Extreme deprivation, loss of basic trust and how to listen the unrepresented pain

Abstract

The author describes how the idea of an external traumatic event producing psychic suffering is at the root of psychoanalysis, from different theoretical and clinical perspectives. The difference proposed in this paper is the psychoanalytic work with people who present a history of serious traumatic events, carried out in primary health care, in a different setting from that usual, describing the origins and prolonged effects of trauma in a group of people who would not have the possibility of being listened to and approached with psychoanalytic guidance, because they do not have the knowledge, the desire or the means to pay for analysis or psychotherapy.
After a brief theoretical review, in which he discusses the concept of trauma and highlights the presence of basic fault and the unrepresentable in the psyche, the author describes cases of people with a history of physical and sexual abuse, poor or living in situations of poverty, coming from unhealthy places, with often dysfunctional family configurations, in which subjective and emotional poverty predominate, presenting severe symptoms, including personality disorders, severe anxiety and depression, poor impulse control leading to aggression, violence and, frequently, self-destructive behaviors such as suicide attempts.
He discusses the countertransference issues raised by listening things that has no mental representation, and proposes a modified and more participatory technique, in which the analyst is a witness and participant in a process of validating the real trauma and reconstructing and reintegrating damaged aspects of the mind.