The Future of Mental Health interview series continues with interviews this past week with Claudia Gold on The Silenced Child, Robert Stolorow on emotional trauma and psychoanalysis, Gayle Flanigan on Rose Hill Center, Robert Salvit on Kabbalah and spiritual healing, Susan Raeburn on group psychotherapy, Robert Whitaker on Mad in America, and Isabel Clarke on psychosis and spiritual experiences.
Here is my interview with Robert Stolorow on emotional trauma and psychoanalysis. (To access all the interviews, please visit here.)
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Someone you love is in severe emotional distress. How can you “be” with that person in a way that helps and heals? You aren’t a pill he or she can swallow; you are a vulnerable, perhaps suffering human being in relation with another vulnerable, clearly suffering human being. What should you “do” and how should you “be”? This is a central question of psychotherapy, where one person is supposed to sit across from another person and be of help. Here is Robert Stolorow on this important subject.
Interview with Robert Stolorow
EM: Your background is in psychoanalysis, which for readers who don’t know is the name given to Freud’s way of conceptualizing emotional and mental distress. Which parts of “contemporary psychoanalysis” continue to seem important and relevant to you?
RS: Traditionally, in psychology, psychiatry, and psychoanalysis, the term character has been used to refer to constellations or configurations of behavioral traits: “Anal characters” are said to be compulsive and perfectionistic; “hysterical characters” are described as histrionic; “passive-aggressive characters” show anger covertly by withholding; “narcissistic characters” are excessively self-centered; “borderline characters” form chaotic and primitive relationships; and so on. How might character be understood from a phenomenological perspective like mine that takes organizations or worlds of emotional experiencing as its principal focus?
I have long contended that such organizations of emotional experiencing always take form in contexts of human interrelatedness. Developmentally, recurring patterns of emotional interaction within the child-caregiver system give rise to principles (thematic patterns, meaning-structures, cognitive-emotional schemas) that shape subsequent emotional experiences, especially experiences of significant relationships. Such organizing principles are unconscious, not in the sense of being repressed, but in being prereflective. Ordinarily, we just experience our experiences; we do not reflect on the principles or meanings that shape them. The totality of a person’s prereflective organizing principles, from my perspective, constitutes his or her character.
From this perspective, there can be no character “types,” since every person’s array of organizing principles is unique and singular, a product of his or her unique life history. These organizing principles show up in virtually every significant aspect of a person’s life—in one’s recurring relationship patterns, vocational choices, political commitments, interests, creative activity, fantasies, dreams, and emotional disturbances. Psychoanalytic therapy is a dialogical method for bringing this prereflective organizing activity into reflective self-awareness so that, hopefully, it can be transformed.
EM: You are very interested in trauma, which no doubt also interests many of our readers. What are your thoughts on the importance of trauma as it relates to emotional and mental distress?
RS: Early contexts of emotional trauma have particularly important consequences for the development of character as I have conceived it. From my perspective, developmental trauma is viewed, not as an instinctual flooding of an ill-equipped Cartesian container, as Freud would have it, but as an experience of unbearable painful emotion. Furthermore, the intolerability of an emotional state cannot be explained solely, or even primarily, on the basis of the quantity or intensity of the painful feelings evoked by an injurious event. Traumatic emotional states can be grasped only in terms of the relational systems in which they are felt. Developmental trauma originates within a formative relational context whose central feature is malattunement to painful emotion, a breakdown of the child–caregiver system leading to the child’s loss of emotional integrating capacity and, thereby, to an unbearable, overwhelmed, disorganized state. Painful or frightening emotion becomes traumatic when the attunement that the child needs to assist in its tolerance and integration is profoundly absent.
From the claim that trauma is constituted in a relational context wherein severe emotional pain cannot find an understating home in which it can be held, it follows that injurious childhood experiences in and of themselves need not be traumatic (or at least not lastingly so) or pathogenic, provided that they occur within a responsive milieu. Pain is not pathology. It is the absence of adequate attunement to the child’s painful emotional reactions that renders them unendurable and, thus, a source of traumatic states and psychopathology.
I have contended that emotional trauma is built into the basic constitution of human existence. In virtue of our existential vulnerability—of our finitude and the finitude of all those we love—the possibility of emotional trauma constantly impends and is ever present.
EM: What “heals trauma,” would you say (if “healing trauma” is the way you would put it)?
RS: What is the proper therapeutic stance toward such trauma and vulnerability? How can a therapeutic relationship be constituted wherein the therapist can serve as a relational home for unbearable emotional pain and existential vulnerability? Recently, I have been moving toward a more active, relationally engaged form of therapeutic comportment that I call emotional dwelling. In dwelling, one does not merely seek empathically to understand the other’s emotional pain from the other’s perspective. One does that, but much more. In dwelling, one leans into the other’s emotional pain and participates in it, perhaps with aid of one’s own analogous experiences of pain.
I have found that this active, engaged, participatory comportment is especially important in the therapeutic approach to emotional trauma. The language that one uses to address another’s experience of emotional trauma meets the trauma head-on, articulating the unbearable and the unendurable, saying the unsayable, unmitigated by any efforts to soothe, comfort, encourage, or reassure—such efforts invariably being experienced by the other as a shunning or turning away from his or her traumatized state. Let me give an example of emotional dwelling and the sort of language it employs from my own personal life.
My father suffered a terrible trauma when he was 10 years old. He was sitting in class, the kid sitting in front of him was horsing around, the teacher threw a book at the kid, the kid ducked, and the book took my dad’s eye out on the spot. For the rest of his life, he lived in terror of blindness—a terror that I remember pervaded our household when I was growing up. Sixty years after that terrible trauma, he was to have cataract surgery on his remaining eye, and his optic nerve was vulnerable to being knocked out in virtue of the glaucoma medication he had been using for decades.
When I went to see him just prior to the surgery, I found him in a massively (re)traumatized state—terrified, fragmented, disorganized, and deeply ashamed of the state he was in. Family members tried to offer him reassurance: “I’m sure it will be fine.” Really? Such platitudes only demonstrated to him that no one wanted to be close to him in his traumatized state. Having gone through my own experience of devastating trauma, I knew what he needed instead. I said, “Dad, you have been terrified of blindness for nearly your entire life, and there’s a good chance that this surgery will blind you! You are going to be a fucking maniac until you find out whether the surgery blinds you! You’re going to be psychotic; you’re going to be climbing the walls!” In response to my dwelling with his terror, my dad came together right before my eyes and, as was our custom, we had a couple of martinis together. The surgery was successful and did not blind him.
If we are to be an understanding relational home for a traumatized person, we must tolerate, even draw upon, our own existential vulnerabilities so that we can dwell unflinchingly with his or her unbearable and recurring emotional pain. When we dwell with others’ unendurable pain, their shattered emotional worlds are enabled to shine with a kind of sacredness that calls forth an understanding and caring engagement within which traumatized states can be gradually transformed into bearable painful feelings. Emotional pain and existential vulnerability that find a hospitable relational home can be seamlessly and constitutively integrated into whom one experiences oneself as being.
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Absorbed for nearly four decades in the project of rethinking psychoanalysis as a form of phenomenological inquiry, Robert D. Stolorow, PhD, is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (Routledge, 2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (Routledge, 2007) and coauthor of eight other books.
Robert Stolorow links:
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.