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THE PSYCHODYNAMICS OF RESILIENCE

Autor: Alexandru Trifan
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Resilience is a conceptual field in wich psychiatry is replaced by psihology, sociology and psyhodinamic explanation. This includes the development of posttraumatic stress disturbances, the theory of coping and the attribution of meaning process. The paper ains to give some response to the tree questions: how does serious life events afect the individuals? how does an individual cope with traumatic experience? wich factors influence the consequences of traumatic events and the process of coping with them?

A definition of psychotrauma is derived from psychoanalysis namely the conflict between the tendency or compulsion and the reality principle. Situations that generate psychotraumatic effects are: inability, eruption in the existence of a dramatic conjuncture, extreme psychosomatic discomfort. [1,6] All these bombard the brain so powerfully that they defeat the brain stimuli barrier postulated by Sigmund Freud and generate two types of events.

A. Manifestations of denial: perplexity, lack of response to incitation, inability to concentrate, amnesia, constrained ideation, affective flattening, retro-fixation in old roles (regression) denial of the traumatic event with its suppression to the depth of unconsciousness, sense of loss of contact with reality, loss of control, retreat into activities.

B. Intrusive manifestations: tension and hypervigilant behaviour, recurrent thoughts about the traumatic event, during both wakefulness and sleep, imagining the repetitive return of the occurrence of event, inability to banish it from the mind, distressing ideo-affective bursts, nightmares, search for the retrieval of losses, frequent startles. [1, 7]
The unfolding of these events is shaped and influenced by the victim’s mental resilience but it occurs mostly under a scheme proposed by Kleber and Brown. [1]

FIG 1

Quantitative assessment of the posttraumatic development of performed (Serban Ionescu: Traité de resilience assistee) [3] with three psychological instruments: EDRS (Échelle de développment en relation avec le stress = Stress-Related Growth Scale) IDPT (Inventaire de développement posttraumatique = Inventory of post-traumatic growth) and EDB (Échelle visant a déceler les benefices = Scale meant to a detect benefits). The core of inner processing is giving sense to the psycho-traumatic event. In the last several years, I studied the process of attributing meaning in a group of children and adolescents aged between 14 and 18, classified as witnesses, that is, subjects who have witnessed violence – physical and mental – exerted on parents, persecuted for their political beliefs. The psychodynamic disturbances recorded in the immediately following period were:, guilt for non-intervention, the collapse of self-esteem, confusion in assessing moral values, manifestations of insecurity, disengagement of attachments. The progress of the installation of posttraumatic resilience showed that the process of attributing meaning followed three stages:, rejection of the justification of violence and guilt with drafting of one’s own truth, assessment of the long-term consequences of discrimination, separating this assessment from the anxiety linked to possible hopeless consequences. Certainly, in the process of psychodynamic processing, the vulnerability embodied by the Ego “weakness”, the low cohesion of the self and the lax attachment play an important role. (2, 6) In the inner processing, what Bion called: ‘truth instinct’ comes into play. During the processing, the victim repeatedly asks her/himself haunting questions: why happens this just to me? What is my guilt? What justifies the punishment? These questions generate a state of perplexity, leading to a disqualification of the Ego, a concept that has been described by Recamier. The answer to these questions is related to the personological, developmental type determined by the existence of a false self, coherent self, incoherent self, non-adhesive self. [6]

FIG 2

The coping process begins with the restructuring of the schemes. They (Gestalt) represent an umbrella concept that occupies an important place in cognitive psychology, defining ideo -affective configurations stored in memory, consisting of elements of past experiences and reactions. Although they are abstract constructs, Landman and Manis think that they provide the foundations of behaviour. [1]

FIG 3

The coping process is seen as a exchange of the old patterns with new ones. As the reality of traumatic events cannot be changed, the models and interior configurations should be revised in such a way as to conform to the victimizing realities. One of the most important mental schemes of personality is self-esteem. Being badly shaken in the case of aggression, it is recovering gradually. The moment when this recovery finishes is called “completion”. A trauma that is registered in the working memory has, according to the Freudian theory, a compulsion to repeat itself. The memory is relived repeatedly until it is moved from the active memory into the passive one, marking thus the “perfection”. Coping is not completed until the active memory is not controlled and locked against the repetition of intrusive memories, which are prohibited to come out from the passive memory. The phenomenon of controlling and ceasing the emergence of intrusions indicates the appearance of resilient coping. Control mechanisms are assimilated by psychoanalysis as defences. (4, 6) Repression is the transfer of the active memory sector into that of the passive memory. (5, 6) However, unlike repression, the control phenomenon has more nuanced effects. Thus, the hyper-control of the penetration of intrusions into current memory prevents, by its intensity, the configurational processing. On the other hand, an inefficient control produces the invasion of anxiety into the active memory and the insufficient enrolment of the traumatic event into the passive in memory. Horowitz proposes a simple scheme of posttraumatic coping. (1)
In Scheme 3 of the psychodynamics of resilience, the scheme of the psychodynamic functioning of consciousness is instructive since it occurs in the development of the posttraumatic period, also imagined by Horowitz.

FIG 4

The development of a resilient coping scale takes as its starting point the model devised by Laura Polk (cited by Serban Ionescu et al.) (3), consisting in 26 variables grouped into four parts: dispositions pattern (intelligence, self-esteem, confidence and personal effectiveness), relational pattern (social support), philosophical pattern (the belief that facilitates attribution of meaning, defining goals and a balanced view of life), situational pattern (the ability to test reality, to solve problems concerning actions and the analysis of the consequences). The presence of these patterns corresponds to the criteria of a resilient coping.
Graphic schematization of resilient functioning is formalized in a model of psycho-traumatic scenario (after Kleber and Brom, amended)

FIG 5

Resilient coping is installed with the return of the normal modulation of the input of the stimuli. Sigmund Freud’s theory about the stimulus barrier is well known (which Horowitz calls the stimulus modulation mechanism). According to this theory, excessive mental stimulation activates a blocking phenomenon;consequently, the barrier does not allow excessive stimuli to enter the consciousness. Thus, the anxiety that accompanies traumatic condition represents such intense stimulation that triggers the activation of the barrier and the blocking of the normal input-output flow with impaired reality testing. (1)
In specific cases, the posttraumatic period becomes structured as post-traumatic stress syndrome (PTSD). The Diagnostic and Statistical Manual of Mental Disorders (DSM)( 2, 7) highlights that for a diagnosis of PTSD the following criteria are needed: at least one re-experience symptom (intrusions), three symptoms of avoidance and two manifestations of hypervigilance (hyperarousal). Symptoms must persist for at least one month and cause significant functional suffering.
Psychodynamics of posttraumatic stress disorder in adolescents is shown in developmental stages.

FIG 6

If diagnostic criteria in adolescents are similar to those in adults, in the young child there are two major limitations. Firstly, the verbal expression ability of suffering is not formed completely therefore, the clinician must make deductions derived from the behaviour and from the reports of parents and of teachers. Nothing can replace direct clinical observation. Secondly, children may show symptoms that are not included in the DSM, such as loss of recently acquired skills (regression / emergence of new fears and anxieties or reactivation of old ones, separation anxiety, which can go up to clinging (attaching and psychosomatic manifestations such as nausea and headache). In addition, post-traumatic anxiety can take the form of distractibility, hyperactivity and impulsivity. Depression makes its appearance when posttraumatic adversities have accumulated.

References:

  1. Kleber Rolf J. şi Bromm Danny. Coping with Trauma (Theart, Prevention and Treatment), Ed. Swets şi Zeittinger, Amsterdam, 1990.
  2. Fischer, Gottfried, Riedsesser Peter, Tratat de Psihotraumatologie, Editura Trei, 2001
  3. Ionescu Şerban (sub red.), Traite de resilience asistee, Ed. Puf, 2011.
  4. Mertens Wolfgang: Introducere în terapia psihanalitică, Editura Trei, 2003.
  5. Toma, Helmuth, Kächele, Horst, Tratat de psihanaliză contemporană vol. I – Fundamente, Ed. Trei, 1999, vol. II, Practică, Ed. Trei, 2009.
  6. Trifan, Alexandru: Psihanaliza pentru medici, Ed. Viaţa Medicală Românească, 2001.
  7. Traifan Alexandru: personlogie marginală şi psihotraumatică, Ed. Trei, 2006.