From terror of sleep to love of death

Let us imagine a supposedly caring mother who raises on her child the Sacrificial Blade. Let us imagine a supposedly protecting father, who leaves his child to the grip of terror instead of helping him. Let us imagine that this same child, object of the deadly maternal jouissance mortifère, decides he is a subject walking towards death to kill the most possible enemies.

This is the history of Samson in the land of the Philistines. This is the scenario that will be unfold in the following presentation. A scenario which is played out in the body more than in the spirit.

Is it the chance of references? Is it personal taste? Or is it simply a dramatic increase of this type of symptom? these last years I have seen a lot of traumatized people at my office. I have also had the opportunity to work in a general hospital, where I treated patients with a variety of problems caused by illness, accidents, or simply the experience of being hopitalized. This text is the result of the reflexions which this clinical experience inspired. Not surprisingly they center around the notion of traumatism. Given that all the Freudian research was centered around the notion of trauma, including « Traumdeutung » as pointed out ByEdward Robins, last year, I have subscribed to a valid tradition.

Surprise and amnesia

What is traumatism? How can we characterize it? Adnan Houbballah, who worked with trauma victims of the Lebanon war, calls for the notion of surprise as the finest criteria. The patient does not expect the surge of aggression. This criterion should be viewed with caution, as the potential trauma victim is not oblivious that he is in a potentially dangerous place. But he denies the danger by believing in his lucky star and maintaining his fundamental conviction that he is sheltered from death, regardless of the circumstances.

A double denial can hide behind this criterion of surprise: the denial of the victim’s responsibility in putting himself in danger, and denial of the fragility of his natural integrity, in effect the eventuality of his death. However, we must exercise caution when interpreting these denials. There is a danger the patient could feel accused or responsible for the aggression he suffered.

Another criterion Houbballah discusses is amnesia or the relative amnesia of the patient concerning every aspect of his life before the traumatization. It is as if life after the traumatism reached such an intensity that it eclipses the peacefull and naïve perception of reality before the event. The period before trauma becomes a lost paradise. Something was there, is no longer there and may never return.

The trauma energy

This difference between the present and the bygone past may be found in Freud’s description of the difference between the thing (das Ding) and the object. Lacan took up the idea to introduce the concept of the plus-de-jouir which he worked out in echo with the plus-value of Marx. According to Lacan, this difference, this dissatisfaction which the child or the infant tests by comparing the first pleasure with the Thing, and the current satisfaction, is the plus-de-jouir . The child allots the absence of his jouissance to the fact that the Other -the capitalist mother keeps it for herself and therefore deprives him from it.

To better understand the phenomenon I will use of an example cherished by Lacan: the hydroelectric dam. The dam is already a reserve of water which puts an end to the state of nature of the river. Retroactively this sta te of nature will be the model of the lost pleasure. But the accumulation of water can become excessive and the floodgates are then necessary to evacuate it. It is the model of the pleasure principle. On the other hand by these same flood gates one can produce with turbines the electricity which will be used to work out and to diffuse the most refined forms of civilization. These turbines producing electricity are the model of the jouissance which seizes the subject signifiers and allows what Freud called sublimation. The dam plays here the role of the trauma which comes to hustle an idyllic state of nature to function like a jouissance.

The libidinal surplusses

Victims abound in the description of libidinal surpluses which appear in the form of excessive pains (often without any tissue-injuries) or inflammation of members not necessarily implicated in the trauma. The inflammation can be centered on the injured member and radiate gradually in an increasingly large area. Thus a finger of the left hand can radiate in the hand, the arm, the shoulder, the head and possibly all the left side of the body and cause all kinds of somatic events.

On the psychological level, these excesses of jouissance trigger the person to be extremely irritable, fatigable and narcissistic. The trauma is a gigantic machine to produce jouissance without the opportunity of discharging it or decreasing its levels. The sexual pleasure is often out of reach, and even the depression which, usually, allows thanks to the super-ego to maintain lower levels, is not able to act effectively. The depression might be present but is not enough to counterbalance the overflow of libidinal production.

A two stroke pump

Now that the external features of the trauma are taking shape, we can wonder how and when a given event will either become a trauma or will remain an ordinary event of the subject’s history .

According to Freud, a trauma occurrs when the sensitivity of the subject is overwhelmed by the event. Freud also teaches us that excess starts as soon as perception exceeds the sample taken on reality to identify its nature. However many massive events may not have a traumatic effect. We can also stress the fact that in our way of posing the problems, the sexual trauma does not need to be distinguished from the violent one. The perceptive excess which reaches the sensitivity can as well be sexual. We can thus use some of Freud’s indications, even if, originaly, he has worked them out for the sexual traumas.

The indication of Freud on this subject is to say that the sexual trauma takes place in two strokes: the event itself followed, sometimes after a long time, by the après-coup effect which transforms the event into trauma. It is only after a certain instinctual maturation that the event is hijacked and transformed into trauma.

Clinically speaking, it appeared to me that the violent trauma can also function in two strokes, the first of which is the event itself. The clinical examples really abounded in this direction.

• a worker undergoes a benign accident then, a little later, is turned in derision by his boss who fears to pay the damages due to the trauma victims.
• A road trauma victim whose car overturned, does not receive assistance and must extract herself from her car all alone.
• a workman whose arm is caught between two rotary drums is released after one hour of effort.
• a patient suffering from discal hernia learns from his orthopedist that he can do nothing neither to cure it nor to relieve his pain.
• a taxi driver wildly attacked by a customer does not receive any help from the witnesses or a rather meager help from the police.

All these examples tend to be two-stroke traumatisms with a clear similarity regarding the second stroke. In all the cases a guardian is unable to protect the subject from the attacks of accident, illness or death. I have seen these patients for long periods of time and they all came back on several occasions over the second stroke by regarding it as determinant. In their mind, the guardian not only failed in his obligations, being unable to help them, but they sometimes also suspect him of taking pleasure from this incapacity.

All occurs as if the guardian, possibly god, who protected them, had discredited himself and that the triangulation which barred attacks from the external world, had collapsed. The subject is caught in a dual relationship with the evil, in a kind of permanent internal war. Day and night, the subject fights against this real and virtual enemy. The feeling of fear is constant. At the physical level the pain can replace the fear or be added to it.

An unlimited system of libido production is born. All the techniques aiming at decreasing this libido flood will be of little effect, especially in quantitative terms. The subject is at the mercy of this evil Other. He is caught in the fascination it exerts on him.

The impossible appeasement

One of the means which the subject usually uses to decrease the libido level is to sleep. When evening comes, the nervous system is saturated. It has a hard time accepting new stimulations. During sleep, the nerves discharge stimulations they accumulated during the day. When morning comes, the sensitivity to perceptions is much greater. They are greeted more easily and with pleasure. The sleep is so much a moment of appeasing the impulses that when, for an unspecified reason, psychic or physical, the sleeper receives stimuli, the dream intervenes to divert these stimulations in a convincing scenario which aims at alleviating concerns of the sleeper and enabling him to continue its sleep. « the dream is the guard of the sleep », said Freud.

However, with a trauma victim, things do not occur at all in the same way. For him to sleep is a difficult venture. His fear and his fear of pain are so important that sleeping means not protecting himself from danger. And if, he takes sleeping pills, he will resist them as much as possible, considering them an important threat by remaining awake in spite of the pill, or by waking earlier than the usual effect of the pill. Finally if, despite all these obstacles a trauma victim ends up falling asleep and seriously undertakes to rest, at this point intervenes the traumatic dream which puts an end to his last velleities of rest. Moreover it is very remarkable to note that the traumatic dreams are much more frequent after tiring days which make the rest more enviable.

The sinusoïdal paradox of the traumatic dream

Rest is the enemy of a trauma victim because during rest he is defenseless vis-a-vis his virtual enemy. The trauma victim lives the very paradoxical situation that his greater concern is to be reassured and, consequently, that what reassures him the most is to be particularly anxious. He alternates continuously between two poles: extreme exhaustion and extreme anxiety.

From this point of view the traumatic dream plays the same role as the nontraumatic dream: it « reassures » the trauma victim, like any normal dream, but by worrying him enormously and awakes him so that he cannot sink anymore in the terrifying (un)quiétude of sleep. In other words the traumatic dream does not differ from the non traumatic dream qualitatively. Its spectacular feature comes simply from the logical effects of this particular relationship between the subject and his virtual enemy. Which comes in its turn from the collapse of the protecting triangle that shelters him from real and virtual dangers of evil.

How life and death oppose themselves 

After these considerations, how can we reconsider the opposition of life and death that Freud had worked out since his analysis of the traumatic dream? For a while, and until now for the IPA societies, the life/death opposition has been considered as equivalent to the opposition between sexuality and sadomasochism. Let us be clear about that, this opinion is completely wrong. Freud writes very clearly in the «Malaise» that sadism and masochism are a mix of life and death. Without the help of a certain quantity of sexuality the death instinct would not be perceptible. Lacan and Dolto continued the idea and interpreted the life and death on the side of the excitation and the rest of the drives. Whether these drives are violent or sexual would not change anything with the matter.

Death, according to them, has to be found on the side of the inanimate, the sleep and the rest. On the side of a loosening of the vital tension. Whereas life has to be found into all that contributes to the mobilization of this vital tension and directs it towards a particular goal. This goal being either an enemy or a sexual object. Also Dolto used to say that life needed mental representations to spread itself, but death didn’t need any representation. The absence of representation was enough.

To vanish or to face up to death

Death instinct is the tendancy to rest. This tendency increases when the patient is tired. The danger of subjective vanishing is then important. To avoid this subjective death, the subject calls upon what can stimulate him and mobilize his vital tension. The traumatic dream plays this part. Thus the opposition between life and death instincts appears in the trauma, in an alternative between dying and vanishing. To die being paradoxically on the life side. The death appeal as a continuation of life is not so astonishing when one thinks of the Homeric heroes (about which Thierry Hentsch wrote in « Raconter et mourir ») which, rather than to have a dull life without history, choose aventure and death to write their name in the eternal registers of history.

Representing death

I would defend, on the other hand, contrary to Dolto, that there is a representation of death into the psyche. It is more by chance that I have been able to make this discovery. Within the scope of my work at the general hospital, I have been asked to the bedside of a lady who had just been involved in a car accident a few days ago. Her car had overturned into a ditch. She suffered from multiple fractures to the hip and injuries to the stomach and the lungs. This lady did not lose consciousness after the accident and remained lucid enough to look for her cell phone in her purse and call for help. She fainted only in the hospital, and only because of the medication remained a few days in a half-coma. Awaking from this period, she suffered from nightmares for which she asked to consult a psychologist. To my great surprise the nightmares she reported were not traumatic. They were rather situations where she was going to be absorbed by holes or various spider webs made of ropes.

I could have maintained the idea that it was traumatic dreams. There were certainly reasons to do so; The hole absorbing her might have been the ravine into which she had fallen. But I would have had the feeling of distorting things. I prefered to interpret the dreams towards a fear of vanishing. The associations which followed concerned her mother against whom she felt a great anger, and who she had not seen for more than 7 years. On the other hand she had a great affection for her father who had always supported her in all circumstances. Her life had been marked by this simple opposition between mother and father. The following associations, during the next meetings, were centered around this opposition. Culminating on this major information, which was probably one of the causes of the accident, namely that her employers gave her the work load of four other people after having dismissed them. Without, of course, increasing her wages. Knowing that this woman was an agent and worked on the road, the increase of risk was important. Like the hares caught in a collet, she couldn’t move back, She couldn’t imagine giving up this excess work without falling into the arms of this mother she hated for reasons I will get to know in the following sessions. For this lady, the inconceivable was the idea of a rest or to return to the maternal bosom, because her mother prefered one of her sisters in an exagerated way. In a moment of great weakness, she developed what we can qualify as a vanishing counter-traumatic dream. Therefore she represented death.

About the importance of listening

All those who take care of the immediate consequences of accidents, recognize the importance of what is said immediately after them. There seems to be a kind of blessed period after the accident where an attentive ear can indeed achieve miracles. One can believe consequently, that between the accident and the moment when the accident becomes a traumatism there is a certain lapse of time during which the fact of talking with somebody mitigates the psychological effects of the accident and slows down its transformation into a traumatism. However, the determining factor which seems to trigger the fall into the traumatism is the discredit supported by a protective third party due to the the fact that he was unable to protect the trauma victim from evil. Consequently, an appropriate listening at the right moment can save this third party of discredit or in all cases, to moderate this discredit. In other words, the maintenance of the tranferential bond can save the « goodwill » of the third party who realy wants to help even if the trauma victim will have to understand the limits of his helping power. It will prove at least that he didn’t want to harm him or to get a jouissance out of the trauma.As this listener is not identifying himself to the great Other, he might realy be a third party.

The Other either mighty or missing

The miraculous logic of this help comes from the fact that it recognizes the limits, sometimes very restricted, of the assistance that one can offer while maintaining a benevolent presence. What is particularly suffering in the remarks of the patients and which rather frequently arise, is the complaint that the third party which should have helped them, doctor, police officer, boss, not only did not give assistance but also showed indifference, contempt or rejection. The lack of solicitude was added to the failure to help. The slightest lack of solicitude thus has an opposite effect of the attentive listening. One triggers the sudden appearance of the trauma whereas listening postpones it. The logic of the catastrophe is that, the trammuma victim allots to the Other an absolute power doubled with unwillingness. «He could have saved me but refused to do so». This Other is not missing. His omnipotence makes him stick to the real on which he has an absolute control.

Before the phallus

With trauma victims the symbolic and the real are closely overlapping. Transfer has an effect on the physiological level. The functional disturbances of the internal organs, the pains, with or without physiological injuries, the inflammations of members or wounds, the inflammation of the nervous system, can undergo important modifications in an unfavourable or favorable direction according to the sign of the therapeutic reaction. The mix of real and symbolic is quite different from the one we can observe in conversion. In the latter real is a blank paper entirely subjected to meaning registered on it. Only the central nervous system is affected superficialy. With trauma victims, on the contrary, there are the physiological and organic functions which are hustled. The symbolic and the real seem mixed in the same way as they can be in the infant or in female sexuality without the help of sifgnifiers. The indices that have to be interpreted are signs to be deciphered in the context. A little like Dolto used to do with the infants by pointing out the somatic movements, dates and events. All this information enabled her to formulate the interpretation by which she imputed a subjectivity to the infant even if no signifier can testify for this subjectivity.

The traumatic dreams contain signifiers which can open the way to free associations. But the somatic movements are often dumb and we have to import the subjectivity to some extent from outside. I have been called once for a patient which had just survived a cerebral hemorrhage and two successive CVA’s. His very anxious daughter had made the request of it. I understood almost nothing from what he said. His daughter translated, at least what she understood. He said he should never have survived his CVA and said he wished to die. I used with him the doltoienne technique: the imputation of subjectivity. I told him that in a certain way, and owing to the fact that he had survived, his body had made the decision to live rather than to die. This intervention probably had a salutary effect owing to the fact that the complaint of the patient was suspended. I had the feeling that my argument had touched him. I believe that his favorable evolution at the physical level was the proof that my interpretation had an effect or at least that it was true in the sense that he had actually decided to live.

The Other doesn’t miss the phallus anymore

To summarize, concerning the traumatic neurosis, I would say that the accident becomes a traumatism when the protective triangle falls. The patient is then caught in an alternative between vanishing on one hand, and facing death on the other hand. The two phenomena are in fact dependent. The protective triangle is constituted by the subject, the Other and the phallus. Immediately after the accident there is still a chance to save the phallus by ensuring an attentive listening. In all other cases, the phallus disappears and the subject is caught all alone, facing an Other which is no more lacking.

Conclusion

To conclude, I would say that the effectiveness of the post incidental intervention lies in the fact that it shows to the subject that he is not alone vis-a-vis the whole power of the accident. The fact that it can speak, that he can address himself to somebody, puts a limit on the harming power of the powerfull accident. It becomes « not all ». The tranferential relationship revives, the lack in the Other, one moment erased by the accident.

The neurosis settles in two times. The time of the accident which cancels the lack in the Other and presents the accident as very powerful, and a second time during which the phallus or any object which incarnates the lack in the Other, does not come to dispute this powerful Other and thus lets it settle for good.

From now on the subject is captive of the Other. Nothing can move him away any more. The subject is here reduced to the biological real inhabited by the symbolic nature of the Other. There is here a mixture of real and symbolic which appears especially in various psychosomatic symptoms. Generally when there is no injury the effect will be a hyper stimulation of the different nervous systems with the varied consequences that that can have.

In spite of the fact that the subject is caught in the Other’s jouissance, in spite of the fact that the subject complies without obstacles to the discrete action of the death instinct, there are still avenues towards a therapeutic perspective, there are embryos of solution which appear spontaneously. Oddly enough the first element of an opening is the traumatic dream itself. Contrary to appearances, the dream belongs to the solution rather than to the problem. One could describe the action of the traumatic dream in several ways that are all the same.

The dream triangulates the dual relationship between the subject and the great Other. One can also say that it introduces libido where there was only death instinct, or that it turns a primarily mortifère situation into masochism or that it introduces the imaginary or the signifiers where there were only a mix of real and symbolic. But one can say finally that it contributes to stimulate a libido which, otherwise, would have succumbed to a total appeasing.

In all these ways of describing the phenomenon, there is the idea that stimulation is needed where there would have been an impressive drop of libido. In this direction the permanent hyper stimulation of one of the nervous systems can very well belong to the same « therapeutic » phenomenon. All the somatic phenomena which go towards a hyper stimulation activate the same urgency to stimulate not to sink in a total instinctual depression.

All these symptoms deserved to be inserted in the alternative to vanish or die. It is totaly acceptable for a patient to hear that the hyper stimulation of his senses is there to counter his fear of a too great rest in which he could vanish.

By doing this, we confront a medical conception of the body which stipulates that The body is only matter and that it does not talk. We have to document a conception of the body where it would be fashioned by the symbolic system on one hand, and stimulated by signifiers on the other hand. Exactly comparable in that with unconscious, which is the Other’s desire and produces signifiers which animate the libido.

The master signifiers which allow this production of signifiers have all the caractéristics of being uncertain. The phallus is uncertain. We are not sure if it exists or not. Just like god or the uniform rectilinear motion. When the phallus and god and all those master signifiers are absent there is still the fear of an enemy which we don’t know if he exists or not and when he will strike or not. This fear replaces all the other missing signifiers and this may happen for a lot of people at the same time like in the United States today.