Response to Don Kalsched's ‘Daimonic elements in early trauma’ and Elizabeth Urban's ‘Developmental aspects of trauma and traumatic aspects of development’
Kalsched is well known as the author of The Inner World of Trauma, in which he examines ‘what happens in the inner world… when life in the outer world becomes unbearable’. This book presented another way of looking at and understanding the inner world phenomena which arose in response to trauma, defined as ‘unbearable anxiety’. By carefully examining the dreams which immediately followed the events his patients described, Kalsched found that he was being presented with images of the way the psyche defended itself. The metaphor he used to describe this imagery was that it was a portrait of an archetypal defence system. Kalsched's thesis is that these defence systems are attempts by the patient to contain the trauma and can act as an obstacle to the therapeutic endeavour. Masud Khan, quoted by Kalsched, referred to this difficulty in working with traumatized patients as ‘the difficulty in making progress with the patient's practice of self cure’. The latter phrase has been adapted by Kalsched who calls this defensive system a ‘self care system’.
Kalsched's work illustrates the fact that while we are getting better at seeing where illness has started and where its roots may lie, we still find it extremely difficult to shift the effects of years of our patients looking after themselves in ways which are no longer adapted to reality. When it becomes apparent to Kalsched's patients that their self cure/self care systems are not working, they seek help.
Kalsched has developed a theory based on his clinical experience that this ‘self care’ system, once an ally and defence against further trauma, contributes to the atrophying of the creative and life-giving qualities of the self. This ‘self care’ system can be thought of as a version of Fordham's defences of the self. Kalsched describes it as if a part of the psyche outside the ego reacts to what feels like a repetition in the transference of the original trauma, sometimes called re-traumatization, (wrongly and inaccurately in my opinion) by itself taking possession of the psyche like a daimonic, harmful spirit. This archetypal defence is characterized by dissociation. Dissociation means the personal pain and memories which are part of the experience are kept separate from the experience. Kalsched's thesis is that the nature of the ‘self care’ system takes the sufferer away from the ordinary and leads them towards the extraordinary, the daimonic.
In what way is this ‘self care’ system different from the dissociated material which we encounter in the analysis of the shadow? The main difference between this shadow material and that of ‘ordinary’ neurosis is that ‘ordinary’ neurosis does not originate in trauma. For traumatized patients such as Kalsched's the trauma was such that it could not be managed, and so could not be recognized by the ego: the experience was therefore split off, sometimes into the patient's body, to be protected by the usual amnesias.
There is a similarity here to Rosenfeld's descriptions of how patients through projective identificatory mechanisms identify with damaged internal objects, felt to be somatic, i.e., they become hypochondriacal; a confusion of self and object thus arises and this constellation is hung onto as a defence against the integration of another part of the self in which depressive and persecutory anxieties exist (Rosenfeld 1958). For these patients it is unbearable to come face to face with the impact of their depression and feelings of persecution. In my experience this area of the analysis of the projective identificatory content, and the struggle the patient puts up against reintegrating depressive and persecutory pain is the core of the initial task when working with traumatized/abused patients.
If the analysis is to succeed, the patient has to have the experience in the transference with the analyst, which means that the cycle of abusing the analyst and feeling abused by the analyst has to be lived through, with different outcomes. Some analysts have commented that what they have to go through to facilitate the integration of these dissociated experiences is more than they wish to repeat. Joanne certainly put Dr Kalsched through the mill. And it is the treatment of these patients that I want to think about in relation to Kalsched's theory. Many clinicians will recognize the patient's behaviour in analysis as Kalsched describes it and the ways these patients create confusion in the analyst, how they behave in an aggrieved and also an entitled way. They want special treatment, but woe betide the analyst if he gives it. In a sense the analyst feels as if he is damned if he does and damned if he doesn’t.
In discussing Kalsched's work I want first to comment on his language which personifies hypothetical structures and mixes Winnicott's ideas with Fordham’s. Kalsched speaks of the way trauma threatens the existence of ‘personal self hood’ in the developing psyche of the child. Personal selfhood sounds as if it is something to do with a sense of oneself and thus is part of the ego. But Kalsched I think means something to do with the ‘Jungian self’. He also uses the Winnicottian idea of an initial state of unintegration which he describes as being ‘merged with the mother’. Fordham has gone to considerable lengths to demonstrate that this Jungian fallacy of the mother and child being in an initial state of merger is at best episodic and not a core state of the developing infant, whose self deintegrates and reintegrates, but is separate from the mother before birth (Fordham 1985).
In trying to understand this confusing mix of incompatible theories I wondered whether what was being described was not a hypothetical developmental model but a reconstruction from an aspect of Kalsched's transference feelings for his adult patients, whose transference to him he uses as much as he analyses. The further difficulty with the personification and concretization of psychic structures is that it gives the impression that he is describing something which exists rather than describing ways of experiencing. Phrases such as ‘basic fault’, ‘falling into an archetypal world already there to catch her’ suggest a world ‘out there’ which can be talked about as separate from the patient's observing self. This can lead to a false observing position from which the patient Joanne, e.g., interacts with her analyst, when in fact her inner world has not developed sufficiently for her to have achieved a resolution of the trauma nor a resolution of the Oedipal situation.
Kalsched's conceptualization also raises questions about the containing aspect of the self and what is contained by what. This in turn has implications for analytic technique and practice. In what follows I am going to describe how I understand analysis and in so doing I am implicitly asking Kalsched, how he thinks his analysis works. I have in mind here the evidence in his paper (in this vol of JAP) of the patient Joanne and the other accounts in his book, where following a period of mutual unconsciousness in which Kalsched often found himself behaving in untypical ways with patients, such as giving his home telephone number, or arranging a special session to look at films of the patient's childhood, the analysis then takes off in what is described as the beginning of the therapeutic resolution.
Joanne fell in love with Dr Kalsched. Her intense Oedipal feelings were activated in the transference and when she telephoned him at 3 am she was clearly wanting to get between mummy and daddy. When daddy told her to go back to her own room she could begin to examine this whole constellation of being addicted to an abusing object, treating it as if she was entitled to special treatment while also feeling a poor little abandoned girl. This process was present in the night time phone call. To translate this into my theory, that is my Jungian version of object relations, the act of giving the patient Joanne his home number was felt by her both as love/care/agape and abuse. On the one hand, it seemed like a proof of love, on the other, it confirmed for the patient that she had something in her which was bad and made even her analyst behave in an inappropriate manner. It was a countertransference enactment which contained the elements of the patient's psychopathology which had not been integrated and which needed working through. Gradually we are told this experience of giving the telephone number took on a symbolic meaning in the psyche and the obstacles in the way of the analysis (the ‘self care’ system) dissolved. At least that is how it is described. There seems to be almost a paradox here. By pushing the analyst's boundaries did the patient start to find her own? Or, more likely, did the countertransference enactment alert the analyst to the need to be firmer and thus more containing to his patient? Did the concreteness of the act give the momentum to the integration? If there is some truth to this view it raises questions about whether this was a conscious technique, which I do not think it was, or was it something which arose from Kalsched's particular interactions with his patient which lead him to substitute actions for words. If it is the latter, then it is probably not to be generalized except in the manner of Jung's encouragement to us to find individual solutions to our patient's needs. Potentially it seems a high risk strategy to abandon language for actions. The patient's shadow feelings about herself would have to be worked over again and again, but I am not convinced this happened.
If it did not happen, then her recovery might be part of a manic defence whereby the patient could claim to have integrated the experience of getting her analyst to cross the boundary, while simultaneously denying the loss of the analysis and burying her anger about feeling she is rotten to the core and beyond redemption as confirmed by her successful seduction of him.
If I bring my own experience of analysing traumatized patients into this discussion I recognize that at this moment of countertransference enactment, the patient has, so to say triumphantly, put the analyst in the position she has felt in all her life. The analyst has been cornered, which is the patient's experience. The analyst feels guilty and aggrieved, which the patient feels much of the time. In other words this is projective identification writ large and as such requires analysis of a meticulous kind, using what Roth calls level 3 and 4 interpretations (Roth 2001). A level 3 interpretation is one in which the analyst addresses ‘the way in which patients feel we are enacting, and indeed pull us to enact in the session the scenarios of their inner world – in order to maintain an inner status quo’. A level 4 interpretation is one in which the analyst recognizes that an unconsidered response of his reflects an enactment which refers both to the patient and the analyst and their defences and may lead to the analyst making an interpretation to himself before being able to address what is happening between him and his patient. When the analyst then speaks to the patient what he says might have the form, ‘I am repeatedly taking up your… and this is like your experience in the dream…’, thereby linking the analyst's behaviour in the session to the patient's fantasy or dream thoughts. This personal attention to the process is a painful and difficult task with frequently most unpleasant countertransference affects. It is ordinary, not daimonic and requires repeated and careful interpretation.
Kalsched's ‘self care’ system gives rise to splitting and idealization. Polar opposites appear which can be investigated and elucidated through the transference. In this way the transference becomes memory in action and the evidence of the distortion in the patient's adaptation to reality. The transference has emotional and structural features which are archetypal, but these are not primarily understood, by me certainly, as personifications of archetypal content. Kalsched's thesis is that I am missing something vital. But I am reminded here of Jung's statement:
Interpretations make use of certain linguistic matrices that are themselves derived from primordial images. From whatever side we approach this question, everywhere we find ourselves confronted with the history of language, with images, motifs that lead straight back to the primitive wonder-world.
(Jung 1958, para. 67)
In other words, perhaps we too reach into the collective when we genuinely interpret unconscious affect.
Kalsched's approach raises other questions about technique. I am thinking in particular about how the analyst working within this understanding of the daimonic handles the negative affect which has to be faced for the integration of the opposites within the personality. Can the negative affect be integrated without it being interpreted in relation to the analyst? And does the infrequency of the interviews make this harder to contain within the analysis?
This is not to say that the transference is the only space where links between symbolic resolutions and containment occur. We know from Jung's work and our own that in the analysis of dreams we are able to help our patients bring together unconscious affect and the ego.
A further reflection I have is, what bearing does the enactment just described (with Joanne) have on Jung's statement that patients need a real relationship with their analyst? Is Kalsched behaving in a ‘real’ way? Is this enactment an incarnation – what Kalsched was referring to when he said: ‘the magical layer of the unconscious cannot be assimilated by the ego until it has been incarnated in a human interaction (Kalsched 1996, p. 26)’? Does the analyst have to become the embodiment of an archetypal image for the analysis of traumatized patients to progress?
Fordham/Plaut discussed the impossibility of incarnating the archetype in the early 70s ( JAP 1970, Vol. 15, 1 & 2). The background to this was the Society of Analytical Psychology's (SAP’s) interest in interpretation and language, countertransference and technique and how too many different languages for the same phenomenon lead to what Bion called the ‘Tower of Babel situation’, i.e., a confusion of tongues. The reason I bring this in here is that Kalsched's language necessarily evokes what Jung called the ‘primitive wonder world’. The question then arises whether the analyst, by interpreting in the language of daimonic possession, is incarnating the spirit world in a way which obscures a more transference based conceptualization?
By using the language of daimonic possession are we making a dynamic process static/immobile/fascinating? If we focus on the image, is the delusional projective dynamic in the transference lost, i.e., not analysed? And is Kalsched's solution to this quandary therefore to project into a transitional play area (in Winnicott's language) those aspects of the archetypal image which if kept too close to the ego might threaten it? And does he through this reprojection accomplish the analysis there? This in the Roth formulation would be a level 2 interpretation. A level 2 interpretation is one in which the analyst is trying to introduce the patient to aspects of ‘herself and her internal object relationships that she does not consciously experience or know about’ (Roth 2001, p. 534).
Putting this another way, is introjection of an image a manifestation of an inner desire, delusion, or projection, which is Jung's view, or is it the taking of the outside world into the inside? This second view is Ferenczi's (Ferenczi 1926). I am not sure what Kalsched's position is on this as he implies that Ferenczi's position is congruent with Jung’s.
In the first case example Kalsched describes the patient saying to him that when she was being violated as a child she dissociated and went into ‘the arms of the blessed mother’. His comment on that is to say, ‘this true self potential fell into an archetypal world already there to catch her… the Great Mother, in the absence of her personal mother’. As well as this archetypal perspective there is also one which comes from the projective identificatory content of the exchange Kalsched is having with his patient. In this formulation the patient has projected an idealized mother into her analyst with the purpose of protecting her/him from the anger and guilt this patient felt that this mother/analyst went off and left her to the mercy of her father every Sunday. The reference to her personal mother's church going is present in the words and images she uses, ‘the arms of the blessed mother’. This is personal experience writ large. These two elements, the archetypal and the personal, are both present. Kalsched in using the language of metapsychology is emphasizing the archetypal underpinning of the psyche, that his patient was able to turn to this fantasy (the arms of the blessed mother) as a refuge at the time the trauma was happening.
The other feature of Kalsched's approach which I want to mention is the self. Fordham thought that the defences of the self were a powerful and distorted manifestation of a system, which was often seemingly implacable. The ring round the mandala is for keeping out the intruders as well as keeping in whatever it is in each individual's myth which constitutes their soul (Fordham 1985). Kalsched has stated in his book his view that in the traumatized patient the spirit pole of the archetype attacks the instinctual pole with the consequence that the self in this anthropomorphic representation becomes the hostage. Jung's concept of the purposive actions of the psyche has been lost to the patient in this description. Perhaps it could be reintroduced by the analyst's use of analyst-centred interpretation (Steiner 1993, chap. 11).
If Kalsched's theme is how the investigation and treatment of traumatic events lead to development, Urban's theme is the study of developmental lines which become traumatic. Essentially what she is asking us to think about is how in the structuring of the personality, when surges of development trigger ever more complex structures, the potential for the establishment of what may become internal trauma occurs. The events are seemingly ordinary, everyday ones, but careful observation reveals them to be mighty in their impact, not least because of their timing.
Urban shows how the developmental line starts in ordinary experience rather than an obviously traumatic one, and how under pressure it may develop into a fissure. Her sources are not just the analytical and psychotherapeutic, but the experimental and observational data which is now available.
Urban's conceptualization builds on the deintegrative/reintegrative model of Michael Fordham. This is important as she is drawing attention to the fact that the Winnicottian description of the infant being unintegrated at birth is not part of our Jungian model. Observational data indicate that discriminatory processes start very early in the psyche, pre-ego though not pre-self. They predate the sense of self, but then that is an ego function. Fordham thought that actions of the self could certainly be observed in utero. And our theorizing, what Kalsched has called in a resonant phrase ‘the quantum physics of the baby-mind’, has at its centre the presence of the self and its actions from the beginning of life. Urban's work derives from careful attention to small behaviours over time and the conceptualization of them. Thus saying no to a child less than 10 months old is not understood by the child as an instruction not to do something; later, saying no, becomes meaningful, and when associated with the loss of mother and the arrival of a usurper, as with Barnaby, traumatic. The line Urban traces shows how developmental and emotional factors interact to give significance to the inevitable events of family life. Her investigation of origins leads her to posit that as the nervous system matures according to its timetable, so the mutual responses of the parent and child alter. The scope here for understanding internal trauma revealed by our adult patients when they regress is very great.
In the case material from the analysis of Charles we see how the recent break-up of his long-standing relationship with Donna revived feelings from his Oedipal situation and his feelings of inferiority and loss in relation to a powerful father. In Urban's material the traumatized aspects of the personality related to failures in development are revealed and analysed in the context of personal experience deriving from childhood; in Kalsched's material the image is approached as a personification of a transpersonal care system, with personal resonances.
One of the differences which I am highlighting reveals our attitude to the psyche and the self. Kalsched sees his traumatized patients less frequently than SAP trained analysts do and he emphasizes in the analysis his work on his patient's dream life. This method relies heavily, I would suggest, on the integrative actions of the self during periods of severe emotional instability. Urban's method derives from her experience of infancy and childhood. It leads her to see the patient more frequently and to provide in the analytic frame the containment the patient needs during periods of extreme turmoil. Is it perhaps the analytic frame that represents the enactment of care for our patients here in the UK? Both methods rely on the integrative action of the self, but Urban's approach attends to the patient's ego weaknesses in a more literal way. In a sense you could say that Urban's analytic frame provides the structure within which the analytic care system can operate, while Kalsched's analytic frame encourages the patients to objectify their psychic experience such that they can monitor their autonomous ‘self care’ system which has broken down.
But Kalsched's view is that the self as described by Jung is not up to the task of looking after the whole personality and that Jung overestimated the integrative capacities of the self. Other writers have pointed out that Jung has tended to idealize the self and Satinover linked this to loss and a failure to mourn (Satinover 1985). Inherent in this argument is a view that Jung's approach does not differentiate self and object. When in a Jungian patient's dream a significant figure is killed it is likely to be understood as a part of the self being attacked by another part. This is used defensively to mean that these warring internal figures are expressing aggressive drives which are maladapted to the situation (or not as the case may be). Support for this view comes from Jung's description of his own ‘confrontation with the unconscious’, in which he described what he was doing as a ‘scientific experiment which I myself was conducting’. It was either this or what he called ‘ losing command of myself’ and ‘becoming prey to the fantasies – and as a psychiatrist I realized only too well what that meant’ (Jung 1963, p. 172). What is not addressed is that the dream may be pointing to the unbearable loss which murdering an ambivalently held object entails, and that this consequently involves a process of painful mourning. This brings together what Rosenfeld (1958) noted was persecutory and depressive anxiety.
In thinking about technique Urban illustrated how her countertransference affects were communications from the patient's unconscious which she formulated into interpretations. This model helped her understand her patient's dream world and its relation to his self. She illustrated this in her interpretation of the dreams of her adult patient. Kalsched's approach, if I have understood him correctly, is to help his patients see that the figures in their dreams are manifestations of an archetypal defensive system. Does this approach involve what Kalsched in his book described as ‘softer techniques’? One way of thinking about this is to ask oneself whether archetypal images primarily express parts of the self, or whether they express the way human beings interact.
In one sense one could describe Kalsched's approach as being within the overall Jungian position that in each of us is something primitive and elemental which is activated by trauma. It is possible to address this by modifying the defensive system which has contained the person up to this point. Monitoring of this process goes on through dream imagery. The other point of view thinks of trauma as disruptions in object relationships, in particular, object relationships which are not sufficiently differentiated with the result that self and object get muddled up. The patient hates herself for hating the analyst in a way which paralyses her.
Finally, I would like to say that I particularly value this opportunity to explore and discuss these issues which are from different clinical approaches. Especially valuable is this context are Kalsched's care and attention to the work of Jung and Freud.
Trauma is like a complex which is highly resistant to being re-examined; it is subject to repeated attacks from what in object relations theory is often described as an internal saboteur. The effects of trauma are often psychotic in their emotional intensity and dissociated features. This is very marked, for instance, in adults who have suffered abuse as children; here the trauma as a complex can often contain the subversive and powerful feeling expressed by the patient, that what happened, happened because they deserved it, and made it happen, because they were bad. This view of the trauma as complex treats the experience as organized and all of a piece, albeit subject to splitting and idealization and containing dissociated experience.
Some of the points I have made are quite simple, some are very complicated and all have been stimulated by my engagement with the work of Kalsched and Urban. I have given Kalsched's work more attention because I am familiar with Urban's way of thinking and this has informed the questions I have raised about Kalsched's approach. In summary I am grateful to both authors for exposing their work to our scrutiny.