What does it mean when certain symptoms keep repeatedly emerging? What does it mean when a certain traumatic experience plays over and over again in someone’s life and causes problems and suffering? There is a lot of talk of trauma these days. However, what is often less addressed is the process that accompanies it, the social context within which it happens and resources. All three are necessary to be understood more clearly in order to deal with mental distress more effectively.
The process of creation of trauma usually happens when people are not able to process a certain event which exceeds their ability to cope and it is too overwhelming. Since they are not able to process this at the time when it is happening, the accompanying emotional reaction is repressed and stored in the body. It might emerge later in life when one encounters another similar situation. It can emerge in the form of symptoms, coming in many different forms—panic attacks, depressive episodes, inability to breathe, inability to focus, lack of motivation, insomnia… The logic of the process behind them is, however, similar—when one gets triggered by something that resembles the situation of original traumatization, one is thrown into the same emotional situation that has caused the original experience felt as traumatic. This often happens at an unconscious level.
All of this also happens within a certain social context. It happens within certain relationships that have certain power constellations embedded within them. However, when the symptoms emerge, they often happen within new situations and new relations that resemble the original social context. This constitutes the re-enactment of the original event that has overwhelmed the organism. When this happens, the person can be thrown into the same emotional state that accompanied the original event, even though the situation now might be different. However, its enactment is what is similar and it is to the original enactment that the organism might respond later in time.
Numerous theories of psychotherapy portray this process. It originated in the Freud’s idea of repetition compulsion. Freud noted that we unconsciously repeat our original repressed emotional content in an attempt to resolve it. This means we repeat emotionally painful situations from the past in situations which might not be the same, but often resemble the original situation. This happens until the content is brought to the consciousness and is resolved. This is the idea behind psychotherapy: to provide a safe setting in which those issues can be resolved in a new and constructive manner.
For example, if someone was sexually assaulted by a man at some point in their life, perhaps the accompanying profound feelings of sadness and rage have been deeply buried because social circumstances have been unfavorable to let them out. Later, however, they can perhaps feel anxiety in situations in which other people without similar experience do not feel the anxiety. They can feel anxious when approached by men, which can create problems in the later establishment of relations with men in general or intimate relations. They can feel anxious when walking on a dark street at night, though the particular street is usually considered safe.
The idea behind the therapy process is then to find new ways of being within the safe environment of the therapeutic relationship. The therapeutic relationship should create a safe environment for the person to address this experience, to process accompanying emotions that were initially buried and to experience new ways of being. These new ways of being should, ideally, translate to other areas of one’s life and help them to relate to the world more constructively.
There can, however, be hardships with the translation of this kind of trauma-resolution to other areas of life. The blocks of emotional experiences are usually deeply ingrained within our psyche and our bodily experiences. They can manifest as a very concrete blockages which take time to resolve in safe settings. When one tries going against them, they can manifest as very concrete fear, restraint or feelings of uneasiness felt at bodily level. This is why the therapeutic process working on such blockages is usually a process that takes time. Time and effort are often required for the blockages to resolve in the safe environment. This is also why the focus is often on paying attention to blockages and there is a need to be present with them. To acknowledge them, to enter them gently and gently accompany them to their resolution.
What is often ignored is the role of the social context in creation of trauma. Due to the coupled effect of the omnipresent paradigm of individuality and the dominant biological paradigm, the role of social context in the creation of mental distress is heavily ignored in the current mental health paradigm. This is why we should appreciate the Power Threat Meaning Framework, developed by the Division of Clinical Psychology of the British Psychological Society, created in order to give a more meaningful approach and narrative to the experience of mental suffering. This framework calls the symptoms which are responses to trauma “threat responses” and sees them as learned behaviour or experience that one had to acquire in order to survive. Basically, what is seen as pathology in classical mental health system is a complex web of surviving strategies and responses learned in early childhood and/or aversive circumstances, which then later in life, might cause suffering.
Rationally, a person can be aware of this. Emotionally, they can still go to the emotional state resembling the one from the original traumatic event when a perceived threat triggers this response inside of them. The response to the original trauma can be so strong that the person cannot consciously contain bodily symptoms and emotional responses that emerge. In the above-mentioned example of sexual assault, the person might tremble walking in the dark or feel insecure and be unable to stop it, although rationally they can fully understand that there isn’t any reason to feel so at that particular later moment in time. It is thus useful to explore within a safe setting both how power relations in a particular social context might operate to contribute to this fear and what can be done about it.
What is also rarely mentioned is that there is usually a strong sense of ontological insecurity that accompanies states of mental distress. As Ronald Laing noted, the experience of ontological security is characterized by “a firm sense of one’s own and other people’s identity, permanency of things, reliability of the natural processes and substantiality of others”. All of this can be shaken in the experience of mental distress. On the level of the subjective experience, when trauma happens the world stops being a coherent place that makes sense and the meaning is hard to find.
There is always a social component to this and this is an additional reason to appreciate the Power Threat Meaning Framework which includes it in conceptualization. Initial trauma often happens within the social context of unequal distribution of power, with similar distributions of power or perceived ones posing a trigger in the future and wreaking further havoc in person’s life. Experiences of social adversity, economic, racial or any other kinds in which one’s agency, life and identity are put under the power of someone else can cause re-traumatization or add to the initial one. As George Atwood claims, a person never exists within a void, but always in an intersubjective social context. Failing to note how one’s social context with its power relations operates to re-create original traumatic experience is hardly working on the original trauma in its entirety.
Further, it is important to note that the very first step in recovery is the re-creation of the ontological feeling of safety. This is a prerequisite to all the further work with traumatic experience. The feelings of mental distress and accompanying ontological insecurity can bring with themselves a state of deregulation in which it is not easy to do any kind of coherent re-making of sense of what happened. This can further then be done only after the anxiety and ontological insecurity have been levelled down and the sense of coherence has been re-established.
Psychotherapy is a good resource not only for processing unresolved traumatic experiences, but also for regulation of the overbearing anxiety, ontological insecurity or distressing emotional experience. Non-judgemental co-presence can itself have a healing aspect. A warm presence can mean the world to ontological security. This is partially what happens in therapeutic context. The therapist holds space for clients until they are able to feel ontological security on their own again. How loving presence can help in extreme states is described by Michael Cornwall, who has written extensively on how loving co-presence can help aid in an experience of psychosis.
However, sometimes finding such social contexts in times of mental distress can be difficult. Therapy can also be a privilege. Often it is conditional on how much money one has or the availability of the therapeutic resources in certain geographical areas. This is why it is important to be reminded of the other resources that can be used to restore feelings of ontological security, at least.
Resources can be social (persons one trusts or can feel safe with, self-help groups if there are any in the area), physical (walking, running, spending time in nature or in other environments in which a person can feel safe or at ease), intellectual (books can be good source of self-help in the face of the lack of mental health resources), meditations and visualisations, many of which can be found on the internet. Visualisation of time spent within a safe social setting or with an important person from the past can also be helpful in times of distress. Furthermore, a sense of capability is an important resource in states of mental distress, too. Thus, doing some simple chores or taking care of things can sometimes give one a sense of coherence.
It is important to talk about all of this. Things that make us feel nourished in the context of trauma and/or a social context with an unequal distribution of power, as well as within re-enactments of trauma, are what make a difference in our ability to survive them. It is also important to understand this process and how it works. To be able to understand what is happening to you is to have agency in this process.
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.
Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.