| Post Traumatic Stress Disorder (PTSD) is a | | | | overwhelming trauma such as the Holocaust during |
| psychological syndrome first recognized by the | | | | World War II in Europe and the nuclear bombing of |
| Diagnostic and Statistical Manual of Mental Disorders in | | | | Hiroshima and Nagasaki in Japan. It was clear that for |
| 1980 (American Psychiatric Association).The literature | | | | the patients exhibiting symptoms such as those |
| on traumatic anxiety covers a wide range of varying | | | | mentioned above, the abuse of drugs was part of an |
| circumstances and experiences. The effects of these | | | | effort to self-medicate and ease the emotional pain. |
| experiences, whether from natural disasters or | | | | The drug abuse, then, was seen as a serious, yet |
| events of human creation, war, terrorism or single | | | | secondary problem, whose goal was both to mask |
| acts of violence against one person are often | | | | and alter those feelings of being powerless to change |
| determined by the individual's capacity to cope with | | | | one's intolerable emotional state. This same approach |
| stress. This in turn is a function of each person's early | | | | can be used to understand those individuals who |
| developmental experiences with trust, constancy and | | | | survived early-life incest and sexual abuse.However, |
| mastery. Traumatic abuse, sexual or otherwise, in the | | | | there is a much more limited discussion as to how |
| first years of human life not only effects the child in | | | | the wider understanding applies to adult survivors of |
| the moment, but has a more lasting effect on the | | | | early childhood incest experiences. Working with |
| ongoing development of the defense system | | | | those suffering PTSD as a result of war experiences, |
| itself.Individual psychology believes that traumatic | | | | we learned first to note the cluster of characteristic |
| anxiety is most often seen as resulting when the ego | | | | symptoms, and to see the connection between an |
| is "overwhelmed or disorganized" with the defenses | | | | overwhelming distressing and disorienting event, |
| employed in the service of maintaining a sense of | | | | often beyond the normal range of human coping |
| self-constancy and continuity. More specifically, the | | | | capacities, and the resultant later symptomatology. |
| defense function acts to ward off a sense of | | | | The stimuli producing these events were experienced |
| discontinuity or void in one's identity. Therefore, the | | | | with such an intense terror and helplessness |
| trauma is considered an attack, real or potential, | | | | notwithstanding all attempts to deny, internalize or |
| escalating the anxiety to terror as a consequence | | | | act out, the traumatic event is relived as a series of |
| the protective rage is rendered unconscious and | | | | intrusive recollections or as repetitious dreams and |
| turned inward to depression and guilt, or outward to | | | | nightmares in which the trauma recurs. Though the |
| action discharge. This process is called into action to | | | | symptomatology varies from person to person, it |
| protect against these powerful threats to the | | | | remains a number of common characteristics. Quite |
| integration of the self. It reminds one of the | | | | often there are dissociative disorders: fugue states, |
| often-quoted words of Freud "that what makes us | | | | period of derealization, amnesias and trance state, |
| neurotic in adulthood is what we learned in childhood | | | | lasting for a few moments, for several hours, and |
| to stay alive." The key is the breakdown in the | | | | even for several days. Because of the extensive use |
| growing psychic apparatus and its ability to provide | | | | of denial in most cases of sexual abuse, complete |
| stimulus barrier. Therefore, effecting a breach in the | | | | loss of memory of the abusive events are quite |
| ego's boundaries or protective shield.These stimuli are | | | | common. Of course, what is also quite common is |
| experienced as overwhelming and producing a sense | | | | that the individual becomes symptomatic (usually |
| of helplessness, often leading to a sense of | | | | bouts of depression or intense free-floating anxiety), |
| hopelessness. Clearly, the trauma can be | | | | or given to explosive action discharge.Another |
| psychological, emotional, physical, or sexual (most | | | | expression of the dissociative symptoms mentioned |
| commonly, incest), often involving aspects of all four. | | | | is found in the expression by incest survivors the |
| In the case of incest what stands out - adding to the | | | | feelings of depersonalization, feeling detached and |
| terror caused by the actual and potential attack, with | | | | estranged from others. Some survivors exhibit a |
| its accompanying sense of helplessness - is the | | | | need for a hypervigilance of their surroundings and |
| humiliation, shame, and feelings of degradation. | | | | talk of an exaggerated sensitivity to touch. Also |
| Commonly, these feelings lead to an identification | | | | commonly experienced is a kind of anhedonia, a loss |
| with the aggressor internalizing the sadistic and | | | | of the experience of pleasure, an incapacity for |
| masochistic components (all rendered unconscious), | | | | happiness or to feel strong emotions, especially those |
| resulting in intense guilt and self-blame. Perhaps the | | | | associated with trust, intimacy, tenderness and |
| most crucial component of the trauma for survivors | | | | sexuality. Still another affective disturbance commonly |
| of sexual abuse is not only that it results from acts | | | | found in incest survivors and other sufferers of |
| causing severe pain, suffering, humiliation and | | | | post-traumatic conditions is called alexithymia, it is |
| intimidation, but that it is inflicted by those deemed | | | | characterized by poorly differentiated affects which |
| protectors. Another factor in this process is the | | | | inadequately serve the signal function. Sufferers |
| strong demand from the instigators that the victim | | | | often think in very pragmatic ways, almost robot-like, |
| become part of a conspiracy of silence. This leads to | | | | appearing super-adjusted to reality and quite stoical in |
| further operations by the victim's defense system in | | | | appearance. In psychotherapy these individuals tend |
| order "to stay alive," primary among them being the | | | | to recount trivial, chronologically ordered events of |
| defense of denial.My interest in traumatic stress and | | | | daily life in monotonous detail. They stifle imagination, |
| anxiety began over two decades ago. At the time I | | | | intuition, empathy, fantasy, especially in relation to |
| was involved in a project working with Vietnam | | | | others. This phenomenon is seen from a |
| veterans addicted to various kinds of drugs. This | | | | psychoanalytic perspective as a group of |
| project was designed to study the effect of | | | | developmental defenses against totally terrifying |
| psychotherapy as an adjunct to chemotherapy | | | | experiences of early life.from a historical perspective, |
| (methadone) on the addicted veterans. While working | | | | the disguised or hidden victims of incest and sexual |
| with this group, I noticed that many of the patients | | | | abuse have long remained unrecognized or |
| diagnosed with divergent kings of addictive disorders | | | | disbelieved. For many, in the mental health profession, |
| also exhibited symptoms of depression, anxiety, | | | | the central nature of trauma in the development of |
| sadness, profound withdrawal, and brooding. Also, I | | | | psychopathology is indisputable. And, of the traumas |
| observed that these veterans suffered severe mood | | | | in early childhood, the most damaging to the individual |
| swings, deep character change and survivior-guilt | | | | psyche is the trauma of incest. Its growing |
| nightmares. At the core was always the | | | | recognition in recent years has been a welcome |
| overwhelming sense of helplessness and | | | | turnaround from the earlier view that the individual's |
| hopelessness. In the past these symptoms were | | | | memory of incest and sexual abuse was invariably |
| most often associated with survivors of | | | | the expression of an infantile wishful fantasy. |