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RESILIENCE AND PSYCHOTRAUMATOLOGY – SPECIFIC SIGNIFICANT INTERDEPENDENCES. RESILIENCE: RESISTANCE AND SOMETHING QUALITATIVELY EXTRA

Autor: Ştefan Milea
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Operational definitions are presented of concepts that revolve around tandem psychotraumatology-resilience.
We propose two new concepts: the psychotraumatic factor and the potentially psychotraumatic factor and we support their usefulness.
We state that psychotraumatology has a special place within assisted resilience where approaches are directly subordinated to the particularities of psychotrauma.

A. Introduction.

Resilience and psychotraumatology are two areas with basic notions that do not have unanimously accepted definitions. Therefore, we shall choose such essential operational formulas that are indispensable to a coherent approach to the subject. Thus:

1. Resilience is a term used in other areas, too. In the field of psychology, it is a concept without a generally accepted consensus (Manciaux- 2001 Lighezzolo and Tuchey -2004, -2011 Ionescu). At basic level, it represents the ability to deal with adverse life situations by oneself. A more elaborate and more adequate formulation emphasizes that resilience is not limited to mere resistance (with which it should not be confused), but it also takes into account a process of exploitation of the confrontation and of recovering from it strengthened. Or, what Tomkiewicz (2001) calls, a certain personality enrichment and Pourtois et al. (2011) label as positive neo-development. Furthermore, resilience is a complex, interactive, shared and permanent process, meaning that it is as old as humankind is, it uses personal and contextual resources, is universal and takes place in interaction with the people around, with the physical, social and cultural environment. It has an individual form and a group form; there is also a natural form and one that Ionescu (2006) named ‘assisted resilience’.

2. Natural resilience is the ability to cope with adverse conditions of life without outside assistance provided for this purpose.

3. Assisted resilience. If natural resilience is the one that, in the opinion of Ionescu (2011), is carried out without any help offered by professionals, assisted resilience is the process facilitated deliberately by outside help. It begins with the identification of individuals, groups or communities at risk and with the development of certain preventive programs aiming at encouraging, supporting, stimulating and even initiating the resilient behaviour. The approach focuses on:
Respecting, encouraging and stimulating the individual’rsquo;s right to his/her own order, to decide what and how it has to be done, and to act according to his/her own health promoting options;
Identifying the individual spots of resistance, the skills, the support people whom Cyrulnik (2001) has called tutors of resilience, and the social support networks;
Finding and updating the protective factors and the resources existing in the patient and in the community;
Stimulating the skills and creativity;
Instilling and fostering hope, optimism, confidence and self-esteem;
Building empathic relationships and favourable conditions, which means intervention on family, friends, peers and the community including destigmatizing actions;
Stimulating the effort to seek and find one’s own solutions to resolve situations as well as the support persons;
Finding and providing affordable solutions and solving formulas including the one to forgive and come to terms with the situation;
Counselling regarding the choice of optimal solutions and how to accomplish them, as well as stimulating and encouraging efforts to continue and finalize the chosen solutions;
Counselling, teaching, helping to cope with difficulties but without being substituted;
Last but not least, identifying confrontations necessary to the existential exercise, to training, experimenting success and failure, evidence and means of increasing both confidence and self-esteem and a genuine resilience.

4. Psychotraumatology is “the science that deals with the study and treatment of injuries of the soul” (Riedesser and Fischer -2003 / 2007).
5. Psycho-pathogenic factor (context or event). Although this concept is very widely used, surprisingly, its definition is found neither in DEX nor in the available specialized dictionaries. We believe that, in general, it includes everything that by nature, obviously, determines psychobiological dysfunction. (We do not say mental disorders because, on the one hand, they are at their basis, and, on the other hand, mental disorders are associated with other clinical manifestations (somatization disorders), which, not infrequently, and especially in children and adolescents, occupy the foreground of the clinical picture).
We say that it leads naturally to psychobiological dysfunction in order to emphasize the fact that their harmfulness is intrinsic, authentic and widely recognized by external observers as opposed to factors that only the individual subjectivity considers harmful.
The term psycho-pathogenic factor covers two distinct realities. The first one is represented by factors that act pathogenically by means of certain physiological mechanisms. The second one includes factors that directly affect the brain, such as the physical, chemical, biological, genetic agents, etc.
Within the category of factors acting pathogenically through psychological mechanisms, some are part of those, whom we shall call psychotraumatogenic because, as we shall see, they can be metamorphosed into psychotraumas.
Other factors in this category, different from them, use other pathogenic psychological mechanisms and pathways. For example, they operate insidiously, well concealed or provide secondary benefits as in the case of hyper-protective education (Milea 2006), of some forms of sexual abuse, of dependence state or of what, in a more general formulation, Riedesser and Fischer ( 2003/2007) call under- and oversocialisation.

6. Psychotrauma (PT) psychotraumatic factor, psychic trauma (Talaban Andrucovici – 1992), psychic traumatism (Lafon -1973, Laplanche and Pontalis – 1988, C Barrois – 1997), or simplified, trauma or traumatism (Popescu-Neveanu -1978, DEX -1984, -1996 Sillamy, Chemama 1997). All these are synonymous notions that came to be used colloquially, too, but they are not sufficiently and clearly individualised, since we consider that they are erroneously confused with the notion of psychopatogenic factor, context or event (see also Milea -2014).
For Riedesser and Fischer (2003/2007), psychic traumatization “is defined as a vital experience of discrepancy between threatening situational factors and individual possibilities of command, an experience that is accompanied by feelings of helplessness and defenceless abandonment, which produces a lasting shattering to the understanding of the self and of the world. In fact, psychotrauma is a form of psychobiological dysfunction that can be defined as negative (mental) experience generating disorders, built through the subjective processing of the external or internal, present or future, reality, which is perceived as source of injury appreciated as inevitable and unacceptable. (Milea -2014). Here, when it comes to internal factors, we consider the thoughts, ideas, opinions, memories, feelings, one’s own conscience, pulsions etc.
In the case of psychotrauma, between external or internal factors that are at its origin, individual subjectivity is interposed, as a retort where such factors are processed, putting its own stamp on three key elements. It operates in the assessment of the significance of external or internal factors, in the assessment of the individual’s ability to cope (an aspect to be stressed) and of course, in the appreciation of the relationship between the first two values.
It is not just the feelings that are characterized by brutality, great intensity, dramatic and unexpected nature, as it is usually assumed, but also the vast number of those who, although apparently modest, are distinguished by persistence over time, repetitive character, cumulative action, ability to potentiate or to use vulnerabilities, critical periods of development or unfavourable circumstances. It is the merit of Kahn (1963) and of Keilson (1979) quoted by Riedesser and Fischer -2003 / 2007) to have introduced the notions of cumulative trauma, respectively the one of sequential traumatization.
Of course, situations or factors recognized as psychopathogenic are primarily at the origin of psychotrauma. But it is not all of them, and not only them. This is because, on the one hand, the involvement of subjectivity does so that, for various reasons, some psychopathogenic factors would not be metamorphosed into psychotraumas. On the other hand, as we shall see, other factors of the external or internal environment, although devoid of danger, may be incorrectly placed by the individual’s subjectivity at the origin of certain psychotraumas. As such, the definition psychotrauma centred on the involvement of individual subjectivity requires a delineation of two new concepts that can be called: apsychotraumatogenic factors and b – potentially psychotraumatogenic factors.
aPsychotraumatogenic factors. We emphasize, that they are not psychopathogenic. The concept includes those external or internal factors that may underlie psychotraumas. We say they may underlie and not that they underlie because, as we shall see, they do not automatically lead to the establishment of psychotraumas. It is a separate concept. It is delimited from the concept of psychopatogenic factor and has to be separated from it because just as not all psychopatogenic factors are also psychotraumatogenic, the vice versa is not valid, either. Indeed, this time, subjectivity, the retort where psychotraumas are created, may operate discriminations on the external or internal reality that it is facing. As a result, depending on the individual and on the situation, four different situations may be identified in practice.

The first of them, the ordinary one, is represented by the confrontation with psychopatogenic factors, which, being qualified, are converted into psychotraumas.

The second aspect takes into consideration the meeting with factors similar to the above ones. But this time, for various reasons beyond them, some of them being temporary, factors such as age, mental level, presence of certain cognitive disability, personality structure, situational or socio-cultural context, lack of experience or knowledge, etc. are not recognized by subjectivity as a real source of insurmountable and unacceptable injury and therefore they are minimized or even ignored. This means no psychotrauma is constituted and there are no pathological consequences. However, depending on the situation, some of these factors may employ other psychopathogenic mechanisms, different from the ones belonging to the psychotraumatic model. We give the example of groundlessly ignoring or minimizing certain risks and even accepting them without any strong reason as in the case of vagrancy, the participation in antisocial acts, or the use of drugs.

The third aspect relates to situations where the genuine psychopatogenic factors are not psychotraumatogenic because, as mentioned above, by their nature, they either use other pathogenic psychological mechanisms, or assault the brain directly.

And finally, the fourth aspect, the most outstanding one, is represented by the meeting with factors of the internal or external environment, devoid of intrinsic psychopatogenic nature but which, sometimes erroneously, the subjectivity perceives as uncontrollable aggressors and converts them into psychotraumas. Excessive prudence, self-distrust or lack of experience or various forms of vulnerability may be at the root of this phenomenon.

b – Potentially psychotraumatogenic factors. It is a new concept (Milea-2014) designed to delineate the factors as mentioned above, although by their nature, they have nothing, or no sufficient reason, to be metamorphosed into psychotrauma; for strictly personal reasons, each individual’s own subjectivity may wrongly invest them with such a meaning. In other words, they become a source of false psychotrauma, only after their erroneous processing by the individual’s own subjectivity and only if it confers such status to these factors. That occurs because of the intervention, alone or in combination, of four inadequate mechanisms, namely:
a – investing a neutral or banal situation with a status of a source of insurmountable and unacceptable injury;
b – amplifying exaggeratedly the significance of an otherwise controllable risk;
c – minimizing the individual’s resources, ability or possibility to overcome the situation;
d – incorrectly assessing the relationship between the level of risk and the defence means available. The reverse phenomenon is well known, too, where the real dangers are ignored or minimized by individual subjectivity in the same way as the involved person can accept the risk and even the sacrifice knowingly, i.e. starting from certain beliefs or from hopes of obtaining certain advantages, if only a future life.
It results that, on the one hand, it is the subjectivity, which varies from one individual to another, that, starting from false premises, builds and certifies the category of potentially psychotraumatogenic factors, transforms them into authentic psychotraumas, and contributes to their great thematic diversity. From within it, each individual chooses only what his subjectivity sees fit. As such, potentially psychotraumatogenic factors can be placed in the present, past or future, (within them, the anticipation phenomenon being very productive) can be totally neutral, or just exaggerations of existential obstacles that can be overcome, or accepted and very often necessary to training, normal growth and development or to the assertion or valuing of the individual.
On the other hand, potentially psychotraumatogenic factors represent a distinct reality within the etiopathogenic factors because by their intrinsic nature they are not harmful. That puts them outside the scope of factors recognized as psychopatogenic. It also constitutes them in a special category, which makes a distinct mark among the psychotraumatogenic factors, although, in their turn they are rightful part of it. However, they are intertwined both with the ones and with the others at the pole where both types are intertwined with normality and life’s maturation tests.

B.
Psychotrauma, a special attacker endowed with features having specific impact on the resilience approach.

We consider:
l The character of a product of the individual subjectivity. Being a form of living and thus, in its turn, a subjective structure, psychotrauma is actually the direct cause of the disorders that represent it at clinical level. This is because, on the one hand, subjectivity is what decides which of the elements of external or internal reality are adverse and whether and how they can be coped with honourably. On the other hand, following the track psychotraumatogenic event à psychotrauma à disorder, subjectivity again is also the one that has the last word. It results that psychotrauma is not the event that the individual has to face, but it is what and how the individual’s subjectivity appreciates as being real, after processing and assessing that particular event, and, not least, the means to cope with it. In other words, it is a distinct reality, different in content and form from its source.
l The strictly customised character. It is a major feature with multiple causes and meanings. It is due to the involvement of individual subjectivity, the instance varies from one individual to another, so that what may be a drama for a certain person, for another, it is a simple misfortune, a funny situation or even a beneficial one. The following issues contribute to the phenomenon:
Personality of the individual, where genetic heritage, the quality of early childhood attachment relationships, life experience, present and future options, etc. get involved as variables.
Socio-cultural component, that involves the moral norms and social values to which the individual adheres, the relationships with others and their opinions, the offer of support on the part of the community or the lack of it, the law, the feelings of shame and guilt, the social inequality etc. It is well understood that there are many situations where compassion of others, their help or, on the contrary, their disapproval, disinterest or culpability contribute directly to the profile and size of experience.
Thinking, memory and affectivity. This aspect, too, makes psychotrauma fundamentally different from all other types of aggression. We consider the assessment of meanings and consequences of events, existing emotional burden or one that accompanied anterior traumatic experiences, their memories, assessment of the available solutions and of the ability to engage them, choice of defence manner, the quality of the ability to predict of the thinking and the possible distortion of its most important involved variables. Let us recall here the concepts of cumulative trauma and sequential trauma that have been mentioned above.
The customised character of psychotrauma is the one that gives identity to the potentially psychopatogenic factors. In turn, they prove the customised character of the psychotrauma.
l Specific temporal discrepancies between the moment of the presence of the psychotraumatogenic factor and the one of the formation of psychotrauma. We mean here the phenomena of temporization, reminiscence and anticipatory character.
Temporization of the process that establishes the psychotrauma. This time, unlike the well-known and trivial incubation period, the delay in the constitution of psychotrauma is based on two mechanisms characteristic to psychotraumatology.
The first mechanism takes into account the process of recognition, awareness and mental processing of the traumatic situation (that sometimes may take a very long time), a process that also includes the means of defence and the ratio between them, and one that involves many objective, subjective, incidental or constantly changing factors. A representative and suggestive model here is the child sexual abuse and hyper-protective education whose harmful effects are usually recognized only at maturity and sometimes not even then.
The second mechanism employed to delay the establishment of psychotraumas is the well-known process of protecting the discharge or what Sillamy (1996) calls “the ego’s unconscious psychological defence mechanism through which feelings, memories and impulses that are unpleasant or in disagreement with the social person are kept outside the field of consciousness”.
Remanence of negative experiences, respectively the extension of negative experience well after the factors that generated it has ceased to exist. This is not just the usual confrontation with direct negative effects due to already overcome drama. This time, a series of complex mechanisms of conscious and unconscious self-maintenance and psychological reactivation are engaged and may sometimes be present along the whole life. They are primarily involved in memory, thinking, emotional sphere and moral norms. Once the aggression has been consumed, everything that surrounds and keeps the memory of events alive (i.e. reunion with people, objects, places, words, gestures, or similar events recounted, memories generating painful, intrusive replications of the experience, and, very importantly, even the protecting care, which the victim is often surrounded with) keep the past suffering awake. To these, one should add the dreams that can become true nightmares, the anxious-depressive background that is part of the normal consequences of any psychotraumatizing experience and, very important, one’s own conscience that continues to torment the present, sometimes more and more aggressively. Here is one of the reasons why Riedesser and Fischer (2003/2007) rightly consider the name of post-traumatic stress disorder as unreasonable.
Anticipatory character. This is a very special aspect, specific to psychotraumatology. We know that, the individual’s subjectivity based on the prospective nature of thinking, on the defence instinct and on memory is able to foresee dangers and the ability to cope with them and to enforce the enactment of a defensive behaviour. However, such a predictive capability is a double-edged sword. This is because on the one hand, it is a protective factor of major importance since it gives the necessary time to prepare a kind of behaviour required by caution, and to engage certain defence solutions. On the other hand, the assessment of both the size of the risks lurking or waiting for us, and the ability to control them is not always appropriate. Therefore, there are many situations, too where the danger is oversized or ability to cope is undervalued, which means that the individual’s subjectivity may exaggerate and confer a character of future, uncontrollable threats to situations that could be fully resolved and are even very unlikely.
l Involvement of certain specific autogenetic mechanisms for the establishment of psychotrauma. This aspect is not singular in medicine and the autoimmune pathology is an example in this respect. However, in this case, peculiar mechanisms are present.
A first mechanism, a very active one, has already been mentioned. It refers to the fact that that the individual’s subjectivity can be deceiving and may assign a status of psychotraumaogenic factor to fully controllable realities.
A second autogenetic mechanism is provided by the already pointed out phenomenon of anticipation where at least the exaggerations are not to be neglected.
The third mechanism involves the complex of unresolved intrapsychic conflicts. The psychoanalytic concept speaks of the opposition between different instances of the personality, between the conscious and the repressed component of the unconscious, as well as of the existence of desires, motivations and impulses that are totally or partially incompatible, unacceptable or insufferable. At the origin of some of intrapsychic conflicts is the specifically human capacity to judge not only the others but also oneself and to enter in a conflict not only with the former but also with the interior part of the self. Caragiu (2015) believes that four pairs of opposites dominate the current existence, namely: pleasure / pain, strength / weakness, sense / absurd, life / death.

C. DISCUSSIONS

All the above allows the identification of certain aspects of greatest practical importance that are specific to the interaction between psychotraumatology and resilience, namely:

1. Subjectivity: the common ground of psychotraumatology and of resilience. This is because psychotrauma, the core of psychotraumatology, is the product of subjectivity, while the latter is the main instrument of the resilience approach.
2. Subjectivity: a central section of the tandem psychotraumatology-resilience. It is obvious that both areas have individual subjectivity in their centre. At its level they interact and express themselves with priority. Moreover, in its relationship with psychotraumatology, resilience recognizes four significant roles of subjectivity, namely:
a –
First is the role of main actor involved in the genesis psychotraumas.
b –
The second, opposite to the first, is the curative role, being the main decision factor and the conductor of the resilience process employed to choose, to engage, to organize and to control solutions meant to overcome the existential impasse.
c –
The third role is preventive. This is because subjectivity, being the retort where psychotrauma is constituted, in the same way, when it is well directed, can act in four ways: to find solutions, to deactivate exaggerated perception of the significance of current or future threats, to appreciate realistically the capacity of defence and to eliminate false threats. Thus, it can act preventively by transforming undesirable conditions in controlled aggressions and even in samples necessary to the statement of one’s own values.
d –
The fourth role is the maturing one. On the one hand, it stems from the fact that subjectivity is one that is meant to properly delineate the genuine dangers generating psychotrauma and leave the free space necessary to the development of confrontations that are indispensable to existential exercise, to training, to experiencing success and failure, ways necessary to the empowerment of various functions, of encouragement, of increasing confidence and self-esteem, of resilient attitude that is also necessary to normal mental development.
On the other hand, resilience counselling should have the same role, concerning both the elimination of false threats and the awareness of minimized or ignored real dangers.
From all these, it is inferred that, in the case of psychotraumatology, resilience is required to focus primarily, not on pathogenic factors like in medicine in general, but on the subjectivity of the individual, which is the instrument employed directly in the way they, together with the means meant for dealing with them are perceived by the individual.
Let us not forget that, in reality, it is not the psychopatogenic factors that are directly involved in the development of pathological manifestations, but the psychotrauma that is managed directly by the subjectivity of the individual. It is a distinct reality, which is different at the level of psychotraumatogenic situations.

3. Potentially psychotraumatogenic factors. It is a proven concept of the psychotraumatology – resilience tandem. This may be explained by the fact that within the resilience belonging to psychotraumatology, a special place is also held by circumstances underlying unacceptable false threats. Such threats are the sources of authentic psychotraumas, and the individual subjectivity is the main responsible factor for them. They are the more particularly important for assisted resilience, as they are easier to ignore, more difficult to anticipate, recognize and understand by the persons concerned to provide useful services. In their case, one must take into account not only the present and what the individual subjectivity present often keeps to itself but also the future targeted by the prospective thinking. Moreover, they are also closely related to the efforts to help the assisted individual to place as judiciously as possible the mobile line demarcating the real threats from both the false threats and the obstacles that are indispensable to the existential maturation and self-assertion. The reverse approach of the awareness of the existence of ignored real dangers belongs also to the field of assisted resilience. Of course, both phenomena, that of minimizing, respectively of amplifying threats, are primarily common with children and adolescents, who are known for the ease with which they may deceive themselves and “see” inevitable and unacceptable hazards even where they are missing or, conversely, they minimize or ignore obvious threats.
4. In psychotraumatology, resilience has a strictly customised character. This results in a high degree of complexity for each case. For example, we shall mention only the involvement of potentially psychotraumatogenic factors that are peculiar to each individual in part.
In the case of assisted resilience, the strictly customised character is of great importance because it represents a formidable obstacle for those who want to fully understand the situation, to evaluate it, to anticipate its evolution and to assist the resilience process effectively.
Moreover, the strictly customised character of the resilience approach in psychotraumatology, on the one hand, requires a thorough knowledge of many aspects of the present, past and future relating to each case. On the other hand, the fact restrains the automatic generalization of findings based on experience and of the easy a transition from general to specific, actual cases. Besides, this time, significant differences between individual and collective approaches should be acknowledged, too.

5. Specific impact of temporal inconsistencies on the resilience approach. Unquestionably, temporal inconsistencies between the moment of the presence of the psychotraumatogenic factor and the establishment of negative emotions is an issue facing all those involved in the field of assisted resilience.
The temporization phenomenon should keep our attention awake and we should not delude ourselves to believe that everything is in order before assessing the situation in detail and taking care about returning later on. It also obliges us not to feel guilty if problems occur subsequently that have not been anticipated.
In turn, the remanence phenomenon requires that care should not be considered completed if the traumatic event has passed or to believe that it is sufficient to remove the cause or to say that everything has passed.
The phenomenon of anticipation of insurmountable and unacceptable hazards is even more subtle, delicate and durable. If, for example, it provides time for responding appropriately, for defence, in the case of their false nature, it requires a special ability on the part of the support person. The problems consist in the difficulty of tracing the proper demarcation, impregnated with subjectivity, between what is genuine threat, what is an exaggeration, what is controllable or what is acceptable or even necessary existential challenge. It means that we should not overlook the fact that false threats can generate exaggerated or even totally inadequate defence measures, can block actual actions without cause, whose risks would deserve to be assumed as behaviours meant for different skills, proving the ability to overcome obstacles and self-assertion, which must be always present in the mind of the one who provides support to the person in risk situations.

D. Conclusions.

All of the above allow us to state that:
l Psychotraumatology has a special place within assisted resilience, where approaches are subordinated directly to the particularities of psychotrauma.
l To be effective, the professional in the field of the tandem psychotraumatology- assisted resilience must act through and in consensus with individual subjectivity.
l Within the tandem psychotraumatology-assisted resilience, the focus should be moved out from the psychotraumatogenic factors to the subjectivity of the individual, which is the turntable both of the pathogenic process and of the curative and prophylactic approach.
l The resilience intervention within psychotraumatology is strictly customised, which requires a thorough knowledge both clinical, of the past, present and future of the targeted person or population group, and of the socio-cultural economic and environmental context.
l The resilience intervention within psychotraumatology is obliged to accept to identify and to build on two new concepts, the psychotraumatogenic factor and the potentially psychotraumatogenic factor.

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