A relational psychoanalytic perspective on trauma, dissociation, and their relationship to psychopathology and borderline organisation
10.4081/rp.2022.709
Il lavoro prende in considerazione due dei concetti più discussi all’interno della prospettiva relazionale in psicoanalisi: la dissociazione e il trauma. Posti all’interno della tradizione e della riflessione relazionale italiana da oltre 25 anni, gli autori propongono un modello di trauma, dissociazione e organizzazione borderline per evidenziare la loro prospettiva clinica su questi fenomeni e sulla funzione fondamentale della mente dissociante in una specifica prospettiva psicopatologica. A partire dall’osservazione clinica dei livelli descrittivi e fenomenologici e da un modello dei processi psichici coinvolti, questo contributo vuole riflettere sull’esperienza traumatica e su come la dissociazione articoli una possibilità di vita psichica e vitalità residua. Considerando il funzionamento dell’individuo e delle sue relazioni, il lavoro focalizzerà anche l’attenzione sull’esito che la dissociazione ha sugli aspetti esistenziali dell’esperienza soggettivamente e/o oggettivamente traumatica. L’idea è quella di fornire al clinico una prospettiva osservativa, concettuale e operativa che permetta di cogliere diagnosticamente i diversi livelli di funzionamento della mente del paziente. Il lavoro in particolare si concentra sul livello di organizzazione borderline e la specifica psicopatologia connessa. La riflessione sull’organizzazione borderline invita a connettere in modo sistemico mente, corpo, relazione e affetti, nella prospettiva dell’attaccamento e della molteplicità dell’esperienza soggettiva cercando di dare massimo risalto alla specificità della persona che si ha di fronte, alle sue risorse soggettive, ai suoi molteplici livelli di funzionamento.
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Daniele Paradiso
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Ricerca Psicoanalitica
psicopatologia.
Una prospettiva psicoanalitica relazionale sul trauma, sulla dissociazione, e sul loro rapporto con la psicopatologia e l’organizzazione borderline
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Scritti
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2022-07-06
2023-01-31
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Ricerca Psicoanal
Daniele Paradiso
2022/12/30
10.4081/rp.2022.709
Istituto Mitchell, Torino. Dipartimento di Psicologia, Università di Torino
2037-7851
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psicopatologia.
it
Yeomans, F. E., Clarkin J. F., & Kernberg O. F., (2015). Transference focused psychotherapy for borderline personality disorder. A clinical guide. Washington, DC: American Psychiatric Association. Tr. it. La terapia focalizzata sul transfert per il disturbo borderline di personalità. Roma: Giovanni Fioriti, 2017.
Una prospettiva psicoanalitica relazionale sul trauma, sulla dissociazione, e sul loro rapporto con la psicopatologia e l’organizzazione borderline
https://www.pagepress.org/socialsciences/rp/article/download/709/725
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                                     Ricerca Psicoanalitica | pISSN 1827-4625 | Year XXXIII, s1, 2022
                                                                             doi:10.4081/rp.2022.709


                                                                                         WRITINGS



A relational psychoanalytic perspective on trauma,
dissociation, and their relationship to psychopathology and
borderline organisation1

Cesare Albasi*, Alioscia Boschiroli*, Daniele Paradiso*




                                                               ly
                                                             on
ABSTRACT. – The paper considers two of the most discussed concepts within the relational
perspective in psychoanalysis: dissociation and trauma. Placed within the Italian relational

                                                 e
tradition and reflection for over 25 years, the authors propose a model of trauma,
                                              us
dissociation and borderline organisation to highlight their clinical perspective on these
phenomena and on the fundamental function of the dissociating mind in a specific
psychopathological perspective. Starting with clinical observation of descriptive and
                                           al

phenomenological levels and a model of the psychic processes involved, this contribution
                                       ci


aims to reflect on the traumatic experience and how dissociation articulates a possibility of
                                  er



psychic life and residual vitality. Considering the functioning of the individual and his
relationships, the paper also focuses on the outcome that dissociation has on the existential
                             m




aspects of the subjectively and/or objectively traumatic experience. The aim was to provide
                     om




the clinician with an observational, conceptual and operational perspective that allows for
a diagnostic grasp of the different levels of functioning of the patient’s mind. The paper in
particular focuses on the level of borderline organisation and the specific related
                 -c




psychopathology. Reflection on borderline organisation invites us to connect mind, body,
          on




relationships and affections in a systemic manner, from the perspective of attachment and
the multiplicity of subjective experience, trying to give maximum emphasis to the
      N




specificity of the person in front of us, to his or her subjective resources and multiple levels
of functioning.

Key words: Relational psychoanalysis; trauma; dissociation; borderline; attachment;
psychopathology.




   *Mitchell Institute, Turin. Department of Psychology, University of Turin.
Corresponding author’s e-mail: cesare.albasi@unito.it
   1   Previous versions of some sections of this report have been published in: Albasi,
2006, 2008a, 2008b, 2009a.
18                Cesare Albasi, Alioscia Boschiroli and Daniele Paradiso



Introduction

    With the aim of exploring the developments of relational perspectives in
psychoanalysis, the reflection proposed in this monographic issue - dedicat-
ed to Italian relational contributions - provides an important opportunity to
compare concepts considered relevant for the construction of an updated
map of the basic values of the therapeutic relationship, not only for relation-
ally oriented clinicians but for clinicians tout court.
    Today’s landscape sometimes appears disorienting when one thinks of
Stephen A. Mitchell’s inclusive project: some contributions classify rela-
tionals by dividing us into relationals with a capital ‘r’ or a lower case one.
These distinctions are part of a context in which one observes the instru-
mental use of what began as a strongly ethical movement oriented towards




                                                                       ly
the construction of a psychoanalytic dialogue that would bring to light the




                                                                 on
problems that theories and theorists defended to the detriment of the
patients, in order to feel that they belonged to Psychoanalysis; Theorists
                                                     e
who sometimes revealed a lack of aptitude for an epistemologically precise
                                                  us
theory, and a fragility of self-esteem that was often the motivation for an
uncritical search for institutional affiliations to which patients and ‘candi-
                                               al

dates’ have been and are sacrificed. These are serious, worrying problems
                                           ci


that have been widely acknowledged and denounced over a long period of
                                      er



time and have marked the history of our discipline, which, being first and
                                 m




foremost and necessarily part of the clinical practice, must have as its ulti-
                        om




mate aim the interest of patients as persons and subjects.
    Even the International Association for Relational Psychoanalysis and
Psychotherapy (IARPP) itself runs the risk of institutionalising traditionalism;
                    -c




a socio-historical process described in the literature. At the most recent IARPP
               on




conference held in Los Angeles in June 2022, in her closing remarks Margaret
           N




Black Mitchell felt the need to remind everyone present of the fundamental
values which led Stephen Mitchell to think of an association for psychoanaly-
sis that would be open, inclusive, dialogic, creative, and capable of keeping
alive the spirit of research and clinical rigour. These qualities should strongly
characterise clinical theory and relational therapeutic practice.
    Even as regards groups that fit in the relational paradigm, there is a risk
that in local movements these values tend to wither, to the point of becom-
ing emptied of meaning, drowned in a logic which aims at the consolidation
of a self-referential corporate position, of influences and of the market,
rather than opening and opening up to scientific dialogues on how to clini-
cally encounter human suffering, in the theoretical spirit proposed and sup-
ported by Mitchell.
    The conceptual primacy goes to the clinical relationship rather than
belief in a theory (relational or otherwise) or institutions of reference.
    The paper presented here focuses on the concepts of trauma, dissociation
     Trauma, dissociation, and their relationship to psychopathology and borderline organisation   19



and borderline pathology developed in the theoretical, epistemological and
ethical framework outlined above, as they have been developed in the
authors’ work over the last 25 years during which, as a relationally oriented
group in Turin, the authors (Capello & Albasi, 1995; Albasi, & Boschiroli,
2003; Boschiroli 2001, 2003, 2018, 2020; Boschiroli, Albasi, & Granieri
2003; Paradiso 2012, 2015, 2017, 2018, 2022; Paradiso, Celentani, &
Albasi, 2017) have been committed to the development and dissemination
of a relational culture in clinical practice, research and training both within
the University, by founding the Relational Studies Association, and with the
activities at the School of Psychotherapy of the Mitchell Institute.


Trauma and dissociation in relational psychoanalysis




                                                                     ly
                                                               on
    The concepts of trauma and dissociation have been among the object of
clinical and scientific reflection for several decades now. A fervent debate has

                                                   e
taken place about them in many areas of psychological, psychiatric, neu-
                                                us
ropsychiatric and neuroscientific disciplines. In relational psychoanalysis,
these concepts provide a reference point for all clinicians and theorists. As
                                             al

Sue Grand argues in her contribution to the landmark anthology, Decentering
                                         ci


relational theory: a comparative critique, edited by Aron, Grand, Slochower:
                                    er



‘Today, trauma is the focal point of relational psychoanalysis. Dissociation,
                               m




fragmentation enactment, affective dysregulation, multiple self-states, somat-
ic communications, attachment disorders, gaps in mentalization: these terms
                      om




are now familiar to us. (...) The term trauma has today become a broad con-
tainer that includes anything from genocide to Gerson’s concept of dead third,
                 -c




to the chronic non-tuning relationship in infancy and early childhood. And all
           on




of these relate to the collapse of mentalization’ (2018, p. 7).
    The large amount of research available to us has highlighted some com-
      N




mon dimensions: i) first of all, the evidence that trauma is a consistent
object of scientific study (or research hypothesis, or construct). This implies
an invitation, in clinical work, to keep in mind the clinical hypothesis that
severe disorders of mental functioning (including psychosis) and personal-
ity (to which we refer with the concept of borderline organisation) have
developed in a context of traumatic experiences; ii) furthermore, that trau-
ma is a specific experience of a serious failure in the actual relationship
between the individual and his or her caregivers, or in more general terms:
between organism and environment2; iii) finally, that the particularity and



    2   From a theoretical point of view, from a psychological-clinical and evolutionary per-
spective, we can analogically understand ‘environment’ to mean attachment figures and
‘organism’ to mean mental processes.
20                   Cesare Albasi, Alioscia Boschiroli and Daniele Paradiso



specificity of this failure relates to the subjectivity of the individual; it is
therefore not easily classifiable through discrete categories and must there-
fore be understood in terms of intersubjective processes3.
    In clinical research on trauma, therefore, the theoretical moment is of con-
siderable importance: it requires a careful conceptualisation of both the inter-
nal and relational properties and processes that constitute its essence, as well
as the critical conditions and processes specifically aimed at coping with it
defensively, and among these in particular the dissociative processes.
    Conceptually, many perspectives on the study of trauma have been pro-
posed4. In this contribution we adopt a relational psychoanalytic perspec-
tive that focuses on the subjective and intersubjective processes of attach-
ment, trauma and dissociation; not, therefore, an external observational,
descriptive and taxonomic point of view. We will attempt to formulate some




                                                                          ly
hypotheses about the mental and relational processes (of the individual and




                                                                    on
of attachment figures) that might mark a specific configuration of experi-
ence as traumatic. In fact, in order for the concepts of trauma and dissocia-

                                                        e
tion to generate thinking in support of clinical practice in an essential way
                                                     us
(for example, therapeutic work with a relational psychoanalytic orientation,
but not only), their formulation must imply the dimensions of subjectivity,
                                                  al

relationship, processes (i.e. the sense of the processuality of phenomena)
                                              ci
                                         er
                                    m




    3    These considerations are by no means taken for granted: the history of psychoanaly-
sis has been built around the hypothesis of a traumatic relational etiopathogenesis for psy-
                            om




chic disorders, passing through divisions and obscuration of various kinds. Suffice it to
remember how many people in the world have resorted to psychoanalytically oriented treat-
                       -c




ments (in private or public practice, in services): the fact that its underlying models revolve
around drives and repression, rather than trauma and dissociation, has meant a great deal for
                 on




the health of so many people.
    4    For example, it is possible to adopt a descriptive point of view that is more linked to
             N




the definition of event types, defence or avoidance behaviour and symptom collections, a
point of view that we could schematically define as outwardly oriented (cf. the research tra-
ditions on stress, coping, post-traumatic stress disorder, etc.). Also possible is a nosological
perspective which, looking at external, symptomatic manifestations, has mistakenly been
defined atheoretical in an attempt to suspend etiopathogenetic hypotheses, such as the one
proposed by the various A.P.A. DSMs. (even though, in fact, the diagnosis of post-traumatic
stress disorder refers to the aetiology); but the syndromic classificatory nosological approach
to psychopathology, only one of many possible (Albasi, 2008b), as has increasingly been
acknowledged, is not the most useful for case formulation and psychotherapeutic care (for a
bibliography on the subject, see PDM Task Force, 2006; Lingiardi, McWilliams, 2017).
From a classificatory and nosographic point of view, it continues to be considered interesting
to make descriptive distinctions between nosographic frameworks, thus between borderline
pathology and trauma/dissociation (Lewis, Caputi, Grenyer, 2012; Lewis, Grenyer, 2009),
and between different traumatic symptom frameworks such as PTSD (post-traumatic stress
disorder) and complex post-traumatic stress disorder (Herman 1992a, 1992b), and extreme
stress disorder not otherwise specified (DESNOS: disorder of extreme stress not otherwise
specified) (van der Kolk, 2005).
    Trauma, dissociation, and their relationship to psychopathology and borderline organisation   21



and the multiplicity of levels of functioning; dimensions that represent the
cornerstones of psychotherapeutic praxis.
    With reference to this aim (and to confront the contemporary use of the
term dissociation which, as noted by many, may be ‘elusive, vague, confus-
ing and contradictory’, Dell, O’Neil 2009, p. 225), combining the traditions
of the Infant Research, attachment theory and the relational perspective in
psychoanalysis, the concept of dissociation was developed, emphasising its
processual dimensions and responding to the clinical need to make specific
the psychopathological phenomenology encompassed by this concept.
    The first point is that dissociative processes are sometimes confused
with dissociated contents (hence clinicians reason of dissociated parts, dis-
sociated aspects, etc.). Dissociative processes are a mental activity, a men-
tal function, they are structured in terms of functions, operations. Hence, to




                                                                    ly
understand patients with borderline organisation one must reason of a con-




                                                              on
cept of dissociating mind rather than dissociated mind; have a process-ori-
ented epistemological and clinical sensibility; and learn to express oneself

                                                  e
with adverbs and verbs rather than with nouns and adjectives.
                                               us
    The observational perspective for understanding this pathological prob-
lem is therefore to look at the patient’s mind as active, and his or her expe-
                                            al

rience as dissociatively structuring.
                                        ci


    The second point is that dissociation or, rather, dissociative processes
                                   er



should be understood as preventing the search for the meaning of experi-
                              m




ence (as far in advance as possible), that is, paradoxically, the functioning
of the mind itself (and we are faced with the first need to reason by para-
                     om




doxes: the mind functioning by actively suspending its functioning). Here
too we wish to emphasise that, rather than speaking of dissociated meanings
                -c




which implies that the mind possesses those meanings and excludes them
          on




from consciousness (as it does in the case of neurotic conflict), it is better
to think in terms of the patient’s experience of confusion, of feeling unable
     N




to formulate an experience with meanings, that is, of feeling the experience
as his own (i.e. fully subjective), thus not feeling the inner reality of what he
is nevertheless experiencing in his relations.
    As we know, the concept of psychological defence which is most useful
in describing the functioning proper to neurotic organisation, implies a
defensive exclusion from consciousness of experiences formulated and
articulated in the mind, for example with links between representations and
affections. The formulation of these experiences within the mind is suffi-
cient to involve, subjectively, a meaning that would be experienced as dis-
turbing, activating important conflicts. Hence, the mind’s defensive activity
intervenes by deteriorating these experiences (e.g. also by intervening on
the representation-affection nexus, as in the case of repression, which dis-
engages representations, or rationalisations, which disengage affections).
Defences keep the consciousness clear by preventing the subjective experi-
22                   Cesare Albasi, Alioscia Boschiroli and Daniele Paradiso



ence of certain connections, thus preventing the subjective experience of the
meanings that would result from these connections.
    On the contrary, dissociative processes concern situations in which one
is unable to formulate experience in any way. The experience of feeling
alive, with a living, functioning mind that seeks the meaning of experience,
is compromised. Schematically, we must imagine dissociative processes as
processes that anticipate the formation of connections, in that they are
deployed to exclude from consciousness, not the experience of a possible
conflicting meaning, but the confusion brought about by the experience of
not being able to search for meaning; We also call this confusion the sense
of fragmentation and, ultimately, it is the anguish of going mad, in other
words the fear of having a radical panic attack (as Pao, 1979, defined the
psychotic experience), the fear of having an attack of anxiety so strong that




                                                                          ly
one imagines one cannot recover. Dissociation is activated because a person




                                                                    on
is afraid of dying. And, in fact, the death of the mind coincides with the
impossibility to seek meaning. The threat one experiences in the experience

                                                        e
of trauma is the fear of going mad, of losing contact with reality, of no
                                                     us
longer knowing what is real, and not feeling real; a psychotic crisis, in its
experiential components, is to experience the disappearance of one’s mind,
                                                  al

its death; which, not being the death of the body and the complete cessation
                                              ci


of existence, entails the paradox of having to witness one’s inability to live
                                         er



as an integral person, with one’s capacity to seek the meaning of experience.
                                    m




Dissociation is an attempt to survive by ‘standing outside’.
                           om




A relational perspective on psychopathology: trauma, dissociation,
                       -c




levels of personality organisation
                 on




    Various levels of personality organisation have been hypothesised in the
             N




psychoanalytic tradition, often also acknowledged in the broader non-psy-
choanalytically oriented clinical literature. Although it would be necessary
to broaden the debate on psychotic organisation beyond what is the actual
focus of this paper, as the term ‘psychotic’ can be used either exclusively
for a disorder (as is the case in the first edition of the PDM - Psychodynamic
Diagnostic Manual, PDM Task Force, 2006), or also for a personality
organisation, the concepts healthy, neurotic and borderline levels enjoy
broad consensus.
    These concepts can be used more from an ‘aut-aut’ categorical perspec-
tive (the patient either has one organisation or the other, in the tradition of
Kernberg5, and, with due distinctions, Bergeret), or from a dimensional per-


     5   Kernberg (1967, 2004).
    Trauma, dissociation, and their relationship to psychopathology and borderline organisation   23



spective, according to which each one of us can be described as functioning
on all these levels even when the prevalence of one level characterises our
current functioning.
    With regard to the borderline concept, we have to consider separately:
on the one hand, the psychopathological contents that all authors (or manu-
als) acknowledge and describe in more or less the same way; and on the
other hand, the use of these contents within a diagnostic system or theory.
The psychopathological contents, i.e. the borderline phenomenology, are
well summarised, for instance, in the nine statements that the DSMs have
proposed from 1980 onwards. All clinicians may converge around those.
But the psychiatrists who compiled the DSMs have then: i) considered the
psychopathology described by means of this concept as a nosographic per-
sonality disorder among others listed as personality disorders (far more




                                                                    ly
defined and specified by pathological features limited to single main dimen-




                                                              on
sions, while from this point of view the borderline concept has been much
discussed and articulated on several dimensions); ii) followed the noso-

                                                  e
graphic tradition that has subjected the use of this concept to the cut-off
                                               us
requirements entailed by a system based on statistical and solely categorical
logic. These choices, theoretical (despite the DSMs being self-styled as
                                            al

atheoretical), if not ideological, or power-based, or commercial (Kutchins,
                                        ci


Kirk, 1997; Gøtzsche, 2015), are at least purely conventional and, as we
                                   er



know from decades of literature on the subject, not motivated by unambigu-
                              m




ous clinical reasons.
    The core, or conceptual dimensions of the construct, of borderline
                     om




pathology have been described with some differences by the various
authors who have dealt with it (e.g. Kernberg, 1967, 1975; Adler, 1985;
                -c




Linehan, 1993; Liotti, 1999; Fonagy & Target, 2001; Fonagy et al., 2002;
          on




Dell & O’Neil, 2009; Meares, 2012), but revolve around the following clin-
ical issues: regulation issues (involving both internal dimensions such as
     N




affections and mental states, and dimensions of impulsivity and conduct);
problematic self-experiences and identity diffusion (instability, mutability,
oscillations, painful incoherence), related to division processes; relationship
issues including chaos and disorganisation, related to projective identifica-
tion mechanisms, and decompensated reactions to fantasies or experiences
of abandonment, separation, loneliness, and other anaclitic issues.
    The aforementioned clinical issues can be integrated into a theoretical
model which interprets the level of borderline functioning through the con-
cepts of trauma and dissociation as formulated predominantly in relational
psychoanalysis.
    The dimensional approach to the use of levels of organisation has the
advantage of being able to describe, and thus diagnose, a patient as predom-
inantly healthy but with psychopathological aspects that are better
described in a borderline (dissociative) rather than a neurotic (conflictual)
24                  Cesare Albasi, Alioscia Boschiroli and Daniele Paradiso



sense; this same hypothetical patient would be confusingly described as
‘neurotic’ if personality organisations were used in an exclusively categor-
ical way, as not ‘severe’ as a borderline6 patient and not healthy as having
pathological aspects. Diagnostic differences are therefore relevant, and cli-
nicians are familiar with working in psychotherapeutic treatment with
patients who are predominantly healthy but who show suffering related not
to conflicts but to dissociative aspects and problematic areas better
described through the concepts of borderline psychopathology (absence of
meaning, sense of emptiness and lack of value, inability to feel protagonists
of part of their lives or relationships) rather than neurotic pathology (con-
flict between incompatible meanings).




                                                                         ly
Dissociation




                                                                   on
    Dissociation is an hypothesis in order to speak of a mental activity

                                                       e
which, in extreme experiences, anticipates the establishment of internal
                                                    us
connections; hence it is necessary to reason in paradoxical terms of poten-
tial connections that have never been formed, that were prevented in
                                                 al

advance; and to hypothesise that dissociation, more specifically, is to be
                                             ci


considered rather as a process that anticipates connections, than a destruc-
                                        er



tion of mental connections.
                                   m




    Better still, if we wanted to express this concept of dissociation in the par-
adoxical terms it calls for, we would have to understand the lack of connec-
                           om




tions, between the implicit and explicit levels in traumatic experiences, as a
loss of the potentiality/possibility of connections (which is a natural potential-
                      -c




ity of the mind and a requirement of its functioning). One loses the connec-
                on




tions that constitute the psychic registers for recognising, understanding, and
formulating meanings that are fundamental to human life and potentially
            N




implicated in attachment experiences and relationships (such as anger, con-
flictuality, sexuality, seduction, enjoyment, etc., in particular, the areas where
the interpretative nuances of meaning make a difference). The loss of these
registers, however, not only results in the failure to recognise (like a blind-
ness) the meanings of reciprocal gestures; paradoxically, it leaves both a
sense of ineluctable unconscious expectation for the occurrence of something
pertaining to them (anger, aggression, abuse and neglect, manipulation, etc.)


    6   With regard to disorders as severe as personality disorders diagnosed according to
the DSM criteria (from the third edition onwards), despite their specificity of language,
authors such as Bromberg (1998), who argues that all personality disorders depend on trau-
ma and dissociation, and Yeomans, Clarkin, Kernberg (2015), who argue that all patients suf-
fering from a DSM personality disorder function at the borderline organisation level, agree.
A clinical consistency despite the diversity of language.
    Trauma, dissociation, and their relationship to psychopathology and borderline organisation   25



and, on the psychopathological level, a sense of the need to be able to recog-
nise the meaning of the gestures of the other. which, on the level of descrip-
tive psychopathology, can variously translate into anxiety, depression, disso-
ciative symptoms, impulsivity and conduct disorders, addictions, etc.), and
also the inability to recognise relational experiences centred at a procedural
level on these registers (and thus to act interpersonally without connections
between levels: either at the level of dissociated procedural enactments, or at
the level of persecutory defences or rationalisations, etc.).
    This has important clinical implications: the loss of the potential to con-
struct connections between levels of processing the experience remains as a
deficit for the individual, i.e. not the conflicting inhibition of mental con-
tents and functions, but the lack of the ability to feel and express the differ-
ent facets of his experience. Patients show that they are not able to grasp the




                                                                    ly
nuances of a specific field of meaning, processed by a too imprecise regis-




                                                              on
ter: for example, aggression may be experienced but not modulated between
implicit and explicit (e.g. seduction may frighten or may irritate without the

                                                  e
opportunity to take pleasure in it and play with it, etc.).
                                               us
    This is the paradoxical process typical of trauma and abuse: the abused
person dissociates the experience (prevents its integration into his or her
                                            al

subjectivity) and is terrified that something will happen again that he or she
                                        ci


would not recognise, even if he or she provoked or induced it. His basic
                                   er



confidence and security has been broken, as well as his courage and moti-
                              m




vation to explore the experience.
    It is of utmost importance in directing our clinical attention and our the-
                     om




oretical models to the damage that trauma causes to implicit procedural
levels: trauma causes loss of confidence in the ways one constructs one’s
                -c




internal experience, the aptitude for integrating self-regulation and interac-
          on




tive regulation of one’s states, the ability to trust intuitive evaluations as
essential information for orienting oneself in intimate and attachment rela-
     N




tionships; one disorganises the ways of shaping intimate relationships. In
this area, of procedural implicit relational knowledge, of the skills on ‘how’
to build secure attachment relationships, lies the essence of pathological
post-trauma. Trauma affects the basic implicit skills that are necessary to
experience one’s existence as a set of potentials for realising oneself in inti-
mate relationships in life.
    In experiencing trauma, at stake is one’s being a person, being treated as
less than a person (as an animal, an object, a tool, etc.). The mind cannot
attempt to give meaning or negotiate this experience at any level, because
being a person implies having a mind, and not being recognised within a
developmentally essential attachment relationship as a person with a mind
of one’s own, is incompatible with the minimal needs to formulate one’s
experience by referring it internally to a representation of oneself and the
attachment figures. This is how dissociation works.
26                 Cesare Albasi, Alioscia Boschiroli and Daniele Paradiso



Conclusions

    Currently, the concepts of trauma and dissociation still appear to us as
promising in the study and clinical understanding of the phenomena of the
form of severe pathology which we describe in the concept of borderline
pathology.
    From the perspective of complexity, we can say that as far as immaterial
reality is concerned, trauma is the ultimate expression of anti-vital forces
that disorganise the principles which are necessary for life.
    Observations and descriptions from different theoretical perspectives
often articulate a common underlying principle: life is made possible by
love. On the level of the immaterial reality of the mind, love is the principle
opposed to the threat of trauma. Love is expressed starting with the essential




                                                                        ly
recognition of the other in his or her difference and specificity (within the




                                                                  on
attachment relationship). The development of the mind is the outcome of
processes concerning the development of the complex dynamics of the

                                                      e
encounter of specificity between something that arises spontaneously from
                                                   us
the child’s potentialities (as an active and creative proposer of interactive
gestures and forms of experience, a concept that is referred to as agency)
                                                al

and the process of recognition of these specific potentialities built in the
                                            ci


relationship with attachment figures. This encounter is the developmental
                                       er



context for understanding health and trauma.
                                  m




    The principle of recognition of specificity allows the mind to live, to
organise experience as a subjectivity rich in meaning. In the contemporary
                         om




literature on borderline pathology, it has been observed that on the one
hand, there is love which allows organisation, movement, life, and on the
                     -c




other hand, trauma which leads to chaos, confusion, entropy, fragmentation
               on




and the death of the mind as the impossibility of searching for meanings.
    The concepts of trauma and dissociation are all the more interesting when
           N




they focus on a specific psychopathology, rather than becoming synonymous
with relational psychopathology in a broad sense. The risk of a generic rela-
tional perspective on psychopathology in psychoanalysis is to consider all
psychopathology as somehow of traumatic origin, understanding trauma as a
synonym of a relational aetiology (to be contrasted with the drive aetiology
of Freudian metapsychology). This ‘political’ use of the term trauma to indi-
cate a non-drive theoretical position is perhaps of little interest to the practical
clinician. The term trauma loses clinical specificity and becomes a synonym
for ‘etiopathogenetic’ (any cause of psychopathology is considered trauma,
all pathology is of traumatic origin because it is relational in origin, etc.).
These positions mistake the relational origin of pathology, such as health, for
the specificity of trauma with respect to other different conditions of conflict-
ual and/or pathogenic non-traumatic origin (in any case, from the perspective
of complexity, we speak of cause in a non-linear sense). The concept of trau-
     Trauma, dissociation, and their relationship to psychopathology and borderline organisation   27



ma is useful from two theoretical-clinical points of view: in a more categori-
cal perspective, to understand severe pathology, such as the one related to bor-
derline organisation and psychosis; in a more dimensional perspective, the
concepts of trauma and dissociation are useful to understand a specific level
or mode of pathological functioning which, when understood in this sense
(level or mode), is ubiquitous and can cause important difficulties in function-
ing in healthy, neurotic, borderline, psychotic people, with different intensity
or prevalence. Once one has understood what trauma is and how it functions,
one can acknowledge it as part of the experience of many patients beyond the
categorical aspects which might include them in different diagnostic classes.


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Conflict of interests: the authors declare no potential conflict of interests.

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Received for publication: 6 July 2022.
Accepted for publication: 7 October 2022.

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©Copyright: the Author(s), 2022
Licensee PAGEPress, Italy
Ricerca Psicoanalitica 2022; XXXIII(s1):709
doi:10.4081/rp.2022.709

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