Author: Davoine, François and Jean-Max Gaudillière
Publisher: New York: Other Press, 2004
Reviewed By: James E. Gorney, Fall 2004, pp. 43-45
In History Beyond Trauma Françoise Davoine and Jean-Max Gaudillière have provided the social sciences, and in particular psychoanalysis, with a profound and original illumination of the theory and treatment of psychosis. Over the course of this ambitious, encyclopaedic volume, the authors summarize and integrate thirty years of their collaborative clinical and theoretical investigation of psychotic phenomena. This is an essential book for all interested in the psychoanalytic understanding of madness and trauma.
Drawing upon their early studies in philosophy and classics, subsequent academic experience as professors of sociology, and eventual psychoanalytic training in the school of Lacan, Davoine and Gaudillière approach madness not as a symptom, pathology or structure in the DSM, but rather as a Place. This is the place where the symbolic order, which guarantees an individual’s connection to language, history and social relations, has ruptured, exploded or disappeared. Consequently, one of the most original and important insights to be found in this work is that the psychotic is engaged in a form of research investigation into the nature and history of this place; he or she is a seeker.
In the clinical situation, the therapist is second in command to the patient---the Principal Investigator—who desperately attempts to articulate an unspeakable dimension of trauma and catastrophe, which has come to be foreclosed in individual or social history. Within this context, Davoine and Gaudillière draw upon numerous other powerful traditions to inform this non-reductionistic formulation of the psychotic experience. From their many years of contact with clinicians associated with the Austen Riggs Center they have assimilated the work of Sullivan, Fromm-Reichman, Searles and Otto Will. They also have been significantly influenced by the texts of Winnicott, Bion and Gaetano Benedetti. Within History Beyond Trauma the authors weave multiple strands of the many French and non-French masters from whom they have learned; yet, as they themselves are quick to point out, their most profound teachers have been those psychotic patients with whom they have engaged in psychoanalytic exploration over the years.
As Gerard Fromm notes in his forward to this volume, History Beyond Trauma is written in a literary, philosophical, non-linear and somewhat elliptical style. In other words, it is at times very French. For those not used to this manner of discourse it may take some getting used to, but patience and perseverance will provide considerable rewards to the reader. Indeed, as the book unfolds, an overarching polyphonic structure emerges, as in a complex musical score, in which theoretical, philosophical, literary and clinical perspectives upon psychosis begin to synergize each other in surprising ways. The book is divided into two sections: Part I–Lessons of Madness, and Part II–Lessons from the Front. Broadly speaking, Part I develops a philosophic and psychoanalytic theoretical model of psychosis and Part II develops a framework for the psychoanalytic treatment of psychosis by drawing upon principles derived from war psychiatry. The theoretical and clinical sections of the book dovetail; they mutually enrich and inform each other.
The essential insight which is developed with great nuance and complexity in Part I is that the psychotic symptom is a marker pointing toward a Place; a place of unspeakable catastrophe, destruction and horror once inhabited in the past, and now still relived in the present. The symptom both masks and begins to communicate the madness, mute pain and terror of this as yet un-symbolized location. The un-symbolized trauma comes to haunt the subject, while at the same time foreclosing free access to individual, familial, or social history. It is only when this place of trauma can be named and inserted into the symbolic order of language that the horror can be remembered, and not just re-lived repetitively as if it is branded or carved into one’s very being. When the catastrophe inhabiting the place of the Real (the unsymbolized) can be brought into a “social link” through the dialectic of symbolic speech in a human relationship, then the trauma can be remembered, spoken, eventually integrated, and even, for long periods, usefully repressed or forgotten. This field of symbolic language is entered through the inscription of a name or a word that functions as a signifier. How to facilitate the emergence of such a signifier, in word or perhaps, at first, in gesture, within the psychoanalytic situation is at the center of Davoine and Gaudillière’s clinical concern. A general framework for clinical praxis with psychotic patients eventually comes to center stage within Part II.
The authors radically locate psychosis within a social and historical field of investigation. In regard to “madness”, they assert; “we never use this word to describe the structure of an individual but instead to characterize a form of social link in an extreme situation” (p. xxii). It is precisely the unsymbolized and unremembered trauma of such “extreme situations” that come to haunt the psychotic subject. Within psychosis there is a collapse of time as well as personal identity. The individual is inhabited in the present not only by ghosts from his own earlier life experience, but also those of preceding generations. The authors draw upon their own personal history, as well as their French and European identities, to develop a model of trauma based upon the paradigm of war. Davoine and Gaudillière were literally born into a war zone in the early 1940’s. They and their patients had parents and grandparents who were directly affected by both of the world wars fought on their native soil. In toto, the carnage, brutality and social disruption of war lead to breakdowns in the symbolic order, the rule of law and the predictability of social relations. This collapse becomes for the authors the basis of a powerfully illuminating model of trauma. They go on to illustrate their concept of trauma as a war zone with vivid clinical material. From this perspective, they take particular care in asserting, “the connection between madness and trauma is not a causal one. For there can be no transition from the past to the present when the impact of disaster has immobilized time” (p. xxx). Thus, the psychotic patient transmits from generation to generation “pieces of frozen time,” eventually bringing a war zone into the analyst’s consulting room.
Davoine and Gaudillière examine this zone of collapsed time through multiple lenses. First and foremost it is a place where conventional, reliable rules and norms of symbolic speech have been exploded; in their place the psychotic individual engages in Wittgensteinian language games. The patient in the place of madness initially comes to the therapist in a state of “rupture, departure and confrontation,” thereby thrusting the therapist into a battle scene. This war zone becomes an empty possibility within which the first beginnings of symbolic exchange may be inscribed. This would constitute a first step away from madness, toward the horizon of the symbolic. At this juncture, the authors provide a rich metaphor for the entire therapeutic process via elaborating the etymological metaphor of the ancient Greek word Symbalon:
“Symbolon emphasizes the signifying gesture in which two new allies exchange the two pieces of a broken shard, in such a way that their being fitted together later on is a pledge of mutual hospitality for them and their descendants. These humble bits and pieces, broken for the occasion, take the place of one’s word given as a guarantee. Of no intrinsic value, they are the basis of value and the foundation of the social tie, at the same time as they are the possibility of language itself (p. 66).”
Thus, to restore the place of language is to restore the place of the symbolic order itself. This is the task of the analyst, who must now approach the patient in madness upon the battlefield, carrying the broken shards of his own humanity and history. Within the book, this now shifts the focus to the nature of the therapeutic relationship in the field of madness.
Part II of History Beyond Trauma delineates the conditions necessary for a psychoanalytic investigation into trauma and madness that can facilitate symbolic exchange and activate therapeutic transformation. Toward this end, Davoine and Gaudillière, remaining within their model of war, recount research that led them to uncover the first principles of war psychiatry. These were developed by Thomas W. Salmon in 1917 to deal with shell-shocked soldiers returning traumatized from the front. The so-called “Salmon Principles” are elaborated upon in Part II by the authors and the implications of each of these principles for establishing the possibility of psychoanalytic work with traumatized, psychotic individuals is developed in detail. Thus, the second half of the book is particularly rich in clinical wisdom and insight. For Davoine and Gaudillière the Salmon Principles become broad technical guidelines for transforming standard psychoanalytic technique and the therapeutic frame for work with those who are psychotic. The principles are:
Proximity opens up a new space of trustworthiness amid chaos.
Immediacy creates a living temporality in contact with urgency.
Expectancy constructs a welcome to the return from hell.
Simplicity emphasizes the obligation to speak without jargon.
Modifying traditional psychoanalytic practice in light of these principles may at first, to some, seem radical and controversial, yet they are consistent with modifications proposed by many other important psychoanalytic researchers into madness, i.e. Fromm-Reichman, Searles, Otto Will, Winnicott, Margaret Little and Benedetti.
Davoine and Gaudillière contend that Proximity not only refers to the actual physical encounter within the consulting room, it also involves a willingness to engage face to face upon the battlefield of a traumatic place; a taking up the gauntlet and a determination to survive the patient’s destructiveness without undue retaliation. From this distinctly Winnicottian position, the authors assert that the details of the real trauma will eventually become revealed within the specifics of the transference relationship. Through the unfolding of the transference, a significant relational bond develops: “Combat evokes in those who are fighting side by side a passion for taking care of the other physically and psychically, equivalent to the earliest and deepest family relationships” (p. 154). Thus, referencing the etymology of the ancient Greek term Therapôn, meaning a second in combat and ritual double, the therapist is understood as a comrade in arms. Together confronting trauma, the therapeutic dyad engaged in the psychoanalysis of madness create “a psychoanalysis upside down. Far from lifting a repression it becomes the tool that makes repression possible and puts an end to the catastrophic effects of the Real” (p. 158)
For Davoine and Gaudillière, the principle of Immediacy opens up the possibility of establishing contact with the patient at the maximal locus of urgency. When they contend that “It is better to conceive of all crises of madness as beginnings” (p. 168), the authors follow in a long tradition, beginning with Sullivan in his early work Conceptions of Modern Psychiatry (1940) which postulated that the moment of madness creates the potential for hope and re-integration. Within psychoanalysis, psychosis cannot be approached at a distance. Immediacy implies active engagement, and that may engender risk, uncertainty and confusion in the analyst. Again, Davoine and Gaudillière turn conventional psychoanalysis on its head when they propose that upon entering this field of madness, “transferentially the response comes first, then the formulation of the problem of which the analyst will come to be part once he has become confused” (p. 169). It is the gradual working out of this confusion via the identification and naming of ghosts that comes to constitute the fabric of the treatment. Efforts to reduce the immediacy of this encounter by primary recourse to psychotropic medication or behavioral interventions are understood by the authors to be most often a countertransferential backing away by the analyst from the dangerous urgency of the battle scene. In the face of contemporary prevailing modes of treatment offered to psychotic individuals in America and Europe, the authors’ point of view in this regard is unsparing, controversial and ultimately courageous.
The principle of Expectancy references the realm of the interpersonal, of alterity, the place of relying on a trustworthy other. It conjures images of wounded buddies forging a bond in the trenches and implies a form of mutuality in which both participants in the analytic situation bring shards of their own traumas and histories with them (the Symbolon) into the evolving relationship. Davoine and Gaudillière are not thereby proposing a boundaryless, mutual confessional, but rather they recognize that upon entering a zone of trauma, two histories converge in analytic space. Put another way, they assert that when analyst and patient encounter each other in the war zone, all of both of their relatives and ancestors also enter this space. The past is also in the present. Therefore, there are critical moments when the analyst’s own life, memories, experiences and history must be articulated to initiate symbolic exchange. It is possible for this then to be experienced by the psychotic patient as a trustworthy affirmation. Yet, the affirmation of expectancy begins with the very first word uttered by the analyst at the very beginning of the first session. The authors put it very clearly: “This first ‘Yes’ from the analyst is a primal affirmation that in fact presides over the judgment of existence we have spoken of and opens out the field of speech: ‘Yes, something happened, something happed to you; it’s not all in your head, and what you’re showing is the only way you could bear witness to it. No, these events are not the cause of your condition but the object of your investigation’ (p. 221).”
The principle of Simplicity can best be illustrated through a consideration of the many generous clinical accounts offered throughout the book. The authors believe that psychoanalysis is within an ancient and long tradition of oral history and their stories of transformative clinical encounters with psychotic patients are masterfully realized and beautifully presented. Within these accounts both analysts are heard to speak simply, directly, and above all, with profound honesty to their mad patients. They make creative use of found objects to initiate symbolic exchange when speech fails or is not yet possible. They utilize aspects of their own (sometimes traumatic) histories in order to make points of connection with patients who have disappeared, exploded or evaporated. Davoine and Gaudillière are true masters of their craft and it is mesmerizing, and a rare privilege, to observe them help create small (and sometimes large) miracles within the consulting room. Often these clinicians appear more related to shamans or medicine men than to scientists or doctors. Yet, within the arena of madness, this is exactly the direction to which a radical trust in unconscious processes inexorably leads. Shamans and medicine men are also fundamental exemplars of an ancient oral tradition.
In summary, History Beyond Trauma is a singularly important contribution to psychoanalysis in general, and the theory and treatment of psychosis in particular. It rests on the shoulders of giants from the past while it simultaneously charts radically creative new directions for the future. For those of us engaged in the ongoing work of undertaking psychoanalytic exploration with traumatized and psychotic patients, this is an indispensable volume. Particularly in this age of managed care, antipsychotic medication and DSM-driven psychiatry, History Beyond Trauma offers hope for the healing power of symbolic exchange within a human relationship. Beyond the dilemma of psychosis, Davoine and Gaudillière deserve to be read by all who believe in the transformative potential of the psychoanalytic relationship. In my judgment, this magnificent book is likely to become an essential part of the psychoanalytic canon for generations to come. It deserves the widest possible readership.