Abstract
This chapter acknowledges models of trauma-related dissociation as important correctives to traditional psychoanalytic models; in particular in achieving a balanced understanding between internal and external realities, broadly corresponding to historical ideas of Freud verses Janet respectively. However while accepting the limitations of any one approach, we also acknowledge the convergence of concepts from trauma theory, psychoanalysis and anthropology around selected questions. This includes an appreciation of the resonance of early Freudian models with contemporary trauma theories inspired by Janet, alongside the implicit psychoanalytic notions of “psychic defence” articulated by proponents of the model of traumatic structural dissociation. As an introduction to this area, we outline contemporary psychoanalytic understanding of “primitive defence mechanisms” at work in the genesis and maintenance of psychotic-states, supported by case material, and explore the cultural articulation and shaping of such mechanisms. We also explore the convergence of psychoanalytic and anthropological theories of symbolism, considered alongside understanding of diminished symbolic capacity in psychosis, and apply this to an understanding of psychotic precipitation or exacerbation at the time of new moon (fulan lotuk). We go onto interrogate the transcultural utility of more controversial psychoanalytic concepts such as the Oedipus complex to presentations of psychotic-phenomena in Timor-Leste. We also outline how a model akin to that of dissociative-conversion, predicated on lay cultural notions of madness, may give rise to psychotic-like symptoms that are more organised than superficially apparent. Finally we set out a developmental account of dissociation-psychosis drawing on contemporary models derived from attachment theory and infant observation research (while recognizing the need for appropriate cultural adaptation of such models) operating in the wider context of trauma chronology and severity, and sociocultural resources and practices, to further illuminate aspects of our findings.
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- 1.
While there is no accepted definition or usage, and differences between British and American convention, in this work we use the spelling “phantasy” rather than “fantasy” to describe the subject’s unconscious ideas and desires, to include, as Isaacs (1948, 81 quoted in Spillius et al. 2011, Chap. 1) puts it, “the psychic representation of instinct.” As noted in The New Dictionary of Kleinian Thought however, this need not always imply fanciful deviation from commonly accepted understandings of interpersonal or material reality (Spillius et al. 2011, Chap. 1).
- 2.
The psychoanalytic position is often blamed for the failure of late 19th and early 20th Century Western societies to acknowledge the reality of childhood sexual abuse (Castillo 1994; but cf. Gilman 1984). However in relation to Freud’s so called “abandonment of his seduction theory” which Masson (2003) argues amounted to a denial of the reality of child sexual abuse, Ahbel-Rappe (2006) cogently demonstrates that a reading of Freud pro toto shows that what Freud in fact abandoned was, more specifically, a belief in the repression of memories of childhood abuse and their analytic reconstruction. Here, we might point out, that contemporary psychologists have also questioned the explanatory value of repression as a concept, instead pointing to models of affect-patterned information processing as an alternative (Kihlstrom 1987, 2005; Seligman and Kirmayer 2008; Kirmayer 1994). Ahbel-Rappe (2006) maintains that Freud continued to acknowledge that childhood sexual abuse may sometimes occur (although perhaps less commonly than he had previously asserted and unhelpfully assigning blame more to older children than adults, who he did not feel had invariably been victims of previous adult sexual assault or seduction).
- 3.
Although, at least in Western enculturated persons, the therapeutic framing and subsequent analysis of distorted Oedipal conflicts, has been shown to be of significant therapeutic value in intractable psychotic patients (Jackson and Williams 1994).
- 4.
Indeed looking at the potential for synergy between culture and psyche, his persecutory beliefs might also be understood as the culturally inverse image of guilt—fitting a context in which the self is not seen as bounded and autonomous, but rather constructed through a social reciprocity and genealogy, which extends into the unseen world. Although his paranoia may also be understandable in the context of a proposed traumatic aetiology (and his fear of the police may have been partly a consequence of his arrest and confinement) persecutory beliefs might also be viewed as a latent cultural possibility of a cosmos where disgruntled spirits are free to roam and hunt the living (cf. Jilek and Jilek-Aall 1970).
- 5.
The causes, experience and consequences of guilt (such as going to hell) are of course subject to considerable cultural shaping, in dialectical relationship with more intrapsychic and interpersonal dimensions. Whether the embodied, visceral association of “burning with guilt” has any psychophysiological basis before culture (and upon which meaning is then elaborated) is less clear.
- 6.
Examples of “ideas as light sources” given include: “I see what you're saying. … That’s an insightful idea. That was a brilliant remark. The argument is clear” and conversely “It was a murky discussion…The discussion was opaque” (Lakoff and Johnson 2003, 48; italics in original).
- 7.
Indeed, For Jung (1977) it’s waxing and waning stood for the changeability—or corruptibility—of mankind, the latter interpretation taken up by the Catholic church, through the teaching of St. Augustine (Jung 1977), which later became so influential in Timorese culture. It would be interesting to explore ethnographically whether traces of such an idea were evoked through teachings and metaphors used by Catholic priests in Timor-Leste.
- 8.
- 9.
This is a difficult to assess cross-culturally. Certainly in at least two persons from the BRR cohort (interviewed inter-episodically when well—BP4, Emilio and BP10, Renata: see Sect. 2.3.4 incl. Table 2.1) we were struck by what from our own perspective appeared to be a concreteness of thought, possibly indicative of impaired symbolic capacity (Pestalozzi 2003). However this might also be explainable by difficulties with concept translation, lack of formal education and apparent amnesia for the events in question. Impaired symbolic capacity might itself be secondary to past overwhelming trauma (see Sect. 4.1.1).
- 10.
Consistent empirical evidence of an association between the moon and psychotic reactions or exacerbations is lacking in Western societies (McCrae 2011; see also Sect. 5.4), but since streets and homes in high-income countries are often flooded with electric lights, alongside the decline of the power of myth in our secular age (Obeyesekere 1984, pt. 3: Myth Models; see Sects. 4.1.1 and 4.2.1), any looping effect (Sect. 1.7.2) between cultural attributions regarding the lunar cycle and changes in mental state and behaviour is likely to have been significant weakened. As Sass (1992) notes however in his monumental Madness and Modernism, sometimes an association might be at the level of analogy rather than causality. Of course, under the right conditions, our thesis would suggest that such a metaphor may become both trigger and context to “act into” (cf. Pearce 2007; see Sect. 1.7.1), if symbolically resonant with individual experience (see Sect. 4.2.1). However cultural symbols derive meaning not from absolute properties but from their cultural interpretation, and relation to other symbols. Therefore although we might conjecture that the full-moon in pre-industrial societies might have made an apt metaphor for the excess of feeling and thought characteristic of a manic-episode, a full but waning moon might, as with the new moon in Timor-Leste, be a symbol of loss after its peak (cf. Silva 2008), as in the saying from The Witch of Edminton, (quoted in McCrae 2011, 51) “When the moon’s in the full, then wit’s in the wane.” Similarly the new moon and early waxing crescent can be a symbol of growth to come, and indeed is invoked in a different context, amongst the Mambai of Timor-Leste, in their “rites of transition” at the end of the dry season (Traube 1986, 156).
- 11.
In light of the double meaning ascribed to the word “cock” in English, it is of interest in the context of this discussion about the Oedipus complex, that the compound Tetum words for penis and cockerel share the same root, manu, translated as a bird or chicken. Additional suffixes narrow or transform meaning such that cockerel is denoted manu aman (chicken + male) and penis is manu oan (chicken + young).
- 12.
In fact, Freud did acknowledge the impact of external traumatic experience, particularly in his early work but also in later work, including his account of the genesis of delusions (see Sect. 3.1). In his earlier work, referring to “traumatic neuroses” Freud ([1917]2001b, 274–275) wrote that “These patients regularly repeat the traumatic situation in their dreams; where hysteriform attacks occur that admit of an analysis, we find that the attack corresponds to a complete transplanting of the patient into the traumatic situation. It is as though these patients had not yet finished with the traumatic situation, as though they were still faced by it as an immediate task which has not been dealt with.” However, notwithstanding such acknowledgements, throughout his writings Freud generally privileged intrapsychic realities over external ones.
- 13.
With the development and publication of DSM-III in 1980 mainstream psychiatry moved away sunderstanding of mental distress informed by social science and psychoanalysis (Wilson 1993), and thereby questions of meaning. While DSM-III and its successors (now up to DSM-5) avouch to be atheoretical, as Gaines (1992, 3) has shown, a deep rooted “ethnobiological essentialism” in fact permeates the texts, and contemporary dominant biological approaches to psychosis continue to eschew questions of meaning as irrelevant. Indeed, the notion that psychotic phenomena were beyond understanding, is often attributed to Karl Jaspers, however as Hoerl (2013) has clearly shown, a close reading of Jasper’s General Psychopathology and related publications, suggests Jasper’s attempted to understand psychotic phenomena (which he differentiated from causally explaining). This included an interest in what he termed true reactive psychosis (German: echte reaktive Psychose) which had some influence on the Scandinavian school (Castagnini 2010, 55). He did however acknowledge limits of understanding, in particular, where psychotic symptoms were not readily understandable from prior psychological states, for example, as in passivity phenomena (Hoerl 2013). We would argue however that in some instances an apparent lack of understanding may be simply due to a lack of sufficient personal and contextual information; in other instances breakdown in inference from prior psychological states may be on account of mental leaps mediated by unconscious processes, particularly the more primitive psychodynamic defence mechanisms earlier discussed (Sect. 3.1.1), that do not readily lend themselves to empathic understanding by non-psychotic individuals. In any case, there is a long history of resistance to DSM’s influence, amongst which we would include transcultural psychiatric (e.g. Jenkins and Barrett 2004—edited vol.), psychoanalytic (e.g. Jackson and Williams 1994; Lucas 2008) and genuine phenomenological (e.g. Humpston 2014; Sass 1992) approaches to psychosis, alongside much detailed ethnographic work (for a list of recent works see Hopper 2008) that have attempted to illuminate understanding and meaning in psychotic phenomena. It obviously also includes the work of the so called anti-psychiatrists, such as R. D. Laing, who were an important inspiration for a new generation of critically minded psychiatrists (e.g. Bracken et al. 2012; Thomas et al. 2004). Such approaches strive for “thick description” and tend to draw on sociological, interpretative and cultural phenomenological approaches, alongside systemic and psychoanalytic thinking, in order to re-position questions of meaning and context as a central concern. While in most countries such critical voices have remained subaltern, in France (Vallée 2011) and until recently in Scandinavia (Castagnini 2010), resistance has been more institutionalised within national frameworks of practice including alternative diagnostic schemata, and spawning alternative therapeutic approaches, attending to context and meaning—an important example being the intensive, network-systemic Open Dialogue and trauma-informed approach to new onset psychosis in Finland (Seikkula et al. 2011) that has published exceptional and provocative outcomes, and to which we will return in later discussions in the final chapter.
- 14.
Indeed, as explicated earlier (see Sect. 2.3), the laying down of memories itself is always mediated through personal, social and cultural filters (even when spilt-off) and invariably re-worked over time. There is therefore no original primary experience or memory on which to call upon, untouched by social and cultural processes (Dennett 1993).
- 15.
Captured by the concept of “catathymia” (a term originally coined by the Swiss psychiatrist W. M. Maier in 1912) and invoked by both Wimmer ([1916]2003) and Faergeman (1963) in their classic works; Castagnini (2010, 55) outlines this as “the process of sensitization whereby memories of past experiences are recollected by events thematically related to them, provoking abnormal (idiosyncratic) reactions.”
- 16.
Bourdieu (1992, 73) approaches this from the obverse: “The body believes what it plays at: it weeps if it mimes grief.”
- 17.
The meaning and resonance of some of these terms is self-evident. Perhaps less evidently ambitendency is described as “appearing ‘stuck’ in an indecisive, hesitant movement” and posturing refers particularly to the maintenance of often unusual and uncomfortable postures for extended periods (Casher and Bess 2010, 37). Catatonia can also be seen in the presence of organic disease affecting the brain.
- 18.
Such a statement may raise significant objections from those who have a strong social constructionist or narrative view of the self. It is however compatible with Hacking’s (1999) idea of “interactive [human] kinds,” in which nature and culture are viewed in a dialectical movement, and in which we have rooted our epistemology (see Sect. 1.7.2).
- 19.
We need to acknowledge much of this work and theorising derives from Western mother-child dyads, and its applications to possible extended networks of care needs further working out (cf. Howes and Spieker 2008). In an extended network it would seem unlikely that all carers would be consistent in their mirroring of the infant-child. Is this mitigated by the dominant effect of a primary caregiver, or does this inconsistency itself contribute to the higher prevalence of dissociative phenomena (not necessarily pathological) in non-Western settings and how does this contrast with the role of working mothers and professional, non-familial childcare in the West?
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Rodger, J., Steel, Z. (2016). Integration with Psychoanalysis and Its Cultural Applications. In: Between Trauma and the Sacred. Cultural Studies of Science and Medicine . Springer, Cham. https://doi.org/10.1007/978-3-319-24424-2_3
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