Atrocity Touring Psychoanalysis:
Mark B. Borg, Jr. PhD
Borg, Jr., M. B. (2003). Atrocity Touring Psychoanalysis: A Case Study in Traumatic Enactment. Mind and Human Interaction, 13: 132-144.
AN EARLY MORNING TELEVISION NEWS STORY on the viewing platform built at "ground zero" in lower Manhattan recently triggered memories of my first psychoanalytic training case. Those interviewees who opposed the platform argued that it was disrespectful; those who supported it claimed that it represented an important part of the mourning process. The story ended with a woman happily stating, "I am here to celebrate my fortieth birthday." My patient, a self-proclaimed "atrocity tourist," died on her fortieth birthday in November, 2000. I have spent much time wondering how she would have experienced the September 11 events, seeing that many of her most painful moments were associated with the intergenerational transmission of traumas that had occurred to members of her immediate family.
The ground zero platform differs from most atrocity sites in that it was built while the remains of the victims were still being recovered. In most cases, memorials or commemorative plaques are not placed until long after the atrocity has ended. A common symptom of individuals whose family dynamics are haunted by intergenerationally transmitted trauma, is the denial of past traumatic events. It is perhaps due to our connections to one another and our own histories that such denial or myths are difficult to sustain. Atrocities, as with other psychosocially silenced experiences, are often expressed via misunderstood and problematic ways of relating to other people and the world at large. These problematic ways of relating obscure the links between psychosocially silenced experiences and sustained critical reflection and discussion. The need to address and work through severe impediments to establishing links between experiences is especially important for patients who feel the impacts of trauma that has affected the lives of previous generations (Bar-On, 1999).
Other significant differences between previous and current forms of atrocity tourism entail practices of consumerism, which perhaps serve to thwart the silence normally associated with atrocities. Thus, we are quickly exposed to such advertising slogans as "I Love New York, now more than ever," slogans that are used in conjunction with the mayor trumpeting the city's need for free-spending tourists "now, more than ever." The positive response of out-of-towners to New York's plight partly explains the five-hour long lines that have formed to witness ostensibly to mourn the September 11 tragedy. However, while the inner workings of trauma are perhaps being played out among platform visitors, it is unknown to what extent their primary motivations as well as those of the people who created the observation platform of the atrocity site are associated with mourning.
The idea of atrocity touring, as I am referring to it here, refers to the process of identifying with those who have previously suffered in order to maintain certain internalized relations with those others. Once internalized, the atrocities, whether actually experienced or intergenerationally transmitted, can then be enacted in numerous domains of functioning and social interactions in one's daily life.
In our attempt to interpret clues which atrocity tourism holds for understanding the intergenerational transmission of trauma, precursors to our current notions can be found in Freud's (1919) post-World War I insight that
This sharing of the survivors' lives with the dead explains in part my interest in atrocity tourism, especially because of the aforementioned association with the death of my first psychoanalytic patient, whom I will call Charlotte. Her family had been severely traumatized by her father's experiences in the genocidal atrocity known as the Holocaust. But it was not until large numbers of tourists began to visit New York City (where I live and practice) that it occurred to me that the idea of "atrocity tourism" serves as a helpful, provocative metaphor for the analyst's role in working with patients whose lives have been touched by intergenerationally-transmitted trauma.
With increasing stability among post-World War II governments and with contemporary forms of consumerism, foreign visitors are being welcomed with opened arms to places that at one time were hidden from public view. These sites are now promoted as destinations for all-inclusive package deals that promise their purchasers a connection with previously silenced histories. The World Trade Center attack is among the first major disasters of the present century, but it comes on the heels of a century that in terms of war-related deaths stands as the bloodiest in human history (Brenes & Wessells, 2001; United Nations, 2000).
Martineau (1957) suggested that "any buying process is an interaction between the personality of the individual and the so-called 'personality' of the product" (p. 73). Accordingly, psychoanalysis may serve as a means of understanding the motivations behind exploiting or engaging in atrocity tourism. Specifically, Charlotte's treatment is perhaps best viewed as an isomorphic re-enactment of the mix of atrocity tourism and market-economy consumerism that I just referred to. As a consumer product, psychoanalysis is sometimes "marketed" as a process through which individuals purchase an awareness of their deeper needs and desires, thus building a greater capacity for interpersonal relatedness. But Baudrillard's (1998) suggestion that consumption itself is a substitution for lived experience speaks to a central paradox of psychoanalysis: it is at once deeply compelling and real, and yet it cannot substitute for a full and meaningful life outside of the consulting room.
Psychoanalysis can invoke some of the more malignant aspects of atrocity tourism. For some patients, psychoanalytic processes consist of limited engagement and an over-reliance on detached observations both of which can hinder more substantial participation. For some analysts, an unwitting focus on the consumer nature of treatment can result in the false compartmentalization of their private and professional lives, leading to reliance on a detached style that avoids the level of involvement required for working with trauma. Combined, these features of analysis as a consumer item can result in a collusive patient-analyst relationship that stops the more painful aspects of trauma from coming into awareness. Sullivan (1940), however, believed that "Very few patients continue in intensive [psychoanalytic] treatment to uncover trifling difficulties. Those who seem to be doing this are more probably moving towards the revelation of a serious difficulty" (p. 216).
Fortunately, the consumer aspect of psychoanalysis rarely captures the complexity of the analytic endeavor. For analysts dealing with trauma, the process can potentially become a meeting place where fascination, financial motives, and omnipotent fantasies intermingle with altruism, genuine concern, and a determination to maintain hope in the context of dreadful experience. It is in this location where the analyst's dual roles as observer/participant and tourist/vendor converge. In trauma treatment, the consumer and vendor aspects of our work creates professional dimensions that make the process more manageable for both analysts and patients. They add an implicit sense of necessary distance, a means of distancing oneself from the particularly intense transferential riptides involved in trauma work. On the other hand, the tourist and witness aspects of our work can trigger our genuine concern for and engagement with our patients the likes of which some patients have never experienced outside of analysis. This facet of the therapeutic relationship is what Herman (1992) believes is crucial to dealing with atrocity: bearing witness to and validating our patient's trauma.
Multiple impacts are associated with internalized atrocity. Virilio and Lotringer (1997) believe that at the societal level, these impacts can create a collective state of continual preparation for conflict and tragedy that they call "pure war." They assert that such conditions often result in a large-scale fracturing of identity, noting that "the ego is not continuous, it's made up of a series of little deaths and partial identities which do not come back together, or which only manage to come back together by paying the price of anxiety and repression" (p. 43).
When I first met her, Charlotte was a 36-year-old single heterosexual woman of Chinese-Cambodian descent who lived at home with her brother and elderly adoptive parents. She was told by her adoptive parents that she had been born in Cambodia, that her biological father was Chinese and her biological mother Cambodian, and that both were Christians, but beyond that she knew very little about the circumstances surrounding her adoption. To make sense of what may have been their abandonment of her, she imagined that they had been prisoners of the Khmer Rouge. When asked to elaborate, she curtly described the reason for her parents' fantasized imprisonment and torture as "they were intellectuals and Christians." Her being put up for adoption at birth by her biological parents established two of her major treatment themes: abandonment and a sense of victimhood, both of which she attempted to remedy by touring famous atrocity sites around the world. She brought with her a history of personal atrocities in the form of sexual and physical trauma. In addition to the abuse she directly suffered, she also felt the transgenerational effects of her adoptive father's personal atrocity as a Jew sent to Auschwitz during World War II. Charlotte carried enormous amounts of guilt, rage, and loneliness inside her, as well as a considerable number of masochistic and suicidal fantasies.
During our sessions, Charlotte explored her fascination with atrocity tourism her only activity (other than her treatment) that broke up the bleak life that she shared with her family. Caught up in fantasies of mass murder, she was both devastated and fascinated by the thought of what she described as "death's salespeople pawning off glimpses of victimization as a commodity."
Charlotte entered treatment with initial presentations of Major Depressive Disorder, Borderline Personality Disorder and a preoccupation with suicide. She described her upbringing as akin to "living in a concentration camp." Her sarcastic self-description as an "atrocity tourist" marked her as an observer of life rather than a participant. She maintained an enmeshed relationship with her parents that was based on her belief that they could not survive any attempt on her part to establish distance from them. Her elaborate symptom constellation which included suicide attempts and ideations, a fragmented sense of identity, and marked dissociative tendencies ensured that her parents would never accept her as an autonomous adult.
At home, Charlotte often experienced a complete inability to function; she continued to rely on her parents for most of her financial needs. Between the ages of 26 and 36, her primary activities outside of her parent's home were therapy and visiting internationally famous atrocity sites. At first, the motivations for this activity were puzzling to me, but I later found out that Charlotte's excellent writing skills had earned her a job writing travelogues for a travel agency. The agency sent her to atrocity sites worldwide to gather material for her writing. She described this part-time job as her "other calling."
As our work continued, it occurred to me that I had become an atrocity tourist, with Charlotte calling on me to witness the atrocity that she felt her internal life to be. Solnit (1995) describes such a witnessing process as a "gateway for remembering, re-experiencing, understanding, and preparing to go forward, developmentally and historically" (p. xi).
The atrocities in Charlotte's life included very complex fantasies and scenarios that she described in addition to those that were actual parts of her personal history. Charlotte described her father as a violent man whose outbursts she understood to be reactions to her childhood displays of emotion. She believed that his Holocaust experience had made it impossible for him to tolerate even minor expressions of emotion. But his attempts to suppress Charlotte's emotions as a child were so severe that neighbors occasionally intervened and took her into their own homes, sometimes during the middle of the night. Charlotte said she agreed with her mother's assessment that given her father's horrific experiences, his intense reactions to her emotions were "as they should be." During the course of our work together, Charlotte described many incidents of abuse at her father's hands, as well as the horrifying awareness that her mother was both unable and unwilling to stop them.
During the first two years of analysis, Charlotte described a series of molestations and rapes she had been subjected to. She had vague memories of having been molested as a very young child by a "faceless man" who may have been her father. She also claimed that she had been molested several times by her father's brother, another survivor of German concentration camps. Charlotte said that her parents never confronted her uncle, even though she reported his behavior; eventually, they stopped leaving her in his care.
In early adolescence, she began to "unwittingly" become involved in situations that in hindsight she knew were dangerous. One such situation led to her being raped by a therapist when she was in college. She also became addicted to heroin; even though she had been clean for many years before I met her, she said she still fantasized about using the drug, and threatened to start using it again. She went through a five-year period during which she was very promiscuous, sometimes having anonymous sex with multiple partners in bars. She told me that she once had powerful fantasies about becoming a hooker in some of Brooklyn's rougher neighborhoods. She also had a long-term, highly abusive relationship with an older man.
Her history notwithstanding, Charlotte excelled in school graduating from college at the age of twenty-two and accepting a position with a juvenile probation department. She remained at that job for three years, and described it as her "true calling." During one session she told me "I was made for taking care of troubled kids."
She fell in love with a fellow probation officer and made plans to for a wedding, even though she felt increasingly uneasy with what she called his "obsession" with childhood sexual abuse. She said that he had an entire library dedicated to the topic in his home. After accepting the situation as something related to their work, Charlotte encouraged the adolescents that she worked with to accept her fiancé with the same level of trust they gave her. During a social outing, one of her boys punched her fiancé, called Charlotte a "traitor," and never spoke to her again. She recalled "putting the pieces together" and coming to conclusion that the man she planned to marry was a sexual predator. She thus felt that she had done something unthinkable sent one of her charges "into the jaws of a wolf in the fold."
Charlotte struggled for a while to come to terms with what she believed to be her fiancé's behavior, but remained distraught. A few weeks later she attempted to jump out of the car that he was driving at a very fast speed. He pulled over, hit her in the face, and abandoned her on the side of the road. Charlotte walked home and attempted suicide with an overdose of her father's heart medication. She told me that she was more appalled at her perceived betrayal of one of her assigned cases than the violent ending of her engagement. After a brief hospitalization she was released and referred to the clinic where we met ten years later.
The architects of 20th century genocidal campaigns compulsively tried to eliminate history (Shawcross, 2000). For example, the Khmer Rouge destroyed all clocks, forbade all talk of the past, and marked the beginning of their reign with a "zero" calendar year (Chandler, 1996). Charlotte described her adoptive family as following similar, though unwritten rules. Conversations about events prior to her parents' immigration to America was forbidden; emotions were suppressed due to their potential of "stirring up the past." Whereas her family viewed memory as a hostile force, Charlotte's memory grew into an obsession during analysis that is, something to be cultivated, nurtured, and guarded. She expressed her belief that in her submission to her family's strict rules and deprivations, she was actually retracing her adoptive father's concentration camp experience.
A comment that Charlotte made during one of our sessions is a possible answer to the question of why some individuals feel drawn or compelled to visit atrocity sites: "I have this vague sense of responsibility to myself and to humanity to bear witness." When she visited the concentration camp memorials in Germany she asked herself, "What does it matter if I visit such places or spend my life trapped in the over-protection that my parents impose on me?" Answering her own question, she told me, "It only matters if I believe that walking the same ground and breathing the same air confers a special knowledge that reading the books and seeing the pictures and movies do not." She described her experience in terms of a special knowledge that might, in some ill-defined way, help prevent future atrocities. By resurrecting lost history, Charlotte was able to maintain a sense of connectedness social and otherwise with both sets of parents.
Throughout the four years of our analytic relationship, I conceptualized Charlotte's treatment through an interpersonal psychoanalytic lens, which reflects Harry Stack Sullivan's (1964) tenet that "everything that can be found in the human mind has been put there by interpersonal relations" (p. 302). Interpersonal theory's clinical orientation is marked by a) a broadly relational metapsychology, b) an interactive conception of the intrapsychic world, c) a clinical focus on the intersubjective in analysis, d) an operationist perspective that keeps theoretical constructs close to empirical observations, and e) a pragmatic philosophy that allows for radical technical flexibility (Lionells, Fiscalini, Mann & Stern, 1995).
According to interpersonal theory, anxiety serves as both a primary target for therapeutic intervention and a primary source of psychopathology (Sullivan, 1953, 1954). While preventing self-esteem and self-experience from being overwhelmed by anxiety, security operations such as selective inattention and dissociation also limit an individual's personal experience across the dismissed domains of thinking, feeling, behaving, and interacting with others. What Sullivan (1953) called the "self-system" consists of the sum of all security operations that we build inside ourselves to ward off overwhelming anxiety.
Interpersonal psychoanalyst's believe that experience and behavior take on meaning from the continuous series of interpersonal interactions that occur from the beginning to the end of our lives (Stern, 1997; Sullivan, 1953). It is through transference-countertransference interactions that a patient's problematic intrapsychic and relational patterns are brought into the here-and-now of psychoanalysis and exposed for exploration, intervention, and understanding (Levenson, 1991). One exploratory approach is the analysis of patient-analyst enactments, which Hirsch (1998) defines as
According to Levenson (1972, p. 174), what creates change is the analyst's ability to be "trapped, immersed, and participating in the system and then work his way out." The experience of becoming embedded in and emerging from an enactment enables the analytic dyad to articulate the nature and depth of long-standing and significant areas of internal and interpersonal conflict and use them as the basis for interactions. The process of challenging rigid patterns of thinking, relating, and behaving also known as working through is aimed at increasing an individual's flexibility and loosening the tyranny of the self system, which prefers to decrease anxiety by constricting self-experience and limiting awareness of stimuli through dissociation and selective inattention.
The interpersonally-trained psychoanalyst Stephen Mitchell (1993, p. 25) has suggested that "what the patient needs is not clarification or insight so much as a sustained experience of being seen, personally engaged, and, basically, valued and cared about." Part of our task as psychoanalysts is applying this sentiment to our work within the context of intergenerationally transmitted trauma, often reconstructed from unspoken facts of individual histories within families whose members include victims, rescuers, bystanders, and perpetrators. For Charlotte, her work in analysis entailed the re-establishment of basic social contracts (Annan, 2000; Arendt, 1958) a re-engagement with humanity based on trust, despite previous catastrophes that had shattered the social networks in which her parents were embedded.
An important question regarding an individual's interactive patterns as enacted in the transference-countertransference relationship concerns what the person does when threatened with anxiety, pain, or uncertainty. Finding the answers for Charlotte and for the two of us was an important aspect of our attempt to establish a voice for the trauma that she had internalized and enacted. In doing so, we addressed the self-protective, homeostatic tendencies that were being played out between us, which allowed us to begin forming a different kind of relationship a slow process of collaboration and negotiation. For Charlotte, this amounted to our sessions becoming, in her words, "the only place that I am allowed to hear myself speak." Allowing herself to use analysis in this way made it possible for us to directly address our transference-countertransference relationship.
Charlotte entered her analysis feeling very certain that hope and trust were dangerous fantasies to entertain. In the immediate transference relationship that was formed, she viewed me as both interrogator and rescuer. At the beginning of her treatment, however, she was very concerned that I not know the real facts of her life and history. She spent the first six weeks creating an elaborate story about herself, which included a fabricated name, address, and family constellation. By the seventh week she began to acknowledge her true issues of depression, self-hatred, and fascination with atrocity tourism, but falsified almost all other aspects of her life. It wasn't until the sixth month of our work that she participated in a full and accurate construction of her history.
However, at the same time that Charlotte started to admit concealing many facts about her life and identity, she began to attack my initial interpretations and observations. She heard my comments about her fictitious family and developmental history as harsh criticisms, and my desire to know the "real" circumstances of her life as evidence of my intent to have her betray her family, her culture, and herself. She became increasingly disoriented as she gradually lost her general aloofness toward her analysis and our relationship. Her fear of becoming dependent upon me caused a sense of shame that she quickly countered with rage. At many points during her treatment, she threatened to terminate our relationship and hinted that doing so would force her to commit suicide.
The internalized taboos that sanctioned Charlotte's silence on many subjects were reproduced in what we later referred to as our "setup." She gave me false data as "bait"; when I took the bait that is, when I expressed curiosity or an opinion about something she said she used my response as justification of her experience of me as a representative of a traitorous, hostile, and untrustworthy world. In the battles that ensued, the unconscious conflict between the taboo of breaking silence and her need to understand the impact of her family's intergenerational trauma was brought into our emotional engagement. This included the provocation of responses from me that even though they felt abusive to her were received as "deserved." Charlotte let me know that many of our interactions left her feeling that she would eventually be abandoned, which she considered the ultimate form of abuse. In a like manner, these enactments reinforced her ongoing perception that she also deserved her father's abuse. Underlying these highly charged interactions lurked indignant resentment, which I associated with her awareness that, in contrast to her strong desire to live independently, she could not make sense of her inability to do so.
During one session, Charlotte described a dream in which she played the role of her adoptive father's young mother, who was strangled to death in front of him soon after their arrest by Nazi soldiers. She became so absorbed in her description that at one point she shouted, "Save me!" According to Charlotte, this was one of the few details that her father was willing to share during a rare instance of breaking his own rule against discussing his Holocaust experiences. She was clearly very anxious about revealing the incident to me, since it also broke the strict family taboo against discussing trauma or expressing emotions. During our relationship, discussions of symptomatic behaviors, acting out, and psychiatric diagnoses were considered acceptable forms of expression, but Charlotte perceived words as having the power to destroy the sense of security that her family had struggled hard to maintain.
I was confronted with a choice concerning my role in resolving the situation presented in her dream. Was I willing to accept the responsibility of saving Charlotte and her father's mother? According to the dream scenario, I could easily become the epitome of evil or goodness, since the person who killed the mother could also release her. As someone trying to build a relationship by reestablishing a successful social contract of trust, I was in a position to either victimize my patient and destroy her hopes, or to help her. For me, a central issue was identifying how a co-created rescue operation might "save" Charlotte from her constricted approach to living, while avoiding the equally strong potential of such an operation hindering her treatment.
Charlotte often interpreted my efforts to maintain hope in the face of her anxiety and despair as attempts to "save" her. Sometimes I unwittingly enacted the savior role by offering interpretations and advice that turned into monologues. I struggled with my own inability perhaps unwillingness to truly hear Charlotte and to sit with her as she re-experienced horrifying experiences of trauma.
In part due to her transference experience of me as a mix of persecutor and rescuer, Charlotte made room for a middle ground interpretation of who I was and what my intentions were. For me to truly act as a rescuer would mean the loss of Charlotte's potential for regaining a sense of her own agency. She thus began to consider the possibility that I might be genuinely invested in helping her without saving her an important achievement in light of the many ways that Charlotte had compliantly enacted her Borderline Personality Disorder diagnosis during previous treatments.
According to Mitchell (1988), "the analytic situation allows the analysand to recover, reconnect with, and fully experience aspects of [her]self previously disclaimed, hidden, disavowed" (p. 289). Her standard approach to relating that is, creating a sense of security by transforming her anxiety into dissociated experiences and symptomatic behaviors also engulfed her hopes and dreams. Giving voice to her disavowed trauma meant being together in such a manner that she could believe her experiences mattered. Where she had previously interpreted my curiosity as attacks, Charlotte increasingly entertained the idea that I might be invested in helping her despite my imperfections.
This working through process created opportunities for inventing new ways to talk about and experience her life, and to start questioning the belief system and values transmitted within her family and through the wider culture in other words, challenging her self-system (Sullivan, 1953). Toward the end of our work, Charlotte felt enabled to give more specific descriptions of a "lifelong feeling of being damaged," and to fill in the blanks of her personal and family trauma history. She thus entered the process of forming links between her history, her internal life, and the significance of her increasing sense of fascination with a story that was more personal than she had believed possible or desirable.
Numerous attempts have been made to bridge the gap between psychoanalysis and social or cultural theory (see, for example, Butler, 1997; Drescher, 1998; Fromm, 1968; Freud, 1921; Goldner, 1991; Layton, 1999; McCarroll, 1999; and Smelser, 1998). Some cultural theorists have focused on the concept of "colonization," normally used to describe processes by which one culture imposes its values and assumptions on another (Ashcroft, Griffiths & Tiffin, 1995; Fanon, 1967; Sardar, 1997). In such situations, the colonized often feel self-hatred and inferiority in contrast to the "dominant" culture, as well as ambivalence toward indigenous opportunities and resources (Fuery & Mansfield, 2000; Seidman & Rappaport, 1986).
Virilio and Lotringer (1997) have described a concept they refer to as "endocolonization," whereby individuals identify with oppressive forces and consequently colonize their own populations or families; the sense of colonization thus becomes internalized and silently perpetuated within a culture (see also Moses, 1995). Endocolonization is marked by the simultaneous recognition of sources of security and protection as sources of oppression and terror, resulting in profound psychological confusion that can lead to strongly dissociated experiences in individuals (Bromberg, 1998; van der Kolk, McFarlane, & Weisaeth, 1996), families (Goldklank, 1986), and communities or cultures (Borg, Garrod & Dalla, 2001).
The atrocities suffered by Charlotte's adoptive parents exerted a strong influence on her inner life and on permissible intra-family dialogues. Thus, she struggled with all acts of spontaneous self-expression. When attempting to deal with her anxieties, she truncated her sense of agency and her sense of genuine engagement with the world in favor of maintaining security. Atrocity tourism provided her with a means of enacting her connections with her family history through her active engagement with her parents' own tragedies. Yet she continued to maintain her family connection at the cost of silencing various aspects of her self-experience. Treatment allowed her to start developing conscious access to these silenced/enacted aspects of herself.
Our psychoanalytic heritage includes volumes of reports on the difficulties associated with discussing trauma (e.g., Balint, 1968; Bromberg, 1994; Casement, 1982; Davies & Frawley, 1994; Ferenczi, 1988; Freud, 1892; Janet, 1907; Shengold, 1989; Winnicott, 1974). However, Herman (1992) suggests that ours may be the first generation to acknowledge the long-term emotional price for our participation in large-scale violence an idea that may gain support in light of our current level of global communication, which gives greater exposure to both historical and ongoing atrocities. Charlotte faced the task of managing an enormous amount of anxiety, pain, and hurt that her parents and many others in her generation never worked through. In the process, she was the first person in her family to become aware of the old pain and to finally acknowledge its enormity. As a result, she felt increasingly empowered to identify the repetitive sources of pain and to challenge the associated damage cycle.
From her perspective of living in perpetual imprisonment, Charlotte maintained tendencies toward idealization, devaluation, and disruption. Never quite able to sustain a sense of where the danger was coming from, she frequently felt co-opted, consumed, and overwhelmed by the thoughts and feelings of others, including her psychoanalyst. Her absorption in fantasized horrors involving both her biological and adoptive families allowed her to maintain a clear image of the "enemy," and therefore protect herself from the damaging influences coming from outsiders. In the absence of tangible information concerning the histories of either one of her families, Charlotte decided to fill in the blanks on her own, using her observations of her parents' behavior toward people outside the family to make sense of the violence her parents had suffered, and to shed light on their implicit rules concerning sanctioned and non-sanctioned interactions with the outside world.
If viewed as a defense against trauma (Bose, 1995, 1998), we might consider Charlotte's depression as a means of expressing her need to give voice to the undiscussable and indescribable aspects of her personal and familial trauma. Her parents' way of not dealing with their atrocities is remindful of Freud's (1917) discussion of stalled mourning processes that result in intractable and, in Charlotte's case enacted grief. As part of this process, such defenses against the pain of loss as identification and internalization sustained her family-sanctioned silence. Winnicott (1965) suggested that "the development of a self may involve a sophisticated game of hide and seek in which it is a joy to be hidden but a disaster not to be found" (p. 186). The metaphor was fitting for Charlotte, who regularly expressed her conflicting desires to be found (heard, seen, felt, and touched) and to remain hidden.
Charlotte's mother called me on a Friday afternoon to inform me that Charlotte had died. She went to great lengths to assure me that Charlotte had died of "natural causes" resulting from heart failure related to a recent struggle with what we all thought was a severe flu. The emphasis on "natural causes" was related to Charlotte's several suicide attempts throughout her adult life. In what would be her last session, Charlotte was surprised to realize that she had not had suicidal fantasies throughout the previous six months. Her death was, and is still, devastating.
Charlotte attempted to make sense of her fascination with atrocities, though he explanation was fraught with denial: "I originally went and saw what I did for the most prosaic reason I was in the neighborhood. Which isn't to deny that it was fascinating. And devastating. I bear witness whether it does any good or not."
This statement would ultimately make sense of Charlotte's treatment, perhaps of our relationship. Charlotte entered treatment minimizing her needs, uncertain of the causes of her pain, and in denial of the implications of her real and fantasied exposure to atrocity. By the end of her treatment, Charlotte had become increasingly able to share her pain and make sense of the history of trauma in her family and in her life. When I asked Charlotte why she had not been suicidal in the last six months, she said, "because I feel like I have a partner." To me, this captures the heart of Mitchell's (1997) sentiment that it is, foremost, our effort and concern, that sparks and sustains the hope necessary for patients to work through their trauma.
One day, during a particularly difficult stretch of her analysis wherein she had been vividly describing the details of her highly self-destructive behavior throughout her late teens and twenties, Charlotte turned her head an whispered to me in horror, "Mark, I think that my unconscious is trying to kill me." This brought to mind an ongoing theme throughout the fictive work of William S. Burroughs (see, for example, 1961, 1989). Namely, that the most formidable assassin is the one who is unaware of his or her mission, goals, and identity. Looking back it seems that Charlotte had sustained a life wherein these, her mission, her goals, her identity remained vague, at times thoroughly undetectable making her the perfect assassin. Yet thinking back upon the parts of our identities that we shared through our experiences as atrocity tourists in her analysis has caused me to reconsider my initial knee-jerk response to her statement about the desire of her unconscious to kill her. I then said, "Or it's trying to save your life." It now seems possible that both were actually the case. It also seems that atrocity touring had been a potent metaphor of that struggle. In her analysis, she would finally share the lifelong battle between life and death that raged inside her.
Rest in peace.
Annan, K. (2000). Millennium Report of the Secretary-General of the United Nations. New York: United Nations.