Intergenerational trauma - Mechanisms of transmission

Mechanisms of transmission - Historical trauma
There is some difficulty in isolating transmission mechanisms because the current context that is the result of historical events (for example the boarding school catastrophe in American Indians) can continue to affect traumatised populations (Whitbeck et al 2004). With that in mind, Kellerman (2001a) has identified four pathways of transmission, each corresponding to a different theoretical model: Sociocultural and socialisation models, family systems models, psychodynamic models and biological models.

Sociocultural and socialisation models of transmission are based on social learning theories and focus on the child's learning certain behaviours by observing the parents and the social environment. According to Kellerman, the earliest psychoanalytic conceptualisations of "survivor syndrome" following the holocaust (Barocas 1975) led to the identification of a number of symptoms in the parents that included anxiety, depression, guilt, nightmares, and numbing. All of these can be detected by children. Yehuda et al. (2008) found that the presence of post-traumatic symptoms in the offspring of Holocaust survivors was related to the children's perception of their parents' symptoms. Research has also demonstrated that children of survivors may feel that their parents pass a burden on to them (Letzter-Pouw & Werner 2013, Letzter-Pouw et al.2014, Kellerman 2001b).

Writing about Native Americans, Duran and Duran (1995) suggested that because historical trauma becomes part of the cultural memory of a community, it is transmitted by the same mechanisms as all cultural memory and is therefore normalised.

The family systems model focuses on communication between generations, what is talked about or kept a secret, the blurring of boundaries between generations, and the reconfiguration of roles within the family. The parents' fear that children may fall under threat means that they will often become overprotective, and the children themselves over dependent, as was reported in research with Holocaust survivors (Barocas & Barocas 1980, cited in Kellerman 2001b). Additionally, research has suggested that adolescence is a particularly difficult period for such parents to manage because of their own historical problems (Krell 1997, cited in Kellerman 2001b). Communication problems (Trossman 1968, cited in Kellerman 2001b), and difficulties expressing and managing emotions (Nadler et al. 1985, cited in Kellerman 2001b) have also been identified.

The psychoanalytic perspective which pioneered single case study research from the 1960's made a significant contribution to the understanding of pathogenic transmission mechanisms. Judith Kestenberg (1970, 1980, 1982) wrote of a "time tunnel" to describe the transmission of trauma in Holocaust survivors. She described the process as a resurrection of dead objects that have not been sufficiently mourned by the parent in the mind of the child. The child's own psychic centre is dislocated to accommodate the "transposed" context.

Haydee Freyberg similarly wrote of "a telescoping of generations", a "tyrannical intrusion of history" (1980, p. 99). Ilse Grubrich-Simitis (1984), also working with children of Holocaust survivors, put forward the concept of "concretism" to describe the child's ego's lack of capacity to use metaphor to structure time, as a result of the parent's failure to support the child's developing ego. A particularly eloquent account of aspects of the above authors' work is offered by Connolly (2011, p. 612).

Thus the death of time creates a dissociation between history and memory with the result of the creation of a history without memory, history as abstract dead facts, and a memory without history, purely subjective, mythical and therefore ineffective for the creation of meaningful narratives.

Dr Aileen Alleyne (2004, 2005) has focused on the passing of a "legacy of pain" in Afro-Caribbean descendants of slaves, leading to a preoccupation with this pain in what she calls "the cycle of events". The various ways that black individuals communicate with others and themselves, their values and belief systems, their parenting styles and life choices, and their drive, determination and self-worth are partially affected by the intergenerational transmission of the "enemy within". This involves the transmission of scripts detailing anxieties and the ensuing defences/adaptations about relationships with white people. Splits in the ego and paranoid-schizoid processes lead to self-hatred, hypervigilance, and the anticipation of conflict. A significant part of black identity, Dr Alleyne suggests, is structured in relation and in contrast to whiteness.

Volkan (1998, no date), writing from his experience with primarily Eastern European populations affected by armed conflict, writes of "chosen traumas" and the "depositing" (Volkan 2011) of an already formed self or object image in the child's developing self-representation that acts as a "psychological gene" and impels the child to perform tasks such as to repair the mother's psychological well-being or to represent an opportunity for dealing with the trauma in the future. Many more papers are available at Dr Volkan's website.


Mechanisms of transmission - Familial trauma

A particular approach to understanding the intergenerational transmission of familial trauma has been put forward by Susan Berger (2014). In this psychodynamic account, which implicitly also contains a family systems component, the main route of transmission is through changes in family structures. She attempts to understand this by conceptualising the family as a working group (Bion 1960). She argues that tolerating aggression is a central task in a family in order to manage the tasks of individuation and separation faced by the next generation. However, the parent's identification with the aggressor, a common outcome of abuse, is often transmitted to the child resulting in confusion and complication of these developmental tasks as aggression cannot be appropriately localised to present circumstances. Additionally, in the case where the family becomes isolated due to the use of unusual adaptations in the community, there is a risk that an "us and them" mentality develops that is organised around the fight or flight basic assumption (Bion 1960).

Fonagy's model of mentalization (Fonagy et al. 2002) was originally developed to explain early abuse or neglect but, given the ambition of the mentalizing model, (see below), its explanatory potential is not limited to overt early trauma. In an attempt to explain dissociation in the absence of discernible early trauma, Fonagy (1999) focuses on the mechanism by which dissociative defences can be directly transmitted from caregiver to offspring. This model expands on Winnicott's views on the risk of the parent mirroring his or her own mental state to the infant, resulting in the absorption of the parent's self-structure by the infant's self-representation. This can include the parent's dissociative defence. Fonagy explains that this process differs from identification in that a space is created in the infant's mind in which traumatic content can be directly transmitted. This model can be applied to both historical and familial trauma depending on the content that has become dissociated.


Mechanisms of transmission - Attachment trauma

An understanding of how attachment trauma is transmitted from parent to infant arguably dates back to the work of Sandor Ferenczi. Ferenczi's (1949) theorised the installation of an "alien transplant" in the psyche of the child when "adult passions" (particularly around sexuality and aggression) breached the "tenderness" of the child. The parent's own denied traumas would find a way in the child's psyche that would introject the childhood guilt of the adult aggressor, leading to a chronic sense of feeling bad and unworthy.

There have been numerous recent contributions from the relational perspective (particularly American intersubjective and relational psychoanalysis). Brothers (2008) and Storolow (2007) emphasise that trauma shatters familiarity and leads to a loss of meaning and loss of a coherent and recognisable sense of self. Brothers argued that trauma destroys what she calls Systemic Emergent Certainties (SEC) which are replaced by "trauma generated certitudes". The latter rely on dissociation to exclude affecting knowledge and experience which threatens to disrupt the continuity of the traumatised self. The effect of dissociation is a loss in context sensitivity so that the same expectations come to be generalised across a vast range of situations. The traumatised parent feels under threat from the affective expressions of the infant, because the complexity of these presents a threat to the rigid and simplistic trauma generated certitudes, resulting from the restriction of affective experience by dissociation.

There is probably a general agreement in developmental psychology, intersubjective/ relational psychoanalysis, and British psychoanalysis that the effects of trauma are transmitted through moment to moment exchanges between an infant and his or her primary caregiver, a process which is largely nonverbal. The traumatised parent is unable to offer attunement and affective synchronisation to the infant. Allan Schore has studied this process in depth (Schore 2003a, 2003b).

In a British context, Fonagy's theory of mentalizing (Bateman & Fonagy 2004, 2006, Fonagy et al. 2002) is a useful framework to understand the intergenerational transmission of attachment trauma. It is not the particular early relational templates that are transmitted, but the parent's own mentalizing difficulties that complicate the parent's capacity to hold the child in mind. This process inevitably results in the child's emergent mentalizing capacities being undermined. Additionally, the parent's own split off experiences of trauma become communicated to the child in the form of an installation of an alien self which then needs to be projected in order to restore the coherence of the self.


Bibliography

Alleyne, A 2004, December, 'The internal oppressor and black identity wounding', Race andCulture, [online] available at: http://www.confer.uk.com/modules/intergenerational/pdf/aileen-alleyne-paper2.pdf [Accessed 17 Oct. 2014].

Alleyne, A 2005, 'Invisible injuries and silent witnesses: the shadow of racial oppression in workplace contexts', Psychodynamic Practice, [online] vol. 11, no. 3, pp. 283-299, available at: http://dx.doi.org/ 10.1080/14753630500232222 [Accessed 17 Oct. 2014].

Barocas, H 1975, 'Children of purgatory: reflections on the concentration camp survivalsyndrome', International Journal of Social Psychiatry, [online] vol. 21, pp. 87-92, available at:http://dx.doi.org/10.1177/002076407502100202 [Accessed 17 Oct. 2014].

Barocas, H & Barocas C 1980, 'Separation and individuation conflict in children of Holocaust survivors' Journal of Contemporary Psychotherapy, vol. 11, pp. 6-14.

Bateman, A & Fonagy, P 2004, Psychotherapy for borderline personality disorder, Oxford University Press, Oxford, England.

Bateman, A & Fonagy, P 2006, Mentalization-based treatment for borderline personality disorder, Oxford University Press, Oxford England.

Berger, S 2014, 'Whose trauma is it anyway? Furthering our understanding of its intergenerational transmission', Journal of Infant, Child, and Adolescent Psychotherapy, [online] vol. 13, no. 3, pp. 169-181, Available at: http://dx.doi.org/10.1080/15289168.2014.937975 [Accessed 1 Nov. 2014].

Bion, WR (1960), Experiences in groups, Routledge, London, England, 1968.

Brothers, D 2008, Toward a psychology of uncertainty, Analytic Press, New York, NY.

Connolly, A (2011), 'Healing the wounds of our fathers: intergenerational trauma, memory, symbolization and narrative', Journal of Analytical Psychology, [online] vol. 56, pp. 607-626, available at:http://dx.doi.org/10.1111/j.1468-5922.2011.01936.x [Accessed 17th Oct. 2014].

Danieli, Y 1998, International handbook of multigenerational legacies of trauma, Plenum Press, New York, NY.

Duran, E & Duran, B 1995, Native American post-colonial psychology, State University of New York Press, Albany, NY.

Ferenczi, S 1949, 'Confusion of the tongues between the adults and the child: the language of tenderness and of passion', International Journal of Psychoanalysis, [online] vol. 30. Pp. 225-230, available at:http://kevinsartain.com/aps/confusion-of-the-tongues-between-the-adults-and-the-childe28094the-language-of-tenderness-and-of-passion.pdf [Accessed 17 Oct. 2014].

Fonagy, P. (1999). The transgenerational transmission of holocaust trauma. Attachment & Human Development, [online] vol. 1, no. 1, pp. 92-114, available at: http://dx.doi.org/10.1080/14616739900134041[Accessed 17 Oct. 2014].

Fonagy, P, Gyorgy, G, Jurist EL & Target, M 2002, Affect regulation, mentalization, and the development of the self, Other Press, New York, NY.

Freyberg, J 1980, 'Difficulties in separation-individuation as experienced by offspring ofNazi Holocaust survivors', American Journal of Orthopsychiatry, vol. 50, no. 1, pp. 87-95, available at:http://dx.doi.org/10.1111/j.1939-0025.1980.tb03265.x [Accessed 19 Oct. 2014].

Grubrich-Simitis, I 1984, 'From concretism to metaphor: thoughts on some theoretical and technical aspects of the psychoanalytical work with children of Holocaust survivors'. Psychoanalytic Study of the Child, vol. 39, p. 301ff.

Kellerman, NPF 2001a, 'Transmission of Holocaust trauma: an integrative view', Psychiatry, vol. 64, no. 3, pp. 256-267.

Kellerman, NPF 2001b, 'Perceived parental rearing behavior in children of Holocaust survivors', Israel Journal of Psychiatry and Related Sciences, vol. 38, pp. 58-68.

Kestenberg, J 1972, 'Psychoanalytic contributions to the problem of children of survivors from Nazi persecution', Israel Annals of Psychiatry, vol. 10, pp. 311-325.

Kestenberg, J 1980, 'Psychoanalysis of children of survivors from the Holocaust: case presentations and assessment', in M Bergmann & M Jucovy (eds), Generations of Holocaust, Basic Books, New York, NY, pp. 137-158.

Kestenberg, J 1982, 'A metapsychological assessment based on an analysis of a survivor's child', in M Bergmann & M Jucovy (eds), Generations of Holocaust, Basic Books, New York, NY, pp. 137-158.

Krell, R 1997, 'Psychological reverberations of the Holocaust in the lives of child survivors', [online] available at: http://www.ushmm.org/m/pdfs/20040908-krell.pdf [Accessed 17 Oct. 2014].

LeGruy, J 2005, Post traumatic slave syndrome, Joy DeGruy Publications, Portland, OR.

Letzter-Pouw, SE, Shrira, A, Ben-Ezra, M & Palgi, Y 2014, 'Trauma transmission through perceived parental burden among Holocaust survivors' offspring and grandchildren', Psychological Trauma: Theory, Research, Practice, and Policy, [online] vol. 6, no. 4, pp. 420-429, available at: http://dx.doi.org/10.1037/a0033741[Accessed 17 Oct. 2014].

Letzter-Pouw, SE & Werner, P 2013, 'The relationship between female Holocaust childsurvivors' unresolved losses and their offspring's emotional wellbeing', Journal of Loss and Trauma, [online] vol. 18, pp. 396-408, available at: http://dx.doi.org/10.1080/15325024.2012.701126 [Accessed 17 Oct. 2014].

Nadler, A, Kav-Venaki, S & Gleitman, B 1985, 'Transgenerational effects of the Holocaust: externalization of aggression second generation of Holocaust survivors', Journal of Clinical and Consulting Psychology, [online] vol. 53, pp. 365-369, available at: http://dx.doi.org/10.1037/0022-006X.53.3.365 [Accessed 17 Oct. 2014].

Schore, A 2003a, Affect regulation & the repair of the self, WW Norton Publishing Inc, New York, NY.

Schore, A 2003b, Affect dysregulation & disorders of the self, WW Norton Publishing Inc, New York, NY.

Stolorow, RD 2007, Trauma and human existence: autobiographical, psychoanalytic, and philosophical reflections, The Analytic Press, Hillsdale, NJ.

Trossman, B 1968, 'Adolescent children of concentration camp survivors', Canadian Psychiatric Association Journal, vol. 12, pp. 370-377.

Volkan, VD 1998, August, 'Tansgenerational transmissions and chosen traumas', Opening address XIII International Congress International Association of Group Psychotherapy [online] available at:http://www.vamikvolkan.com/Transgenerational-Transmissions-and-Chosen-Traumas.php [Accessed 17 Oct. 2014].

Volkan, VD no date, 'Bosnia-Herzegovina: chosen trauma and its transgenerational transmission, [online] available at: http://www.vamikvolkan.com/Bosnia-Herzegovina%3A-Chosen-Trauma-and-Its-Transgenerational-Transmision.php [Accessed 17 Oct. 2014].

Whitbeck, LB, Adams, GW, Hoyt, DR & Chen, X 2004, 'Conceptualizing and measuring historical trauma among American Indian people', American Journal of Community Psychology, vol. 33, no. 3-4, pp. 119-30.

Yehuda, R, Bell, A, Bierer, LM & Schmeidler, J 2008, 'Maternal, not paternal PTSD is related to increased risk for PTSD in offspring of Holocaust survivors', Journal of Psychiatric Research, [online] vol. 42, pp. 1104-1111, available at: http://dx.doi.org/ 10.1016/j.jpsychires.2008.01.002 [Accessed 17 Oct. 2014].

Yehuda, R, Halligan, SL & Bierer, ML 2001, 'Relationship of parental trauma exposure and PTSD to PTSD depressive and anxiety disorders in offspring', Journal of Psychiatric Research, [online] vol. 35, pp. 261-270, available at: http://dx.doi.org/10.1016/S00223956(01)000322 [Accessed 17 Oct. 2014].