their fantasy world, people have difficulty understanding the intentions and feelings of others in the real world. In this way, silence began and continued for subsequent generations of Estonians as a fantasy world with regard to collective memories about the past and present.” (Parktal, 2012, pp. 354)

Meeting with unknown (PowerPoint). Both men and women desire from the other that which they lack, and this essential lack is phallus. “”The man wants to find the phallus in the woman to overcome his fear of losing it, and the woman longs to receive from the man the phallus she lacks. We can only desire that which we lack, and in the act of love each one gives to the other that which he does not possess.” (Etchegoyen, 2005, pp. 142). The state of “Waiting Godot” will probably also dominate here in this meeting listening presentation and “wounded healer” might appear in case of trauma.

Wounded healer (PowerPoint). The unbearable lightness of being. (M. Kundera). Who else will be able to describe essence of wounded human being as Czech born French writer Milan Kundera, who vent exile in France in 1975. Many questions and thoughts may appear if we think about wounded healer and some additional concepts will be for clarity added: “empathic strain (pinge, pingutus, ülepingutusest vigastama või nikastama)” and “vicarious (asendav, kujuteldav) traumatization”. Two concepts closely related to psychoanalytic work with traumatized patients, which we also can relate additionally with “wounded healer”. Those concepts will be discussed later one.

Taking ideology with pleasure (PowerPoint). Sometimes “phallus” is simply penis. Lacan usually uses the term “penis” to denote the real biological organ and reserves the term “phallus” to denote the imaginary and symbolic functions of this organ. Marina Abramovic presents for us painful loss of symbolic function of ideology. By my experiences sharing thoughts about trauma, like doing this presentation now here, brings kind of situation –K (minus knowledge) by Bion ideas about α-function and reverse β-function (Lopez-Corvo, 2000) or the uncanny by Freud (2003), something that has undergone repression and then returned from it, in not understandable form. Talking to you, will be then much more about hiding by talking and not saying by saying words.

Observing ego (PowerPoint). Zero is in the minds of observers. How we are looking and see photograph of a young boy belonging to a migrant worker mentioned earlier, depends on understanding of presence or absence. At the same time on the unconscious level the unspeakable will be felt. This kind of situation of resistance for painful memories, feelings and thoughts or by Bion “nameless dread” i.e. a state of mind that is not thinkable (Hinshelwood, 1999) might evoke intense feeling of discomfort for listeners. Also, being empathically open for the patient, psychoanalyst will be vulnerable for patient material exactly by same reasons, he/she had traumatized in past. In the K-activity psychoanalyst will been engaged in knowing, based on sensual reality, being conscious about his own emotional experience and being able to abstract from it a statement, which will represent this experience adequately. –K represent link in mind in where understanding is in absence, meaning is abstracted (raskesti mõistetav) and leaving denuded (paljaks riisutud) representations. The threat of being engulfed by this space of having no boundaries to contain anxiety, fear, and result is a psychic catastrophe – what Bion calls “nameless dread”. By Bion “…infant’s as yet unformulated fear of death is transformed by the failure of containment into nameless dread.” (Britton, 1998, pp. 56). Britton (1998) has said about –K “The return of namelessness would seem to be an intrusion of chaos into the ordered, differentiated world and so in the old cosmology we seem to find Bion’s concept of nameless dread represented as a Chaos monster, the personification of -K.” (pp. 55).Indeed this kind situation in state of mind of is not thinkable (Hinshelwood, 1999), and might evoke intense feeling of discomfort.

3. Empathic strain (pressure, burden). In book edited by Wilson and Lindy (1994) concept of empathic strain is described as following.

Empathic strain (PowerPoint). Phallus unites. For both men and women the phallus establishes the absence on which desire is based.

As mentioned earlier, desire has its roots in lack of phallus and this lack unites in act of love man and woman, when each one gives to the other that which he does not possess. In trauma work “the trauma story” is explored in a “safe-holding” environment, and empathy is pivotal for the recovery process in where trauma is placed in newer meaning system. Clinician capacity for genuine empathy is in utmost importance. Another important aspect of trauma work is also identification with traumatized patient; projection oneself into internal world of patient. Therapist own involvement will be seen through countertransference, which might rupture (1. Katkestus, rebestus; rebend; 2. Katkestama, rebestama; rebendi all kannatama) empathy.

Therapist own involvement (PowerPoint). Godot never came. Extreme countertransference feelings might cause empathic strain and determine affective reactions in the therapist. Haven given up on language therapists may stay “prisoners of affect” as Kristeva phrases (1989, p.14).

Empathy, identification and countertransference are interrelated processes and the relation between empathy and countertransference depends on counter identification as well as identifications with patient affects. “…the analyst both identifies with the patient and the same time pulls back from that identification to view patient’s conflict with objectivity.” (p.8, Wilson & Lindy, 1994). Counter identification is also part of countertransference and if it operates imperfectly it can make empathy to diminish or to vanish altogether. In extreme countertransference feelings might cause empathic strain and determine affective reactions in the therapist.

Empathy will vanish (PowerPoint). Sometimes phallus is plainly and absolutely the erect penis. Four distinct modes of empathic strain have been described by Wilson & Lindy (p.15), when emphatic link is destroyed or therapeutic role is lost.

Two normative modes are:

-empathic disequilibrium (uncertainty, vulnerability, unmodified affect), emphatic link is destroyed;

-emphatic withdrawal (blank screen facade, intellectualization, misperception of dynamics), therapeutic role is lost.

Empathic withdrawal (PowerPoint). We can only desire that which we lack, and in the act of love each one gives to the other that what he does not possess.

Two personalized modes are:

-empathic enmeshment (loss of boundary, over involvement, reciprocal dependency), therapist is drown (drawn into) in patient internal world;

-empathic regression (withdrawal, denial, distancing), mostly somatic and physiological (bodily) impairment, when for example cruelties described by patient are unbearable to take by analyst.

4. Vicarious (substituting, back up) traumatization (VT) is described by Doctor and Shiromoto (2009) as a form of PTSD that may develop in helping professions working with traumatized individuals as a result of directly empathizing and identifying with the issues and stressors impacting their patients.

Vicarious traumatization (PowerPoint). The man wants to find the phallus in the woman to overcome his fear of losing it. For example traumatic event as violent death of patients child, might be experienced by psychoanalyst as if death of psychoanalysts own child. Trauma workers who have experienced in past trauma in their lives are the most susceptible to develop vicarious traumatic reactions themselves.

East European psychoanalyst will be closely in touch with VT because we all are experienced war trauma and trauma from life in totalitarian society and are traumatized some less some more.

Usual day in Soviet life (PowerPoint). The woman longs to receive from the man the phallus which she lacks. We can compare vicarious traumatization with infection attacking therapist suddenly. VT is similar with countertransference, but will be different because VT will change the therapist life significantly for worse.

Making therapist life worse (PowerPoint). Sinking into see of autoerotism.

Vicarious traumatization has following red flags for trauma workers:

-preoccupation with client problems;

-loss of interest in formerly enjoyed pleasures;

-weight loss or insomnia;

-feelings of hopelessness and helplessness;

-substance abuse;

-violent suicidal thoughts (p.308).

Vicarious traumatization includes following characteristics:

-an over identification with client’s problems;

-denying the clients trauma (an unconscious mechanism to avoid traumatization);

-social withdrawal;

-feelings of extreme vulnerability;

-generalized hopelessness;

-an increased sensitization to violence;

-changes in ones sense of identity and world view (p.309).

5. Some ending words. Trauma destroys the present life of the individual, by demanding the victim to live continuously in past. Making peace with past traumatic experiences with help of psychoanalysis or/and art, literature, poetry and music, helps restore continuity in time and allows to be in the present with memories of the past and fantasies about the future, maintaining its own mental integrity. It is like growing out from latency, by making connections between childhood and adulthood in the life cycle.

And I’d like also to add the comment from colleague from London, who has visited Estonia many times and has had long term professional relationship with Estonian colleagues in Jungian Society. Geraldine Godsil has written in contexts of Bion thinking: “The link between the totalitarian objects of a repressive system and the internal domination of beta screen and bizarre objects might be further clarified in the ongoing clinical discussions taking place in many different countries recovering from totalitarian rule. This has to be a process of mutual learning if we are to avoid the unconscious re-enactment of totalitarian attitudes. Otherwise these will almost certainly reverberate (peegeldub tagasi) in the group processes of our cross cultural clinical engagements at many different levels.”(p.11)

Over the hills and far away (PowerPoint). Happy moment of united couple. Gary Moore Northern Irish musician has the song “Over the hills and far away” about holding personal secret of the woman in prize of imprisonment for ten years, with words in it:

Over the hills and far away, for ten long years he’ll count the days. Over the mountains and the seas, a prisoner’s life for him there’ll be.

And later…

Over the hills and far away, he swears he will return one day. As sure as the river reach the seas, back in his arms is where she’ll be. What has this song to do with topic of presentation, I do not know exactly, but it seems to me important to share some of the words from song about men who is suffering and had the hope.

This was good place to stop and end the presentation with happy end as I thought earlier, but later I understood that doing so I will be presenting one of the characteristics of vicarious traumatization – denying trauma.

I will end with words from Etkind (2013) about phenomenon characterizing results of Soviet terror – the misrecognition of close people returning from Gulag.

“In an uncanny way, scenes of misrecognition of a father by his son, of a son by his mother, of brother by brother, illuminate the extent of the Soviet state’s radical intervention into the most private aspects of family and kinship. The closest of relatives did not recognize each other because the state effectively transformed one or both of them. With the collapse gulag and later, the USSR, the story of the misrecognition of the returned became trope for the tragedy of “repressions” and the futility of “rehabilitation.” Strikingly, the interminable mourning for those who did not return but were not known to be dead transformed the longing of love into its opposite, the horror of the uncanny.” (p.59).

Thank you for your attention.

Literature:

Berger,J, Mohr, J. (1975) A Sevent Man. London: Penguin

Countertransference with treatment of Post-Traumatic Stress. (1994) Eds.

Wilson, J.P. and Lindy, J.D. N.Y.: Guilford Press.

Doctor, R.M., Shiromoto, F.N. (2009) The encyclopedia of trauma and traumatic stress disorders. Facts On Life Inc.

Etchegoyen, R. H. (2005) Fundamentals of Psychoanalytic Technique. London: Karnac Books

Godsil, G. (2013) Reversal and recovery in trauma: how Bion can further illuminate Jung and Fordham’s interest in unrepresentability. Manuscript.

Hinshelwood, R.D. (1999) Countertransference and the therapeutic relationship. Resent Kleinian developments in technique. http://www.dspp.com/papers/hinshelwood.htm

Gary Moore – Lyrics: http://www.lyrics007.com/Gary%20Moore%20Lyrics/Over%20The%20Hills%20And%20Far%20Away%20Lyrics.html

Etkind, A. (2013) Warped mourning: stories of the undead in the land of the unburied. Stanford, CA: Stanford University Press.

Etchegoyen, R. H. (2005) Fundamentals of psychoanalytic technique. London: Karnac Books, pp. 114 – 146

Nouwen, H. (1979) The wounded healer. New York: Image Books Doubleday

Parktal, A. (2012) Lost Chances and Prosperous Present? The Traumatic Past and Estonian Life Today. Journal of Loss and Trauma, 17:350–357

Ants Parktal, 16.09.2013/16.03.2018/30.03.2018

Ettekanne PowerPoint esitlusena lae alla siit. Tallinn 07.04.18. Ettekanne

[1] This paper was presented at Scientific Meeting of the Dutch Psychoanalytic Societies Friday 11^th of October 2013 and has been elaborated for Tallinn meeting.

[2] https://en.wikipedia.org/wiki/Wounded_healer

[3] A collective trauma is a traumatic psychological effect shared by a group of people of any size, up to and including an entire society. Traumatic events witnessed by an entire society can stir up collective sentiment, often resulting in a shift in that society’s culture and mass actions. https://en.wikipedia.org/wiki/Collective_trauma

[4] Destruction battalions were special units of the Soviet army created for destruction of all material and human resources (prisoners, for example) before the Soviet army left and the German army took over Estonia.

[5] Voluntary self-defense units were organized during the occupation of Estonia by the Soviet army, and after its retreat back to Russia, for protection of material recourses and people and for restoring the Estonian Republic after the Soviet occupation.

[6] The Forest brothers were Estonian partisans, people with different aims, who hid in woods for many reasons, mainly hiding from the Soviet terror or fighting actively against the Soviet order.

[7] https://www.youtube.com/watch?v=-ECUtkv2qV8

[8] In addition, there will be added thoughts from Etchegoyen (2005), Ch. 10, The dialectics of the transference according to Lacan; Ch. 11, The theory of the sujet supposé savoir – the subject supposed to know. Both chapters are about Lacan’s theory, which helps to understand change of meanings during trauma.

[9] The good internal object is part of object (usually mother) internalized in childhood; a mental representation which mediates and supports the relationship between self and environment.

[10] We can also see signifier as unstable meaning, which can never have a univocal or fixed meaning. On the contrary, its meaning varies according to the position which it occupies in the structure. (http://nosubject.com/index.php?title=Signifier )

[11] A Seventh Man is a book, in the form of photography and text by John Berger and Jean Mohr, on migrant workers in Europe. It was first published in 1975.