Psychological Trauma: A Collection of Essays Ranging from Domestic to Political Abuse

By Brian Trappler

Since the subject of psychological trauma has become popularized, and as a result of the mushrooming industry of lay therapists, the strength of this publication relies on the expertise of the author in addressing a wide array of trauma-related material. It begins with a description of the full scope of trauma-related symptoms and syndromes. The author pays special attention to the subject of the crucial role of early attachment and nurture. There is a significant body of didactic material balanced by personal reports of known trauma-vignettes which are dissected using the language established by known trauma experts.

• Language: English
• Publisher: AuthorHouse
• Release date: Aug 13, 2014
• ISBN: 9781496901859

Brian Trappler

After graduating Medical School in 1974 at WITS University in Johannesburg, Dr Trappler spent three years as a House-Officer in Medicine, Surgery, Pediatrics, and Intensive Coronary Care. After passing his written examination of the Royal College of Physicians of London he attended a 3-year Residency in Psychiatry at the University of British Columbia, Vancouver, and in 1981 graduated as a Psychiatrist at the Royal College of Physicians of Canada, obtaining the highest score in the Board Examination in the country. He moved to Brooklyn in 1981, where he completed a two-year Fellowship in Psychosomatic Medicine. Dr. Trappler was appointed Assistant Professor in Biological Research at Columbia University from 1988 to 1994. He became Associate Clinical Professor in Psychiatry at the State University of New York at Brooklyn from 1994-2010. During this time he was Associate Medical Director of the Anxiety Clinic at SUNY Downstate, Director of Training in Psycho-Pathology at SUNY Medical School, Lecturer in Pharmacology, and Deputy Director of Geriatric Fellowship Program As Co-Director in Neuroscience Education, he was charged by the Dean to represent the Department in developing an Integrated Neuroscience Curriculum at the SUNY Medical School at Downstate. As Director of psychiatric inpatient education he supervised residents, psychiatric fellows, and psychology doctoral interns using an integrated model of group and individual psychotherapy as well as teaching pharmacotherapy. Dr. Trappler`s clinical research, individual case-reports and letters to editors have been published in various peer-reviewed journals, including the American Journal of Psychiatry and the American Journal of Geriatric Psychiatry. He has also served as a referee for several prestigious psychiatric journals, including the Journal of Clinical Psychology, Journal of Traumatic Stress, Annals of Psychopharmacology, and Acta Scandinavia.

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© 2014 Brian Trappler, M.D. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 09/02/2014

ISBN: 978-1-4969-0184-2 (sc)

ISBN: 978-1-4969-0185-9 (e)

Library of Congress Control Number: 2014906267

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Contents

Dedication

Introduction

Tripartite Theory of Trauma

The Acute Psychological effects of Trauma

The Cardinal Symptoms of Trauma

Type 1 and Type-II Trauma

Effects of prolonged trauma on Self-Functions

Disorders of the Self

Early Childhood Development: The Good Caretaker and Long-Term Behavioral Adaptations

The predator and Disorders of the Self

Political Terrorism and the Stockholm Syndrome

War Torn Civilian Victims of Political Terrorism

PTSD and Natural Disasters: What to expect from survivors

New York Firefighters: A Sample of First-Responders 12 Years Following the Collapse of the World Trade Center

Khalid Sheikh Mohammed: Will the Trial in New York be Traumatic or Therapeutic?

Pan Am Flight 103 – Convicted Bomber Mohmed al-Megrahi’s Release May Exacerbate PTSD

Chabad and Brooklyn Bridge Shooting

ISIS, Jihad in Europe, and the shooting in Toulouse

Who killed the Fogels?

Rescue functions following a Terrorist Attack

General Principals in Trauma Healing

Group Therapy for Victims of Chronic Abuse

Creating a Therapeutic Narrative

Dedication

This book is dedicated to my son Aaron Meir. Meir was my greatest friend and ally during the 28 short years that he dwelt amongst us. His mission was simple: to illuminate the dark world with infinite kindness. He was incapable of seeing, discussing, or submitting to the dark negative forces that subdue the rest of us. He was buried in the Old Mystical City of Safed amongst the original Kabbalists of the Arizal.

Introduction

In this new collection of essays I examine several current trauma-related topics.

The book is divided into the following sections:

1. The effects of an acute traumatic event.

2. The effects of prolonged trauma

3. An examination of early attachment behavior and nurture

4. A section on political terrorism

5. A section that explores several basic principles in trauma-recovery

The symptoms of Acute Type I trauma are truly distinct from those of prolonged interpersonal trauma (Type II), and this is a subject that I discuss in several chapters.

Whereas PTSD is significantly dominated by the neurophysiology of the fear cascade with continuous kindling of stress-circuitry, Type-II trauma causes a disturbance in self-functioning.

The effects of chronic interpersonal trauma were documented by Judith Herman in a book titled "Trauma and Recovery: The aftermath of violence-from domestic violence to political terror" (published by Basic Books in 1999).

Herman`s observations emanated from decades of clinical work with populations ranging from child-abuse to holocaust survivors.

The symptoms discovered by Herman were so different from PTSD, that they warranted a distinct trauma category, which she termed Complex Trauma.

While the goal is to use a language familiar to the reader, Trauma Psychology uses language gleaned from psychological schools of thought traditionally regarded as being too oblique for lay readers.

The role of early nurture, and the disruptive-effect of early abuse or neglect requires an understanding of certain fundamental principles in child development.

For this reason I have devoted an entire section to examining trauma from the perspective of Object-Relations and Self-Psychology. I continue to use the term Complex Trauma to capture the effects of early parental failure as originally defined by Judith Herman in her classic manuscript Trauma and Recovery.

Deficiencies in self-function had previously evaded diagnostic attention because of the way PTSD dominated the trauma-literature. Symptoms such as loss of sense of agency, diminished sense of empowerment, and the inability to control interpersonal power-dynamics, fall within the spectrum of self-functions.

In order to accommodate the emerging reality of self-functions, the D.S.M. III Oversight Committee delegated an independent Axis-2 domain, which addresses developmental and personality disorders.

Since the symptoms of Complex Trauma are manifest by failures in areas of self-function, the disturbed interpersonal relationships found among abuse-victims are often placed in the diagnostic category of Personality Disorders.

Interpersonal trauma disrupts the templates that define current relationships.

While victims of child abuse may also fulfill the criteria of Borderline Personality Disorder, a failure to recognize comorbid Complex Trauma prevents access to effective trauma-recovery therapies.

Victims of interpersonal abuse have difficulty in sustaining power-symmetry in relationships, an arena in which they are most prone to re-enact their trauma. This phenomenon was first described by Freud, who coined the term repetition-compulsion. This refers to sustained patterns of trauma-re-enactment. The compulsive element speaks to the inevitability of repeating learned patterns of behavior.

Some victims of Complex Trauma are prone to a pattern of obedience and the repetition of submissive relationships. Victims of hostage situations, such as kidnapping or mistreated prisoners - of- war may present with symptoms dominated by the loss of personal sense of autonomy.

The title Stockholm syndrome has received public attention following several high-profile cases like Patty Hearst.

I left an entire section for victims of political terrorism. This section includes several real-life vignettes characterizing the Stockholm syndrome and spurs a discussion on the psychology of State Terrorism and Tyranny.

Applied at the global level civilization is facing threats at multiple levels.

Since the U.S. has retracted from its leadership- role as watchdog for global democracy and human rights, there has been an ensuing vacuum in global caretaking.

This coincides with widespread regional instabilities, exacerbations of longstanding territorial disputes, and the threat of terrorism being taken to a non-conventional dimension.

Whenever a caretaker looks the other way it sends a subliminal endorsement to bullies that they can act with impunity; even on the global stage.

While the range of treatments for victims of interpersonal abuse are prolific, there are some fundamental principles for effective trauma-therapy.

When a sudden life-threatening event overwhelms an individual`s psychological defenses, it leaves a lingering sense of dread which easily becomes reactivated by subsequent trauma-triggers.

This combines with distressing visitations of memory - fragments stemming from the failure to psychologically process the original traumatic event.

The goal of any treatment intervention includes identifying and desensitizing the victim to these threat-triggers.

This explains the priority of establishing a safe holding-environment for all trauma-victims.

The use of traditional exposure-therapy techniques for trauma victims was called into question after reports showed that several populations of trauma victims became overwhelmed and experienced unmanageable psychological pain and distress when confronting any reminder of that trauma.

This point is illustrated in the chapter on the treatment of New York Firefighters following the collapse of the World Trade Center.

Traditional exposure-therapy often fails in the treatment of trauma victims. As long as exposure to trauma-reminders produces emotional distress (affective dysregulation), the effort to formulate a trauma narrative becomes disrupted.

Clinical studies by Marylene Cloitre and colleagues have shown therapy to be more effective when combining techniques that provide victims with skill-sets that address self-soothing functions.

Victims are first taught to identify their emotional reactions. They need to show the capacity to remain calm when challenged with trauma-triggers.

Providing them with a safe holding-environment and the above-mentioned techniques that create an emotional comfort-zone are the fundamental pre-requisites for the recovery process.

This allows the process to move forward, weaving disparate memory fragments (such as flashbacks) into a unique trauma-narrative.

This correlates with a neurobiological shift from emotional, right-brain sensory-dominated trauma-recollections, into rational, left-brain, language-dominated trauma narratives.

The goal of therapy is to transform raw, emotionally-laden trauma-fragments into rational emotionally-neutral narrative-codes which the brain can download into long-term memory.

Unrecovered trauma-victims remain hostage to the lingering effects of fear-arousal- avoidance (in Acute, Type-I Trauma) or with a lack of autonomous adaptive self-functions (in prolonged Type-II Trauma).

The trauma-narrative has to be transformed into a healing template. This varies according to the victim`s stage in recovery and unique life-circumstances.

For instance, a battered spouse would need to make a decision pertaining to personal safety followed by taking the rational advice of friends and family.

Children, who are often unable to free themselves from the entrapment of an abusive parent, require social, communal, or legal intervention by vigilant caretakers (ranging from other family-members to teachers and medical staff). The presumption is that the surrogate caretaker is both benevolent and competent. This is an area that is discussed in textbooks in Social Psychiatry and relevant legal publications. The existing practice is to transition a victim into the most culturally-sensitive safe holding - environment.

An area for further study involves the recovery of victims of political trauma.

The chapters published in this book in the section political trauma are vignettes that serve as samples to illustrate trauma-dynamics from a political perspective.

There are several unique qualities to each victim population.

There is also a dynamic resemblance between a child-victim and a civilian victim of political terrorism. In this paradigm both victims are helpless and require protection. The likelihood of suffering a trauma - occurrence correlates directly with the degree of caretaker competence or negligence.

Other trauma populations don`t lend themselves to the same dynamics.

While rescue responses do require government resources in victims of natural disasters, the role of caretaking doesn`t pertain to acts of G-d.

Civilians can be victim to Type I Trauma (like the attacks on Twin Towers and the Pentagon) or Type II Trauma. In Modern Terrorism and Psychological Trauma 2007, Richard Altschuler, New England Press), I selected an article examining the compounding effects of civil war trauma in 8 towns in Bosnia Hercegovina; a study by David Kinzie examining PTSD symptom-reactivation among five ethnically diverse groups of refugees from war-torn countries following the September 11 attacks; and a discussion with Arieh Shalev regarding his proposed Continuous Terror Model after finding high levels of traumatic anxiety in neighborhood communities exposed to continuous threat.

The ramifications of issues ranging from prisoner-release to the transfer of terrorists from military to criminal courts have not only academic implications.

The section on Political Trauma in this collection of essays examines the role of media in modern terrorism, the effects of caretaker indifference, and the danger of governmental tyranny.

There are periodic references throughout the book to concepts introduced by several forefathers to Trauma Psychology and Self Psychology, including Janet, Freud, Carl Jung, Kohut, Mahler, and others.

The Chapter on Political terrorism will challenge the lay reader to be informed about the nature of predators. They can be unique in their cunningness. Living on the heels of tyrants such as Stalin and Hitler should have ensured a lingering skepticism toward any political agency afforded excessive power. Following the horrors of the holocaust, non-political agencies were set up to prevent any repetition of the atrocities of the twentieth century.

Populations or communities that are endangered represent the symbolic political equivalence to an endangered child. Appointed caretakers in both circumstances need to protect the victim from the perpetrator. The caretaker needs to address