Swimming Lessons: Aging, Dissociation, and Embodied Resonance

Social wariness and anxiety can take different forms. Paranoid anxiety focuses on the malevolence of others, whereas social anxiety focuses on the inadequacies in the self in competing for social position and social acceptance. This study investigates whether shame and shame memories are differently associated with paranoid and social anxieties. Shame, traumatic impact of shame memory, centrality of shame memory, paranoia and social anxiety were assessed using self-report questionnaires in 328 participants recruited from the general population. Results from path analyses show that external shame is specifically associated with paranoid anxiety. In contrast, internal shame is specifically associated with social anxiety. In addition, shame memories, which function like traumatic memories, or that are a central reference point to the individual's self-identity and life story, are significantly associated with paranoid anxiety, even when current external and internal shame are considered at the same time. Thus, traumatic impact of shame memory and centrality of shame memory predict paranoia (but not social anxiety) even when considering for current feelings of shame. Our study supports the evolutionary model suggesting there are two different types of 'conspecific' anxiety, with different evolutionary histories, functions and psychological processes. Paranoia, but less so social anxiety, is associated with traumatic impact and the centrality of shame memories. Researchers and clinicians should distinguish between types of shame memory, particularly those where the self might have felt vulnerable and subordinate and perceived others as threatening and hostile, holding malevolent intentions towards the self.

Considering the work of the South African Truth and Reconciliation Commission (TRC), the criticisms levelled against it, and the literary response it has evoked in terms of a struggle over definitions of trauma and recovery can help the debate over the perceived monocultural bias of trauma theory in its ‘classical’, mid-1990s formulation and the fraught relationship between such tendencies and the commitment to social justice on which the field prides itself. Insofar as the TRC mapped Euro-American concepts of trauma and recovery onto an apartheid-colonial situation, it was subject to the same problems and limitations faced by trauma theory—problems and limitations which post-apartheid literature has not been slow to confront. Sindiwe Magona’s truth-and-reconciliation novel Mother to Mother, for example, can be seen to supplement the work of the TRC by critically revisiting its limits, exclusions, and elisions—and thus also to suggest a possible way for ‘traditional’ trauma theory to reinvent and renew itself.

Objective: Early trauma exposure has been demonstrated to significantly impact brain volume. Childhood trauma also contributes to onset of psychopathology, particularly depression. We sought to identify gray matter volume changes unique to trauma exposure in adolescent depression and hypothesized that adolescents with diagnosis of major depressive disorder (MDD) and childhood trauma would have smaller gray matter volume and thickness in areas previously identified as reduced with childhood trauma exposure relative to non-traumatized depressed adolescents and healthy controls. Methods: We obtained structural MRI scans for 120 adolescents with a history of past trauma exposure and a current diagnosis major depressive disorder (MDD, n=29), a diagnosis of MDD, but no trauma exposure (n=49), and healthy controls (n=42). Adolescents with a diagnosis of MDD and trauma exposure compared with adolescents with MDD and no history of trauma exposure showed increased gray matter volume in the right superior parietal lobe (p=0.001), a cortical region important for processing of visuospatial cues and implicated in traumatic memory. Positive trauma history status included sexual or physical abuse, or trauma with risk of death or bodily harm. Results: Our findings indicate increased right superior parietal volume in depressed adolescents with history of trauma exposure that is distinct from findings related to depression or suicidal behavior. Conclusion: Our finding of increased superior parietal volume in adolescents exposed to past trauma compared with adolescents not exposed to past trauma may indicate differences in information processing, particularly visuospatial processing and working memory, in trauma exposed, depressed adolescents. The absence of any significant relationships between superior parietal lobe volume abnormality and measures of present symptom severity, suicidal ideation, past suicide attempt and medication in adolescents with history of depression and past trauma suggests that increased right superior parietal lobe volume may be related to trauma exposure in adolescents with depression.

EPA-1687 – True traumas, dissociation spectrum symptoms and differential ability profiling

Maladaptive daydreaming (MD) is a new proposed mental disorder in which an excessive absorption in vivid, narrative fantasies generates impairments in various life domains. This study aimed to examine the role of traumatic life experiences and immature, neurotic, and mature defense styles in MD. Three hundred and fifty-six Italian adults, ranging in age from 18 to 60 years completed an online survey, including measures of MD, traumatic life events, and defense styles. A multiple mediation model showed that immature, neurotic, and mature defense styles fully mediated the relationship between traumatic life experiences and MD. These findings suggest that clinical interventions for people with a history of traumatic experience who developed MD should aim to help them acquire more adaptive coping strategies to deal with traumatic memories.

Replies to Dr. Kaplan and Dr. Nahum (this issue) focus on the complexly layered aspects of both attachment dimensions and clinical engagement. Attachment is looked at in the context of multiple self states. Thus, despite the predominant annihilation anxiety that accompanies disorganized attachment, there may also be self experiences of shame and humiliation generated by dependency needs. In response to the Boston Change Process Study Group, the paper proposes the idea that there is “something more” than implicit relational knowledge— something that is not subsumed under that theoretical paradigm. In keeping with the theme of multiple self states, “dissociation” and “enactment” are believed to be useful concepts in providing a path for transformative relational experience.

According to some relational approaches, mental health is expressed by the ability to move between various self-states while maintaining the adequate presence of the illusion that the self is continuous in time and space. Patients undergoing combined therapy are granted with the inimitable space existing between the two forms of therapy—individual and group therapy. Within the combined therapy patients, as well as therapists, are challenged by the multiplicity of self-states arising in light of this complex situation as part of a mutual intersubjective process. The article analyses the advantages of the combined therapy in light of the theories dealing with multiple self states. A clinical vignette will be presented to illustrate the theoretical notions.

To the Editor: Two recent studies,1,2 including one reported in the Journal of the American Geriatrics Society,1 used Veterans Affairs (VA) patient databases to establish posttraumatic stress disorder (PTSD) as a risk factor for dementia. PTSD and dementia are common and place considerable burden on patients, caretakers, and society.3,4 The co-occurrence of conditions involving memory loss (dementia) and intrusive expression of trauma memories (PTSD) underscores the need to better understand their interactions. Reports of cases in which PTSD worsened with cognitive decline5 and mild cognitive impairment as a precipitant for "delayed-onset PTSD"6 suggest that pathways between dementia and PTSD are bidirectional and that neurodegeneration can disinhibit trauma memories. Current models of PTSD refer to amygdala activation that is inadequately inhibited by higher cortical structures.7 Specific dementia subtypes affect cortical and subcortical structures differently.8 The objectives of the current study were to characterize activation of war trauma memories in veterans with dementia and evaluate relationships with dementia subtypes. Dramatic presentations evaluated by the principal investigator (PI) (DLD) inspired this study, which was conducted by reviewing patient records and was approved by the Washington, DC, VA Medical Center institutional review board. Cases were identified from the complete roster of psychiatric evaluations for a geriatric medicine clinic over a 2-year period based on a diagnosis of dementia and a caregiver's report of new-onset disruptive behavior related to patients' traumatic military experiences. Controls were selected in a 2:1 ratio by identifying patients with dementia who had also served in a war zone but did not have reports of reenactments of traumatic military experiences. After the PI identified cases and controls from the clinic roster, postgraduate trainees reviewed chart files guided by a chart review instrument. Data included demographics; war theater of service; the presence of PTSD, hypertension, diabetes mellitus, stroke, Parkinson's disease (PD), and symptoms associated with Lewy body dementia (LBD) (severe sensitivity to antipsychotic medications, visual hallucinations, and severe sleep wake disturbance); and dementia subtypes that the PI had previously diagnosed using available clinical and laboratory data. Sixteen cases of 197 (8%) patients that the PI saw during the study period met the case criteria. All had episodes with vocalizations of war-related references (e.g., asking for help from soldiers, "secure the perimeter"). For all cases, most episodes occurred at night and appeared to arise from sleep. Seven had episodes in which they were physically combative, including by shielding a spouse from perceived danger. All of the cases and two of the 32 controls had prior diagnoses of PTSD (P<.001). There were no differences in the frequency of other diagnoses except a trend for higher rates of strokes (P<.09), and LBD features were more frequent in the cases (all P<.001). As indicated in Figure 1, the distribution of dementia subtypes was significantly different in the two groups, with all but one case having been diagnosed with a subcortical type of dementia. Percentage of cases and controls with specific dementia subtypes, chi-square=11.3, P<.02. Although preliminary because of the limitations of retrospective chart review and the experience of one clinic, these observations suggest that trauma-related reenactments are not uncommon in older war veterans with dementia and occur in those previously diagnosed with PTSD. Episodes that appear to be dissociative flashbacks can be dramatic and disruptive. A predominance of sleep-related episodes and a preliminary association with subcortical dementias was also found. These associations suggest a relationship with rapid eye movement (REM) behavior disorder (RBD), which features behavioral enactments during sleep due to failure of the normal inhibition of motor activity of REM sleep. RBD has been found to be a prodrome of LBD and PD9 and has been linked to PTSD.10 Thus RBD might provide a relevant model for understanding relationships between trauma memory reactivation of PTSD and dementia. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Dr. Mellman has recently been engaged as a consultant to Eisai pharmaceuticals. The activity has no relationship to the study report. Dr. Mellman's activity as a mentor to novice investigators was supported in part by National Institutes of Health Frant K24 MH001917, a midcareer award in patient-oriented research. Author Contributions: Everyone who contributed significantly to the work has been included in the authorship, and all authors contributed to the conception and design, acquisition of data, analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; and final approval of the submitted manuscript. Sponsor's Role: There was no external sponsorship of the study.

PurposeThe purpose of this study was to investigate cognitive behavior therapists and trainees’s beliefs about various aspects of traumatic memory and to investigate cognitive behavior therapists’ practices in relation to alleged traumatic experiences and whether they are linked with their beliefs about various aspects of traumatic memory.Design/methodology/approachIn the current study, the authors surveyed, by a questionnaire (in Italian), certified Italian cognitive behavioral (CB) therapists and trainees with respect to their beliefs in traumatic memories and whether they discussed about the possibility of repressed memory with their patients.FindingsThe majority of participants held strong beliefs about many controversial aspects related to traumatic memory, such as the mind being able to block out of consciousness memories of traumatic experiences. Also, more than half of CB therapists stated that they sometimes discussed about the importance of traumatic events in the genesis of their patient’s disorder and half of them sometimes talked with patients about memories for traumatic events of which they may be unaware. Such practices could lead to false memories of abuseOriginality/valueOne particularly novel finding relates to the evidence that therapists reported that they had discussed with patients the importance of traumatic events in the genesis of their illness and frequently noted that they talked about the possibility of repressed memories with them. In turn, patients may be induced to recall traumatic experiences from their lives, thereby producing false memories which may tear families apart and could even lead to wrongful convictions.

In view of the current challenges to reconciliation and unity between the DRC and the URCSA this article attempts to join in the transdisciplinary discourse on cultural trauma and collective memory in order to find a way of dealing collectively with past traumas in a constructive way. It argues that the concepts of cultural trauma and collective memory are significant in dealing with distresses of the past, in order to create a collective memory, which implies taking responsibility for the present and the future. It further introduces a collective pastoral hermeneutics to assist both churches to take responsibility for the past by embodying collective memory shared with the ‘other’ in order to transform the past in the present for the future.

Ernaux's Testimony of Shame Lawrence D. Kritzman ANNIE ERNAUX'S LA HONTE (1997) is a semi-autobiographical work in which the author explores how a traumatic memory is stored and frozen in the mind.' Her reflection is built on the assumption that memory can never be truly authenticated since traumatic experience precludes direct access to testimony. "Il n'y a pas de vraie mémoire de soi" (37). Consequently her attempt to remember things past, the adolescent youth of the summer of 1952 as "little Annie D," constitutes a quest for understanding unimpeded by the imposition of an artificial reality. "Naturellement pas de récit, qui produirait une réalité au lieu de la chercher" (38). Based on the premise that language puts memory into question, it reflects, however, on the manner in which one perceives the world and takes hold of one's life story however elusive it may be. "Ce qui m'importe, c'est de retrouver les mots avec lesquels je me pensais et pensais le monde autour. Dire ce qu'étaient pour moi le normal et l'inadmissable , l'impensable même" (37). What Emaux recognizes must remain an incomplete narrative nevertheless affords her the possibility of engaging in a cognitive performance capable of unraveling unassimilated memory. In so doing, Ernaux's story suggests that the initial shamefulness prompting her to find the words to "dire l'inadmissible" also entails, and perhaps even requires, the provisional adoption of a mask of shameless normality and invisibility ("dire Ie normal"). Until Emaux is able to do this she cannot let herself feel authorized to take pleasure in being the object of the gaze without the accompanying fear of experiencing affective confinement. At the core of Ernaux's writerly quest is the desire to describe the etiology of her perception of shame. She situates the birth of this feeling in an event of domestic violence that she witnessed in June 1952. "Mon père a voulu tuer ma mère un dimanche de juin, au début de l'après-midi" (16). This scene of primitive violence revealed the dark forces that fatally marked her existence as being flawed and committed her to an interminable feeling of malaise. Trauma, which literally signifies "injury" or "wound," signals, as Freud has suggested, a situation of helplessness and the anxiety that it produces. Victim of an affective paralysis, Emaux lived with a story that she was unable to put into words. "J'ai toujours eu cette scène en moi comme une image sans mots ni phrases" (17). The image of violence imprinted on the mind's eye makes evident the act of bearing witness as well as its failure to be articulated Vol. XXXIX, No. 4 139 L'Esprit Créateur discursively. Ernaux's testimony neither effaces the truth nor attempts to deny it. Yet she cannot undo the shock of the event since the act of witnessing paradoxically realizes what Cathy Carath terms "the witnessing, precisely of impossibility."2 Instead of experiencing a sense of immediacy while observing a photographic image of herself at age twelve, the mature writer now discovers in it an uncertainty that allows her to fall prey to mis-recognition and an inability to repossess the mystery of the past. "Je ne croirais pas qu'il s'agisse de moi. (Certitude que 'c'est moi', impossibilité de me reconnaître, 'ce n'est pas moi')" (25). The traumatic event, the violence her father inflicted on her mother, functions as a disruption in the continuity of experience and necessitates an ellipsis in the narrative of her life's story. "Nulle part il n'y avait de place pour la scène du dimanche de juin" (108). The adolescent girl was obliged to efface the experience that pained her. The wound that is the result of the event, the shock of seeing her mother stricken: the impact of this trauma short-circuited the assignment of meaning and ultimately rendered language somewhat obtuse. "Les mots que je retrouve sont opaques, des pierres impossibles à bouger" (69). In this context memory became the site of the unthinkable, making the young subject immune to self-expression. "Il n'y avait...

Trauma is not an unambiguously defined concept. After a discussion of various definitions and different types of trauma, a description is given of short- and long-term outcomes of traumatic experiences. For the treatment of traumatized individuals, and above all, for the interpretation of this kind of experience it is important to note that traumatic memories are subject to some specific psychic transformations. The traumatized self-states are not completely dissociated from the mind’s associative network. Specific interpretive strategies are described that focus on the irreparable break in basic trust, the need to control relationships, the importance of the reconstruction of the trauma, the restoring of the paralyzed agency of the traumatized self, and the particular attention that must be paid to enactments in the treatment. In the final part, a new understanding of memory in so-called Embodied Cognitive Science is described. Memory is no longer a retrieval of stored knowledge in the brain, but a function of the entire organism, the product of complex, dynamic recategorization and invariably embodied interactive processes. By way of a clinical example, the manner is illustrated in which this new conception provides an alternative explanation as to how traumatic memories function, and how the latter are understood in psychoanalytic treatment.

Jung used creative methods such as picture-making and active imagination to work with complexes and in particular trauma and dissociation. A clinical example of a 60-year-old woman demonstrates the benefits of using creative methods to work with issues linked to early life, such as somatic intrusions of early childhood trauma. Significant inner figures were delineated, including the original figure associated with the infantile dissociative split. The figures illustrated Jung's complex theory by making visible the nonverbal inner states that were initially feared and experienced as Other. Within an analytic relationship that included a working through, an innate creative process unfolded that permitted inner figures to become agents of change within her psyche. This paper highlights the value of Jung's complex theory and the use of creative methods when working with dissociation, regression and unformulated infantile states, even when the analysand is in the later stages of adulthood.

A growing number of studies are indicating that a number of people report psychological growth after experiencing trauma. This may be so because suffering stimulates the need and search for meaning [1]. In this cross-sectional and correlational study, we sought the relationship of subjective wellbeing to posttraumatic growth in view of past trauma experiences and perceived stress. In particular, we investigated a sample of tertiary students’ perceived stress, past traumas, subjective well-being, faith maturity, positive and negative affect, and personality, together with demographic correlates. Past traumas included loss of a loved one, chronic or acute illness, injury, divorce, violent crime, and job loss, amongst others. Only a quarter of respondents experienced their trauma/s 5 years or more prior the study, thus indicating relatively recent trauma experiences. Post-traumatic growth correlated with personality, faith maturity, wellbeing and positive affect. In examining the patterns of correlations noted above, a hierarchical multiple regression analysis was employed. Posttraumatic growth was found to have unique variance even after partialling out key variables such as perceived stress, personality and faith maturity. Although situational factors and personality did play important roles, this study clearly points at the relevance of faith maturity and posttraumatic growth for the promotion of holistic wellbeing of those affected by trauma. Religious beliefs may counter hopelessness and form an important buffer in this equation. The psycho-social implications of these results were discussed.

This article draws upon Jenny Edkins’ notion of ‘trauma time’ and asks how it helps us to better understand entanglement with past trauma in the context of gender-based violence (GBV). Edkins argues that enacting trauma time allows for multiple narratives and resistance, challenging the normalisation of traumas by sovereign power within linear time. I propose that trauma time offers valuable insights into better understanding GBV by highlighting the socio-political nature of trauma and critiquing the linear narrative of healing and restoring social order. Through an analysis of debates over the Gender Recognition Reform Bill in the United Kingdom, this article unpacks how social actors enact trauma time surrounding various forms of GBV, especially gendered violence against trans people. I argue that while sharing some similarities with gender critical feminists’ invocation of trauma time, the enactment of trauma time by trans rights activists troubles and challenges the reproduction of the linear narratives that hide multiple sites of violence. Going beyond examining individual temporal experiences of trauma, this article interrogates how different ways of enacting trauma time, originating from systemic sources of GBV, reveal non-linear and multiple temporalities. It also contributes to a deeper understanding of societal contestations over negotiating and challenging temporal order.