Sverre Varvin

Emergence of Severe Traumatic Experiences: An Assimilation Analysis of Psychoanalytic Therapy with a Political Refugee

Warded off traumatic experiences can have pathological effects by impinging on consciousness (e.g., recurrent nightmares), on behavior (e.g., avoidance of intimacy), or on the body (e.g., pains). Assimilation or integration of these problematic experiences is a common goal for different psychotherapies. In this article, we describe the psychoanalytic therapy of a political refugee who had suffered traumatic losses. Using assimilation analysis, we tracked the emergence of her warded off memories of loss. The interaction and alliance with the therapist seemed to promote a long and complicated process of mourning, in which she explored and assimilated (integrated) the loss. The analysis focuses on the early stages of assimilation, from warded off to problem formulation, stressing the complexity and pain of this process. It also illustrates a progression from somatic (symptomatic) expression to verbal symbolic expression of the problematic experience. Abgespaltene traumatische Erfahrungen konnen pathologische...

The influence of extreme traumatization on body, mind and social relations

Extreme traumatization affects the individuals relation to others in several social and psychological ways. The post‐traumatic experiences are characterized by helplessness, insecurity, anxiety, loss of basic trust, and fragmentation of perspectives on ones own life. Special considerations should be given to the destruction of the ability to regulate negative emotions (extreme fear, distress, anguish, anger, rage, shame) in relation to others and activate internal good and empathic object relations. Destruction of the capacity for symbolization of traumatic experience may threaten the mind with chaotic states against which the ‘I’ tries to defend itself and find a balanced psychic mise‐en‐scene. The authors emphasize three dimensions that the analyst should observe in his understanding of the traumatized mind and its conflicts. The proposed dimensions are called the body‐other dimension, the subject‐group dimension, and the subject‐discourse dimension. All three dimensions have specific structural characteristics that are expressed in the analytic relation. Extreme trauma causes disturbances in each of these dimensions. The authors present clinical material from a traumatized refugee to illustrate the analytic work.

Towards a better use of psychoanalytic concepts: A model illustrated using the concept of enactment†

It is well known that there is a lack of consensus about how to decide between competing and sometimes mutually contradictory theories, and how to integrate divergent concepts and theories. In view of this situation the Project Committee on Conceptual Integration developed a method that allows comparison between different versions of concepts, their underlying theories and basic assumptions. Only when placed in a frame of reference can similarities and differences be seen in a methodically comprehensible and reproducible way. We used “enactment” to study the problems of comparing concepts systematically. Almost all psychoanalytic schools have developed a conceptualization of it. We made a sort of provisional canon of relevant papers we have chosen from the different schools. The five steps of our method for analyzing the concept of enactment will be presented. The first step is the history of the concept; the second the phenomenology; the third a methodological analysis of the construction of the concept. In order to compare different conceptualizations we must know the main dimensions of the meaning space of the concept, this is the fourth step. Finally, in step five we discuss if and to what extent an integration of the different versions of enactment is possible.

Extreme Traumatisation: Strategies for Mental Survival

Disruption and loss characterise the life of the person who has undergone extreme traumatisation (torture, concentration camp, etc.), especially when he/she lives in exile. This presents new challenges both in understanding trauma and massive traumatisation and in treating it. When planning and conducting treatment, it is of special importance to take into consideration the mental survival strategies that the person has developed. These are mental capacities that aim both at developing methods of avoiding the pain of re-experiencing and at achieving solutions to the dilemmas posed by the posttraumatic phase. The latter often consists of aborted attempts at mentalisation and integration of traumatic experiences. The traumatised person will often experience the therapeutic encounter as threatening because of fear of re-experiencing and re-traumatisation, and also because having experienced atrocities disturbs or damages the capacity for developing a trusting relationship. This paper discusses the complexities of the consequences of this situation and describes a model for a psychoanalytic approach to the treatment of these patients, focusing on the disturbance of symbolisation and mentalisation caused by trauma. Treatment must address this and provide a setting where experiences that have been insufficiently symbolised (expressed in somatisation, acting, non-verbal characteristics of speech, procedural aspects of transference, etc.) can be placed in context through a process of historisation.

Relationships of Childhood Adverse Experiences With Mental Health and Quality of Life at Treatment Start for Adult Refugees Traumatized by Pre-Flight Experiences of War and Human Rights Violations

Abstract Adverse and potentially traumatic experiences (PTEs) in childhood were examined among 54 adult refugee patients with pre-flight PTEs of war and human rights violations (HRVs) and related to mental health and quality of life at treatment start. Extent of childhood PTEs was more strongly related to mental health and quality of life than the extent of war and HRV experiences. Childhood PTEs were significantly related to arousal and avoidance symptoms of posttraumatic stress disorder (PTSD) and to quality of life, whereas pre-flight war and HRV experiences were significantly related to reexperiencing symptoms of PTSD only. Within childhood adversities, experiences of family violence and external violence, but not of loss and illness, were significantly related to increased mental health symptoms and reduced quality of life. These results point to the importance of taking childhood adverse experiences into account in research and treatment planning for adult refugees with war and HRVs trauma.

Humiliation and the victim identity in conditions of political and violent conflict

The humiliation and traumatization of political opponents during periods of violent and non-violent conflict can create deadlocked situations with great potential for regression, and may serve to aggravate the conflict or escalate the level of violence. In this article, I will examine this type of regressive dynamic. My point of departure is the current terror situation and the “war against terror” as it is being conducted in different parts of the world. The key concepts in this connection are violations of human rights, victim psychology, group processes and the development of regressive group identities. Political-ideological-religious discourses can serve to mediate between collective unconscious fantasies and the actual misery/humiliation experienced at group and individual levels. They can reinforce an identity as victim, and the significance of this identity is often underestimated when the background of terror and violent conflicts is being analysed.

Unconscious phantasy and its conceptualizations: An attempt at conceptual integration

That there is a lack of consensus as to how to decide between competing, at times even contradictory theories, and about how to integrate divergent concepts and theories is well known. In view of this situation, the Committee on Conceptual Integration (2009–2013) developed a method for comparing the different versions of any given concept, together with the underlying theories and fundamental assumptions on which they are based. Only when situated in the same frame of reference do similarities and differences begin to appear in a methodically comprehensible and reproducible form. After having studied the concept of enactment followed by the publication of a paper in this Journal in 2013, we proceeded to analyze the concept of unconscious phantasy while at the same time continuing to improve our method. Unconscious phantasy counts among the central concepts in psychoanalysis. We identified a wide range of definitions along with their various theoretical backgrounds. Our primary concern in the present paper addresses the dimensional analysis of the semantic space occupied by the various conceptualizations. By way of deconstructing the concepts we endeavoured to establish the extent to which the integration of the different conceptualizations of unconscious phantasy might be achieved.

A retrospective follow-up investigation of a group of schizophrenic patients treated in a psychotherapeutic unit : the Kastanjebakken study

Of 27 patients treated in a small psychotherapeutic unit, 26 were diagnosed as schizophrenics, and 1 as suffering from schizoaffective disorder according to DSM-III. One patient committed suicide during the observation period, and follow-up data were obtained for 26. Fourteen patients left the treatment program prematurely, 3 early and 11 in the midphase of the treatment. Nine female patients had good outcome (HSRS score greater than 52), 3 of whom had left the program early while 6 completed it. Seventeen patients showed no marked improvement. Level of functioning before admission was a good predictor of outcome. Therapeutic alliance and continuity of treatment were important for favorable outcome.

Our Relations to Refugees: Between Compassion and Dehumanization*

After the so-called refugee crisis of 2015–2016 European reactions to foreigners had come to the fore and we are seeing xenophobic political and populist movements become increasingly mainstream. The massive rejection of refugees/asylum seekers taking place has made their conditions before, during and after flight, increasingly difficult and dangerous. This paper relates current xenophobia to historical attitudinal trends in Europe regarding Islam, and claims that a much more basic conflict is at work: the one between anti-modernism/traditionalism and modernism/globalization. Narratives on refugees often relate them to both the foreign (Islam) and to “trauma”. In an environment of insecurity and collective anxiety, refugees may represent something alien and frightening but also fascinating. I will argue that current concepts and theories about “trauma” or “the person with trauma” are insufficient to understand the complexity of the refugee predicament. Due to individual and collective countertransference reactions, the word “trauma” tends to lose its theoretical anchoring and becomes an object of projection for un-nameable anxieties. This disturbs relations to refugees at both societal and clinical levels and lays the groundwork for the poor conditions that they are currently experiencing. Historically, attitudes towards refugees fall somewhere along a continuum between compassion and rejection/dehumanization. At the moment, they seem much closer to the latter. I would argue that today’s xenophobia and/or xeno-racism reflect the fact that, both for individuals and for society, refugees have come to represent the Freudian Uncanny/das Unheimliche.

Genocide and ethnic cleansing. Psychoanalytic and social-psychological viewpoints

The author tries to set ethnic cleansing and genocide in relation to both psychoanalytic understanding of the human mind and of groups, and to certain aspects of modern society and modernism. Following the Polish sociologist Zygmund Bauman, he claims that genocidal situations can be a product of certain properties of modern society which under certain situations (i.e., under totalitarian conditions) can come into being. Malignant group processes can then cause more-or-less organized cruel acts. The worst example is the Holocaust during the second world war, but the problem has seen new, sad repetition in recent years (i.e., Bosnia Herzegovina). Psychoanalysis can shed light on and partly explain how individuals and groups under these circumstances can change and then execute cruel acts, often on a mass-scale. The importance of prevention is stressed. An aspect of this is the afterwork (including the work of grief) after the atrocities, so as to prevent the next generations continuing the cruelties.