On Trauma and Pathogenesis

Parents who repeatedly rebuff the child's primary selfobject needs are usually not able to provide attuned responsiveness to the child's emotional reactions. The child perceives his painful reactive feelings are unwelcome or damaging to the caregiver and must be defensively sequestered in order to preserve the needed bond. Under such circumstances these walled off painful feelings become a source of lifelong inner conflict and vulnerability to traumatic states, and in analysis their re exposure to the analyst tends to be strenuously resisted.

The "Double Injury" of Childhood Trauma

In Confusion of Tongues (1932), Ferenczi describes trauma of child sexual abuse as a *double injury*: first, the child is overwhelmed by the intrusion of adult sexuality; second, and even more damaging, the child’s reality is betrayed when their protest or suffering is denied, dismissed, or punished. This second wound forces the child to disown their own experience and often to identify with the aggressor, leaving lasting psychological scars.

On Depression

"Endogenous depression is a myth, a psychiatric fantasy - not a reality. Every depression is caused by something depressing that has happened, with no exceptions. Sometimes though people don’t know what it is, or don’t want to know what is causing them to feel so bad. It is a paradox that human beings will plummet into deadly moods and all the while be avoiding or unable to look at what it is that has brought them there. Naive observers examine someone’s life and see none of the standard precipitants in the advent of depression – loss, disappointment, failure - and then - crudely, stupidly - draw the conclusion that it has arisen “from within,” endogenously, by which they usually mean from within the neurochemical environment of the person’s brain. Strangely enough, the patient will often cling to such an explanation, because the depression was actually experienced as “coming from nowhere,” as having no connection to the person’s present or past circumstances. What that means though is that the depression has been somehow stripped of its context – of depressing things happening – and the first step in helping such a person will be to restore the gloom that has enveloped him or her to its formative setting, its human context. There will be a story there, perhaps never before told, and one has to discover that story. Chemically numbing someone’s painful mood states would be the opposite of what would make sense in most instances."

On Therapeutic Change

"All we can do, and it's a great deal, is set the stage for change. To repeat, my therapeutic algorithm consists of a fixed and contained frame, a deconstructive inquiry which potentiates defenses and leads to a much augmented version of the patient's operations in the relationship with the therapist. It is there that the working-through takes place, for me not a simple clarification of dynamics, but a very complex, analogic experience which we can comment on, but never fully grasp conceptually"

On the Vulnerability of Children

"But the hearts of small children are delicate organs. A cruel beginning in this world can twist them into curious shapes. The heart of a hurt child can shrink so that forever afterward it is hard and pitted as the seed of a peach. Or again, the heart of such a child may fester and swell until it is a misery to carry within the body, easily chafed and hurt by the most ordinary things."

On Trauma

"If we are to be an understanding relational home for a traumatized person, we must tolerate, even draw upon, our own existential vulnerabilities so that we can dwell unflinchingly with his or her unbearable and recurring emotional pain. When we dwell with others’ unendurable pain, their shattered emotional worlds are enabled to shine with a kind of sacredness that calls forth an understanding and caring engagement within which traumatized states can be gradually transformed into bearable painful feelings."