A working through with Dr. Herman and beyond

Why do some clients remain extreme forever? Extreme in their thinking and their emoting. Words of rage, lamentations of tragedy. Vicious voice, continual bawling. Actually, I don't know how common this is. I had a client, a man, who was apoplectic – furious tears and hatred – nearly every session. Another, a woman, who couldn't stop weeping about her father's abuse and mother's neglect. She was angry, too – wanted to strike her mother – but essentially she was tragedy and maudlinness apotheosized. I believe I know why the man was fixed in his rage. He had never reached the dimension of grief, the helpless and needy place where I could join him like a healing, repairing parent, beneath the powerful but escapist anger which I could not join. I would say that the woman was in the same boat, despite her "Hoover Dam of tears" each session. She mixed her grief with her rage, which buoyed it and kept it from landing in its deepest dimension: pure pain. She was a teenager but resisted being a child.

This explanation, though, doesn't address the matter of extremity. Most clients can cry or express anger. What made these two different, so "dramatic"? Was it the power of their trauma? The man had suffered continual sexual and physical abuse from two generations of family. The woman's father nearly broke her back. But we know that Post-Traumatic Stress Disorder manifests in triggered symptoms (flashbacks, hyperarousal, rage), not a seamless cataract, not a unitary "theme" of them. And that PTSD requires some symptoms of numbing – amnesia, the deadening of sensation and emotion. These two clients were never numbed. The answer, I believe, lies in the deformation of character described by Judith Herman in her "new diagnosis," Complex Post-Traumatic Stress Disorder.

These individuals' characters, their personalities, warped in an atmosphere of traumatic oppression in their childhood homes. Depth psychology is aware that children always change in homes where there is no empathy – the primary ingredient of physical, sexual and mental abuse. They become repressed, then depressed, the substrate of their eventual problems. They become symptomatic. But this will not transform their outlook on life, their personality, unless no escape of any kind is possible, no help for pain, no light appears. My multiply-abused client was never noticed by teachers, never helped by other family members or by the kindness of strangers or by the police who would sometimes knock at the door. The woman wrote a letter to the middle school she attended twenty-seven years ago, excoriating it for ignoring signs of her abuse, a suddenly crippled child. I can look – now – at these two adults and see beneath their behavior a pilot light of warped, alarmed personality. This is the wrong coloration of attitude that one wakes up with and falls asleep to, the eternal dark energy background of the person. It could never change over the years, the decades, because they could never grow. Growth requires ground. It may be rocky. It may be poor of nutrients. But it can't be a monolith of poison.

These clients, and people in the world like them, should be understood to have personality disorder. Though we must see them differently than we do those whose personality deformed in the crucible of the separation-individuation phases.