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Trauma Cumulativo: Quando a estória sobrevive entre a repetição relacional do trauma e o corpo

Resumo

As formulações dominantes na literatura descrevem a perturbação pós-traumática como uma perturbação da memória. No âmbito de extensa investigação extra clínica e prática clínica, apresentamos um modelo das consequências pós-traumáticas como uma perturbação da identidade, especificamente uma dissociação estrutural da personalidade. Descrevemos a dissociação estrutural terciária associada ao trauma cumulativo precoce ocorrido num contexto relacional. Apresentamos a expressão da narrativa psíquica na dissociação estrutural terciária em duas modalidades: 1) enactment de sistemas relacionados dissociados na qual a divisão de múltiplas representações do self e dos objetos instauram a oscilação entre múltiplos sistemas relacionais: vítima, perseguidor e salvador; 2) preocupações ou sintomas somáticos com predomínio de um pensamento concreto que origina que o corpo seja o continente dos afetos não-elaborados e dessimbolizados expressos como memórias corporificadas. Propomos que a repetição relacional do trauma no triângulo do drama e/ou as preocupações ou sintomas somáticos deverão ser analisadas na relação transferência-contratransferência destes pacientes como procedimento de explicitação no aqui-e-agora dos sistemas relacionais implícitos. Este processo auxilia na estruturação e integração progressiva das partes dissociadas no self que promovem a mudança estrutural do psiquismo.

Palavras-chave

Trauma cumulativo, Identidade, Dissociação estrutural da personalidade, Triângulo do drama, Memórias corporificadas

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Biografia Autor

Paulo Ferrajão

Psicólogo Clínico, Professor Auxiliar. Faculdade de Ciências da Saúde e do Desporto, Universidade Europeia.

António Esteves

Psicólogo.

Mairi Stumpf

Psicóloga e Psicoterapeuta.


Referências

  1. Abraham, N., & Törok, M. (1995). A casca e o núcleo. Escuta.
  2. Alayarian, A. (2011). Trauma, torture, and dissociation: A psychoanalytic view. Karnac Books.
  3. Allen, J. (2005). Coping with trauma: Hope through understanding. American Psychiatric Publishing.
  4. Auerhahn, N. C., Laub, D., & Peskin, H. (1993). Psychotherapy with Holocaust survivors. Psychotherapy: Theory, Research, Practice, Training, 30(3), 434–442. https://doi.org/10.1037/0033-3204.30.3.434
  5. Bion, W. R. (1962). Learning from experience. Karnac Books.
  6. Bohleber, Werner. (2007). Recordação, trauma e memória coletiva: a luta pela recordação em psicanálise. Revista Brasileira de Psicanálise, 41(1), 154-175. http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pd=S0486-641X2007000100015&lng=pt&tlng=pt.
  7. Bokanowski, T. (2005). Variations on the concept of traumatism: traumatism, traumatic, trauma. The International journal of psycho-analysis, 86(2), 251-265. https://doi.org/10.1516/pplt-h9dr-dw3a-x1xu
  8. Bonomi, C. (2003). Between symbol and antisymbol: The meaning of trauma reconsidered. International Forum of Psychoanalysis, 12(1), 17-21. https://doi.org/10.1080/08037060310005214
  9. Boulanger, G. (2002). Wounded by reality: The collapse of the self in adult onset trauma. Contemporary Psychoanalysis, 38(1), 45–76. https://doi.org/10.1080/00107530.2002.10745806
  10. Bremner, J. D. (2007). Neuroimaging in posttraumatic stress disorder and other stress-related disorders. Neuroimaging Clin N Am, 17(4), 523-538, ix. https://doi.org/10.1016/j.nic.2007.07.003
  11. Bremner J. D. (2007). Neuroimaging in posttraumatic stress disorder and other stress-related disorders. Neuroimaging Clinics of North America, 17(4), 523–ix. https://doi.org/10.1016/j.nic.2007.07.003
  12. Bremner, J. D., & Vermetten, E. (2001). Stress and development: behavioral and biological consequences. Dev Psychopathol, 13(3), 473-489. https://doi.org/10.1017/s0954579401003042
  13. Bremne, J. D., & Vermetten, E. (2001). Stress and development: behavioral and biological consequences. Development and Psychopathology, 13(3), 473–489. https://doi.org/10.1017/s0954579401003042
  14. Bromberg, P. M. (2001). The gorilla did it: Some thoughts on dissociation, the real, and the really real. Psychoanalytic Dialogues, 11(3), 385–404. https://doi.org/10.1080/10481881109348619
  15. Brown, L. J. (2005). The cognitive effects of trauma: reversal of alpha function and the formation of a beta screen. The Psychoanalytic quarterly, 74(2), 397-420. https://doi.org/10.1002/j.2167-4086.2005.tb00212.x
  16. Brown, L. J. (2006). Julie’s museum: the evolution of thinking, dreaming and historicization in the treatment of traumatized patients. The International journal of psycho-analysis, 87(6), 1569-1585. https://doi.org/10.1516/bv7n-l9px-yjbr-cwej
  17. Caruth, C. (1995). Trauma: Explorations in memory. The John Hopkins University Press.
  18. Cohen, J. (1985). Trauma and repression. Psychoanalytic Inquiry, 5(1), 163–189. https://doi.org/10.1080/07351698509533580
  19. Daud, A., af Klinteberg, B., & Rydelius, P. A. (2008). Trauma, PTSD and personality: the relationship between prolonged traumatization and personality impairments. Scandinavian journal of Caring Sciences, 22(3), 331–340. https://doi.org/10.1111/j.1471-6712.2007.00532.x
  20. Davies, J. M., & Frawley, M. G. (1994). Treating the adult survivor of childhood sexual abuse: A psychoanalytic perspective. Basic Books.
  21. De Bellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A., Frustaci, K., & Ryan, N. D. (1999). A.E. Bennett Research Award. Developmental traumatology. Part II: Brain development. Biol Psychiatry, 45(10), 1271-1284. https://doi.org/10.1016/s0006-3223(99)00045-1
  22. Ferenczi, S. (1949). Confusion of tongues between adults and the child: The language of tenderness and of passion. Contemporary Psychoanalysis, 24(2), 196–206. https://doi.org/10.1080/00107530.1988.10746234
  23. Ferrajão, P. C., Badoud, D. M., & Oliveira, R. A. (2017). Mental strategies as mediators of the link between attachment and PTSD. Psychological trauma: Theory, research, practice and policy, 9(6), 731–740. https://doi.org/10.1037/tra0000251
  24. Ferrajão, P. C., & Elklit, A. (2020). World assumptions and posttraumatic stress in a treatment-seeking sample of survivors of childhood sexual abuse: A longitudinal study. Psychology of Violence, 10(5), 501–508. https://doi.org/10.1037/vio0000280
  25. Ferrajão, P., & Elklit, A. (2021). Attachment and social support mediate associations between polyvictimization and psychological distress in early Uganda and Kenya adolescents. Child Abuse & neglect, 121, 105271. https://doi.org/10.1016/j.chiabu.2021.105271
  26. Ferrajão, P. C., & Oliveira, R. A. (2015). From self-integration in personal schemas of morally experiences to self-awareness of mental states: A qualitative study among a sample of Portuguese war veterans. Traumatology, 21(1), 22-31. https://doi.org/10.1037/trm0000019
  27. Freud, S. (1895). Studies on hysteria. In Standard Edition 2. Hogarth Press.
  28. Freud, S. (1914). Remembering, repeating, and working-through. In Standard Edition 12 (pp. 147-156). London: Hogarth Press.
  29. Garland, C. (Eds.) (1998). Understanding trauma – A psychoanalytical review. Karnac Books.
  30. Gerson, S. (2009). When the third is dead: Memory, mourning, and witnessing in the aftermath of the Holocaust. The International Journal of Psychoanalysis, 90(6), 1341-1357. https://doi.org/10.1111/j.1745-8315.2009.00214.x
  31. Gerzi, S. (2005). Trauma, narcissism and the two attractors in trauma. The International Journal of Psychoanalysis, 86(4), 1033–1050. https://doi.org/10.1516/2TTK-G0TL-9DWL-UHWY
  32. Grinberg, L. (2001). Teoría da identificação. Climepsi.
  33. Grubrich-Simitis, I. (1981). Extreme traumatization as cumulative trauma -Psychoanalytic investigations of the effects of concentration camp experiences on survivors and their children. Psychoanalytic Study of the Child, 36(1), 415-450. https://doi.org/10.1080/00797308.1981.11823352
  34. Hartke, R. (2005). The basic traumatic situation in the analytical relationship. International Journal of Psycho-Analysis, 86(2), 267-290. https://doi.org/10.1516/T89E-QAL4-P81C-XDXJ
  35. Herman, J. (1992). Trauma and recovery: The aftermath of violence. Basic Books.
  36. Hopper, E. (1991). Encapsulation as a defence against the fear of annihilation. The International journal of psycho-analysis, 72 (4), 607-624. https://pubmed.ncbi.nlm.nih.gov/1797716/
  37. Jackowski, A., de Araújo, C., de Lacerda, A., Mari, J. J., & Kaufman, J. (2009). Neurostructural imaging findings in children with post-traumatic stress disorder: Brief review. Psychiatry Clin Neurosci, 63(1), 1-8. https://doi.org/10.1111/j.1440-1819.2008.01906.x
  38. Janet , P. (1889). L’automatisme psychologique. Alcan.
  39. Khan, M. R. (1963). The concept of cumulative trauma. Psychoanalytic Study of the Child, 18(1), 286-306. https://doi.org/10.1080/00797308.1963.11822932
  40. Knox J. (2003). Trauma and defences: their roots in relationship. An overview. The Journal of Analytical Psychology, 48(2), 207–233. https://doi.org/10.1111/1465-5922.t01-2-00007
  41. Kramer, M., Schoen, L. S., & Kinney, L. (1987). Nightmares in Vietnam veterans. The Journal of the American Academy of Psychoanalysis, 15(1), 67–81. https://doi.org/10.1521/jaap.1.1987.15.1.67
  42. Laub, D., & Auerhahn, N. C. (1989). Failed empathy: a central theme in the survivor’s holocaust experience. Psychoanalytic Psychology, 6(4), 377-400. https://doi.org/10.1037/0736-9735.6.4.377
  43. Laub, D., & Lee, S. (2003). Thanatos and massive psychic trauma: the impact of the death instinct on knowing, remembering, and forgetting. Journal of the American Psychoanalytic Association, 51(2), 433-464. https://doi.org/10.1177/00030651030510021201
  44. Leuzinger-Bohleber, M. (2008). Biographical truths and their clinical consequences: understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis. The International journal of psycho-analysis, 89(6), 1165-1187. https://doi.org/10.1111/j.1745-8315.2008.00100.x
  45. Lindy, J. D. (1985). The trauma membrane and other clinical concepts derived from psychotherapeutic work with survivors of natural disasters. Psychiatric Annals, 15(3), 153–160. https://doi.org/10.3928/0048-5713-19850301-06
  46. Lindy, J. D., & Wilson, J. P. (2001). Respecting the trauma membrane: Above all, do no harm. In J. P. Wilson, M. J. Friedman, J. D. Lindy (Eds.), Treating psychological trauma and PTSD (pp. 432-445). Guilford Press.
  47. Liotti, G. (1999). Understanding the dissociative processes: The contribution of attachment theory. Psychoanalytic Inquiry, 19(5), 757-783. https://doi.org/10.1080/07351699909534275
  48. McDougall J. (1984). The “dis-affected” patient: reflections on affect pathology. The Psychoanalytic Quarterly, 53(3), 386–409.
  49. Meissner, W. W. (2006). Psychoanalysis and the mind-body relation: Psychosomatic perspectives. Bulletin of the Menninger Clinic, 70(4), 295-315. https://doi.org/10.1521/bumc.2006.70.4.295
  50. Miliora, M. T. (1998). Trauma, dissociation, and somatization: a self-psychological perspective. The Journal of the American Academy of Psychoanalysis, 26(2), 273-293. https://doi.org/10.1521/jaap.1.1998.26.2.273
  51. Mitrani, J. L. (1995). Toward an understanding of unmentalized experience. The Psychoanalytic quarterly, 64(1), 68-112. https://doi.org/10.1080/21674086.1995.11927444
  52. Ogden, T. H. (1989). The primitive edge of experience. Jason Aronson.
  53. Orlandini, A. (2004). Repetition compulsion in a trauma victim: Is the “Analgesia principle” beyond the pleasure principle? Clinical implications. Journal of the American Academy of Psychoanalysis, 32(3), 525–540. https://doi.org/10.1521/jaap.32.3.525.44777
  54. Rosenbaum, B., & Varvin, S. (2007). The influence of extreme traumatization on body, mind and social relations. The International Journal of Psycho-analysis, 88(Pt 6), 1527–1542. https://doi.org/10.1111/j.1745-8315.2007.tb00758.x
  55. Stein H. H. (2007). Combat veterans: impressions of an analytic observer in a non-analytic setting. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 35(4), 575–589. https://doi.org/10.1521/jaap.2007.35.4.575
  56. van der Hart, O., Nijenhuis, E., Steele, K., & Brown, D. (2004). Trauma-related dissociation: conceptual clarity lost and found. The Australian and New Zealand Journal of Psychiatry, 38(11-12), 906–914. https://doi.org/10.1080/j.1440-1614.2004.01480.x
  57. van der Kolk B. A. (1989). The compulsion to repeat the trauma. Re-enactment, revictimization, and masochism. The Psychiatric Clinics of North America, 12(2), 389–411.
  58. van der Kolk, B. A. (1996). The body keeps the score. Approaches to the psychobiology of posttraumatic stress disorder. In B. A. van der Kolk , A. C. McFarlane & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 214-241). Guilford Press.
  59. van Harmelen, A., van Tol, M. J., van der Wee, N. J., Veltman, D. J., Aleman, A., Spinhoven, P., van Buchem, M. A., Zitman, F. G., Penninx, B. W., & Elzinga, B. M. (2010). Reduced medial prefrontal cortex volume in adults reporting childhood emotional maltreatment. Biol Psychiatry, 68(9), 832-838. https://doi.org/10.1016/j.biopsych.2010.06.011
  60. Varvin, S. (2003). Extreme traumatisation: Strategies for Mental Survival. International Forum of Psychoanalysis, 12 (1), 5-12. (1976).
  61. Varvin, S. (2007, July). Trauma and resilience. Paper presented at45th International Psychoanalytical Association Congress, Berlin, Germany.
  62. Varvin, S., & Rosenbaum, B. (2015). Trauma: Depletion and resilience. Revista Portuguesa de Psicanálise, 34(2), 6-17.
  63. Winnicott, D. W. (1997). Introdução primária à realidade externa: os estágios iniciais. In D. W. Winnicott, Pensando sobre crianças. Artmed.
  64. Winnicott, D. W. (1956/2000). A preocupação materna primária. In D. W. Winnicott, Da pediatria à psicanálise: obras escolhidas (pp. 399-405). Imago.
  65. Yorke C. (1986). Reflections on the problem of psychic trauma. The Psychoanalytic Study of the Child, 41, 221–236. https://doi.org/10.1080/00797308.1986.11823458