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If you follow one of the above physician assistant hyperlinks, or take a look at the website that might have popped up when you entered my, not yet so fantastic site, you'll see what I mean. These physician assistant sites are so useful that they put my little effort to shame. Seeing I'm not exactly flushed with content yet, you may as well leave my little website now to visit one of the physician assistant sites I've linked to. But before you do go I'd just like to say that I'm putting lots of work and effort into this physician assistant place of mine and I'd be pleased if you'd remember it and come back again one day soon. Traumas as Social Interactions by: Sam Vaknin
("He" in this text - to mean "He" or "She"). We react to serious mishaps, life altering setbacks, disasters, abuse, and death by going through the phases of grieving. Traumas are the complex outcomes of psychodynamic and biochemical processes. But the particulars of traumas depend heavily on the interaction between the victim and his social milieu. It would seem that while the victim progresses from denial to helplessness, rage, depression and thence to acceptance of the traumatizing events - society demonstrates a diametrically opposed progression. This incompatibility, this mismatch of psychological phases is what leads to the formation and crystallization of trauma. PHASE I Victim phase I - DENIAL The magnitude of such unfortunate events is often so overwhelming, their nature so alien, and their message so menacing - that denial sets in as a defence mechanism aimed at self preservation. The victim denies that the event occurred, that he or she is being abused, that a loved one passed away. Society phase I - ACCEPTANCE, MOVING ON The victim's nearest ("Society") - his colleagues, his employees, his clients, even his spouse, children, and friends - rarely experience the events with the same shattering intensity. They are likely to accept the bad news and move on. Even at their most considerate and empathic, they are likely to lose patience with the victim's state of mind. They tend to ignore the victim, or chastise him, to mock, or to deride his feelings or behaviour, to collude to repress the painful memories, or to trivialize them. Summary Phase I The mismatch between the victim's reactive patterns and emotional needs and society's matter-of-fact attitude hinders growth and healing. The victim requires society's help in avoiding a head-on confrontation with a reality he cannot digest. Instead, society serves as a constant and mentally destabilizing reminder of the root of the victim's unbearable agony (the Job syndrome). PHASE II Victim phase II - HELPLESSNESS Denial gradually gives way to a sense of all-pervasive and humiliating helplessness, often accompanied by debilitating fatigue and mental disintegration. These are among the classic symptoms of PTSD (Post Traumatic Stress Disorder). These are the bitter results of the internalization and integration of the harsh realization that there is nothing one can do to alter the outcomes of a natural, or man-made, catastrophe. The horror in confronting one's finiteness, meaninglessness, negligibility, and powerlessness - is overpowering. Society phase II - DEPRESSION The more the members of society come to grips with the magnitude of the loss, or evil, or threat represented by the grief inducing events - the sadder they become. Depression is often little more than suppressed or self-directed anger. The anger, in this case, is belatedly induced by an identified or diffuse source of threat, or of evil, or loss. It is a higher level variant of the "fight or flight" reaction, tampered by the rational understanding that the "source" is often too abstract to tackle directly. Summary Phase II Thus, when the victim is most in need, terrified by his helplessness and adrift - society is immersed in depression and unable to provide a holding and supporting environment. Growth and healing is again retarded by social interaction. The victim's innate sense of annulment is enhanced by the self-addressed anger (=depression) of those around him. PHASE III Both the victim and society react with RAGE to their predicaments. In an effort to narcissistically reassert himself, the victim develops a grandiose sense of anger directed at paranoidally selected, unreal, diffuse, and abstract targets (=frustration sources). By expressing aggression, the victim re-acquires mastery of the world and of himself. Members of society use rage to re-direct the root cause of their depression (which is, as we said, self directed anger) and to channel it safely. To ensure that this expressed aggression alleviates their depression - real targets must are selected and real punishments meted out. In this respect, "social rage" differs from the victim's. The former is intended to sublimate aggression and channel it in a socially acceptable manner - the latter to reassert narcissistic self-love as an antidote to an all-devouring sense of helplessness. In other words, society, by itself being in a state of rage, positively enforces the narcissistic rage reactions of the grieving victim. This, in the long run, is counter-productive, inhibits personal growth, and prevents healing. It also erodes the reality test of the victim and encourages self-delusions, paranoidal ideation, and ideas of reference. PHASE IV Victim Phase IV - DEPRESSION As the consequences of narcissistic rage - both social and personal - grow more unacceptable, depression sets in. The victim internalizes his aggressive impulses. Self directed rage is safer but is the cause of great sadness and even suicidal ideation. The victim's depression is a way of conforming to social norms. It is also instrumental in ridding the victim of the unhealthy residues of narcissistic regression. It is when the victim acknowledges the malignancy of his rage (and its anti-social nature) that he adopts a depressive stance. Society Phase IV - HELPLESSNESS People around the victim ("society") also emerge from their phase of rage transformed. As they realize the futility of their rage, they feel more and more helpless and devoid of options. They grasp their limitations and the irrelevance of their good intentions. They accept the inevitability of loss and evil and Kafkaesquely agree to live under an ominous cloud of arbitrary judgement, meted out by impersonal powers. Summary Phase IV Again, the members of society are unable to help the victim to emerge from a self-destructive phase. His depression is enhanced by their apparent helplessness. Their introversion and inefficacy induce in the victim a feeling of nightmarish isolation and alienation. Healing and growth are once again retarded or even inhibited. PHASE V Victim Phase V - ACCEPTANCE AND MOVING ON Depression - if pathologically protracted and in conjunction with other mental health problems - sometimes leads to suicide. But more often, it allows the victim to process mentally hurtful and potentially harmful material and paves the way to acceptance. Depression is a laboratory of the psyche. Withdrawal from social pressures enables the direct transformation of anger into other emotions, some of them otherwise socially unacceptable. The honest encounter between the victim and his own (possible) death often becomes a cathartic and self-empowering inner dynamic. The victim emerges ready to move on. Society Phase V - DENIAL Society, on the other hand, having exhausted its reactive arsenal - resorts to denial. As memories fade and as the victim recovers and abandons his obsessive-compulsive dwelling on his pain - society feels morally justified to forget and forgive. This mood of historical revisionism, of moral leniency, of effusive forgiveness, of re-interpretation, and of a refusal to remember in detail - leads to a repression and denial of the painful events by society. Summary Phase V This final mismatch between the victim's emotional needs and society's reactions is less damaging to the victim. He is now more resilient, stronger, more flexible, and more willing to forgive and forget. Society's denial is really a denial of the victim. But, having ridden himself of more primitive narcissistic defences - the victim can do without society's acceptance, approval, or look. Having endured the purgatory of grieving, he has now re-acquired his self, independent of societ |
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