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    1. Unassimilated Happenings(Pierre Janet) By Ivor Browne

    2. Self-Organisation

    4. Living Systems Definition Contains a number of elements Dynamic process Boundary - regulates what goes in and out Maintains and renews itself Locus of control within itself (self-organising) Reproduces itself

    5. Key Criteria of a Living System Pattern of Organisation The configuration of relationships that determines the systems essential characteristics Structure The physical embodiment of the systems pattern of organisation Life Process The activity involved in the continual embodiment of the systems pattern of organisation

    6. Two Types of Systems

    7. History of Traumatic Neurosis From ancient times the adverse emotional effects of trauma have been recognised by philosophers and writers In 1859 Briquet suggested Hysterical symptoms came as a result of traumatic events. He first formulated the concept of dissociation (desaggregation). Charcot (1825-1893) first related the symptoms of dissociation to brain changes following a traumatic event

    8. History of Traumatic Neurosis (cont.) Dr. Jacob Da Costa (1871) described a group American Civil War veterans who were physically sound but complained of palpitations, cardiac pain, tachycardia, headache, dimness of vision, and giddiness. He labeled the condition irritable heart. This became known as Da Costas syndrome. After World War One, Sir Thomas Lewis (1919) referred to a similar syndrome as soldier;s heart, Openheimer called it neurocirculatory asthenia.

    9. Unexperienced Experience When something happens we do not fully experience it as it happens The integration of experience is a process, taking place over time, involving neurophysiologic and somatic work Why has this simple fact of everyday experience been overlooked?

    10. There Appear to be Two Main Reasons 1. We repeatedly find descriptions of how traumatic experiences are re-lived, re-experienced, or re-enacted. The fundamental error here is the use of the prefix Re and the description of unresolved traumatic experience as repressed memory. 2. Certain historical factors surrounding the early work of Sigmund Freud, for it was he, who first clearly drew attention to the whole issue of traumatic neurosis.

    11. Fight or Flight Walter Cannon (1928): A living creature faced with a threat to its physical integrity responds to the challenge with a fight or flight response. Homeostasis(Cannon): when the threat has been dealt with in one way or the other, the physiology returns to its more or less steady state. Cannon failed to emphasize an equally ancient strategy for survival seen in many species.

    12. Freeze Response Where fight or flight are not possible an organism has the capacity, when faced with an overwhelming threat, to freeze or play dead. This involves an immediate, primitive biological, adaptive response acting at the level of the primitive brain, outside of conscious awareness or control. E.g. The cat and the mouse; the spider, when you touch it with your finger, curls into ball and plays dead. Other animals, such as the hedgehog, for which this form of inhibition is their only means of defense.

    13. Freeze Response (cont.) With traumatic events several factors combine to determine whether the initial shock and freezing which occurs is maintained indefinitely. Where there is alcoholism, marital conflict, or simply a family with little trust, warmth or security and the open expression of emotion is discouraged, then freezing is likely to supervene. Obviously worse, of course, is the situation where physical or sexual abuse, etc. is occurring within the family itself, being perpetrated by a father or near relative.

    14. Freeze Response (cont.) The freezing of an experience can take several forms, from a complete blocking of the entire experience, in both its cognitive and emotional aspects, to a partial suspension of the event. The latter response is seen where, after a first rush of emotion, there is a complete inhibition of all feeling, but not of action. This leaves the person free to take whatever measures are necessary for survival. But, short of actual survival, it is also an essential device to enable individuals to deal with the practical problems which arise following a tragedy.

    15. The Frozen Present In humans this defense is now used as a way of avoiding internal destabilisation. The potentially disintegrative effect of the external threat is signalled by the initial surge of emotion. Our biological structure seems to be able to specify in advance that to fully experience the threatening encounter would destroy or disintegrate our core organisation. The capacity to suspend the integration of the experience appears to involve the Medial Temporal Lobe.

    17. The Frozen Present When an event takes place we may not fully experience it as it happens. We do take an impression of the raw experience, otherwise it would no longer exist within us. But integration fails to progress beyond this point. This is why such experiences, if activated years later, are experienced as happening now.

    18. Declarative Memory Most research into memory has been an attempt to understand the various forms of dementia. This memory processing system involves the hyppocampus and related areas of the primitive brain. What is missing from this research is whether we have the capacity, when subjected to an overwhelming traumatic experience, to block this memory processing system.

    19. The Amygdala. The amygdala are not a component of the medial temporal lobe memory system. They are important for other functions concerning conditioned fear and the attachment of affect to neural stimuli. They also have a role in making associations among sensory modalities. In identifying these emotional connections of the amygdala we are perhaps getting closer to the site for the blocking mechanism which occurs when one is faced with an overwhelming trauma.

    21. Traumatic Experience Traumatic experiences can be of many kinds including the following: Life threatening - birth, near death, drowning, etc. Loss - key relationship, pet, job, self-esteem, suicide, etc. Physical trauma - accident, operation, illness. Cruelty - physical, sexual abuse, torture, etc. Family conflict, alcoholism, drug abuse, gambling, etc.

    22. Traumatic Experience (cont.) How traumatic an event is depends not only on the seriousness of the event, but also on the internal state of the person at that time. The traumatic experience therefore is the summation of the external event and all the learned past of that person, including previous insults or experiences of a similar kind which were frozen and not integrated.

    23. Traumatic Experience (cont.) It is now as if the trauma is within the person but not part of them. This internalised stressor now exists, outside of time, in a potentially unstable state. The person retains these subsidiaries in an inchoate form, some of which may be represented somatically as well as centrally. One may be unable therefore to consciously identify the threatening experience, it is as if it had never happened.

    24. Traumatic Experience (cont.) If activated later by some life event, the experience breaks through and causes flashbacks, nightmares, etc. This triggers painful emotional responses, which the individual once again tries to suspend, but now only partially successfully. This then gives rise to the full-blown syndrome of Post Traumatic Stress Disorder.

    25. Freud and Janet Freud and Janet were contemporaries. Freud (1826) was three years older, but Janet (1829), who died in 1947, outlived him by almost 8 years. Although they never met they were aware of each others work. In a letter to Fliess freud stated: Our work on hysteria has at last received proper recognition from Janet in Paris. Janet Praised the work of Breuer and Freud: We are glad to find that several authors, particularly M.M. Breuer and Freud have recently verified our interpretation, already somewhat old, of subconscious fixed ideas with hystericals.

    26. Freud in Paris Freud went to Paris from October 1885 until February 1886 to study under Charcot, the great French neurologist. In 1914 Freud wrote: Influenced by Charcots use of the traumatic origin of hysteria, one was readily inclined to accept as true and etiologically significant the statements made by patients in which they ascribe their symptoms to passive sexual experience in the first years of childhood, to put it bluntly, to seduction.

    27. Freud and Breuer Back in Vienna Freud joined forces with Joseph Breuer to work on the traumatic origin of the neuroses. In The Aetiology of Hysteria Freud stated: We must take our start from Joseph Breuers momentous discovery; the symptoms of hysteria. are determined by certain experiences of the patient which have operated in a traumatic fashion They further stated: Hysterics suffer mainly from reminiscences

    28. Freud and Breuer They stated that these memories were: Found to be astonishingly intact and to possess remarkable sensory force and when they returned, they acted with all the effective strength of new experience. They stressed the importance of the affective component: We found to our great surprise that each individuals hysterical symptom immediately and permanently disappeared when we had succeeded in bringing to light the memory of the event by which it was provoked and in arousing its accompanying affectRecollection without affect almost invariably produces no result.

    29. Seduction Theory Freuds other great contribution (and why he parted company with Breuer) was to stress the importance of sexual abuse in early childhood, in the genesis of hysteria. Unfortunately he went too far: what ever case and whatever symptom we take as our point of departure, in the end we infallibly come to the field of sexual experience.

    30. Hoist with his own Petard In The Aetiology of Hysteria Freud stated: If you submit my assertion that the aetiology of hysteria lies in sexual life to the strictest examination, you will find thatin some 18 cases of hysteria I have been able to discover this connection in every single symptom, and where circumstances allowed, to confirm it by therapeutic success.

    31. Seduction Theory (cont.) In the French journal Review Neurologique (March 1986) Freud said: In none of these cases was an event of the kind found above (seduction in childhood) missing. It was represented either by a brutal assault committed by an adult or by a seduction less rapid and less repulsive but reaching the same conclusion.

    32. From Fact to Fantasy In little more than a year Freud underwent a complete change of heart. Earnest Jones in his biography of Freud described what happened: Up to the spring of 1897 Freud still held firmly to his conviction of the reality of child traumasAt that time doubts began to creep inThe great secret of something, which in the last few months has gradually dawned on me. It was the awful truth that most - not all - of the seductions in childhood which his patients had revealed and on which he had built his whole theory of hysteria, never occurred.

    33. The Assault on Truth Jeffrey Masson in his book The Assault on Truth(1985) described the circumstances surrounding Freuds abandonment of the Seduction Theory. Masson was working as project director of the Freud Archives and was to be appointed as full director by Anna Freud and Kurt Eissler, but because he published the hidden correspondence from Freud to Fleiss he was quickly dismissed for letting the cat out of the bag.

    34. Abandonment of the Seduction Theory In April 1896 Freud presented his paper The Aetiology of Hysteria to the Society for Psychology and Neurology in Vienna and he described to Fleiss what happened: A lecture on the aetiology of hysteria at the Psychiatric Society met with an icy reception from the asses, and from Kraft-Ebbing the strange comment it sounds like a scientific fairytale and this after one has demonstrated to them the solution to a more than a thousand year old problem, a source of the Nile. A month later, on the 4th May he wrote: I am as isolated as you could wish me to be, and a void is forming around me.

    35. The Debacle of Emma Eckstein Fleiss believed the nose was an alternate sexual organ. Operate on the nose and you would cure hysteria. Fleiss came to Vienna (Feb. 1895) and operated on Emma. The operation was not a success, he left soon afterwards. She developed a purulent discharge. Freud called in another surgeon. He pulled out a yard of gauze, a flood of blood came and she almost bled to death.

    36. Emma Eckstein (cont.) She suffered a relapsing course with recurrent bleeding for several months. On 16 April 1896 Freud told Fleiss: A completely surprising explanation of Ecksteins haemorrhages which will give you much pleasure you were right, that her episodes of bleeding were hysterical On 4 May: when she saw how affected I was by her first haemorrhage she experienced this as an old wish to be loved in her illness she became restless during the night because of an unconscious wish to entice me to go there and since I did not come during the night she renewed the bleeding as an unfailing means of rearousing my affection.

    37. Fact to Fantasy So, in one masterly stroke, a botched operation was changed from fact to fantasy bleeding out of her longing for Freud himself. Thus he found a way to rehabilitate himself in the eyes of his medical colleagues, so that he, a Jew, could once again find himself accepted in conservative catholic Vienna, and be able to earn a living. While in Paris Freud used to go down to the morgue and he would have been familiar with the issue of sexual assaults on children which was under active discussion at that time.

    38. Ambroise Auguste Tardieu He was professor of legal medicine at University of Paris. His Etude medico Legale (1857) drew attention, for the first time, to the frequency of sexual assaults on children. In France during 1858 to 1869, there were 9,125 persons accused of rape or attempted rape of children, most aged between 4 and 12, almost all of them were girls. Tardieu did not doubt the authenticity of these sexual assaults on children.

    39. Alfred Fournier & P.C. Brouardel Within 30 years his two successors took a starkly different view. Articles by: 1) Fournier Simulation of sexual attacks on young children (1880) 2) Brouardel The Causes of Error in Expert Opinion with Respect to Sexual Assaults(1883).

    40. Brouardel Hysteria plays a considerable role in the genesis of these false accusations, either because of the genital hallucinations which stem from the great neurosis or because hysterics do not hesitate to invent mendacious stories with the sole purpose of attracting attention to themselves and to make themselves interesting.

    41. Fact to Fantasy (cont.) In The History of the Psychoanalytic Movement (1914) Freud explained: When this ideology broke down under the weight of its own improbability and contradiction in definitely ascertainable circumstances, the result at first was helpless bewilderment .if hysterical subjects trace back their symptoms to traumas that are fictitious, then the new fact which emerges is precisely that they create such scenes in fantasy This reflection was soon followed by the discovery that these fantasies were intended to cover up the auto-erotic activity in the first years of childhoodand now, from behind the fantasies, the whole range of a childs sexual life came to light.

    42. Fact to Fantasy This new insight opened the way to turn painful reality into fantasy and to blur the distinction between them. Out of this came the whole development of classical psychoanalysis. Psychoanalysis and psychotherapy in general have remained in a state of confusion because of this up to the present day. Thus awareness of the frequency, and serious implications, of sexual abuse was delayed for nearly a hundred years.

    43. Pierre Janet The widespread popularity of psychoanalysis virtually eclipsed the work of Pierre Janet so that, when he died in 1947, his death was hardly reported in the media. Nevertheless, the emphasis he placed on traumatic antecedents, dissociation, and the retraction of the field of consciousness, offered a model of psychological trauma which remains valid today.

    44. Psychological Healing In the above work, under a sub-heading - Unassimilated Happenings, he described the effects of psychological trauma as follows: All the patients seem to have had the evolution of their lives checked: they are attached upon an obstacle that they cannot get beyond. The happening we describe as traumatic has been brought about by a situation to which the individual ought to reactwhat characterises these attached patients is that they have not succeeded in liquidating the difficult situationStrictly speaking then, one who retains a fixed idea of a happening cannot be said to have a memory of the happening. It is only for convenience that we speak of it as a traumatic memory.

    45. Diagnostic and Statistical Manual In DSM4 the distinction between acute, chronic and delayed onset PTSD is now accepted. In their list of symptoms no distinction is made as to the different times when these occur. In fact a long period, often of many years, may elapse following the trauma, before the emergence of the acute symptoms of PTSD. During this latent phase they may show few symptoms, only a constricted life pattern, with recurrent episodes of depression. Most had been attending psychiatrists with a diagnosis of clinical depression.

    46. False Memory Syndrome For generations the abuse of women and children of both sexes, both physical and sexual, carried out primarily by men, was a dark secret. It was only through the courage of a few pediatricians, the feminist movement, and one or two psychiatrists, which finally, over the past 30 or 40 years, brought this abuse , and the extent of it, out into the light of day. Until then there was a culture of silence which meant that victims had no where to turn.

    47. False Memory Syndrome (cont.) Unfortunately, when the wall of silence was finally broken, because those who have been abused tend to present with a range of symptoms, a number of over-enthusiastic therapists and counselors saw abuse lurking below the surface, where no abuse had actually occurred. They actively suggested this to clients using peer pressure, regression techniques, fundamentalist therapeutic groups, etc., and highly suggestible subjects complied with the production of pseudo memories. Thus innocent parents and others were wrongly accused, and the wheel turned full circle, giving rise to organised groups of parents and others attempting to protect themselves from false accusations.

    48. The Repression Debate A number of studies have shown that both children and adults can and do distort past memories. If subjected to suggestive influence they can invent occurrences which have never happened, or which happened to someone else.

    49. The Repression Debate (Contd). It was Bartlett who said as far back as 1932: Some widely held views have to be completely discarded and none more completely than that which treats recall as the re-excitement in some way of fixed and changeless traces(remembering) is an imaginative reconstruction or construction built out of the relation of our attitude towards a whole mass of organised past reactions or experience.

    50. The Repression Debate (Contd). Psychologist Endel Tulving has also described this misconception: One of the most widely held, but wrong, beliefs, that people have about memory, is that memories exist, somewhere in the brain, like books exist in a library, or packages of soap on the supermarket shelves, and that memory is equivalent to somehow retrieving them. The whole concept of repression is built on this misconception.

    51. Repression The usual explanation of what is happening is summed up in Freuds own words in 1924 when he wrote: The theory of repression is the corner stone of our understanding of the neurosis.

    52. Repression Continued It is now clear that when a long-term memory is retrieved, it is reassembled from a number of inputs, from various times in the past, and therefore is essentially a new creation. Hence, if what we are dealing with here is simply repressed memory, it will be quite impossible to distinguish between a true recollection and a fantasy. This is the argument put forward in questioning the reliability of traumatic experiences retrieved by means of experiential methods.

    53. Repression Continued This argument, however, conceals a crucial misunderstanding of the nature of unresolved traumatic experience. For these experiences are not long-term memories, nor indeed memories in the accepted sense at all, but the suspended frozen present. These are experiences which have not yet been integrated into memory, and therefore have yet to be experienced.

    54. Retrospective Study We reviewed 180 cases and they broke down as follows: True - 110 FMS - 6 Unclear - 53 Dropped out - ------------------ Total - 180

    55. Activation Activation may occur due to another trauma of a similar kind e.g. a person who was sexually abused as a child may in adult life be raped. But the Activation need not be a further serious traumatic episode. It can be something as simple as the first night in the marriage bed, or watching a TV programe about sexual abuse. This for most people may be entirely normal. But because this touched the sensitive frozen experience, for this person, the effect may be catastrophic and unleash full-blown PTSD.

    56. Activation Continued The Activation of Frozen experience explains why so many cases of traumatic neurosis only present for treatment in adult life. Once Activation has taken place the individual is now in a dysfunctional state. They are unable to maintain the freeze so as to be able to cope, but, on the other hand, they are unable to fully experience and integrate the blocked trauma of many years earlier.

    57. Dissociation When a person is subjected to the same traumatic experience again, and again. e.g.. Where there is incestuous abuse within the family. In such cases the child is face with an impossible situation. Dissociation is then likely to supervene with a splitting of the personality. In this way the two dimensions of the personality continue to learn and develop quite separately - one visible and available to consciousness, the other hidden and only likely to appear when activated.

    58. Multiple Personality Such Dissociation is very common in Traumatic neurosis. Very rarely this may spontaneously give rise to multiple personality - historically there are a few recorded examples of this. There is ample evidence however that the majority of the latter are iatrogenic; i.e. the result of active suggestion by enthusiastic therapists who believe this to be a common clinical reality.

    60. D.S.M. It was only in the closing years of the 20th century that the realisation that trauma could lead to enduring consequences was finally accepted. The essential symptoms of what is now recognised as P.T.S.D were described by Kardiner as far back as the Second World War, Which he termed a Physioneurosis. Yet it was only as a result of the Viet-Nam War and the publication of D.S.M. 3, that P.T.S.D. was finally enshrined in an official psychiatric classification. Erich Lindemann(1944): Symptomatology and Management of Acute Grief.

    61. Post Traumatic Stress Disorder (As described in D.S.M. IV) (A) The person has been exposed to a traumatic event in which both of the following were present: (1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death, or serious injury, or a threat to the physical integrity of self or others. (2) the persons response involved intense fear, helplessness, or horror. In children this may be expressedby disorganised or agitated behaviour.

    62. P.T.S.D. (cont.) (B) The traumatic event is persistently (re-) experienced in one or more of the following ways: (1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. (2) recurrent distressing dreams of the event. (3) acting or feeling as if the traumatic event were recurring (illusions, hallucinations, and dissociative flashback episodes,including those that occur on awaking or when intoxicated.

    63. P.T.S.D. (cont.) (4) intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event. (5) physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event.

    64. P.T.S.D. (cont.) (C) Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, as indicated by three or (or more) of the following: efforts to avoid thoughts, feelings or conversations associated with the trauma. (2) efforts to avoid activities, places, or people that arouse recollections of the trauma. (3) inability to recall an important aspect of the trauma.

    65. P.T.S.D. (cont.) (4) markedly diminished interest or participation in significant activities. (5) feeling of detachment or estrangement from others. (6) restricted range of affect (e.g. unable to have loving feelings.) (7) sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span.

    66. P.T.S.D. (cont.) (D). Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: (1) difficulty in falling or staying asleep (2) irritability or outbursts of anger (3) difficulty concentrating. (4) hypervigilance (5) exaggerated startle response

    67. The Family - A Living System The family is a living system with its own separate life and existence. Where there is a block in the clients family we typically find there is not only a secret , but also a myth. The myth is that if these things were ever spoken of, somebody would break down or be destroyed.

    68. The Family Myth The thing to do then is bring the family together face to face with the client. It is obviously most satisfactory when the truth can be brought out and accepted by all. If they refuse to be involved, they can still be faced openly with the truth, or one can even write an account of it and send it to them. If there is denial by the family the client may become the guardian of the secret.

    70. Reappraisal Persons who have been traumatised or abused over many years will typically, have a strongly negative self-image. They may have self-destructive tendencies, either to mutilate themselves or attempt suicide. When they come for therapy major areas of their personality may be dissociated. They dont know why they have all these negative feelings about themselves.

    71. Reappraisal Continued As the experiential phase nears completion they are able to take responsibility for their dissociated aspects and to integrate these. Then a reappraisal of their situation becomes possible. They can then dis-confirm their previous anticipation that things will always be the same. Thus reappraisal is essentially a cognitive phase.

    73. Revictimisation The strange finding that many patients suffering from Post Traumatic Stress seem to be stuck as if there were a theme running through their life. They continue to be subjected to the same kind of traumatic experience, over and over again. (e.g. where there has been sexual abuse early in childhood, one finds the person being abused by others in adolescence and then perhaps subjected to rape or other kinds of sexual abuse again and again in adult life).

    74. Revictimisation Continued In these instances it is as if the individual lives out a theme, which the external world continually plays back to them. This phenomenon is usually explained as arising from early personality formation, which then tends to attract the same kind of traumatic insult later, and evokes a reciprocal response in those who carry a complimentary tendency. ( e.g. the daughters of alcoholics who in adult life are attracted by, and attractive to, alcoholics whom they often end up marrying. A similar situation of mutuality has been noted in battered wives who attract those who will brutalise them.)

    75. Revictimisation Continued This undoubtedly represents part of the explanation. However, in a sizeable minority of patients, one finds traumatic incidents happening, which could conceivably be due to coincidence, but, when these occur over and over again, the odds against their happening by chance are unconvincing. It was this phenomenon which Carl Jung, in his tentative way, adverted to in his essays on Synchronicity. . He commented on the way the external world seemed to match the internal preoccupation of the person concerned.

    76. Transpersonal Experience The ancient yogic philosophy of Karma points to another possible explanation of these strange repetitive interactions. Stanislav Grof calls these obscure linkages co-ex systems and points out that the theme usually extends into the transpersonal area. He cites those who have experiences which are not from their present life, but have all the immediacy and vividness of real experiences. I too have frequently found the subject spontaneously going into an experience, which is not from their present life, but which they experience as an episode from a former lifetime.

    77. Transpersonal Experience (cont.) I have often found that it is only when the person has fully experienced one or more of these transpersonal episodes they are able to take a new direction in life. They are then no longer subjected to the same kind of traumatic insult again and again.

    78. END Thank you Ladies & Gentlemen