Memory and its Emergence: Undoing Dissociation

Jung and Affective Neuroscience, A Clinical Perspective

Margaret Wilkinson
Hope Valley, England
Society of Analytical Psychology

Introduction

In the last ten years both analysts and neuroscientists have begun to challenge the analytic world to explore the analytic view of the mind in relation to knowledge emerging from the field of neuroscience. I find that ‘in many ways it is Jung’s understanding of the mind, the human condition, and the self, that is most compatible with the insights that are emerging from neuroscience today’. (Wilkinson, 2004, p. 84) Schore comments: ‘The centre of psychic life shifts from Freud’s ego, which he located in the speech area on the left hand side(of the brain) … and the posterior areas of the verbal left hemisphere, to the highest levels of the right hemisphere, the locus of the bodily based self system’. (Schore 2001a, p. 77)

Today I would like to consider the insights that neuroscience has to offer us as we seek to work with those patients whose early experience has diminished their capacity to be ‘in mind’ and with it their capacity for reflective self-function, whose defences are dissociative, whose need has been to keep unbearable experience at bay, out of mind. I wish to look first at dissociationist theory and its development, then to focus on the insights to be gained from neuroscience with regard to early trauma and its effect on the encoding and recall of memory. Finally I turn to the nature of cure and argue that hemispheric integration is the key to undoing dissociation and the prelude to individuation.

Dissociation

Janet and later Charcot in Paris towards the end of the nineteenth century were the first to suggest that some patients described as hysterical were actually victims of trauma and to propose that traumatic memories may become split off. Both Freud and Jung studied in Paris, embraced dissociationist theory and wrote convincingly in support of it. Jung commented, ‘As a result of some psychic upheaval whole tracts of our being can plunge back into the unconscious and vanish from the surface for years and decades … disturbances caused by affects are known technically as phenomena of dissociation, and are indicative of a psychic split’, (1934, §286) and warned that the real emotional significance of a childhood traumatic ‘experience remains hidden all along from the patient, so that not reaching consciousness, the emotion never wears itself out, it is never used up’. (1912, §222) He elucidated, ‘A traumatic complex brings about the dissociation of the psyche. The complex is not under the control of the will and for this reason it possesses the quality of psychic autonomy’. (1928, §266) He described such complexes as ‘autonomous splinter psyches’, fragments, which became split off because of traumatic experience. (1934, §203) Jung warned how the traumatic complex may suddenly return to consciousness commenting, ‘it forces itself tyrannically upon the conscious mind. The explosion of affect is a complete invasion of the individual. It pounces upon him like an enemy or a wild animal’. (1928, §267) Later both Freud and Jung were to move away from this inter-psychic view of development and rather came to stress the intrapsychic world of fantasy at the expense of the effects of traumatic experience. The effects of adverse external experience lost ground to fantasy as analysts sought to understand the roots of internal object relations within the psyche. However, work with soldiers from World War I, studies of Vietnam veterans, and research with those who had been sexually abused in childhood led to renewed emphasis on Jung’s earlier perspective that real, overwhelmingly traumatic, events might disappear from the mind and be held only in the unconscious, in implicit memory, in the forms of complexes. Bowlby’s ground-breaking work on attachment theory and the research studies that followed in its wake provided further solid ground for rejecting ‘excessive Kleinian emphasis on fantasy’ emphasising ‘that real traumatic events … happen to children and that these real events exert a strong developmental influence’ on the way children experience the world and relate to others in the future. (Eagle, 2000, p. 126)

In recent years huge interest has developed in contemporary neuroscience and attachment theory and their relevance to clinical practice; the un-doing of trauma such as Jung described is an area where such insights are of particular value to us in our clinical work. Jung emphasised that ‘the psyche of the child in its preconscious state is anything but a tabula rasa: it is already preformed in a recognisably individual way, and is moreover equipped with all specifically human instincts, as well as with the a priori foundations of the higher functions. On this complicated base the ego arises’. (1962) In this, Jung anticipates the insights of neurologists, such as Damasio, who also comments ‘The brain does not begin its day as a tabula rasa. The brain is imbued at the start of life with knowledge regarding how the organism should be managed … the brain brings along innate knowledge and automated know-how, predetermining many ideas of the body’. (2004, p. 205) However although the brain is hard-wired in this way from the beginning the development of mind is dependant on experience of relating to others, the initial development of mind arising from intimate interactions with the mother and also the father. Knox comments that ‘mind and meaning emerge out of developmental processes and the experience of interpersonal relationships rather than existing a priori’, (2004, p. 16) indeed she goes on to describe the self as ‘a way of conceptualising all the possible emergent features of the human mind’. (2003) Earliest experiences of emotional states arise out of bodily experiences again in relation to the primary caregiver. Thus we may think of the individual as a mind-brain-body being that has emerged from the experience of the earliest and most fundamental experiences of relating. Both nature and nurture have had a part to play in the growth and development of the neuronal connections that go to make up the individual mind. Siegel comments: ‘Relationships may not only be encoded in memory but may also shape the very circuits that enable memory to be processed and self-regulation to be achieved’ (2003, p. 14)

Early brain development is adversely affected by traumatic experiences in the earliest relationships. Schore has brought together evidence from a substantial body of research, including research using EEG and neuro-imaging (fMRI) data and positron emission topography (PET) that demonstrates that unconscious processing of emotion is associated with the right and not left hemisphere and that the right hemisphere is densely interconnected with limbic regions and therefore contains the major circuitry of emotion regulation. (The “f” in fMRI stands for ‘functional’, indicating a scan of the brain actually at work.) Schore reminds us that when trauma (with its associated fight, flight and freeze responses) has been experienced in the context of the earliest attachment relationship, it becomes ‘burned into the developing limbic and autonomic systems of the early maturing right brain … (it becomes) part of implicit memory, and (leads to) enduring structural changes that produce inefficient stress-coping mechanisms’. (Schore, 2002, p. 9)

Jung stressed the profound effects of the early experiences in life. Fordham, drawing on the work of Stein (1967), understood that ‘the self has defence systems designed to preserve individual identity and establish and maintain the difference between self and not-self’. (1976, p. 90) Fordham described the healthy processes of deintegration and integration by which the infant begins to develop a sense of self in the world and emphasised that, when the infant self is threatened by overwhelming experiences it cannot process, the threat of disintegration occurs and the infant self protects itself by a retreat from the world into an autistic state. (1976, pp. 88-93) Fordham argued that ‘if a baby is subjected to noxious stimuli of a pathogenic nature … a persistent over-reaction of the defence system may start to take place’. (1976, p. 91) Such a process may now be understood as the defensive development of neural pathways in order to protect the self.

I will now summarise briefly what neuroscience has contributed to our understanding of the processing of experience, of the encoding and retrieval systems of the mind-brain. Two separate memory systems co-exist in the brain. It is the asymmetries in two hemispheres of the brain, observable in utero, that gives rise to two very different systems for processing and recording different types of experience. Devinsky comments: ‘The right cerebral hemisphere dominates our awareness of physical and emotional self … and a primordial sense of self … in contrast to the linguistic consciousness of the left hemisphere. (2000, p. 69) The earliest memory form is implicit, unconscious, emotional and inaccessible, arising out of right hemisphere processing of information and is on line from birth. It stores acquired skills, conditioned responses, and emotional responses that at an unconscious level manifest themselves in the person’s most fundamental ways of being and behaving. This early form of memory is most dependant on the amygdala and comes into play when processing of sensory information concerning arousal or the emotional content of experience is involved. Later memory is explicit, conscious, informational and accessible, arising from predominantly left hemispheric processing; it comes on line by the time a child is about three years of age. It is dependant on the activity of the hippocampus and the prefrontal cortex. Understanding of the nature of these two systems and the need for their integration is fundamental to our appreciation of the nature of cure for patients who suffer from the dissociative effects of traumatic experience.

Traumatic experience affects both the encoding and recall of the memories associated with it. ‘As danger threatens the brain’s initial response is acted upon in the brain stem, midbrain and thalamus milliseconds before it gets to the cortex where it can be thought about’, (Perry, 1999, p. 18) Part of the brain’s response to severe trauma is to reduce function across the corpus callosum, the major fibre tract that connects the right and left hemispheres. Peter Levine has described how in extreme situations feeling, sensation, behaviour, image and meaning become dissociated from one another. (Levine, 1992, cited in Rothschild, 2000 p. 67) When the different elements of an unbearable experience get dissociated or split off from one another there can be no proper memory of the event. It will not be processed by the hippocampus, which tags time and place to memories, and so it cannot be stored as explicit or narrative memory. It cannot be recalled in the ordinary way because it has not been remembered in the ordinary way. Instead it will be encoded implicitly in the emotional brain and in the body to remind and warn when similar danger should threaten again.

Some degree of emotional stimulation makes encoding and retrieval easier; however, if arousal is over strong and stressful, then explicit memory formation is likely to be impaired. (LeDoux, 2002 p. 222) Pally summarises the process of encoding and retrieval of traumatic memory:

Hyper-arousal of trauma functionally inactivates the left hemisphere of the brain [eliminating hippocampal processing], leaving memory to be encoded primarily on

the right [in amygdaloidal memory] … if the left side does not have the information, the person acts as if they don’t know the information. Subsequently if an environmental stimulus triggers reactivation of the right-sided memory, the left processes it and the information is verbally recalled, [thus making possible the recall of traumatic memory]. (Pally, 2002, p. 123; material in square brackets, mine)

Many for whom trauma has been sustained over time lose memory of it. If the trauma is pre-three years of age, then the processing capacity for that leads to the ability for explicit recall associated with the left hemisphere is not yet available; the processing of early traumatic memory is very much limited to the right brain as the left brain development with its capacity for verbal processing and hippocampal processing of memory is not yet completely on line. In my clinical work I find dissociative defences protect against painful, even unbearable memory. They lie symbolically between ‘in mind’ and ‘out of mind’ protecting the patient from overwhelming affect at a time when it would be truly unbearable yet hinting at the truth ready for the moment when the patient has sufficient ego strength to begin to confront it. The achieving of this, particularly in relation to fear and aggression, forms a major part of the work with these patients.

Miranda Davies, a Jungian child analyst, saw a thirteen-year-old boy who both physically and psychologically presented as a much younger child. (Davies, JAP, 2002, vol. 27, 3) Jay painted a graphic picture of the defences occasioned by trauma when for many sessions he played and replayed a football game with toy wild animals. His analyst experienced dissociation in the form of mindless boredom that overcame her at the endless repetition and the inability to think about the meaning of the play. I was struck by the neuropsychobiological significance underlying the symbolism of the figures Jay had chosen; in conversation his analyst and I were able to explore the significance of the football game in a way that allowed meaning making to occur. On the wing was the cheetah, named by Jay after a player called ‘Rush’ because he could run as fast as the wind to get out of danger (flight). As forwards were a pig and a bull, named by the child after English footballers notoriously associated with aggression (fight). If all else failed the large polar bear from the land of ice occupied the goal (freeze). Hope, but also the internal struggle, was carried by the little boy kangaroo. He could break all the rules, carry the ball and run where he liked. I understood these images as attempts of the mind to represent those experiences that had remained encapsulated in the emotional brain, as yet not available to conscious mind, not yet stored in explicit memory but rather held in implicit memory. Through this metaphorical play Jay sought to explore his defences yet in such a way that for his analyst also they remained out of mind.

Terr writes of the monotonous repetitive play that is the product of traumatic experience and the difficulty that the analyst experiences in helping the child to make the links that enable the processing of the experience, thus allowing the child to move from the concrete to the symbolic. (1991) This is because the first countertransferential response in the therapist is of necessity dissociative. Jay, who wanted his pain to remain out of mind, played out his anxiety in a way that kept it both in mind but out of mind in his analyst and in himself. Jay in his repetitive play trusted his therapist enough to reveal the barebones of his trauma. She concluded that ‘he could convey meaning in a way that seems astonishing in a child with such early and severe deprivation’. (2002, p. 427) She noted that, in play such as the football game, Jay’s archetypal fantasy of the baby kangaroo who could take a free kick and score from the other end of the field, who could run faster than all the other players, and who did not even need other players to back him up, was an amazingly accurate depiction of ‘the defensive, do-it-yourself, heroic psychology of the deprived infant, who has not got the emotional resources to acknowledge his dependency on a mother figure but sustains himself with the omnipotent fantasy that he can overcome all odds and supply his own needs by his own efforts’. (2002, p. 431) Davies comments, ‘I found the play to be defensive and self-compensatory, cutting him off from reality and building a massive protective wall around the frightened, vulnerable, desperately wounded infant at the core of his personality.’ (2002, p. 431)

Can treatment of such early trauma work? Jay’s school reported that by the end of his therapy he was producing four times as much written work and the behavioural difficulties experienced in school before the therapy began had ceased. He was able to move successfully into ordinary state schooling for the last phase of his education.

Integration

Perhaps as yet speculative, nevertheless it may be inferred that the analytic process and the evolving symbolisations associated with it can develop new neural pathways in the brain, and in particular can develop the fibre tract known as the corpus callosum that is the major highway between the two hemispheres, shown to be reduced through the effects of trauma. (Teicher, 2000) It is ‘the blending of the strengths of the right and left hemisphere (that) allows for the maximum integration of our cognitive and emotional experience with our inner and outer worlds’. (Cozolino, 2002, p. 115) Such integration is facilitated as, through the experience of the transference, past is linked with present and emotional experience revisited and reworked. Siegel comments, ‘when one achieves neural integration across the hemispheres one achieves coherent narratives’. (2003, p. 15) Through the analytic process, new entities are added to pre-existing connections, in the transformative way that is the outcome of appropriate and well-timed interpretation. Schore comments that affectively focussed treatment can ‘literally alter the orbito-frontal system’ of the brain’ and suggests that ‘non-verbal transference-countertransference interactions that take place at preconscious-unconscious levels represent right hemisphere to right hemisphere communications of … emotional states between patient and therapist’. (2001b, p. 315)

At the beginning of therapy the greatest need may be for containment with the therapist as the container of uncontainable affect, of unbearable experience, and also as the one who can process the rapidly changing dynamics of the transference and countertransference in order that a narrative may be constructed, that what feels like ‘now’ may settle into ‘then’. There will be a need for meaning making, for naming that which was previously known only in the body, unavailable to the mind. Early relational trauma may give rise to vertical splits within the personality, at the very least there will be the frightened, angry child whose development was stopped by the experience of overwhelming trauma and whose emergence in the consulting-room will mark the first tentative steps towards trust. One might say that part of successful therapy will be the recognition of the threesome in the consulting-room, that is the therapist, the patient who manages the day to day more or less successfully whether adult or child, that is the part of the patient that Solomon has termed the ‘as if’ self, (2003, unpublished paper) and the inner hurt part of the patient that is often characterised as ‘the traumatised child within’. The skill of the analyst is to relate to both without favouring one or the other so that the two may become more able to interact in a caring way one with the other, eventually becoming more wholly integrated into one, allowing a new experience of the self.

The questions surrounding the recall of memory and accuracy of memories that surface in the consulting-room have been widely discussed; however we should also be aware of the way in which the changing of emotional memory may actually be a benign aspect of analytic work, in that the retelling (from explicit) or re-experiencing (from implicit) of memories in the presence of the therapist may lead to a modulation in the quality of the affect associated with the memory, thus modifying the memory. One patient described her recurrent experience of being caught by a flashback as something that once begun, catapulted her into a parallel universe in an instant, much like Harry Potter’s headlong rush towards platform nine and three quarters. Siegel notes that ‘recent studies of flashback conditions suggest an intense activation of the right hemisphere visual cortex and an inhibition of left hemisphere speech areas’. (2003, p. 15) At such moments much will depend on the calm that the therapist is able to sustain within in the face of much that urges consciously and unconsciously towards just the opposite. A lowering of tone and slowing of speech help to counteract the responses triggered in the patient. It may be possible to help the patient to modify their experience by use of a simple phrase such as ‘it was then, not now’. Cozolino suggests that this is effective because it stimulates Broca’s area and encourages the functioning of right and left hemispheres in a more integrated way. (2002)

This process of cure is not only that of making unconscious conscious, as with interpretation but also the interactive experiencing within the therapeutic dyad. It is the combination of the two that enables change. The development of regulation of affect within the patient brings with it the capacity to reflect, that then makes more possible the interpretative moment, in turn bringing with it the possibility of more integrated hemispheric functioning and the development of coherent narrative. Fonagy argues that ‘the ability to represent the idea of an affect is crucial in the achievement of control over overwhelming affect’. (1991, p. 641) For this to occur successfully interpretations must be grounded in the emotional experiencing that occurs within the therapeutic dyad rather than being merely cognitive engaging primarily the left hemisphere alone. Beebe and Lachmann describe the analytic process as ‘a co-constructed interactive process’ in which ‘the narrative dynamic issues and the moment by moment negotiation of relatedness fluctuate between foreground and background’. (2002, p. 17)

I would like to introduce Amanda briefly to you. I have written about the emergence of memory in her treatment more fully in the Journal of Analytical Psychology. (2003, 48, 2, pp. 235-53) Amanda only remembers a difficult relationship with her mother. She was one of three children. She felt the other two children were special, in that her sister was pretty and was her mother’s favourite girl, and her brother was special as the only boy. Her mother gave her a nickname which made her feel ugly and which was in strong contrast to the pet name given to her sister which implied beauty. She loved her father and felt closest to him. One night when she was six years old, in bed in the room she shared with her sister, she heard her parents quarrelling violently downstairs as they often did. Her father came up the stairs, which she could partly see through the open door of the bedroom. As he came into her line of vision he fell forward, making a horrible noise and collapsed on the landing. Amanda realised that she was sobbing and crept into bed with her elder sister. Her mother rushed upstairs, called out to the children to stop crying and slammed the girls’ door shut. Amanda was certain her father was dead and indeed he had died immediately. Her mother admitted later that, in an attempt to keep the children away from the bedroom where his body lay, she had told them he was not dead. They were sent to school the next day as if nothing had happened. Amanda felt totally confused; she was sure he was dead. Later in the day she heard from children in the street that her father had died.

Her mother sent all three children away to boarding school soon after, telling them she had arranged this because she was going to kill herself. It was a school where every child had lost at least one parent, some two. Amanda was frightened about what her mother might do and desperately unhappy at school. She suffered constantly from eyes that were stuck together with infection, as she would pull her lashes out as if she wanted to stop herself from seeing the plight she was in and to stop herself from beginning to cry. She was also plagued by itchy skin, something her father had complained of in the weeks before his death. She was unable to learn and left school with no qualifications. She married young, had children and later with the help of therapy was able to embark on higher education and a career. As she settled into therapy she began to have flashbacks concerning her childhood experience and then her therapist died totally unexpectedly. Amanda said ‘Goodbye’ to her before a fortnight’s break and never saw her again. Some months later Amanda arrived in my consulting-room in a state of numbness, confusion and terror, symbolised in her first words as she arrived ‘Oh, isn’t this a dangerous place to be? As I drove along the lane I felt the rocks would tumble down on me’ (the rocks being the hard millstone grit edge to the moor which stands above the village about half a mile away). It took many months for this state of mind to ease. On one occasion when I had a bout of coughing she became terrified I would die there and then. We worked with her feelings about my vulnerability for many months, especially over the breaks and the anniversaries of the loss and of the death of the therapist. Slowly but surely, first the numbness, then the confusion eased, she became more able to think and was able to return to the dissertation for a higher degree that she had put to one side.

The next phase of the work was dominated by Amanda’s experience of me as the hostile, persecuting, destructive mother analyst. In a moment it seemed she would change, her face would for a moment show fear, and then would become hard as she closed off completely from me. Almost a whole session would pass, as she would struggle with her experience of me as the bad mother. Wordlessness was the most striking feature of her state of being at these times as she became dominated by right brain functioning, by deeply held ways of being and behaving arising out of the traumatic quality of her earliest relational experience, lodged deep in implicit (right brain) memory. Patients who have been traumatised are hyper vigilant and subject to flashbacks. They may be triggered by a stimulus that in some way matches past bad experience and because the brain pattern matches to protect from a repetition of trauma, the patient becomes overwhelmed by an experience that has a ‘here and now’ rather than a ‘there and then’ quality to it. A turning point came when Amanda went home and painted a picture of a fearsome black cat mauling a baby cat. It filled her with fear, but she was able to bring it to the session and it enabled her to engage the left hemisphere of the brain as she thought about material emerging from the right. Haltingly she was able to discuss her uncertainty about whether I was the bad black cat mother attacking her, or whether she was the bad black cat tearing me to shreds. We became able to talk about how aggression becomes internalised, how experience both of being abused and being the abuser made up her internal world. Towards the end of the session we noticed a little cream cat, whom we felt symbolised the child carrying the hope. This little cat is uncannily like my much-loved little female cat that the patient has never seen or known about consciously. She then brought a second painting which she felt came from a very different place in her. It combined elements of the garden outside the consulting room with good elements of her own garden. The hard edge, that terrified her on her visit, had become merged with the garden fence. The edge had become a happy place where people walked freely, as indeed it is in reality.

The work in the consulting-room with its focus on the transference calls forth emotional responses that come from implicit, emotional, amygdaloidal memory traces that affect profoundly the individual’s way of experiencing and relating to others. The more traumatic the early experience of the patient, the more necessary it is for the analyst to keep this firmly in mind. The therapist’s way of working, of containing and moderating the affect evoked, will determine whether an experience ‘kindles’, that is, activates an emergency response where no emergency is, releasing a toxic soup of chemicals in the brain and retraumatising the patient, or whether it facilitates the ‘quenching’ process which then permits analysis of the transference. Such work enables the later left-brain analytic processing, that ‘allows for the structural expansion of the patient’s orbito-frontal system and its cortical and subcortical connections’ (2001a, p. 72) and strengthens cortical control over the amygdala. (LeDoux, 2002)

The plasticity of the brain throughout life enables change. The mirroring of healthy early relational experience by the therapeutic dyad permits new entities to be added to pre-existing connections in both brain-minds. Past is revisited at the level of the implicit, changing deeply founded ways of being and behaving by means of transformative interpretation. Such process involves the integration of hemispheric function within the context of actual relational experience, leading to change in the nature of attachment. Interpretations without relational grounding are merely cognitive, engaging primarily the left hemisphere. However, well timed interpretations, especially those which involve putting feelings into words, encourage healthy and integrated functioning of both hemispheres of the brain and are an intrinsic part of the process of the coming into mind.

Individuation

Analysis is essentially a symbolic activity with the use of metaphor at its heart. Levin and Modell’s work has emphasised the value of metaphor because of its capacity to facilitate integrated working of the two hemispheres of the brain as the patient seeks to recover from traumatic experience. (Pally, 2000, p. 132) Knox reminds us that Jung understood that ‘mental imagery always has its origin in external experience which is then internalised and modified by innate or archetypal expectation, and that as therapists much of our skill lies in being attuned to these transforming symbols which our patients unconsciously communicate to us’. (Knox 2001) This seems to have been the case for Sophie also with a series of paintings.

In the following clinical material I seek to illustrate the process of the symbolic emergence of self as traumatic memory emerged and was transformed through experience in the analytic dyad. These pictures were produced at home during the analysis and brought occasionally to a session. The first picture vividly described the patient’s defended self at the beginning of the analysis, deeply buried in a sarcophagus like structure, the second and the third the way that defended state had come about and the gradual emergence of memory, and the fourth and fifth the emergence of the self as the analysis enabled the defences to be relinquished and released a new energy for living. The pictures were produced in the first three years of a six-year analysis.

Sophie, an artist, who I saw four times weekly for five years, was in her late thirties when she sought help because she had suddenly become unable to work or take care of her family, wishing only to retreat to bed. By the time she came to see me she had been off work for three months. She was depressed, unable to sleep and frightened by what was happening to her. She had two children; a daughter aged nine and son who was fourteen years old when she came into analysis. In her early twenties her first child, a son, had been stillborn. His funeral had been held without her knowledge while she was still in hospital. She felt she had never been able to complete her grieving for him. A counsellor who she had seen for several months when she first became ill referred Sophie to me. She had formed a very intense, possessive transference to him. He felt out of his depth and referred her on to me. She came to analysis because she was frightened by her illness but inevitably started the analysis with a strong negative transference. I was not the ideal and idealised male counsellor, rather I was an uncomfortably close reminder of her denying and depriving mother.

Sophie was the third girl in a family where a son was longed for. Her history is that of early relational trauma, followed by a seemingly isolated incident of childhood sexual abuse. Her mother had felt the third child was bound to be a boy. It was not until Sophie was twelve that a boy was born. She had a difficult labour and when Sophie was born she would not even look at her. The nanny looked after her and her father named her. Her mother was unable to breastfeed Sophie. At two weeks old she was hospitalised without her mother. She is uncertain for how long. When she was a child her mother often said, ‘You were the worst, you were ill and you should have been a boy’. She felt she could never please her mother because she was neither interested in feminine things like her eldest sister nor very attractive like her younger sister; rather she liked getting out into the countryside or painting. Her mother considered both a waste of time for a girl. Sophie’s paintings have documented shifts in her inner world during the analysis. Not surprisingly she brought none for the first six months and then brought the first. She produced it very hesitantly.

In the analysis Sophie’s mother came across as unhappy and bitter. Sophie experienced her as cold, blaming and uncaring. When as a child Sophie was admitted to hospital after a bad fall from her cycle her mother did not come to visit her for several days, and when she came Sophie remembered her first words as, ‘Well what have you managed to do now?’ a refrain repeated throughout her childhood. Sophie told me that the only moment she felt she had pleased her mother was when she announced her engagement to a naval officer, seemingly a rather selfish only son, the apple of his mother’s eye. The marriage had become sterile before the analysis began and the couple separated during the analysis. Sophie felt that the next two pictures showed her internalised relationships as a series of cogs interacting with one another. In telling me about these paintings Sophie described her mother as the bad cog mother and we acknowledged that it was how she sometimes experienced me in the transference, although she sought to keep me as an idealised good mother. She felt her mother’s cog had damaged her cogs and had thus made it difficult for her to get along with others, she felt that her experience of her mother as the tearing, hurting, destroying mother was lodged inside her, affecting the way she encountered and reacted to others.

Sophie turned to her father for closeness and until his son was born he treated her as the son he longed for and took her around the estate with him. She longed to be a boy so that she might inherit the estate that she loved so much; indeed, until her brother was born, she enjoyed a special relationship with her father and secretly cherished a dream that somehow it might be possible for her to inherit the estate.

In the third picture the mother’s cog is seen as a wheel with spikes whirling round and tearing into the flesh of Sophie’s hand. With negative feelings so firmly and understandably experienced in relation to her mother, an important part of the work has been to help Sophie to understand her own destructive impulses. It has been difficult to approach the fantasies of her own destructiveness which were apparent in her feelings about the death of her son and were manifest in her ability to care for her own children at the time of her breakdown, which occurred when her daughter reached the age she had been when she experienced a sexually abusive encounter. In her professional life she is strongly identified with the rescuer working skilfully with and on behalf of vulnerable children.

About a year into the analysis Sophie recounted abuse by the twenty-year-old gardener on the estate when she was eight years old. He had enticed her into the garden-shed telling her he had a surprise, a new pet for her. He had shut the door. She remembered the dense quality of the darkness. She described how he had begun to touch her and had tried to force her to touch him, pretending that what she touched was the new pet. She managed to wriggle away and to escape. Afterwards she ran away and hid; she did not feel able to tell anyone. Sophie never entirely forgot the abuse she experienced, but nevertheless managed to put it out of mind until her daughter became the age that she was when the abuse occurred. It was then that she became ill and sought treatment for depression. The memory of the abuse only came directly to mind in the consulting-room when, in a session some three years into the analysis, somewhere outside, a door suddenly banged shut at a tense moment in the transference and reminded her of the clanging shut of the garden shed door when the abuse took place.

Prior to this Sophie’s happy times as a child had been wandering around the estate, and helping with the animals, later she turned more to drawing and painting. Her mother disapproved of all of these activities, but her father encouraged her love of animals giving her her own flock of sheep to care for. His attitude to her changed as soon as her brother became old enough to walk the farm with him. She had a special walk along a lane that was part of their land. Once she imagined that as she walked there alone she met an ET-type character from outer space. He saw inside her and said, ‘We are the same you and I, we look one way on the outside but our real self inside is very different’. Although Sophie had to conform outwardly it seems that she never entirely lost awareness of her inner truth. Her adaptive self appears to have been just that, rather than an entirely false self that left no room for awareness of inner truth.

As the analysis continued so gradually her paintings began to show a softening of the protective shell to allow the gradual emergence of the true self. Four years into the analysis Sophie painted the last picture in the series that I came to understand as revealing the gradual emergence of the true self. Sophie spent another four years consolidating the experience portrayed in the pictures. Now she would describe herself as much happier. She is engaged in a meaningful relationship, she has a close relationship with her children and has recently gained promotion at work. She continues to work with vulnerable children but her approach to the task is less heroic.

Conclusion

A trauma patient’s early experience causes the self to retreat, hidden from the world by protective defences. Analytic work that encompasses relational as well as interpretive agents of change can bring about the integration of the activity of the hemispheres of the mind-brain that then permits the self to emerge more fully through the process of individuation.

References

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