Joan White (2005): Life as Pain: Psychic Restructuring After Catastrophic Trauma

The purpose of the study was to examine Cambodian Holocaust survivors' experiences of trauma and to explore the intra-psychic restructuring that occurs in response to that enduring experience. Many of these people, having survived the killing fields of Cambodia, had ended up facing the horror of the Thai refugee camps. Arriving in Lynn, Massachusetts, they had faced the traumatic experience of living in an alien country in a hostile inner city environment.

The study employed a qualitative clinical interview and observation method of investigation of psychoanalytic concepts as applied to individuals from a particular culture undergoing the same traumatic experiences. Clinical interviews were conducted with 13 Cambodian immigrants who were patients at Lynn Community Health Center (LCHC) where the researched also attended a community psychotherapy group. The researcher was aided throughout by a bilingual, Kmer speaking, mental health conselor whom the participants had a pre-existing relationship.

The researcher began with the hypothesis that, in order to contain the overwhelming impact of unbearable emotional and physical abuse, the survivors underwent a psychic restructuring whereby a single traumatic incident was used to encapsulate all of their feeling states in one manageable narrative. The private self was thereby obliterated; a pathological, autistic response, characterized by the survival of some elements of the experience was retained.

The findings of this study are consistent with those of similar recent studies (Hooper, 1991; Fink, 2003; Tarantelli, 2003) in that such a catastrophic experience produced an alteration in the psyche and that this experience is encapsulated into the self which prevents further "compromise formations" (Brenner, 2002). This study postulates that one catastrophic experience tends to take precedence and form a node- a point at which subsidiary parts center. It is from this node that thoughts and feelings—past, present, and future—emanate. It is a state of tension, a state of total focus of mind and body caused by the overwhelming intensity of the moment when death became imminent. The screen memory becomes a defense against an expansion of feeling and experience (Casoni, 2001). It is from this tension state of impending death that the energy of survival flows. It was at that point that the decision had been made to live or die, and the choice had been to live. The traumatic moment propels continued survival; however, arousal of all drive impulses are now linked with death, and the survivor continues to maintain the deficit through post-traumatic stress symptoms, i.e. to have other feeling states could mean annihilation. To live without this node of tragic remembrance threatens survival. Pleasure seeking (libidinal) impulses are similarly threatening and are subdued (repressed) or connected to the traumatic node. Thus, this node becomes the container for the libidinal as well as the aggressive drives and represents a restructuring of the psyche in the face of death.

We as psychoanalysts need to understand how psychoanalytic theory applies to different cultures. It is important to understand the cultural context because culture contributes to the molding of defenses and having a knowledge of ethno-cultural issues and beliefs is essential for the therapist to understand the patient's experience of trauma and subsequent adaptation. Additionally, this understanding of cultural influence is necessary in order to know how accepting of therapeutic work the patient will be. For example, the group experience is culturally syntonic and offers a collective self and a libidinal expression. This probably offers the most hope since the individual self is restricted to somatic symptoms and entrapment in the trauma.

Psychoanalysts need to develop cultural sensitivity in order to apply theory and technique to work with survivors of catastrophic trauma. It is a need of growing importance in a world where violent trauma is visited upon entire groups—for example, Bosnia, Rwanda, Sierra Leone—and where the long term psychic dysfunction that results can extend to succeeding generations.