Este artigo é resultante do grupo de trabalho da Federação Europeia de Psicanálise “Working on trauma”, e procura conceptualizar psicanaliticamente os conceitos comuns de “resiliência” e de “exaustão”. Enquanto a resiliência se refere à capacidade interna para utilizar a força do ego, bem como recursos do ambiente, nomeadamente as relações com os outros, o conceito de exaustão descreve um processo que conduz a um estado mental de não-representação, que remete simbolicamente para a falta de alimento de “bons objetos internos”, falta de energia psíquica, estados de desespero profundo e extremo, e absoluta falta de criatividade, ou seja, um processo de desvitalização. Os conceitos serão ligados por um modelo apresentado anteriormente para a conceptualização do “trauma” em que são enfatizadas três dimensões do sujeito traumatizado: dimensão do corpo-mundo, dimensão do sujeito-grupo e dimensão do sujeito-discurso.
Os autores discutem ainda as potencialidades e possível utilidade desses conceitos não apenas para a compreensão do paciente traumatizado, mas também para o seu eventual valor, de um ponto de vista psicanalítico, nos processos terapêuticos.
While resilience points to the individual's ability to use resources in the environment, notably relationships with others and their internal resources and potentialities, the concept depletion/devitalisation describes processes leading to mental states of lack: lack of nourishment from good internal objects, lack of internal and external resources and energy and a state of deep and uttermost despair.
Resilience means “bouncing back” from difficult experiences. It is the process of adapting well in the face of adversity, tragedy, threats, trauma and other significant sources of stress — such as family and relationship problems, serious health problems, or workplace and financial stressors. Our paper will focus on resilience in cases with severe traumatisation.
Research has shown that resilience is ordinary, not extraordinary. Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress. Resilience is not a trait that people either have or do not have. It involves
Artigo aceite para publicação a 25 de Agosto de 2014.
MD, Professor at Oslo and Akershus University College of Applied Sciences (OAUC), Norwegian Psychoanalytical Society. Gustav Vigelands vei 40, 0274 Oslo. E-mail:
MDSci, MD, Professor at the University of Copenhagen Danish Psychoanalytic Society. E-mail:
behaviours, thoughts, and actions that can be obtained by different approaches.
Several factors are associated with resilience, including:
The capacity to make realistic plans and take steps to carry them out
A positive view of yourself and confidence in your strengths and abilities
Skills in communication and problem solving
The capacity to manage strong feelings and impulses
According to the psychoanalyst S. Hauser and his group (Hauser, 1999; Hauser, 2006) based on a longitudinal study of early hospitalized youths, three general capacities characterized the group that as adults proved to have achieved a relatively satisfying life in spite of life's adversities and thus had demonstrated a resilient lifestyle: the “belief that one can influence one's environment, the ability to handle one's thoughts and feelings, and the capacity to form caring relationships” (S. Hauser et al., 2006, p. 262). These capacities are expressions of underlying structures and processes. Their long term study shows that although we know little about the nature and origin of the structures and processes, resilience does not lie either in the competence or relationship; it lies in the development of competence or relationships where they did not exist before (S. Hauser et al., 2006, p. 261). A. Alayarian emphasises intrapsychic factors connected with resilience such as the capacity to build a safe intrapsychic–relational space where the person can “talk to themselves to regulate pain and protect themselves from too many vulnerable feelings” (A. Alayarian, 2007).
The general psychological theory of ego-depletion suggests that one's capacity for self-regulation is a limited resource that can be exhausted. Ego-depletion itself refers to the situation where the self's capacity or willingness to take volitional action is temporarily reduced. Such volitional actions include conscious, controlled processing, active choice making, initiating behaviour, and overriding responses. Volition is the cognitive process by which an individual decides on and commits to a particular course of action. Those are the psychological areas that in a negative way are affected by depletion.
The terms ‘psychic depletion’ and ‘ego-depletion’ manifest themselves in a little less than 50 references in the PeP-Archive. The references are mainly centred round ego-depletion in depression and physical conditions, depletion of drive investment as well as depletion caused by migration.
In this paper we shall focus on the emotional and object-relational aspects of depletion in the context of complex post-traumatic processes. This concerns an emotional process where the person's capacity to initiate and sustain emotional bonds to self and others are severely incapacitated. It designates a mental state where one is not able to give but only receive and be nourished.
According to W. Bohleber (Bohleber, 2000) traumatisation can be described in two dimensions: the psycho-economic dimension and the object relational dimension. As to the psycho-economic dimensions, depletion can be described as a process of gradual loss of energy. The mental apparatus is set on low burning, i.e. barely able to sustain vitality in the forms of wishes, demands and desire. From an object relational perspective this process can be described as a deficiency in the relation to caring, and nourishing self- and object-representation. The traumatised person demonstrates less and less capacity to perform life tasks of care and self care, demonstrates a lack of inner resources and lack of ability to use outer resources, i.e. other persons, for these purposes. We have important knowledge related to depletion from studies of Holocaust survivors and from studies of the life in concentration camps (L. Eitinger, 1973; L. Eitinger & A. Strøm, 1981; H. Krystal, 1971, 1988, 2001, 2003; P. Levi, 1987; W. Niederland, 1981). The problematic term “Muselmann”, used for those who were doomed in Auschwitz and other concentration camps during World-War II, probably describes an end stage of depletion. Primo Levi writes: “This word ‘Muselmann’, I do not know why, was used by the old ones of the camp to describe the weak, the inept, those doomed to selection” [(Levi, 1987) chapter: “The Drowned and the Saved”].
Depletion refers to a process in which the traumatized person's struggle against his/her hopelessness decreases and fades away, or has disappeared. The person withdraws and if there is no help from outside and from someone who cares, this withdrawal may be chronic, lead to diminished interactions with the world, disturbance in psychically vital processes - lack
of perspectives of life and fantasies about a future - and somatic goal–directed activity and well-being, eventually leading towards diseases and death (L. Eitinger, 1964).
Resilience, on the other hand, refers to forces that seek to change, relate and learn. It may be reasonable to think that this refers to integrative aspects of the personality that are concerned with growth and development (R. Emde, 1991) and thus a condition of active and creative inner dialogues and fantasies about a future.
The phenomenology of posttraumatic states is to a large degree characterised by the dynamics between “vitality” and “death”, presence and absence, symbolically represented states of mind and unrepresented or poorly represented mental states. This may lead us to consider different analytical conceptions – derived from the empirical knowledge of the phenomenology of traumatised minds and justified from conceptual research. It is important to emphasise that resilience and depletion are not to be considered as opposite poles in a spectrum of continuities. Each of them needs to be conceived in their own rights. They seem to be different possible “tracks” in a situation of hardship and hopelessness each with their own dynamics.
The concept of depletion challenges the psychoanalytic process, and situations of depletion and non-transference (e.g. domination of bodily reactions rather than mindful reflections) can undermine ability to listen to the countertransference. This may have far-reaching consequences for psychoanalytic practice. It signifies a withdrawn drive investment in external objects, and a subsequent failure in the investment in the “I” or the self. This may be, followed by another withdrawal that numbs the self and makes unavailable any nourishing, trusting objects from their internal interactions with the self. It is an effect of long-term affection of the psychic apparatus, beginning with severe consciously experienced traumatising experiences, which may also be linked with earlier unconsciously experienced unpleasant episodes or deprivations.
This process seems close to the drive processes of melancholia, but the melancholia is characterised by a harsh (super-ego) attack on the “I” or the self, reflected e.g. in the self-devaluation and melancholic delusions. In contrast to melancholia, depletion is characterised by repetitions of empty internal object-relationships that denudes the person's experience of meaning.
The regression to a situation where depletion dominates can be seen as defence against the intense pain, often felt mostly in the body but reflecting an inner reality where availability of empathic bonds to internal objects and the self disappears (D. Laub, 2005). This pain is also related to the gradual loss of relations to external objects. In the internal world, however, aggression may be projected and turn earlier good objects into persecutory object. The person may the try to avoid the consequences of this by means of phobias or by evacuating the pain from the psychic apparatus projecting it onto the body, which may lead to severe states of bodily pain and/or hypochondria.
This in turn makes differentiated relationships with internal objects difficult preventing their re-creation or reparation. As a consequence inner objects may become more and more hostile and persecutory.
Another aspect, exemplified by the first patient, was a probably idealized relation to some internal objects that was mobilized during his hospital stay. He was not able to integrate good aspects and persecutory aspects of his internal object world, and this state of confusion became so persecutory that it determined its evacuation into the body (L. Prego-Silva, 1978). Often physical pain is much more tolerable than psychic pain. Depletion can thus be seen as a numbing resulting from recurrent attacks on the self during traumatization resulting in “raw” emotional states that are not possible to process.
Resilience may mean different things to different analysts and researchers in public health: a process, an outcome, a dynamic, a dynamic steady state in the face of adversity, and defiance of vulnerability are among the variety of understandings of the concept that are extant. For psychoanalysts, the structural dynamics and the processual aspects of the concept of resilience are central.
One way of conceiving resilience is from the perspective of language and symbolisation. This way can be depicted as a constantly
working towards a well-ordered state of neurosis in which the un-symbolised, nontranslatable, traces of trauma are kept apart from (but not secluded from) the symbolisations of daily needs, demands and desires. The topology responsible for this separation is the subject's ability not to merge the imaginary other and the symbolic Other. Memories, mental images, dreams and bodily feelings can thus be transformed into symbolic forms, mainly in the forms of creative language, i.e. language whose expressions (signifiers) can be reflected through the position of the Third. The subject thus manage to stabilize the flow of the signifiers in a balance between the imaginary and symbolic orders, and avoiding being overwhelmed by real order, non-symbolised, state of mind.
In this connection it is pertinent to ask what role psychoanalysis can play. Can psychoanalytic therapy bring into play what is needed to make the difference? And what makes some patients able to use this opportunity to start new ways of relating, and wishing to change and learn from experience?
We are interested in studying how the psychoanalytic therapy can work for patients who are in an exile situation, often marked by adverse circumstances, poor living conditions, racism, loss and lack of familiar cultural environment.
That is, a situation where many of the protective factors that have been connected with resilience are weak or absent. In what way can the concepts of resilience and depletion as used here be fruitful?
We will use material from clinical practice and from a prospective single case treatment study of severely traumatized refugees (S. Varvin, 2003).
I (SV) have been able to follow this man, Mr. A, for 16 years, seeing him through his adolescence and young adulthood, where he came for therapy in intervals but always keept the contact:
Mr. A was from a country in the Middle East and arrived in Norway 14 years old together with his mother and two younger sisters. His father stayed in the region continuing the resistance fight. An older brother had been killed. His childhood from age 5 had been characterized by on-going war; living clandestinely under dangerous conditions, frequent change of place of living and frequent interruptions at school. When he started treatment at the age of 15, he was a depressed and at times chaotic youth, living in a multi-problem family with a mentally ill mother, where he early was given the responsibility to be the man in the house, without having the capacities needed to fulfil the tasks laid upon him. He was at times severely suicidal.
He showed early emergent and often not very visible characteristics identified in resilience research. For example, he believed he was able to influence his situation and his surroundings; he tried to help the family in spite of lack of cooperation on their side; he struggled hard at school and managed to accomplish well. He had ideas about relationships; and even though they were most of the time very few and not intense, he nevertheless tried.
Now, after 20 years, he has completed higher education and is well on his way in an academic professional engagement.
Mr. A said he was in a fog for about ten years, not knowing what would become of him. When he was around 25, his trajectory dramatically changed, as he then determined to create a life for himself. We worked on some dreams in his therapy, where he connected with a deceased important relative. It was a transference dream where and uncle–doctor gave him the advice to pursue a peaceful path. He was at this time convinced that he should go back and fight the oppressive regime in his home country, joining his father. It seemed as if the work with the dream made him halt and redirect his future plans. This was of course a culmination of earlier therapeutic work. His mind struggled with aggression and violence, and the need to take revenge. The reconnection, through the transference, with earlier good objects, representing relations in a peaceful part of his early life, seemed to help on a path towards health. He thus seemed to benefit from the analytic relationship.
During an Adult Attachment interview, I asked a visibly depressed mentally fatigued refugee from Chechnya, Mr. B, about his childhood experience. When asked about his relation to his father he suddenly bursted out crying. He then told about early good and supporting experiences with his father and he markedly changed appearance, his face lightened up, his eyes glared and his gaze changed. He looked directly at me and smiled, although with sadness, revealing that vital forces had been activated. This brief encounter with an early vitalising object relation activated a broad spectrum of emotions not previously apparent during the interview.
Miss C was a thin, slightly bent woman, dressed in ordinary clothes and wearing a traditional Muslim scarf covering her hair. At the first meeting, she was pale and talked in a low voice. Her eyes were much of the time fixed on the table or the floor, and from time to time she looked with a very direct gaze at the therapist. She gave an alarming impression of being not only very depressed, but a person who had almost given up life.
She came from a lower middle-class family in a large city in a middle-east country; the only girl with three brothers. She described her childhood as reasonably comfortable, except for her having to live in a crossfire between her conservative father, who believed girls could only take the Quran school and get married, and a more modern mother who supported her wish for education. Early on she felt her father's attitude to be most unjust, but became accustomed to being quiet about her feelings while nevertheless pursuing her goals with a determined stubbornness. She was the one who took care of other people's problems, and she was extremely afraid of offending or hurting others.
While working in a legal political organisation, mass arrests began to take place shortly after her children were born. Her husband and several members of his extended family were arrested. Eight of them were soon killed or executed. Her husband survived heavily tortured. She was arrested with her two small children, then 4 months and 2 years old, and they spent two years in the most inhuman prison.
First Miss C and her two children had to live in a small cell, less than one square metre in size. As it was impossible to stretch out when sleeping, she developed a technique of bending her legs backwards in order to rest and to give the children more room. At the beginning of therapy (about ten years later), she was still obliged to sleep in that position to get some rest. Food was scarce and hygienic conditions were poor. At a time when her youngest child was about to die of hunger and thirst, the guard brought milk that contained a noxious substance that almost instantly made the child extremely sick and brought him nearer to death. For prolonged periods of time she had to stand, hooded, against the wall, not allowed to sit or take care of the children, who had to crawl on the floor. They could hear the screams of people being tortured, and the mother was hit while the children watched. They were then moved to a larger prison where they were placed in a large, over-crowded cell. The fellow prisoners were regularly tortured, and bleeding and maltreated persons were a common sight. Many had their toes or fingers cut off, some became lame, and some were killed in front of her and the children.
The following are excerpts from her statements in therapy. The therapy was tape-recorded and I have reinterpreted the material with the perspective of resilience and depletion/devitalisation in mind.
P. Yes, because there we have seen so much, too much. We had never expected that human beings could do things like that.
(Comment: she uses “we” and she says “we had never expected”, that is, there seemed to be a representation of a collective normality where things like that should not be done).
P. We have an old proverb saying that what you see is not the same as what you hear.
(Comment: Analyst is an outsider, but nevertheless a potential witness in whom she can confide, one who can or cannot understand).
P. Yes, it was in the middle of the night, they had fetched one from the cell where I was and they raped her.
(Pause, 10 seconds).
Yes, we were all in the same room, and they came. They could come 1, 2 or 3 men. They were covered all over with black clothing so we could not see.
We could not see anything of those people. They were all covered.
In traumatic and war neuroses the human ego is defending itself from a danger which threatens it from without or which is embodied in a shape assumed by the ego itself (…) It might, indeed, be said that in the case of the war neuroses, in contrast to the pure traumatic neuroses and in approximation to the transference neuroses, what is feared is nevertheless an internal enemy.
And in every cell we were about 70 at the time. And then they came, placed themselves in the middle of the room, turned around several times pointing,
and then suddenly stop, and the finger pointed at one of us. The other of us had almost lost the breath while this man turned around, now it will be me, by coincidence. When one was pointed at, we other could breath again, but we were desperate for the person who had been selected - because we did not know. Is it torture or execution?
(pause).
And I remember my friends. They were fetched at 4 o'clock in the night for execution and we were not allowed to raise and say our thanks and say goodbye. And it was like that, if the fellow-prisoners took my children on the lap, they got whipped.
(Comment: This is early in her therapy. She is talking about relations and feelings for others. The focus is equally on relations and on the atrocities done to her. She could speak about he survivor dilemma, the other and not me, and state the suffering in a way that could evoke empathic response in the listener. She was not, even at this point of exasperation, totally demoralised).
Thus, quite early in therapy when she was in a state of apparent depletion and seemed almost totally devitalised, emotion were present either represented as bodily pains, but also sometimes contained in herself or experienced projectively by the analyst. She later described her state of mind at this point in the following way: “Before I was afraid of everything, all the time. Now it is totally changed. I will never forget you.” Her conscious experience was thus mainly of fright and, as she said, she had not been aware it was fright.
Miss C's stay in prison was a malignant experience. Her main objective was to take care of and protect her children during the degrading conditions and stay alive during maltreatment. The five years she lived with her children and mother in her country after release from prison was a long fight for survival with repeated arrests, maltreatment and harassments of her and her family. She was suicidal and suffered sequelae after torture, and at times she was totally lacking energy barely able to walk. “I had to crawl”. She later claimed that this was in many ways worse than being in prison. She lived in constant fear and the oppression did not stop when they had fled. The families remaining in the home country were and are constantly harassed; and the embassy kept exiles under surveillance and reported to authorities in the home country on their activities, and punished their families in different ways.
She suffered form a plethora of posttraumatic symptoms, bodily pain and depression and her emotional life was severely restricted. She was suspicious and withdrew from others. The psychoanalytic therapy started with a “honeymoon-like” phase where she verbalised some of her experiences and thereby gained some immediate feelings of improvement. After this phase she demonstrated increasing negativism characterised by withdrawal and suspicion, while at the same time showing a stubborn search for solutions with a lot of action, seeking alternative treatments, sabotaging sessions etc. For longer periods negative therapeutic reactions were regular and self-reflection and mentalising capacity was almost absent, making therapy tiresome and quite lonesome for the analyst. In hindsight, it was possible to see emergent signs of subsequent resilience, that is, signs of internal processes that contributed to changes leading to resilience, which were present but in a brittle balance with traits of depletion and devitalisation.
In one session she told about the torture and started to cry. She felt she had been made helpless and humiliated by the analyst, went home and isolated herself for two weeks before she returned to therapy. Her therapeutic experience was for her a long march towards something better. In spite of her tendency to negative therapeutic reactions and repeated breaches of the therapeutic frame (usually interpreted as “acting-out”), she stayed on in therapy and managed in the end to live a reasonable life although suffering from bodily sequel after torture.
“Discovery” of early good objects played also here an important role in her recovery. In one session she was able to re-discover a good relationship to her grandmother. Grandmother had earlier been regarded as harsh and unempathic. It was obvious, however, that this mental picture of her grandmother had been coloured by later experiences of oppression, which thus had ‘nachträglich’ destroyed a libidinal source for her.
Miss C showed, then, a resilient pattern where she managed to she recover from her
devitalised state, use relationships, especially the analytic relationship, where she never gave up the desire to make something of her life (the so-called “acting outs” could, in this perspective, be seen as attempts and restoration and a sign of agency) and where she gradually became more reflective and thus able to learn from experience. She came thus out of a condition of almost total depletion and lack of vitality. Again the question is what made her benefit from the special relationship of psychoanalytic therapy?
Bearing in mind the motherhood constellation (D. Stern, 1995), the theme of maintaining the life and growth of her child probably was an important factor connected with her resilience. She knew that if she had given in, she would have failed her children. Keeping emotions inside and not react, had been a life saving strategy during her life under oppression and imprisonment, which led to severe bodily pains and probably was a background for many of her posttraumatic problems. In her therapy she had to learn in her own way how she could regain access to emotions and thus gain vitality.
Depletion and devitalisation are concepts related to the effects of the internal struggle with the impacts of traumatising experiences. This internal struggle is, however, dependent on the emotional, relational and social context of the survivor.
Mr. B and Miss C showed market negative therapeutic reactions in periods during their therapies. Their negativity appeared in different forms but was clearly present. After some years in therapy, after crisis in the transference, both changed and were able to reflect, see therapist as another person in a process where the projective impact lessened and it was possible to do integrative work. These processes were thus characterised by a struggle to get the analyst under control and caused grave disappointments and often withdrawal when the analyst failed. We believe these were processes where the omnipotent control over the object lessened and the patient gradually were able to see the analyst more as a separate person in his own right demonstrating a change from relating to the object to the use of the object (D. Winnicott, 1969). The analyst survived the destruction in accordance with Winnicott's understanding (D. Winnicott, 1969), and in this way the patient was able to move to a position described by S. Hauser et al. (2006), where they could establish emotional ties with others seen as separate persons not under omnipotent control.
This hallmark of developing resilience reflects the complex process after traumatisation that concern the subject's relation to others and the world on several levels. The posttraumatic process implies complex relationships where the development of resilience cannot only, or maybe primarily, be seen as dependent on individual factors be it personality or genetics. Resilience researchers agree about this point, and put weight on culture, ethnicity, social network, and family relations (P. Crittenden, 1985; B. Eisold, 2005; P. Fonagy et al., 1994; M. Harvey & Tummala-Narra, 2007; P. Tummala-Narra, 2007).
We could see in the vignettes presented above that the three factors summarised by S. Hauser; agency, capacity or interest in close constructive relationships and reflexivity were present. We think, however, that one could identify these in all reasonably successful treatments. The question is what determines that these will develop into strategies for creating a better life in spite of previous hardship and traumatisation? Agency, reflectivity and close relationships are dimensions involving several aspects of personality and its relation to others and the world. In the case vignettes good early relationships became apparent as a vitalising force possibly activating resilient ways of coping. Attachment research clearly shows the interconnectedness of relationships, capacity for self reflection and capacity for agency , (P. Crittenden, 1985, 1992), (P. Fonagy, 2001), (P. Fonagy et al., 1993), (Fonagy & M. Target, 1997). Other clinicians and researchers (e.g. A. Alayarian 2007) have also referred to the importance of early relationship experiences, which suggest conceptualizing and studying attachment as a possible mediating element in development of resilience. We say mediating factor, since the development of early good object relations may be exactly what characterises resilience. Schore claims, for example, that resilience against trauma or deleterious effects of trauma is founded in a good enough early attachment to the caregivers and that trauma or neglect in
this phase makes a person vulnerable to later traumatic experiences and that this to a large degree can explain why only a portion of those exposed to traumatising experiences develop PTSD.
In the following we will briefly describe a model that can serve as a framework for the further development of our thinking in this field. In agreement with the view that social trauma and its after-effects are linked with the individual's relation to others and the social context, three dimensions of interaction can be identified (B. Rosenbaum & S. Varvin, 2007; S. Varvin & B. Rosenbaum, 2003):
1 The body-world dimension: This dimension concerns the individual's relation to the other on a dyadic level. This is the level of emotional bodily-mediated regulation of affective states. Emotional withdrawal will diminish the possibility to use others in the process of modulating negative affect. In disordered states, the person may be unable to concretise or symbolize the sensations. Within this dimension, important nonverbal emotional regulatory processes occur between self and others, and there is a self-soothing reliance based on trusting internalised object relations.
Research on affective self-regulatory processes (A. Schore, 1994) and interpersonal regulatory interactions has demonstrated that these self and relational processes are key for maintaining subjectively experienced safety. This is especially pertains to the regulation of negative or unpleasant arousal, which depends on safe early attachment relationships and good enough early containment by mother/caregiver (W. Bion, 1962, 1967), which implies that the object survives the subject's destructivity, in D. Winnicott (1969) terms. These relationships, in turn, are dependent on a growth-promoting cultural and social context (G. Obeyesekere, 1990), including family and social network support (E. Hauff & P. Vaglum, 1995). Moreover, it is reasonable to consider that what on a social psychological level is identified as the urge to create emotional bonds is contingent on a belief shared by the participants in a dyad or a group, namely that emotions can be regulated at this level.
2 The subject-group dimension. This is the dimension of identity formation where one finds one identity as a member of a matrix: family, group and community. It is a “membership” based on the capacity to experience oneself as both belonging to and separate from the group. One is both ordinary (similar to the others in the group) and unique/special (different from the others). The group functions both as a safety background, an arena for intimate emotional relationships, but also as source to knowledge on what one is and what one should/could do. In the close/intimate groups one learns from its members and acquires the ability to empathize and take the other's perspective. A malfunctioning group-identity structure creates a poor background for what may be a desire to change, to relate, and to reflect. In societies where the family and the related larger grouping (e.g., clan, tribe) are the most important organising units of society, and where belonging to such a group is of fundamental importance both for personal and social identity, disturbances in this dimension may have grave disorganising effects.
Binding and unbinding relates to all levels thus evoking concept of symbolisation as the central process in this model representing the manifestation of binding forces. The function of drives is pivotal here with the binding force of Eros with its connection to object cathexis on one hand and the unbinding force of the death drive on the other. Repetition compulsion can function on several levels but without the binding, creating the basis for linkage to the symbolic, repetition tends to become ‘pure repetition’.
The question of why someone, and not others, are able to take advantage of
available resources – especially being able to relate to the analyst in the position of the Other - remain still open. There are probably different answers for each individual regarding the bases of their resilient and depletion outcomes. We believe that our three-dimensional model provide a frame also for analytical listening to the persons who have undergone severe traumatisations. From a humanistic point of view we should know something about what may counteract or destroy resilient outcomes. However, that knowledge seemingly stands in contradiction to the poor and often inhuman and anti-growth promoting conditions refugees are offered… Yet at the same time, we need to build up more systematic interdisciplinary knowledge — which will include individual, interpersonal, family, and socio-cultural domains - on how to avoid counteracting or destroying capacities for resilience. In the end, hope for a better future is built on the capacity to fantasise about ourselves in a different situation. Totalitarian conditions destroy fantasy. It is sad to notice that many refugees coming from totalitarian regimes meet totalitarian conditions as asylum seekers.
ABSTRACT
The paper originates from the work in the ‘EPF-working group on trauma’. Its aim is to create the psychoanalytic conceptual background for the often used (nonpsychoanalytical) terms ‘resilience’ and ‘depletion’. While resilience refers to the individuals internal ability to use ego-strength as well as resources in the environment, notably relations to others, the concept depletion describes a process leading to a mental state of non-representation with lack of nourishment from good internal objects, lack of psychic energy, states of deep and uttermost despair, and total lack of creativity, in other words a devitalising process.
The concepts will be linked with a previously presented model for the conceptualisation of trauma in which three dimensions of the traumatised subject are emphasised: the body-world, the subject-group and the subject discourse dimensions.
The paper will discuss the potentialities and possible usefulness of these concepts not only for the understanding of the traumatized patient, but also for their possible value in the psychoanalytical stance in the therapy processes with patients suffering from the depletion.
KEYWORDS:
Trauma, Resilience, Depletion, Psychoanalytic Therapy, Symbolization
3 Subject-discourse dimension: This dimension relates to the individual's relation to components of his or her culture - to religion, cultural narratives (such as folktales), philosophical texts, moral codes, norms and so forth. It is this level where shared meanings are established; with this cultural level serving as a reservoir for finding ways of understanding existential themes, life-crises, developmental challenges, rite-de-passages etc.