Return of the Repressed: Revisiting Dissociation and the Psychoanalysis of the Traumatized Mind

Abstract

Psychoanalytic treatment is often indicated when trauma and its psyche/soma companion, dissociation, severely disrupt symbolic functioning and associative linking. After Freud’s initial thinking on these matters, repression replaced rather than supplemented dissociation (which occasions segregating units of experience) as the primary defensive response to severe trauma. Because psychoanalysis had “repressed” the salience of dissociation as actively motivated (though passively experienced), an unnecessary schism has occurred between trauma theories and mainstream North American psychoanalysis, and within psychoanalysis itself. To fully restore dissociation’s role in primitive mental states and provide a more integrated approach to technique, it is necessary to comprehend the triadic nature of trauma, which entails economic/drive, structural conflict and deficit, and object-relational factors. For a treatment model that addresses defensive dissociation in the here and now, primary and secondary dissociation must be distinguished, with each differentiated from splitting and repression. Technique requires addressing unconscious, repressed fantasies associated with the “trauma,” object-relational patterns that interfere with linking, and psycho-economic issues that have disrupted ego functioning. A clinical example illustrates both the analyst’s persistence in suffering the dead, eerie space of dissociated trauma and efforts to find language that helps structure the patient’s somatic and enacted expressions (and accompanying dissociative and repressive processes) by which traumatic experiences are registered and conveyed.

Clinical wisdom, science and evidence: The neglected gifts of psychodynamic thinking

“…While typical of children, it may recur in adult life in states of regression and overwhelming anxiety or fear, often accompanied by the blurring of the self-other boundary and a loss of the capacity to form a representational world (Orgel, 1974). Treatment should address the developmental and traumatic dynamics which have undermined the patient’s self-other boundaries ( Diamond, 2020 ).…”

Verbal Communication with the Patient Is Not Enough: The Six Languages of the Sick

“…The unconscious is not a monster fighting us from within, but it is a way our psyche speaks. It must come out because, as Lacan said, “it speaks where it hurts” [ 22 ], that is, our psyche expresses its discomfort in analogy with the cause that provoked it [ 23 ]. Sometimes this will be evident, as in those cases of anorexia due to a rejection of life.…”

Intervenção Clínica no Trauma: Implicações Terapêuticas

“…Na avaliação e tratamento de pacientes com traumatizações que apresentam fenómenos dissociativos é determinante o cuidado de estabelecer uma sensação de construção do holding (Alayarina, 2011;Diamond, 2020;Abram, 2021) que promova um sentimento de segurança, a fim de que o paciente possa vivenciar o seu próprio corpo, os pensamentos, os sentimentos e os relacionamentos, e obter, deste modo, uma melhor noção de si mesmo e do seu espaço psíquico e uma maior resiliência.…”

“…As experiências repetidas de intrusividade, por exemplo, com os sonhos recorrentes, podem ser entendidas como uma tentativa inconsciente de elaborar, no plano fantasmático, uma experiência dolorosa de desamparo profundo. Já a retirada emocional pode ser encarada como um método para o sujeito se proteger de memórias dolorosas (Diamond, 2020).…”