Psychic Trauma

PSYCHIC TRAUMA, experiences that are unpleasant or frightening, more or less deeply disturbing basic psychological and somatic processes. These experiences can vary in nature, both in content and affective coloring, as well as in intensity and duration. P.t., like every experience, is a complex derivative of certain situational moments and the preceding state of the psyche. Only artificially, for schematic purposes, can they be separated from each other. This relativity of separation must be kept in mind when we say that in the genesis of some P.t. situational moments predominate, while in others it is the soil upon which the irritation falls. Thus P.t. can first be divided into two types: some are elementary, unconditional, since they are observed in all people to one degree or another; these primarily include shock traumas; others are complex, individual, conditioned by the peculiarities of the experiencing psyche. These latter constitute the main mass of psychogenies (see).-It is impossible to list and classify traumatic experiences in any way. Neither external causes nor various affective states can, of course, determine the nature and degree of traumatization, since by themselves, without being applied to a specific personality, they are sufficiently abstract. The psychological processing of any event is incomprehensibly diverse, since it depends on 'individuality,' 'nature,' 'character,' 'temperament.' Wars and catastrophes {earthquakes, industrial accidents, railway accidents} create so many traumatic experiences having common features that they must be considered collectively and first of all. Under these conditions, sharp shock P.t. are particularly frequently observed, causing both deep somatic changes and more or less prolonged psychological disorders. The imperialist war was particularly rich in various P.t. Nowhere was such an abundance of pathological reactions, especially of a hysterical nature, observed as here. According to the admission of the German psychiatrist Bumke (Witke), the German army was so struck by these reactions that by the end of the war doubts arose among doctors about the further combat capability of the army. The consequences of psychological shocks, along with other harmful effects, are especially felt after the war, usually in the form of so-called hysterical and organic changes in the psyche. Of course, not only acute shock experiences (fright, danger) but all conditions of the imperialist war were traumatic for its participants. Similarly, the entire complex of experiences associated with arrest, investigation, imprisonment is a source of the most varied P.t. (see Psychogenies). Experiences associated with catastrophes and life-threatening situations can generally be reduced to sharp fright. These experiences affect the somatic most strongly, sharply disrupting the activity of the entire organism, and sometimes leading to death. The consequences of fright are especially severe in people with any organic lesions of the nervous or vascular system. Congenital or acquired after shocks, vasovegetative excitability makes this system easily vulnerable. Acute P.t. in this case can in strength approach more gross traumas of the brain; in both cases, the consequences are fainting, organic twilight states, etc. Nevertheless, the most characteristic property of these psychic traumas is the relatively rapid disappearance of noticeable consequences, and only in persons who are somatically or psychologically unfavorable do these reactions sometimes persist for a very long time. These elementary and deep shocks to the psyche affect animals no less, but of course not in the same way, which has been repeatedly observed in animals that have experienced earthquakes and noted by Pavlov in his dogs during floods. From elementary, one-time P.t., an imperceptible transition leads to more complex and prolonged ones, where individual and ideological prerequisites often have a decisive significance. The death of loved ones, family breakup and other traumatic experiences, insofar as they have an unexpected character, act both as a shock and as a prolonged depressing factor. The moment of duration of P.t. plays a significant role in general. The psyche copes more easily with quickly occurring but soon passing harmful influences than with slowly acting and protracted ones. The latter maintain a constant depression of the basic mood tone, with ever greater force eliminating any lively, joyful excitement. Therefore, such traumas as prolonged servile position (servants), congenital deformity, chronic somatic disease are unconditional, and individual peculiarities in these cases have secondary importance. The consciousness of one's own misfortune, as long as it lasts, can sharply change the basic qualities of personality and develop new traits in character. However, the ability to gradually even out even strong and prolonged disturbances of psychological equilibrium is subject to large individual fluctuations. Strong emotional movements can be a necessary impulse for our life and development. The limit of traumatization, after which a person loses psychological stability, can be established for each person only approximately. The reason for this lies primarily in the different strength and character of emotional excitations of the individual. Only experiences that are specifically unpleasant for the person, so-called 'key traumas' of Kretschmer, affecting its vulnerable sensitive sides, 'complexes,' or causing and exacerbating already existing special reactions and mechanisms, act with special force. Therefore, when assessing the significance of P.t., it is always necessary to take into account the peculiarities of the structure of the given personality and to study its previous reactions anamnestically. Experiences associated with serious operations (eye operations with stay in darkness have special significance), with the doctor's reports of serious illness, give different consequences in different people. Even more individual consequences have various sexual traumas, any internal moral conflicts, etc. Particularly instructive in this respect is the statistical study of the reasons for suicides. At the basis of every traumatic experience there is intense affectivity, emotional anxiety; therefore, experiences associated with fright and fear should be considered a special psychological harm. Unpleasant experiences perceived calmly and rationally cannot lead to illness. Similarly, overfatigue from intense mental work is not a P.t. The second condition for traumatization is the unpleasant coloring of the experience. Even the highest degree of joy very quickly passes into a calm feeling of satisfaction. The usual conception overestimates the significance of P.t. as a cause of diseases, especially mental ones. This can also be said about psychiatry before the period of flourishing of pathological anatomy and biological chemistry, when sharply opposite mechanistic views (Wernicke and others) came to dominate. A correct synthetic view has been developing in the last two decades, and at the present time among exogenous etiological factors P.t. occupy a prominent place. It can be said that psychogenic factors have significance in the symptomatology of every disease. In a narrow etiological sense, the following four different connections between P.t. and disease can be distinguished: 1) P.t. is the only cause of the disease, 2) it is only the last push that unleashes a constitutional or other disease, 3) it complicates or worsens existing diseases and 4) it creates a predisposition to disease. This last circumstance has, among other things, great importance in the formation of various 'neuroses,' functional disorders, psychopathies, pathological development of personality, in a word, where P.t. sometimes requires prolonged psychological processing before its consequences become apparent. The mechanisms of action of P.t., despite successes in the study of constitution, characters and the layered structure of personality, are still unclear in many respects. One can distinguish between purely psychogenic (psychoreactive) and reactive (somato-reactive) consequences of P.t.; however, a strict demarcation between them cannot be drawn. It can be said that different P.t. affect different functional areas and systems (thinking, mood, motor skills, the nervous-vegetative sphere, etc.) to varying degrees. Attempts to isolate more elementary disturbances in the dynamics of nervous-psychic processes have not yet been successful. Only with reservations are (Birnbaum) psychogenic excitation, inhibition, fixation, splitting in various functional systems isolated. It is undoubtedly the main condition for a correct assessment of reactions to P.t. to be the study of the entire reacting personality. In psychogenic formations, dominant representations with a marked affective coloring appear, which displace all other experiences, remain in the psyche for a long time and constantly reappear. These 'fixations' are usually a sign of already existing psychological insufficiency of one kind or another.

Most often observed in these cases are asthenic emotional instability, epileptoid viscosity and a tendency to overvalued formations, schizoid sensitivity and splitting of the psyche into a number of other psychopathic character traits. Egoism, a sense of one's own inferiority, hypercompensation, a desire for evaluation, a desire for illness, a tendency to repressions, and narrowing of consciousness play a major role. Those who are infantile or show some partial delay in mental development can be classified as predominantly 'reactively labile'. Intellectual deficiency is of great importance for the instability in relation to psychic trauma. The psyche of oligophrenics, children, and uncultured peoples, with their weakness of criticism, suggestibility, and predominance of affective life, is especially susceptible to experiences of fright and fear, which proceed in them very acutely, and in children additionally with various neurotic consequences. In small children, fright can be caused by the most random, unexpected impressions, frightening stories. Women, as a rule, are also more labile than adult men, especially during the climacteric period, pregnancy, and menstruation. Breadth of interests, stable class ties, a socially healthy environment, and the predominance of social interests over personal interests primarily counteract the harmful effects of psychic trauma. These conditions must be the basis for developing preventive measures in relation to psychic trauma. It is by no means indifferent how those around relate to the traumatic event. The environment, close people, can sometimes completely negate a serious trauma, and on the other hand, a trivial pretext can turn into a shocking experience. Collective, mass psychic traumas, panic states are created mainly through infection and suggestion. The autonomic system, closely connected with psychic life, is the first to be affected by psychic trauma, often causing disturbances in the activity of internal organs, glands with external and internal secretion, and metabolism. Disorders of the cardiovascular system are most frequently observed. Experiences of fear are intimately connected with the activity of the heart's nervous apparatus. Here lies the cause of many heart disorders and this also explains the brilliant successes of proper psychotherapy in such cases. Special mention should be made of the occurrence of Basedow's disease (fright), bronchial asthma, stomach and intestinal ulcers, generally digestive disorders, and such skin 'reactions' as urticaria, pemphigus, vitiligo, etc. The influence of psychic trauma on the course of chronic diseases is traced with particular persuasiveness in tuberculosis patients. The psycho-sexual sphere is the source of countless psychic conflicts and traumas, which primarily affect the sexual functions in the form of sexual weakness, frigidity, and in women in the form of a number of 'disease symptoms in the absence of any gynecological diseases,' for example, various menstrual disorders; thus, surgeons note their occurrence before surgery. Brief or prolonged affective anxiety in connection with psychic trauma leads to wear and tear of the autonomic system, premature aging, climacteric, arteriosclerosis, and disturbance of trophicity, manifested in graying, baldness, wrinkles, weakness, etc. Endogenous psychoses are often provoked by psychic trauma; this applies to epilepsy and schizophrenia, but even more so to circular psychosis. According to Bleuler, in 10%, and according to Rehm, in 17% of all cases of circular psychosis, attacks are caused by experiences. Schizophrenics often react to psychic trauma with reactions hardly distinguishable from ordinary outbreaks, which however do not cause a noticeable shift in the psyche. In epileptics, after psychic trauma, seizures, mood disorders with aggressiveness, twilight states, and phobias are found. Shocks can also reveal gross organic processes in the brain that previously proceeded without sharp disturbances. Arteriosclerosis, presenile and senile diseases, progressive paralysis can cause catastrophic shifts after psychic trauma.