How Trauma Heals: Catharsis Revisited

how-trauma-heals

The very latest discoveries in the field of trauma therapy take us back just over 120 years to the first days of talk therapy. Dr. Breuer, Freud’s colleague and mentor, was using the then-standard technique of hypnotic suggestion to help a vivacious young woman named Bertha who suffered from severe symptoms of hysteria. She told Dr. Breuer to stop the suggestions and just listen as she recounted experiences of early sexual trauma. She called it “chimney sweeping.” As she told her story, her symptoms melted away. Freud was excited to hear of an alternative to the hypnotic suggestion treatment he didn’t like. He convinced his colleague to publish a paper together (1893) in which they described the healing mechanism and called it catharsis. Here is their analysis:

“We found to our great surprise at first, that each individual hysterical symptom immediately and permanently disappeared when we had succeeded in bringing clearly to light the memory of the event by which it was provoked and in arousing its accompanying affect…”

The latest in trauma therapy is the discovery that definitive resolution of traumatic experiences does require that the feelings be fully accessed. This is the hardest part of the work because re-experiencing the most terrible events, along with feelings of helplessness, terror, and humiliation, is just what survivors have worked so strenuously to avoid.

patrick1212blogWhat else modern trauma therapy is discovering is that for patients to find the courage to access their feelings, they need to do so in a context of safety, trust, and empathic engagement. I think we should give Freud and Breuer a break here, because they were Victorian scientists. They were trying to establish that their science was “objective”—that is, not influenced by the scientist-observer—so they tried (in vain) to keep an emotional distance and didn’t talk about the real human connection that was an essential part of the therapy they conducted.

Freud and Breuer did know quite a bit about hypnosis and dissociation. What the trauma field is relearning is that the dazed look we see in the faces of trauma victims is a result of dissociation, a phenomenon related to self-hypnosis. Humans, some more than others, are capable of distancing feelings and even memories and other mental contents through the capacity we call dissociation. This ability to split one’s consciousness provides remarkable protection from the overwhelming emotions that are part of trauma. Unfortunately, dissociation often remains in place even after the need is ended. When this happens it prevents access to emotions and the healing that can only come with full consciousness feeling.

PTSD, Post Traumatic Stress Disorder is what happens when dissociation allows us to distance from feelings even after the trauma is over and we are in a place of safety. The major symptoms of PTSD all have to do with split off emotions. First, sufferers try to avoid reminders of the trauma, since these can trigger a breakdown of the dissociative barrier and re-experiencing of the feelings. Second, they suffer from flashbacks in which parts of the trauma return in a still split-off, but conscious form. These are very disturbing but do not lead to catharsis. Third, they remain in a state of emotional and physiological vigilance as if waiting for the trauma to be repeated at any moment. This is a natural result of unprocessed and unhealed emotions, or to say it differently, they haven’t yet had the benefit of catharsis.

Many circumstances can lead to healthy undoing of dissociative barriers so that trauma survivors can experience their feelings and heal. The most important is a relationship of safety and trust. Without that, re-experiencing trauma can even do harm. In addition to a safe place, parts of the experience that are not as emotionally charged can trigger recall. This is just what PTSD sufferers try to avoid, but in the right context, it can be instrumental. Especially physical sensations such as sounds, smells, bodily feelings or even an “atmosphere” reminiscent of the trauma. Any of these may be the key to unlocking a dissociative barrier. When this happens in a context of safety, then catharsis can take place and with it the healing that Freud and Breuer described.

What Exactly Is Catharsis?

Modern research has shown that the brain stores the memory of potentially dangerous experiences permanently. This makes sense, because who would want to repeat the same close call or terrible experience again? Just as with dissociation, there is a down side. The storage of bad memories is part of an early-warning system embedded deep in the brain. It works rapidly (before our consciousness grasps what is happening) and prefers to err on the side of caution, even with circumstances that only remotely resemble the original trauma. As a result, massive flight-fight reactions can be triggered when they are are not helpful or beneficial.

If that were the whole story, we would spend our lives in a state of hypervigilance and fear, like sufferers of PTSD. Fortunately, we have also evolved a built-in remedy. The slower but more thoughtful and accurate cerebral cortex also analyzes the danger and if the situation is not as serious as the early warning system assessed, then our fight-flight reaction can be inhibited before it really gets started. Perhaps all we might experience is hair standing on end.

Catharsis happens when memory and feelings connected with trauma become associated with feelings of safety. Then the fight-flight response is inhibited. From then on, when we begin to recall the trauma, the feeling is a dull ache rather than an acute emergency. For this remarkable healing to take place, neurological connections have to be made by strengthening associative synapses. For this to take place, neurons need to be activated, and feeling emotions is what activates those neurons in a way that makes them accessible to forming new associations. Thus, we come full circle. Modern science has rediscovered that consciously experiencing distressing emotions in a context of empathic connection and safety produces long term healing, the healing that Freud first called catharsis.

Catharsis Is Not for Trauma Alone

Actually, catharsis is far more common—even universal—than is realized. Every time you tell a trusted other about something that troubles you, catharsis is the mechanism that makes it feel better. It is unfortunate that this almost-miraculous healing mechanism built into all of us has been trivialized by calling it “venting.” It really is the final common pathway of all the lasting benefits that come from psychotherapy. Not just that, but it is the core of how we cope with life in a dangerous and unpredictable world.

There Is More

I am just putting the finishing touches on a new book, How We Heal and Grow: The Power of Facing Your Feelings. It will be available in October, 2014. While the book is about much more than trauma, I will nonetheless describe catharsis there in greater detail and explain how and why catharsis doesn’t always require an immediate witness. There is also more to say about Bertha and her experience. Please look for the book on this blog.

JS

*Freud, S. and Breuer, J. (1893) “Preliminary Communication,” The Standard Edition, Vol. 2, Hogarth Press, London, 1955, p. 6.

 

9 Comments

  • Dear Jeffery,
    I always enjoy reading your blog posts, and resonate with what you write; and really look forward to reading the book you’ve written, that will be published next month.
    JM from Canada

  • This helps me to understand and trust a bit more in the process with my therapist. Helps to understand why we must “walk through the fire” to heal.

  • I’ve been in psychodynamic relational therapy for 5 years with a trauma specialist. I am a 40 year old survivor of sexual abuse by male relatives from toddler to teen, had an alcoholic father, physically and verbally abusive mother who rejected and insulted me, and who loved my brother to bits, even though he was a drug addict who stole from us and would physically torture me, lock me in the closet for hours, hold me down and cover my nose and mouth til I almost suffocated, then let me get some air and do it again. And again.
    I was often sent away as a child, from one family to another, and felt forgotten by my family. It could be months before my mother would ring to ask of me or talk to me. I dissociate, self harm, am suicidal, have panic attacks, and am very hyper vigilant. I finally went to therapy and it took years to feel safe and trust my therapist enough to share a little of my pain. Last month she announced she’s pregnant and leaving in April for 4 months of maternity leave. I am devastated.
    My feelings of abandonment are sky high, I feel especially worthless, I am furious with her, my cutting had me twice in the ED for sutures, I think of suicide often, and I’ve lost the sense of safety and security I had. I feel so stupid for trusting that she’d be with me through my healing! I regret ever starting this. I’m worse off now because too many things had surfaced. My internal house was cluttered with packed boxes when I started, but now they are torn open with the contents scattered everywhere. Do I quit and try to re-pack everything? Her pregnancy & upcoming leave have brought to the surface huge issues I’m not prepared or equipped to deal with. They might have come up in due course, as more layers were uncovered, but this was a brutal tearing open of my issues. It’s happening according to her timeline, not mine. And it’s literally killing me. I don’t feel safe with her, I certainly don’t feel cared for, so I have all these horrific feelings and no way to work through them. What can I do? I fear for my life already, but especially during her long maternity leave.

    • Seonaidh, I think we are all saddened to hear your story. One of the reasons PTSD has such staying power is that the emotional brain can’t tell the subtle differences between malevolence perpetrated on a child and things that happen in adulthood that feel the same. Well meaning therapists inevitably have breaks in attunement that test both patient and therapist. When things happen that are seriously more traumatic than these, one hopes that faith in the process can survive. Of course what I have said repeatedly still pertains: It is crucially important for any break to be processed openly between therapist and patient. JS

  • Dear Jeffrey,

    Will your book How we heal and grow, The Power of Facing Your Feelings be available in the Appstore book section? I would love to have it on my ipad! Thanks so much! I have read a great deal of books on attachment and psychotherapy but honestly your way of explaining things is the best for me so far!

    I also have a question. I have been seeing my T for 1,5 years now, strong attachment, mother issues…like you described in earlier posts. I think she has great boundaries, I have been trying to push them unconsciously but now I can talk about it openly, however still have strong feelings and I am still very nervous each time I go to see her. (1x a week) At this moment I can not decide if Im sort of getting better managing these feelings and they are much less intense because I have been healing or simply because I decided to give up on her and will look for the same thing somewhere else. I have been crying a lot about it outside therapy, it was very very difficult to bear and understand that she never gonna love me the way I think I love her…etc, but than slowly these feelings are going away. How do I know that it is healing? 🙂 I know it sounds kind of odd but I really cant decide. I changed a lot and therapy did a lot of good to me but this is sort of a question I have now. I never had a so called catharsis in therapy. I had 2 sessions where I was overwhelmed with emotions because I was going through a hard time in private life but never cried in front of her. Im controlling myself all the time, my behaviour. I was never able to fully let it out there in the therapy room. Thanks so much if You take your time to answer!
    Love

    • To all you iPad users, How we Heal and Grow will soon be available in the Appstore. As far as Judith’s other question goes, it’s a great one. Look for a post on the subject. JS

  • The picture above is one from from the movie Stand By Me based on the novella by Stephen King ‘The Body’. When Stephen King was a boy he witnessed the tragic death of his friend who was hit by a train. Many books written by Stephen King involve tragic happenings involving trains and railroad tracks. Books such as Sometimes They Come Back, The Talisman, and The Gunslinger Series are examples of this. I often wonder if this stems from his childhood trauma; is this an expression of covert, childhood PTSD, and is this his way of coping with the pain of losing his friend. I watched an interview on television, I believe it was Cspan, where he said he had no real memory of the trauma; only what was regaled to him by his mother. I believe he has an unconscious memory of this trauma and it comes out in his stories. So my question is this: is it possible to portray, in words, memories that are buried so deep that there is no conscious memory?

    • Dear Hope, Thanks for a very interesting comment. I think of the mind as a “metaphor engine,” amazingly capable of expressing one thing in terms of another. In that way, words can express important things where the original may not have words. On the other hand, it may be that healing the emotions requires something more than words. That is where Peter Levine has a lot to say. I believe there are situations where the body needs to do the talking. JS

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