Abstract
Ira Brenner has been an important contributor to the psychoanalytic literature on various aspects of trauma for a few decades now (see, e.g., Brenner 1988, 2001, 2004). As interest in trauma has grown, both inside and outside of analysis, many others have joined him. Brenner remains, however, in something of a unique position, for a number of reasons that I will detail, and thus any publication of his commands more than the usual amount of interest. I will first summarize some of the contents of his new book and then look at its overarching themes. Finally, I will attempt to delve a little deeper into how far we have come in understanding trauma, thanks in part to Brenner’s work, and ask where we might go from here.
The book contains twelve chapters, five of them previously published. As is usually the case in such a situation, there is some repetition and a certain unevenness and choppiness in the flow of the book. However, with the majority of the chapters written expressly for this book, and given the focus on trauma in all of the author’s work, themes emerge, and it is easy enough to discern the red threads running through the volume.
In the first chapter, Brenner describes his journey so far in exploring the realm of psychic devastation. He worked with Judith Kestenberg on a large project interviewing over a hundred child survivors of the Holocaust (Kestenberg and Brenner 1996). He remains involved in work both with survivors and in treating the effects on the second and third generations. Brenner has also studied and been influenced by one of the foremost psychoanalytic theorists and practitioners in large group psychology: Vamik Volkan. He describes his satisfaction when he was able to introduce these two pioneer analysts to each other and to each other’s ideas. This satisfaction captures the strong integrative tendency in Brenner’s work. He then describes how he was the head of a large inpatient psychiatric unit in Philadelphia when Richard Kluft, one of the pioneers in the modern understanding and treatment of dissociative identity disorder (DID, at the time called multiple personality disorder), started admitting his “multiples” onto the unit. Brenner admits being skeptical at first, but noticed the same faraway look in these patients, and the sense it gave of being in the presence of someone who has been severely traumatized, that he had experienced with Holocaust survivors. And then, when seeing the same thing in one of his outpatients, he became a believer. Brenner probably has more experience in the psychoanalytic treatment of DID patients of various degrees of severity than any analyst except Kluft (2000), who like him is trained analytically. It is this deep experience in so many areas related to severe traumatization, especially DID, that puts Brenner in a unique position to approach the theoretical and clinical problems of trauma. Other important factors are his open-minded curiosity about all things human, and inhuman, as well as the fact that, unlike many modern investigators of trauma, he seems fully convinced of the importance of Freud’s monumental discoveries related to childhood sexuality, aggression, repression, and primary process. He seeks not to replace these ideas with concepts related specifically to trauma, but rather to investigate how these different dynamics interrelate and interact.
The first section of the book, containing three chapters on the “conceptual realm,” explores the nature of dissociation and its relation to concepts and processes such as Freud’s splitting of the ego. Brenner notes that the first analytic patient, Anna O. (Breuer and Freud 1895), suffered from trauma and multiple states of consciousness, with amnesia between them, which we would now diagnose as DID. He describes these dissociated states of consciousness as organized around specific traumas, as well as drives and fantasies. He suggests that the “it’s not me” self organizes various alters, kept apart by amnesic, autohypnotic barriers. This leads to a “mosaic transference.” Brenner stresses the technical importance of developing a therapeutic alliance with each of the alters in this situation. In this section there are cogent discussions of various conceptual aspects of trauma, dissociation, and DID.
In the second section, on the “societal realm,” are chapters on intergenerational transmission, on the play of children in situations of extreme traumatization, on the Israeli/Palestinian conflict, and on the response to 9/11. The chapter on intergenerational transmission of trauma is one of the best. The concrete, unprocessed nature of the memories of parents who are Holocaust survivors is evocatively described, as is the effect on their children, and then on their children’s children. It is clear that what are transmitted are not memories, but realities. These survivors live still in a reality that refuses to become a regular memory, and their children are inexorably drawn into, and trapped in, this reality. The next chapter, describing the play of children during the last days of the Warsaw ghetto, surrounded by death and facing their inevitable death themselves, is profoundly moving. The fact that the children and adolescents still played, sometimes with dead bodies, and that they were also often more realistic about what was happening and what would happen than the adults, are phenomena that may well be connected. Brenner notes the differences between the play of these children and more regular play, such as playing at being characters in heroic stories. He says that the ghetto children were literally playing for their lives. What can this mean? I would think, that they were using reversible, controlled regression—regression in the service of the ego (Kris 1950) and regression in the service of development (Blos 1979)— not just to assimilate and adapt to their surroundings, as every child does, but also to ward off the uncontrolled regressive loss of higher ego functions that is the hallmark of trauma. Thus, their playing was a life-and-death matter: only by playing, even as their physical death approached, could these children ward off the psychic death that this uncontrolled regression would bring. This psychic protection was probably not as available to the adults. The other two chapters in this section, on the Israeli/Palestinian conflict and the response to 9/11, use material from DID patients that parallels some of the intractable splits and divisions and regressive responses to trauma seen in these conflicts. Brenner is clear that he is merely drawing an analogy, to see what light it may throw on these situations.
The third section deals with the “clinical realm.” Here Brenner describes various technical issues and recommendations for the treatment of DID. The importance of first giving the reality of the different alters its due, and connecting with each of them, is stressed, as is the importance at times of using containment rather than interpretation, a containment that allows the different alters and parts to emerge as the analyst holds each of them and their reality in mind. Although many more analysts today are convinced of the reality of DID, and work with these patients, than in decades past, there are certainly also many who doubt that such a disorder exists, or who at least see the different “personalities” or “alters” as the playing out of fantasies, while relational analysts see DID as merely a further extension of the different self states that they see existing in all of us. Brenner argues against both of these positions, with the clinical material he presents throughout the book his strongest backing. The chapters in this section contain many specific, practical recommendations with regard to therapeutic technique with DID patients, many of which are applicable to the treatment of trauma more generally.
The book explores many facets of trauma, with a special focus on DID. Almost every chapter presents at least one extended clinical case and treatment descriptions of Brenner’s work with dissociative patients. This is certainly one of the most important features of the book. The detailed descriptions give analysts who do not see such patients—and even those who have seen some dissociation have rarely seen some of the extremes, described here by Brenner in great depth—a glimpse into how these patients look and behave and what it feels like to be with them. But Brenner uses his work with these patients as both a lens and a probe. With topic after topic—dissociation, denial, intergenerational transmission, social conflict, therapeutic technique in relation to trauma—he uses clinical material to bring aspects of the issues into focus, and to drill deeper into them. For example, in relation to the topic of dissociation, he notes that the alters in DID do not seem to form around the basic split between love and hate, good feelings and bad, that are at the core of the splitting in borderline disorders, as described for instance by Kernberg. Thus, the splits in DID, and by extension in other post-traumatic dissociative splits, are different from the splitting described by object relations theorists and Kleinians as part of both early development and borderline disorders. These splits have more going on than just the disavowal and splitting of the ego described by Freud, and more also than the disparate self states described as part of normal development by relational analysts. Thus, the extreme form of traumatization and response seen in DID magnifies, and makes clearer, the differences between severe trauma and these other processes. Brenner stresses the importance in trauma of such things as autohypnotic states, the functional phenomenon (where the workings of the mind itself are given plastic, perceptual representation), and other altered states of consciousness.
Another overarching theme of the book is the nature of the disordered functioning left after trauma has struck. Brenner refers to this as the “dark matter” of the mind, by analogy to the missing matter in the universe, calculated to make up most of its mass. Although not yet seen or discovered, it has been shown to exert a force in keeping the observable universe from flying apart. Similarly, the dark matter of the mind exerts a profound influence—for example, on Holocaust survivors and their children—and yet it is usually unseen. Even most of those suffering from DID, contrary to its florid presentation in movies, hide their alters not just from others, but from themselves. Brenner notes that many analysts have tried to conceptualize this dark matter. He mentions Freud’s idea of primal repression (1915), Frank’s passive primal repression, the unrememberable and the unforgettable (1969), Bion’s beta elements (1962), the ideas of unformulated experience presented by relational and object relations analysts, and my own idea (Fernando 2009) of the zero process. The case presentations and indeed the entire book, in one way or another, explore the nature of this dark matter, for instance in descriptions of intergenerational transmission, and of play as a way of keeping this dark matter at bay. All the authors who have written on this topic agree on a number of things, such as that this dark matter is formed through overwhelming trauma, that it is less integrated and symbolized than other forms of mental functioning, and that it seems related to forms of defense such as dissociation. Brenner describes a number of organizing influences found in DID patients: perverse sexuality, dream phenomena (especially the functional phenomenon), intergenerational transmission of the trauma of the perpetrator, aggression and near-death experiences, and the organizing effects of dissociation. He asserts that forms of repression are found along with dissociation, and that perceptual memories, not just implicit, nonconscious ones, are important in these dark areas of the mind. This means that not only relational reliving but also reconstruction of repressed and dissociated traumatic memories is important therapeutically.
Thus, Brenner challenges some of the generalizations that have taken hold in the psychoanalytic community regarding the nature of post-traumatic memory and dynamics. Which brings us to the more general questions and issues raised by this book: what can we now say about the nature of trauma and its sequelae? I think one thing we can say is that things may not be as simple as some analysts have asserted. Many psychoanalysts at present subscribe to one version or another of a particular view of trauma: that the core trauma is usually “developmental trauma” related to misattunement of the caregiver to the infant, leading to dysregulation (for instance in processing of affect, in theory of mind), and implicit, emotional memories that are relived with the analyst. Dissociation, in the sense of different self states, is prominent, repression and explicit memories are downplayed, and later developments and traumas are often seen as based on, or in some other way not as important as, the developmental trauma. The clinical material and ideas presented by Brenner bring into question aspects of this view: not so much the existence of these early developmental traumas, but the idea that most later traumas not only can be reduced to these, but that they share their characteristics. As I have mentioned, the splitting between good and bad self- and object images, seen in borderline disorders, and present in early development, is noted by Brenner to be different from the alters in DID, which contain complex aspects of the person and of the person’s reactions to external events. Each alter is built around specific overwhelming traumas, including unprocessed declarative, as well as implicit and emotional, memories. Various processes of autohypnosis, disavowal, and repression work to keep these alters separate from one another, and the traumatic experiences unprocessed and unintegrated. These aspects of DID also largely apply to other forms of trauma and post-traumatic functioning, with of course some specific mechanisms added in DID. To my mind, what this means is that early developmental issues, related to neglect, misattunement, and/or constitutional factors that lead to maldevelopment of various ego functions, should not be conflated with the traumatic process, which relates to an overwhelming experience leading to a sudden but temporary shutdown of some of these functions, and which has some very different consequences. To give just one further example, Brenner talks about the strikingly high level of functioning of at least some of the alters in DID patients, which stands in contrast to the usually more pervasive deficits of borderline and other developmental disorders. Despite pointing out these differences, Brenner does not actually take the step of making a radical differentiation between these two types of problems and dynamics. When I have had the pleasure of presenting with him, or of attending his discussion groups, I have had a chance to ask him about this. From his comments in these situations, and from the contents of this book, it seems that he sees these processes as too complex and interrelated to be as sharply differentiated as I have proposed, even though his observations and conceptualizations pose challenges to certain presently accepted views of trauma. I think he prefers to work close to the clinical material, and make sharp differentiations at particular points where the material calls for it, as I have described in a number of examples, without pushing the generalization of these differentiations too far. However, this book does bring up these issues, and challenges each of us to respond to them by thinking more deeply about trauma both at the theoretical level and as it is presented to us every day in our offices by our patients.
This is a very rich book, and I have described but a few of its riches. I would urge any reader interested in trauma and its consequences to delve into the diverse insights, clinical and theoretical, to be found here. But I would also warn them—Brenner has a low-key, understated style, and many important ideas are mentioned without fanfare, at times almost in passing. Read carefully.