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