Tag: splitting

Trauma: Symptoms of Dissociation and Treatment

The DSM describes main feature of dissociation as a disruption of memory, consciousness and identity or perception. Dissociation is a protective mechanism. Human beings have at their disposal to survive traumatic events.

Abusive painful experiences and memories are put away into isolated compartments in the mind, and separated from regular memories.

Read also: Traumatic and Non-Traumatic Memories

Dissociation is a way the mind organizes information

Dissociation refers to a compartmentalization of experience: elements of an experience are not integrated into a unitary whole but are stored in isolated fragments (van der Hart et.al., 1998).

Exposed to trauma, the mind splits. The part of the brain that continues with the daily functioning of life (the left brain), and the emotional part of the self that holds the traumatic memories (the right brain) and its survival impulses of the moment of trauma becomes unintegrated with each other. This leaves the person with a split sense of self.

In trauma, the left and right hemispheres of the brain becomes more split and less integrated.

Experiencing a split sense of self can be disturbing. To notice the phenomenon as it happens is to gain agency.

The disruption of integration of the hemispheres of the brain leads to the experience of feeling something and “not making sense” of the feelings. The feelings come in the form of emotions, perceptions or physical pain.

The experience of not making sense of what one feels, can be disturbing. As human beings we need to make meaning and understand things about ourselves to feel safe. When such splitting occurs, the trauma survivor experiences blankness and confusion. This contributes to more insecurity. Oftentimes the need to make meaning results in thoughts that are paranoid in nature, intrusive and/or obsessive.

In therapy, clients are guided to 1. first identify the feelings and sensations that make no sense, 2. accept these feelings without making meaning. 3. observe the nature of thoughts that arise from attempt to make meaning, and 4. allowing these sensations to pass (through relaxation or somatic exercises). Each of these steps are tedious and challenging, needing full attention of both therapist and client. This is also solid mindfulness work. The result is the client gaining of agency of the self.

Splitting leaves the client fragmented into parts of personality. As different times the person’s right brain may trigger experience in him/herself a part that is raging and wants to fight or take revenge, a part that is terrified, a part that is ashamed, a part that is needy and/or a part that wants to run away. When these parts are traumatized, they feel out of control.

The left brain engages the other parts of the person that wants agency. These parts manage daily function, the part that is sociable, and the part that is responsible.

Noticing split-off and traumatized parts

One can notice that splitting has occurred through phenomena like experiencing chronic inability to make decisions, continually relapsing into addictive behavior, having intrusive emotions that seem to arise out of nowhere, intrusive thoughts, shifts in mood or behavior, going numb, getting hyper-aroused, collapsing, feeling suicidal, hearing voices, loss of ability to connect with others, difficulty communicating, withdrawal from society, feelings in the body and somatic symptoms that are not based on medical logic.

There are different severity levels of dissociation

Dissociative symptoms can be severe in some people to a point of rendering them incapacitated. Many individuals, however, experience dissociative symptoms, and are still able function and be successful in life.

Treatment of dissociative symptoms with therapy in functioning individuals is a measure to keep the person healthy and functioning. While we can cope with dissociative symptoms, these symptoms do not disappear on their own. Symptoms get worse with age, and are exacerbated by crises in life. This is why and how some seemingly functioning people experience sudden psychological breakdown.

Signs to look out for in functioning individuals

It is clear that severe dissociative symptoms require professional attention. Less obvious or hidden signs of dissociation are worth noticing: 1. difficulties putting things together, not being able to remember conversations, forgetting appointments, or inability to recount coherently what happened in certain situations, 2. experience of doing things that does not seem to add up, like having sexual relationship with someone one finds unattractive, 3. having unexplained chronic pain or somatic symptoms, 4. chronic experience of stuck in life, 5. experience of identity confusion, 5. experience of self-harming or suicidal thoughts.

Therapy that focusses on mindful observation of these symptoms, its triggers and the trauma underlying lead to successful outcome in providing clients with agency over his/her life.

Bibliography

van der Hart, O., van der Kolk, B. A., & Boon, S. (1998). Treatment of dissociative disorders.

The Paranoid-Schizoid Position

Melanie Klein (1997/1924-1963) writes that in the first 3-4 months of life the infant experiences anxiety, which is driven by the fear of annihilation. This is a primary cause of persecutory anxiety.

It would appear that the pain and discomfort he has suffered, as well as the loss of the intra-uterine state, are felt by him as an attack by hostile forces, i.e. as persecution. Persecutory anxiety, therefore, enters from the beginning into his relation to objects in so far as he is exposed to privations.

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The infant’s first feeding experiences are perceived by the child as closely related to the its experiences to its mother’s breast. At this early stage of infancy, the child has yet to grasp the mother as an individual i.e. a whole and separate being.

At this point we may consider the relevance of Bollas’ Transformational Object.

Persecutory Anxiety and Greed

When the child is neither hungry nor full, one can imagine that the child is experiencing a balance in its libidinal and aggressive impulses. These impulses are made stronger when it is reinforced through, e.g. frustration. Klein suggests that the aggressive impulses give rise to emotions of greed. An increase in feelings of greed leads to more frustration and aggression.

Children whose feelings of frustration are reinforced (due to deprivation and/or due to temperament) experience growing persecutory anxiety, and have problems tolerating deprivation and dealing with anxiety.

Persecutory anxiety, however, can in some other children, lead to feeding inhibitions.

Love and Hatred

This swing between gratification and frustration are powerful stimuli for feelings of love and hatred.

As a result, the breast, inasmuch as it is gratifying, is loved and felt to be ‘good’; in so far as it is a source of frustration, it is hated and felt to be ‘bad’. This strong antithesis between the good breast and the bad breast is largely due to lack of integration of the ego, as well as to splitting processes within the ego and in relation to the object. There are, however, grounds for assuming that even during the first three or four months of life the good and the bad object are not wholly distinct from one another in the infant’s mind.

Splitting

This is where we can perceive the concept of splitting. The infant experiences the positive and negative feelings toward the same object. It is at this position in the development of the child’s ego, that it is able to differentiate its experiences as good or bad. It in turn has love or hate emotions towards that same object. This split in feelings is experienced in the paranoid-schizoid position.

Internalization – Projection and Introjection

These experiences of gratification and frustration, which happen due to external stimuli ultimately become internalized. The infant projects its love impulses to the good attributes of the mother’s breast, and destructive impulses towards the frustrating breast.  The infant introjects by building a picture of the good breast and bad breast. This gets developed and distorted by phantasies.

This good-object and bad-object picture becomes a prototype for all external and internal persecutory objects, which the infant takes with it to adulthood.

Emotions in infants are extreme and powerful in nature. Persecutory anxiety deem the “bad object” as terrifying and, as a means of allaying the fears, the infant creates an internal picture of the good object as a powerful, all gratifying object. This is how idealization of the good object comes about. It is a means being omnipotent : creating characteristics of good object to protect one from the bad object.

Moving Forward from the Paranoid-Schizoid to Depressive Position

How Infants Adjust

Even during the earliest stage, however, persecutory anxiety is to some extent counteracted by the infant’s relation to the good breast. I have indicated above that although his feelings focus on the feeding relationship with the mother, represented by her breast, other aspects of the mother enter already into the earliest relation to her; for even the very young infant responds to his mother’s smile, her hands, her voice, her holding him and attending to his needs. The gratification and love which the infant experiences in these situations all help to counteract persecutory anxiety, even the feelings of loss and persecution aroused by the experience of birth. His physical nearness to his mother during feeding—essentially his relation to the good breast—recurrently helps him to overcome the longing for a former lost state, alleviates persecutory anxiety and increases the trust in the good object. p.63

The infant eventually realizes that the good and bad object belong to the same organism, which is, in the infant’s perception the mother. When this happens, the infant develops into the depressive position ( the term has nothing to do with depression).

The desire for unlimited gratification, as well as persecutory anxiety, contribute to the infant’s feeling that both an ideal breast and a dangerous devouring breast exist, which are largely kept apart from each other in the infant’s mind. These two aspects of the mother’s breast are introjected and form the core of the super-ego. p.70

What Klein explains here is the phenomenon of splitting, omnipotence, idealization, denial and control.  — These are aspects of the personality that, in adults are associated with dysfunction if it predominates, controls the life to the individual; and if the individual has no capacity towards ambivalence (seeing in shades of grey instead of black and white).

In the infant, this is stage is a necessary part of ego development. The infant has to temporarily rely on his phantasy to cope with such acute anxiety. The experience of the good and bad alternate swiftly. The mother’s continued loving behavior towards the infant helps the infant develop towards an understanding that good and bad experiences belong to the same person.

If the infant gets enough good experiences it can integrate the good and bad experience. It would have less need to project his hate externally. He can see in wholeness, it’s mother and later, father etc. It moves forward to the depressive position.

Out of the alternating processes of disintegration and integration develops gradually a more integrated ego, with an increased capacity to deal with persecutory anxiety. The infant’s relation to parts of his mother’s body, focusing on her breast, gradually changes into a relation to her as a person.

The Paranoid-Schizoid Position and Personality Disorders

If, for example, the infant experiences overwhelming frustrations and is not able to have a sense of goodness from the mother, its psyche is kept in the paranoid-schizoid position, unable to develop further.  The individual develops a persecutory complex that does not enable him/her to see beyond black and white. This is the precursor to personality disorders (PDs) like schizotypal PD, paranoid PD, borderline PD, narcissistic PD and antisocial PD.

Low functioning personality disorder states indicate the inability of the individual to move dynamically to and from the paranoid-schizoid to the depressive position. The person in this case remains unable to see both good and bad in the same person. Instead there is projections persecution, and paranoid anxiety.

Growth towards the Depressive Position

As the child develops, and if it is given the necessary love, it moves into the depressive position (this has nothing to do with being depressed, but rather an ability to be ambivalent). This is a development. The child recognizes the mother as an individual separate from it. He learns that he is dependent and learns to accept temporary frustrations. He also learns to love, mourn and pine. He is more able to take responsibility for his impulses. He feels guilt, and is able to care. He lessens his hallucination of being omnipotent.

The depressive position is capable of ambivalence : seeing good and bad in the same object. This is also a position of the neurotic.

 

 

Bibliography

Klein, M. (1997). Envy and Gratitude: And Other Works, 1946-1963. Random House.