Freud's sons, Martin (left) and Oliver, 1917
"You are right when you say I have become hard and can’t talk about things … I am frightened that when I get home I won’t be able to function anymore. … Until now everything has been fine. I have learned a lot, without any problems, but I can’t get used to what is happening." Letter from Martin Freud to his father, 24 October 1918
18 October 2014
9.30am - 5.00pm
PSYCHOANALYSIS, TRAUMA AND MILITARY MENTAL HEALTH
Day Conference at The Anna Freud Centre
Military conflict and its psychological consequences has been an important factor in the development of psychiatry and psychoanalysis in the 20th century, and the treatment of casualties of war have led to a new understanding of complex trauma. This important conference looks at the lessons that can be learned from past and current forms of diagnosis and treatment.
SPEAKERS AND TITLES
Lingering Trauma: Freud's War with Psychiatry
Strange Meetings at Northfield: Dilemmas of Psychiatry at War
Ten Years Down: An Army Psychologist’s Reflections
A War in the Mind: Some Challenges of Working Psychoanalytically with Homeless Veterans
Felicity de Zulueta
Psychological Effects of War
Psychoanalytic principles in the understanding of complex trauma
A therapeutic community for traumatised veterans
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In this paper I will look at the context surrounding Freud’s ‘Memorandum on the Electrical Treatment of War Neurotics’ which he presented as an expert witness in 1920 to an Austrian commission of enquiry into the treatment of shell-shock victims. I will also briefly consider his Introduction to ‘Psychoanalysis and the War Neuroses’, the first book published by the International Psychoanalytic Publishing house, and will show how both these papers illustrate enduring aspects of the conflictual relationship between psychoanalysis and psychiatry.
The Northfield Experiments were more than just an experiment in social psychiatry, they also enabled psychiatrists to explore their roles in a time of war. There were a number of contradictions for them, non-combatant guilt (talking to men who had experienced battle trauma, whilst they remained safe at home), the fact that they were officers and thereby senior to the men, and being therapeutic whilst being aware that if successful they may be exposing their patients to danger again. For a year, 1945, they met regularly to discuss the therapies they were providing, and these debates have been recorded verbatim. These notes provide an interesting insight into the controversies, and experiences, that they were subjected to. Central to the developments in the hospital at this time was Major Bridger, an artillery officer, and his ‘out of the box’ thinking was a central inspiration to the evolution of this early therapeutic community approach. His role as the only non-medical officer present in these discussions deserves specific consideration, as a reflection of the dynamics of the whole. This paper will explore some of the issues raised, after briefly setting the discussions in their historical context (both military and psychiatrically).
Remarks about the personal and professional experience of a US Army Psychologist from 2003 to 2013 will be coupled with responses to selected questions put forward by conference organizers. The intent will be to address what comprises daily activity working with Soldiers, thoughts that have arisen over time from that work, and ruminations on the practice of psychology during war.
This will be a clinical case presentation describing individual and group psychotherapy work with homeless veterans within an applied psychoanalytic setting. I will try to give a flavour of how difficult some traumatised veterans can find the intimacy of the therapeutic encounter, and how the strength of their defences, the complexity of their psychopathology, and their sensitivity to humiliation, can make them difficult to reach emotionally. This has implications for how psychoanalytic work is approached and how we might define successful treatment, which I will discuss.
Felicity de Zulueta
Following a short presentation of clips from the film 'Regeneration' to illustrate some of the experiences of traumatised soldiers in World War 1, Felicity will talk about her work with veterans suffering from PTSD and its implications for our understanding of some the current conflicts in the Middle East.
Psychoanalysis has a history linked to war and its impact upon the individual. A number of Freud’s significant theoretical ideas developed from his consideration of the impact of military trauma in World War One. The Tavistock Clinic in its early years has also developed both in theory and practice by working with traumatized veterans.
The Unit for the Study of Trauma and its aftermath was first conceived by Caroline Garland and a group of colleagues at the Tavistock Clinic in 1987. In recent years we have seen increasing numbers of traumatized refugees from war torn countries in Eastern Europe and Africa and those individuals tortured and traumatized by their own governments in the Middle East, South America and so on. These experiences have often been of a more chronic, repetitive and sustained nature and fit with a diagnosis of complex trauma. We are also increasingly referred patients who have had significant developmental trauma, often with a recent adult trauma as the precipitant for referral. Our partnership with Home Base (John Gale, below) and the therapeutic work with veterans makes use of our psychoanalytic understanding of the impact of trauma in the wider context of an individual’s life.
In this paper I give a brief outline of this history before describing some of the theoretical principles which underlie our understanding of trauma from a psychoanalytic perspective.
Home Base is a project for former members of the Armed Forces who are traumatised and homeless, now working in partnership with the Tavistock Clinic Trauma Service. Veterans referred to Home Base will have become homeless partly as a result of the psychological problems they experience. Many suffer from complex trauma, depression, anxiety, or post-traumatic stress disorder (PTSD). A number have diagnosed personality disorder. These problems are frequently exacerbated by alcohol or drug abuse, unemployment and inadequate life skills. Nearly all will have a very limited support network, suffer from a lack of self-esteem, feel worthless and find it hard to from relationships. Home Base provides psychotherapy, accommodation and practical support, in order to help veterans adjust to civilian life. This talk will describe the work of Home Base and the use of psychoanalytic ideas in the treatment and care of traumatised ex-military personnel.
Michael Molnar is a former director of the Freud Museum London and reviews editor of the journal Psychoanalysis and History. As well as publishing many papers in the social history of psychoanalysis and Freud biography, he is editor of The Diary of Sigmund Freud 1929-39 (Chatto, 1992) and author of Looking through Freud's Photos (Karnac, 2014).
Tom Harrison is a medical historian researching for a PhD in the History of Medicine at the University of Birmingham. He previously worked for 28 years as a consultant social psychiatrist, working with people who had experienced severe and long term mental illness. He is actively involved with the Royal College of Psychiatrists, being on the Rehabilitation and Social Psychiatry Faculty, Public Education, and the Patients' and Carers' committees. He has published papers on Leadership, Patient Advocacy, and Mental Health Promotion and is author of Bion, Rickman, Foulkes and the Northfield Experiments (Jessica Kingsley 2000). His present research is on the history of a Therapeutic Community called the Ingrebourne Centre, based in North East London.
Emile K. Wijnans is a Clinical Psychologist and active duty US Army Major currently serving as Chief of the Department of Behavioral Health at the US Army Health Center in Vicenza, Italy. For the past 11 years he has worked with Soldiers from infantry and aviation brigades, recruiters, and drill sergeants in Georgia, Tennessee and South Carolina as well as Iraq and Afghanistan.
Joanne Stubley is a Consultant Psychiatrist in Psychotherapy at the Tavistock Clinic. She leads the adult section of Tavistock Trauma Service, and has considerable experience of working with individuals, groups and organisations who have experienced trauma. She is actively involved in teaching and training in this field, with a particular interest in complex trauma. Dr Stubley is a member of the British Psychoanalytic Society.
The Tavistock Trauma Service offers a psychoanalytic approach to trauma alongside trauma-focused Cognitive behavioural therapy. The service offers a variety of therapeutic packages to single episode trauma, as well as complex and developmental trauma. Unlike many trauma services, a diagnosis of PTSD is not a requirement; rather it is the experience of trauma as central to the presentation that typifies referrals.
John Gale is CEO of Community Housing and Therapy (CHT) a charity specialising in the psychotherapy of the psychoses. Formerly a Benedictine monk, he was director of studies and lectured in philosophy and early church history. After leaving the priesthood he trained as a psychotherapist and has worked in therapeutic communities for over twenty years. He was the clinical director of CHT before being appointed to his present post in 1999.
He is the President of the International Network of Democratic Therapeutic Communities, a board member of the International Society for Psychological and Social Approaches to Psychosis (UK) and of The Consortium of Therapeutic Communities, and a member of the advisory panel of the Community of Communities programme at the Royal College of Psychiatrists. He was the deputy editor of the journal Therapeutic Communities for seven years and is currently a member of its international editorial advisory group. He regularly speaks at conferences and has edited and contributed to books, and published over 20 articles in academic journals. He is particularly interested in the interface between philosophy, psychoanalysis and spirituality.
Mike Swinburne is a Psychoanalytic Psychotherapist in the Trauma Service at the Tavistock Centre. He works with homeless veterans in a therapeutic community run by Community Housing and Therapy. He has a longstanding interest in the application of psychoanalytic thinking to therapeutic community and supported housing settings.
Felicity de Zulueta is an Emeritus Consultant Psychiatrist in Psychotherapy at the South London and Maudsley NHS Trust and Honorary Senior Lecturer in Traumatic Studies at Kings College London. She developed and headed the Traumatic Stress Service in the Maudsley Hospital which specialised in the treatment of adults suffering from Complex PTSD.
She has published papers on Bilingualism, complex PTSD and BPD from an attachment perspective and is author of a "From Pain to Violence; the traumatic roots of destructiveness" (2006). She works as a free-lance consultant Group Analyst and psychotherapist with a training in psychoanalytic psychotherapy, systemic family therapy, group analysis, EMDR and Lifespan Integration.