Trauma & Acute Care Open Access

Commentary

In this paper, lately published in French (September 2016), I tried to study trauma and traumatism, particularly in human disaster situations (terrorist attacks, slaughters, genocides), which are far different from natural disasters [1].

To be well understood, as many psychoanalysts, I had rather distinguish a trauma, which is a wound or an injury, from a traumatism, which designates a peculiar physical or psychological condition (or state) produced by the trauma. Thus, the clinical practice leads us to observe that a psychological traumatism is already an answer to the trauma itself. It is a psychic creation, and it has to be welcomed as such. Moreover, it is now acknowledged that previous traumas weaken the individual and expose him more painfully to future disasters.

Concerning the method, after referring the notion of traumatism to Charcot [2], Freud [3,4] and Ferenczi [5-7], the definitions were specified from contemporary French writing authors: Torok [8], Nachin [9], Briole [10], and the like. Conventional notions of cleavage and dissociation were discussed, as well as more recent ones of "psychological revisionism", proposed by Benghozi, which is a negation of the difficulty and painfulness of the disaster reality, not of the reality itself [11], and of "catastrophic mourning", which I use in order to describe a kind of gloomy, endless and complex process of an impossible grief [12].

The exact term I have chosen in French to describe the reality of a "catastrophic mourning" is "en-deuil". Therefore, it could also be translated into English by "in-grief". Such an expression tries to describe the difficulty of achieving a natural mourning process, as if the disaster was still proceeding: as if it was still in course, but also in curse. This odd phenomenon is not a fixation; strictly speaking, it rather tallies with a tragic (internal) reiteration of the devastation.

Moreover, industrial modern wars and barbarous slaughters have changed our way of considering death. French psychoanalyst Douville explains to what extent [13]. New wars have produced an anthropological mutation of man's relations to the real of his death. The obsession of the forever mutilated corpse eroded the unified image of a body resting in its death. One could not imagine a deceased person resting in a place where the survivors gather in a genuine and peaceful fervour. The crushed, disjointed, fragmented body is no longer a production secreted by certain deliriums, but rather a real that history brings forth as an unavoidable truth and as the haunting of the soldier, thus decomposing the foundations of the self. The integrity of the body (and the person) is lost, hitherto preserved even in death.

More precisely, the present study has been carried on for about twenty years of clinical day-to-day psychoanalytic practice. It deals with more than ninety seriously traumatized patients. A few of those were direct victims of human disasters, seventeen in the past three years: three persons lost a colleague, a friend or a relative because of the very recent terrorist attacks in France, the other fourteen had known an exile with violence, most of them in war situations. Our first results remain tinny. Trauma and psychological traumatism are bound up with the accident and even more with the disaster, especially if it pertains to the barbarous killing of other human beings. Of course, these realities raise questions about hatred and murder. The world wars, the practices of torture and the genocides have changed our way of considering death, particularly owing to the irreversible mutilation of bodies. Listen to, and take care of, people struggling with the devastating effects of disasters leads me to obtain by intuition, then to asseverate, the existence of an "integrity principle", completing the pleasure principle and reality principle proposed by Freud [14,15]. This integrity principle founds itself upon a vow of entirety, a cherished promise of being whole and safe. One could say intact: unbroken, unharmed, unspoiled, fully and duly respected as a human being. As such, it is a profound psychic process, not as self-preservation or withdrawal, not as a defensive psychological fixing, not as a fantasy of totality or omnipotence. Taking care of one’s integrity, promoting it and trying to find it again, if imperilled or lost, is above all an ethical desire, an inalienable wish for the subject to belong – undoubtedly – to the human race.

Eventually, I tried to explore the therapeutic possibilities arising from the identification of these new concepts in the context of a psychoanalytic treatment and an empathetic welcome of the practitioner. After many years of practice, the post-traumatic symptoms and, above all, the available therapeutic pathways, and relative but actual successful issues, confirm the relevance of this new concept of an "integrity principle".

The popular expression "falling apart" or "falling into pieces" let understand the impact of the trauma, which causes a fragmentation of the subject. During their therapy, the traumatized patients seek to recompose themselves, to recover their integrity. For example, a young cellist goes on holiday with friends, carrying his cello with him. Towards the end of the journey, the driver stops at a petrol station to take gas. Passengers come out to stretch their legs. Suddenly, the vehicle caught fire. The fire is quickly controlled, nobody is hurt, but the luggage is burnt and the musical instrument too. An instrumentalist feels at one with his instrument, above all if it is a stringed instrument, which the musician bears close to his body. After this accident, which shocked him deeply, the young man stopped playing cello for years. He feels completely destitute and lost, as an orphan, but also very guilty not to have been able to rescue the cello. By finding a reliable and lasting representation of the integrity of his body, and therefore of his entire person, able to live and to feel complete without the cello, this young man can one day begin to play again his instrument.

The "subjectivation" (becoming subject) of any human being is still in progress, from its birth, or even before, to his death. The psychoanalysis approach, listening to the subject’s singularity and his traumatic dramas with their subsequent effects, can warrant a personalized welcome to the subject and the resumption of its subjectivation process, deeply impaired by the disaster.

Conflict of Interest

This work received no financial support and all authors report no conflicts of interest.

References

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