Ferenczi explored traumatic exposure throughout his career, first via "elasticity," then through the concept of "alloplastic adaption," and finally through "mutual analysis." Freud also saw patients who experienced trauma, however, he chose to diagnose them with "hysteria" and blame Oedipus. Ferenczi did not blame the patient but empathized with them in their great distress and tried to find the most helpful techniques towards catharsis.
Exposure to trauma is an unexceptional event in the United States, with estimates to such exposure ranging from 50-70% of the United States population. (Sidran Institute, 2013; US Department of Veteran Affairs[USDVA], 2013). Despite such distressing statistics, the development of post-traumatic stress disorders, which are marked by substantial clinical impairments is unusual. (American Psychiatric Association[APA],2013). The lifetime risk of experiencing PTSD is 8.7% in the United States,[( lower in Europe) (US Department of Veteran Affairs, 2013)]. Women are twice as likely as men to develop the disorder. (USDVA, 2013). (Place Table 1 here).
The finding that few people develop severe psychopathology despite experiencing serious traumatogenic exposures hearkens back to two earlier hypotheses neglected by 21st Century psychologists: One is that the span between normal and pathological functioning is a bridgeable spectrum, not a fine line. This is the analogy method developed by early psychoanalytic theorists, such as Freud and Ferenczi. For example, mourning, the normal expression of grief, becomes pathological at the extreme opposite of the spectrum as melancholia; dreams, the normal expression of sleep, becomes pathological at the extreme opposite of the spectrum as either narcissism or schizophrenia. (Freud, 1917, 1963). The analogy method is useful to not only understand the phenomena studied, but also leads to an appropriate bridge for therapy, as it offers a window into understanding how individuals experience their disorders, and thus, how far therapists must travel to meet them for an optimal therapeutic encounter. Resurrecting the approach of a spectrum which ends in a pole of normalcy and one of psychopathology with various stations of functionality in between may lead to more reliable and valid therapies for the treatments of such psychopathology as post-traumatic stress disorder (PTSD). Furthermore, the spectrum approach also spans the gap in understanding why fewer people develop disorders despite exposure to traumatic stimuli. This alternative narrative is more commonly employed by psychologists outside of the United States, but its utility is limited, as the medical model is privileged in the actual treatment. (Eisenberg & Margraf, 2015).
The spectrum approach also accounts for various personality factors that may mitigate the development of this disorder, such as temperament, early socialization, socio-economic status, history of traumatic brain injury, and educational status. (APA, 2013). These intra-psychic factors may cause individuals to believe they can actively take control of their lives, or need passively endure them. As Freud said, “The fading…depends….[on] whether there has been an energic reaction to the event that provokes an affect.” (Breuer & Freud, 1895, p. 8). Freud regarded the formation of a neurosis as a passive act representing repression, the seeds of which are planted in early socialization (Freud, 1924, 1963). What does this mean to the modern reader? An energic reaction would be an active working through of the trauma. Engaging in a creative act may be one such expression of an energic reaction. A creative expression would be antithetical to repression, indeed, it would be a sublimation of a trauma, thus, active and not at all defensive.
While Freud proposed the utility of a spectrum approach in understanding psychopathology, Ferenczi grappled with identifying relational factors which might lead to a positive or a negative emotional outcome after traumatic exposures. Ferenczi’s(1955) theory of alloplastic adaptation may be of assistance in understanding the intra-psychic factors which manumit an individual from impairment or bond them with it. Ferenczi was one of the few early psychoanalysts who managed to remain within the Freudian hegemony while simultaneously addressing the reality and frequency of actual child sexual abuse, independent of the Freudian concept of Oedipal fantasy. (However, sexual violence was only one form of traumatic exposure which can later lead to post-traumatic stress disorder. Also included are exposures to natural disasters, combat, traumatic brain injuries, etc.). According to Ferenczi (1933), exposure leads to psychiatric impairment when,
Pathological adults….mistake the play of children for
the desires of a sexually mature person….The real rape of girls…and
boys…are more frequent…than has hitherto been assumed. These children
feel physically and morally helpless…the overpowering force and authority
of the adult makes them dumb…can rob them of their senses.
The same anxiety…if it reaches a certain maximum, compels them to
subordinate themselves like automata to the will of the aggressor,
to divine each one of his desires and to gratify these; completely oblivious of
themselves, they identify themselves with the aggressor.
Through the identification…he…becomes intra-instead of extra-psychic;
the intra-psychic is then subjected, in a dream-like state….When
the child recovers from such an attack, he feels …split. Usually the relation
to a second adult….mother…is not intimate enough for the child to find help…
The…child changes into a mechanical obedient automaton or becomes
defiant…..One part of their personalities…got stuck…where it was
unable to use the alloplastic way of reaction…could only react in
an autoplastic way be a kind of mimicry…a mind which…lacks the
ability to maintain itself with stability in face of unpleasure…(Ferenczi, 1933, pp.
162-163)
Autoplastic adaptation involves an individual reacting “to stimuli of unpleasure with fragmentation….absolute passivity.” (Ferenczi, 1932, p. 165). An autoplastic adaptation usually is interpreted as having a more “primitive stage of ego development.” (Bychowski, 1950). No wonder Ferenczi often referenced survivors as passive, like “automatons.” By contrast, “alloplastic adaptation involves the alteration of the environment in such a way as to make self-destruction and self-reconstruction unnecessary and to enable the ego to maintain its existing equilibrium...A necessary condition for this is a highly developed sense of reality.” (Ferenczi, 1930-1932, p221).To state this empirically, an alloplastic adaptation modulates the risk of psychiatric impairment following traumatic exposure, as it usually is interpreted to mean the individual actively attempts to “alter reality.” (Bychowski, 1950). Secondly, alloplastic implies an environment which offers the necessary buttressing to unite the post-traumatized fragments. As Ferenczi iterates, it is the continuation of an existent relationship with a known caretaker, who is not the aggressor, which predicts whether or not there will be later impairment.
The concepts of alloplastic vs autoplastic adaptation has not sat idly by over the previous century. Bychowski (1950) invoked these concepts in understanding the struggles of an obese patient. He conceptualized her obesity as a defense against being attractive to men. Her guilt led her to enact “autoplastically her phantasy of pregnancy…this wish fulfilment became fused with punishment.” Of course, the guilt led to overeating and lack of exercise, the active cause of her obesity. (Bychowski, 1950, p.3). This study indicates how autoplasticity can be utilized as a window into understanding the etiology of the trauma. However, he does not seem to have made the next logical step of incorporating his empathy into the actual treatment plan.
By contrast, Amati-Sass (2004) does. He writes of the utility of alloplastic adaptation in working with a Latina survivor who “disappeared” into prison as an opponent of a dictatorial South American government. Helping this survivor to later adjust using an alloplastic philosophy enabled her to make
…thinkable and symbolizable the trauma and its unconscious defences (fragmentations, splitting, dissociation, adaptation) and to give the patient the possibility of transforming defensive ambiguity…of transforming alienation…during the working through…the patient has to decode…disturbing affects, shame and catastrophic anxiety, the loss of sense and meaning, the perturbations of his or her sense of identity, but also to be able to de-legitimate, to rediscover his or her opposition to the violence undergone… (Amati-Sas, 2004, p,2)
Long after the trauma, and even after the passing of young adulthood, healthy growth can be found in a new supportive relationship.
In the United States, a major issue in conducting research is the fragmentation within the field. Psychoanalysts and psychologists and psychiatrists are speaking in a confusion of tongues. “Splitting,” “fragmentation,” “Intrapsychic,” “autoplastic,” “alloplastic,” are simply not terms within the empirical oeuvre. If you expect to be taken seriously, one must work within the orthodoxy. That orthodoxy is reflected by understanding how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM5) orders the issues. The current revision includes a section for Trauma and Stressor Related disorders, “in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion. These include “reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder, acute stress disorder, and adjustment disorder.” (APA, 2013, p. 265). And, the current orthodoxy actually meshes quite well with Ferenczian concepts, as it takes into account the distressing influences of an environment run amok:
Psychological distress following exposure…is quite variable. In some cases, symptoms can be….understood within an anxiety or fear-based context…however…many…exhibit…anhedonic and dysphoric symptoms…externalizing angry and aggressive symptoms, or dissociative symptoms….Furthermore, it is not uncommon for the clinical picture to include some combination of the above symptoms. (APA, 2013, p. 265)
However, in all cases, exposure to traumatic stimuli is not sufficient for a diagnosis. There must ensure a degree of intrusive symptoms, and/or dissociative reactions, and or persistent avoidance, and or negative alterations in cognitions and moods, marked alterations in arousal and reactivity, duration, and, most importantly, “the disturbance causes clinically significant distress or impairment in social, occupation, or other important areas of functioning. “ (APA, 2013, p. 272). In other words, traumatic exposure does not cause traumatic illnesses. Personality and environmental factors intervene. Hence, current researchers are implicitly sympathetic to a psychoanalytic bridge spanning normal exposure and traumatic responses (as long as it remains implicit and unstated). And Ferenczi had the foresight to explicitly detail some of these intervening factors which mediate this bridge between alloplastic and autoplastic adaptation.
However, due to the confusion of tongues between clinicians and researchers, one must adapt to reality as well and try to find existing research instruments and validated research concepts that, however, imperfectly, may capture alloplastic and autoplastic issues.
Ferenczi and Freud wrote that energic responses might be key as to whether or not traumatic neurosis would occur. Ferenczi expressed energic as abreaction, where “large quantities of repressed affects might obtain acceptance by the conscious mind and……formation of new symptoms….might be ended.” (Ferenczi, 1932, pp. 156-7). Kahn (2014) wonders whether or not creative expression an active engagement which would serve to mitigate the expression of trauma. Indeed, her research on creative individuals found that all had suffered traumatic exposures and that several scored high enough to be diagnosed with PTSD. However, none of these artists were symptomatic in their daily lives.
