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Ferenczi’s Foresight

Transforming the traumatized from  terrified children to tolerant adults

By Sharon R. Kahn, Ph.D


Presented at the 2015 Ferenczi International Conference in Toronto, Canada


Abstract:

        Traumatic exposure is now an unexceptional event in the United States and would not, by itself, qualify as a diagnosis of Post-Traumatic Stress Disorder (PTSD).  Ferenczi’s (1955) theory of alloplastic adaption may be useful in conceptualizing which pre-existing intra-psychic factors manumit an individual from impairment or band them to the trauma.  Alloplasts, according to Ferenczi,  adapt and alter their environment  in such a way as to make self-destruction and self-reconstruction unnecessary. Autoplasts, by contrast,  react intrapsychically, with fragmentation of their personality, splitting, and passivity.  These concepts will be explored as to their contemporary efficacy.   More recent research on this topic will be summarized and the future of Ferenczi’s foresightful philosophy will be discussed.


        Exposure to trauma is an unexceptional event in the United States, with estimates to such exposure ranging from 50-70% of the United States population. (Sidran Institute, 2013; US Department of Veteran Affairs[USDVA], 2013).  Despite such distressing statistics, the development of post-traumatic stress disorders, which are marked by substantial clinical impairments is unusual. (American Psychiatric Association[APA],2013).  The lifetime risk of experiencing PTSD is 8.7% in the United States,[( lower in Europe)  (US Department of Veteran Affairs, 2013)].  Women are twice as likely as men to develop the disorder. (USDVA, 2013). (Place Table 1 here).

        The finding that few people develop severe psychopathology despite experiencing serious traumatogenic exposures hearkens back to two earlier hypotheses neglected by 21st Century psychologists:  One is that the span between normal and pathological functioning is a bridgeable spectrum, not a fine line.  This is the analogy method developed by early psychoanalytic theorists, such as Freud and Ferenczi.  For example, mourning, the normal expression of grief, becomes pathological at the extreme opposite of the spectrum as melancholia; dreams, the normal expression of sleep, becomes pathological at the extreme opposite of the spectrum as either narcissism or schizophrenia. (Freud, 1917, 1963). The analogy method is useful to not only understand the phenomena studied, but also leads to an appropriate bridge for therapy, as it offers a window into understanding how  individuals experience their disorders, and thus, how far therapists must travel to meet them for an optimal therapeutic encounter.   Resurrecting the approach of a spectrum which ends in a pole of normalcy and one of psychopathology with various stations of functionality in between may lead to more reliable and valid therapies for the treatments of such psychopathology as post-traumatic stress disorder (PTSD). Furthermore, the spectrum approach also spans the gap in understanding why  fewer people develop disorders despite exposure to traumatic stimuli.  This alternative narrative is more commonly employed by psychologists outside of the United States, but its utility is limited, as the medical model is privileged in the actual treatment.  (Eisenberg & Margraf, 2015).

        The spectrum approach also accounts for various personality factors that may mitigate the development of this disorder, such as temperament, early socialization,  socio-economic status, history of traumatic brain injury, and educational status. (APA, 2013). These intra-psychic factors may cause individuals to believe they can actively take control of their lives, or need passively endure them.  As Freud said, “The fading…depends….[on] whether there has been an energic reaction to the event that provokes an affect.” (Breuer & Freud, 1895, p. 8). Freud regarded the formation of a neurosis as a passive act representing repression, the seeds of which are planted in early socialization (Freud, 1924, 1963).  What does this mean to the modern reader? An energic reaction would be an active working through of the trauma.  Engaging in a creative act may be one such expression of an energic reaction. A creative expression would be antithetical to repression, indeed, it would be a sublimation of a trauma, thus, active and not at all defensive. 

        While Freud proposed the utility of a spectrum approach in understanding psychopathology, Ferenczi grappled with identifying relational factors which might lead to a positive or a negative emotional outcome after traumatic exposures.  Ferenczi’s(1955) theory of alloplastic adaptation may be of assistance in understanding the intra-psychic factors which manumit an individual from  impairment or bond them with it.  Ferenczi was one of the few early psychoanalysts who managed to remain within the Freudian hegemony while simultaneously addressing the reality and frequency of actual child sexual abuse, independent of the Freudian concept of Oedipal fantasy. (However, sexual violence was only one form of traumatic exposure which can later lead to post-traumatic stress disorder.  Also included are exposures to natural disasters, combat, traumatic brain injuries, etc.). According to Ferenczi (1933), exposure leads to psychiatric impairment when,

Pathological adults….mistake the play of children for

the desires of a sexually mature person….The real rape of girls…and

boys…are more frequent…than has hitherto been assumed.  These children

feel physically and morally helpless…the overpowering force and authority

of the adult makes them dumb…can rob them of their senses. 

The same anxiety…if it reaches a certain maximum, compels them to

subordinate themselves like automata to the will of the aggressor,

to divine each one of his desires and to gratify these; completely oblivious of

themselves, they identify themselves with the aggressor.

Through the identification…he…becomes intra-instead of extra-psychic;

 the intra-psychic is then subjected, in a dream-like state….When

 the child recovers from such an attack, he feels …split. Usually the relation

to a second adult….mother…is not intimate enough for the child to find help…

The…child changes into a mechanical obedient automaton or becomes

defiant…..One part of their personalities…got stuck…where it was

unable to use the alloplastic way of reaction…could only react in

 an autoplastic way be a kind of mimicry…a mind which…lacks the

ability to maintain itself with stability in face of unpleasure…(Ferenczi, 1933, pp.

162-163)

        Autoplastic adaptation involves an individual reacting “to stimuli of unpleasure with fragmentation….absolute passivity.” (Ferenczi, 1932, p. 165).  An autoplastic adaptation usually is interpreted as having a more “primitive stage of ego development.” (Bychowski, 1950).   No wonder Ferenczi often referenced survivors as passive, like “automatons.” By contrast, “alloplastic adaptation involves the alteration of the environment in such a way as to make self-destruction and self-reconstruction unnecessary and to enable the ego to maintain its existing equilibrium...A necessary condition for this is a highly developed sense of reality.”  (Ferenczi, 1930-1932, p221).To state this empirically, an alloplastic adaptation modulates the risk of psychiatric impairment following traumatic exposure, as it usually is interpreted to mean  the individual actively attempts to “alter reality.” (Bychowski, 1950). Secondly, alloplastic implies an environment which offers the necessary buttressing to unite the post-traumatized fragments.  As Ferenczi iterates, it is the continuation of an existent relationship with a known caretaker, who is not the aggressor,  which predicts whether or not  there will be later impairment.  

        The concepts of alloplastic vs autoplastic adaptation has not sat idly by over the previous century.  Bychowski (1950) invoked these concepts in understanding the struggles of an obese patient.   He conceptualized her obesity as a defense  against being attractive to men.  Her guilt led her to enact “autoplastically her phantasy of pregnancy…this wish fulfilment became fused with punishment.” Of course, the guilt led to overeating and lack of exercise, the active cause of her obesity.  (Bychowski, 1950, p.3).  This study indicates how autoplasticity can be utilized as a window into understanding the etiology of the trauma.  However, he does not seem to have made the next logical step of incorporating his empathy into the actual treatment plan.

        By contrast, Amati-Sass (2004) does.  He writes of the utility of alloplastic adaptation in working with a Latina survivor who “disappeared” into prison as an opponent of a dictatorial South American government.  Helping this survivor to later adjust using an alloplastic philosophy enabled her to make

…thinkable and symbolizable the trauma and its unconscious defences (fragmentations, splitting, dissociation, adaptation) and to give the patient the possibility of transforming defensive ambiguity…of transforming alienation…during the working through…the patient has to decode…disturbing affects, shame and catastrophic anxiety, the loss of sense and meaning, the perturbations of his or her sense of identity, but also to be able to de-legitimate, to rediscover his or her opposition to the violence undergone… (Amati-Sas, 2004, p,2)

Long after the trauma, and even after the passing of young adulthood, healthy growth can be found in a new supportive relationship. 

        In the United States, a major issue in conducting research is the fragmentation within the field.  Psychoanalysts and psychologists and psychiatrists are speaking in a confusion of tongues.  “Splitting,” “fragmentation,” “Intrapsychic,” “autoplastic,” “alloplastic,” are simply not terms within the empirical oeuvre.  If you expect to be taken seriously, one must work within the orthodoxy.  That orthodoxy is reflected by understanding how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM5) orders the issues.  The current revision includes a section for Trauma and Stressor Related disorders, “in which exposure to a traumatic or stressful event is listed explicitly as a diagnostic criterion.  These include “reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder, acute stress disorder, and adjustment disorder.” (APA, 2013, p. 265).    And, the current orthodoxy actually meshes quite well with Ferenczian concepts, as it takes into account the distressing influences of an environment run amok:

        Psychological distress following exposure…is quite variable.   In some cases, symptoms can be….understood within an anxiety or fear-based context…however…many…exhibit…anhedonic and dysphoric symptoms…externalizing angry and aggressive symptoms, or dissociative symptoms….Furthermore, it is not uncommon for the clinical picture to include some combination of the above symptoms. (APA, 2013, p. 265)

        However, in all cases, exposure to traumatic stimuli is not sufficient for a diagnosis.  There must ensure a degree of intrusive symptoms, and/or dissociative reactions, and or persistent avoidance, and or negative alterations in cognitions and moods, marked alterations in arousal and reactivity, duration, and, most importantly, “the disturbance causes clinically significant distress or impairment in social, occupation, or other important areas of functioning. “ (APA, 2013, p. 272).  In other words, traumatic exposure does not cause traumatic illnesses.  Personality and environmental factors intervene. Hence, current researchers are implicitly sympathetic to a psychoanalytic bridge spanning normal exposure and traumatic responses (as long as it remains implicit and unstated).  And Ferenczi had the foresight to explicitly detail some of these intervening factors which mediate this bridge between alloplastic and autoplastic adaptation. 

        However, due to the confusion of tongues between clinicians and researchers, one must adapt to reality as well and try to find existing research instruments and validated research concepts that, however, imperfectly, may capture alloplastic and autoplastic issues. 

        Kahn (2014) investigated the effect of alloplastic adaptation as a modulating factor in the development of post-traumatic stress disorder.  In order to measure alloplastic adaptation, Rotter’s(1966) Locus of control (LOC) inventory was used.  This is a construct used to understand how individuals tend to understand their sense of efficacy in the world.  Individuals who rate themselves as actively controlling the outcomes of events on this self-report questionnaire receive scores of Internal, which may highly correlate with alloplastic adaptation.  Individuals who rate themselves as passive victims with little ability to influence outcomes receive scores of external, which may highly correlate with autoplastic adaptation.  The LOC is a self-report inventory and unfortunately, does not correlate current self-concept with past environmental reinforcers.  It does not establish what intra-psychic factors cause individuals to view themselves as ineffectual puppets, for example, or what happened to them that they view themselves in such a fashion.  Hence, a multi-modal attack is necessary.

        Both Ferenczi and Freud wrote that energic responses might be key as to whether or not traumatic neurosis would occur.  Ferenczi expressed energic as  abreaction, where “large quantities of repressed affects might obtain acceptance by the conscious mind and……formation of new symptoms….might be ended.” (Ferenczi, 1932, pp. 156-7). Creative expression is one way of active engagement to work through a traumatic exposure to experience the appropriate emotional intensity in a socially acceptable manner. To empirically test the concept of abreaction as a modulating factor, participants were asked about their creative pursuits and completed a measure of creative expression (Remote Associates Test, Mednick 1968).  Participants also completed the PTSD Checklist (Weathers, Huska & Kean, 1991)to verify and specify incidents of past traumatic exposure.  Finally, participants underwent a  psychosocial interview with the principal investigator. This study investigated the mitigating impact of diverse personality factors in adulthood  on the post-traumatic functioning.


METHOD:

Participants: Ten inquiries results after the investigator placed pleas on such social media outlets as the Facebook site of a music school, Craig’s list ads, and Linked-In.   Three people choose not to engage in the study after their initial inquiry. 

Inventories: Psychosocial interview, Locus of Control Inventory (LOC), (Nowicki & Duke, 1974), a measure of how individuals understand the relationship between personal agency and its consequences; the Remote Associates Test (RAT), (Mednick, 1968) a measure of creativity, and the PTSD Checklist-Civilian Version (PCL-C) (Weathers, Litz, Huska &Keane, 1994), a measure of traumatic exposure.  Participants who scored as symptomatic on the PCL-C were then asked to complete the Trauma Assessment for Adults-Self-Report Version (Resnick & Best, 2003).

Procedure: Seven participants were ultimately recruited in this manner and engaged in a face-to-face interview with the experimenter. The interview was conducted at various Manhattan coffee shops. Each participant was greeted by the investigator, their identity verified, and offered a complimentary beverage.  Each participant signed informed consent before proceeding.  After consent was obtained, they completed the LOC, the RAT, and the PCL-C.  Participants who scored as symptomatic on the PCL-C were then asked to complete the Trauma Assessment for Adults-Self-Report Version.  After the structured inventories had been completed, they participated in a biopsychosocial interview.   This interview consisted of a thorough investigation of the participant’s childhood memories, education, social relations (past and present), family relations (past and present), trauma exposures, creativity history (past and present), substance use history, criminal history, work history, creative outlets (past and present). Participants were encouraged to reflect back on events for any fresh insights they might have now.  This interview was very similar to an initial psychosocial interview that a psychologist might conduct prior to the initiation of a therapeutic treatment.  Most participants were able to complete the interview within an hour.


RESULTS:

Analysis across all cases: Statistical Results

        Measures of central tendency were utilized to analyze the seven completed protocols. The participants consisted of two American-born females and five males.   Three of the males were born in the United States; one was born in the Dominican Republic, one in South America.  The mean age of the participants was 42.4 years.  Education level ranged from some college to post-doctoral study.  All worked at a professional level, with careers ranging from high school teacher to consultant. Current socio-economic backgrounds ranged from middle-to-upper-middle classes.  Childhood  socio-economic backgrounds ranged from working-class to upper-middle class. No participants reported a childhood history of emotional or behavioral problems. No participants reported a history of traumatic brain injury.  No participants reported an adulthood history of hospitalizations for emotional or behavioral disorders. No participants had a substance use problem at the time of the interview.  All participants were working full-time at the time of the interview.  Three participants were divorced, one participant was currently married, and three had never married at the time of the interview.  Two participants had children, five had no children at the time of the interview.  Two participants scored high enough on the PCL-C to complete the Trauma Assessment for Adults (Resnick & Best, 2003).  These two participants reported multiple traumatic exposures occurring over a 20 year time span.  Traumatic exposures included serious health issues, sexual contact with someone who was at least five years older before age 13, witnessing a violent physical altercation, exposure to a natural disaster, and witnessing a friend or a family member deliberately killed or murdered.  These two cases will be discussed in detail following the overall analysis of cases. (Place Table 2 here).

        The mean score on the LOC was 13, which is Average. The mean score on the Remote Associates Test was 5.7, which is in the eighth percentile for adults.  The mean score on the PLC-C was 26.  Scores under 35 are not considered clinically significant.  Two participants scored over 35 and completed the Trauma Assessment for Adults, which was analyzed in a qualitative fashion.  (Place Table 3 here)

        All participants actively pursued creative outlets.  Among their creative activities were playing in a rock and roll band, screenwriting, song-writing, poetry writing, and learning to play new musical instruments. No participants reported receiving remuneration or reimbursements for these pursuits.

Nature of traumatic exposures reported across all cases:

        Exposure to a natural disaster, serious health issues, sexual contact with someone at least five years older before age 13, witnessing a violent physical altercation, and witnessing a friend or family member deliberately killed or murdered.

Current stressors reported:

        Aging, bankruptcy, death of a parent, family issues (not death), graduation, marriage, personal health concerns, personal weight, retirement, school, time-management, and work related issues.

Unexpected stressors reported:

        Four of the seven participants spontaneously mentioned that they hated their fathers.  During their  biopsychosocial interview , participants were asked to describe their relationships with their mother and father during childhood.  They used strongly negative language  only  when describing  their fathers. One man, age 56, reported that his remembered at age 3, his father spanked him for drawing on the walls.  He stated, “I decided not to love him…we never got along…he doesn’t  love me…I won’t love him back.” A female, age 42, state, “We never got along…I couldn’t stand him…not nice…judgmental, racist….” None of these individuals reported any particulars which would rise to the level of a traumatic incident, such as constant emotional abuse.  Instead, these individuals seem to be overly sensitive to probable paternal misattunement.

Creative pursuits cited:

Playing/learning musical instruments, forming music bands, screenwriting, poetry writing, musical composition. (Place Table 4 here).

Clinical Commentary:

        Two of the seven cases will now be attended to in-depth.  These two males scored significantly high enough on the PTSD Checklist to be considered as having possible diagnosis of PTSD.  Yet, both of these men functioned, worked, raised families, engaged in their communities, and have  not been hospitalized for mental illness in their lifetimes. Thus, they do not meet the research criteria necessary for the diagnosis.  Instead, despite their traumatic exposures, they display alloplastic adaptations.    They will be referred to as The Engineer and The Teacher.

The Engineer:

        The Engineer is a 46 year old man, the youngest following three sisters. He grew up in a northeastern suburb..  His father was a trainer in the school district; his mother was  a college professor.  The Engineer remembers his relationship with his oldest sister as conflicted, as “she thought I was spoiled.” He  got along “great” with the other two sisters.  As for his parents, “I adored them both.” His entry into the school system was not particularly traumatic.  He remembered getting along well with peers, playing sports, and taking music lessons.  His siblings also took music lessons and they were “always playing  music.  The Engineer and his sisters learned to play with proficiency many diverse musical instruments and often performed privately en-famille. . 

        Although early and later childhood years were relatively benign, entry into adolescence marked the beginning of serious exposures to trauma.  When he was 12, he was a witness to serious violence in a school fight. He remembers going to lunch.  Classes were changing.  “A kid [was] running down the hall….another kid running behind”  Everything was going fast and he remembered the scene as chaotic.  “A kid was pushed into a door jamb.  Bang. The other kid jumped on top.  Everyone was surprised.  Kid that was getting beat up was big.  The kid on top was skinny.  The Karate Kid was giving him a whole can of whoop ass.  So much confusion.  Went on longer than it should have, maybe 5 minutes.  I didn’t know the kid [getting beaten] that well.  He was a putz.  An equal opportunity annoyance.  Both got suspended”.

        He abruptly faced minutes of terror where he was rendered a passive spectator to a random act of violence in an environment which was usually ordered and expectable.  Although the exposure to the fight was traumatic, he did not develop any additional symptoms or decompensate into PTSD.  There were no flashbacks, intrusive memories, hypervigilance, etc.  The reminder of his adolescence was generally recalled as  positive.  He mentioned many instances where he demonstrated high levels of success in both the academic and social realms.    He formed a musical combo with friends who performed live music locally.  His parents were proud of his creativity and encouraged him to record, which he did.  He recalls both modern and classical influences on his musical style.    

        Although not particularly interested in academics, he went to college to please his parents.  “Mom said, just get a degree.”  He was recruited by several schools to play hockey and attended college on a hockey scholarship. 

        The second trauma occurred early in young adulthood, when he was incapacitated by a flu virus and needed a heart transplant.  After surgery, he was in the ICU for four days. Later, a cardiac stent was also implanted.   He is currently on a life-long regimen of immunosuppressant’s and pain medication.  Then, in his 30’s, his gall bladder malfunctioned.  They could not do an arthroscopy, so he had to do “old school, cut through stuff.”  He described another long and painful recovery   His personal life was forever impacted by a loss of physical energy.  However, he does not believe this is important as to his lack of a love life.  “I’m picky.  When I get what I want, I’m all in.  Anything she wants, if I find what I want.”

        Although The Engineer has not married as of this writing, he was engaged to be married over a decade ago.  He believes her immaturity ultimately led to their break-up, “She was young, even for her age.  Her looks let her get away with anything.  So many things did not apply.”

        The Engineer works as an engineer, has several  friends with whom he socializes, occasionally dates,  He plays in a rock band that performs at a local restaurant on the weekends.  He copes with his on-going medical traumas by “not dwelling on it.”  He denies any trauma related sequelae, such as nightmares, intrusive thoughts, flashbacks, etc. His idea of a major stressor these days is to get on the 7:55 train to work.  Otherwise, “I’m all set.” He actively engages with daily life and finds it to be satisfying.  He is able to work at a job he enjoys.  He has friends and pursues his interests.  .He meets the criteria of those exposed to trauma but not suffering from PTSD at the present time. He shows resilience and the best sort of alloplastic functioning. There have always been satisfying and intimate relationships which buttress his emotional stability.

Clinical Case #2

        The Schoolteacher is a 40 year old man who was born in the Dominican Republic and came to New York at age 13 with his younger brother, and stepfather. .  As a child in the DR, his biological father was in the military and there was little contact.  His mother did not want him to have any contact with his biological father, probably due to the fact that his father had children by other women.  The Schoolteacher remembers being, “mean to him…Mother wanted me to hate him. She was jealous.  She was angry at him, [when] he wouldn’t forget his dad….Sometimes I saw him and hid….” His mother preceded the family in emigrating to NY, where she lived with her brother.   During that time, he was in the care of his great grandmother.  This was not recalled as a trauma, but as a culturally normal event.  “She (great grandmother) was so loving.  I wasn’t the only kid with parents living outside the DR.  When she came back, it was like Christmas.  This may also indicate early socialization for optimism, to look for the silver lining in every cloud.  Another sister was born right after they came to New York His stepfather was a journalist, his mother a cosmetician.  He describes the stepfather as a hard-worker, who “sometimes yelled at me.”

       The Schoolteacher remembers a childhood filled with art and drawing.  He especially loved to draw “Batman, cartoons.”  His renderings were so successful that “kids used to trade their comic books for my paintings.”  Although the Schoolteacher is ambivalent about his stepfather, the man “used to bring me note pads…put me in art school.” While in the art school, he drew a series of drawings inspired by “The Little Prince”  which were later exhibited at the school.   He recalled “loving school, every subject.”   Yet, life in the DR could be frightening and unprotected.  Before he had reached the age of 13, he reported being sexually molested by a 30 year old female babysitter.  Again, he normalizes this in the interview as common in his culture, yet, despite that description, he also states now he is very careful when it came to who cares for his son.

        Upon arrival in NYC and his entry into public school, he found the transition “shocking.”  The students were “disrespectful.”  He couldn’t communicate, due to his language problems.  Learning English was recalled as a lengthy process.  Worse, studying made him the object of peer ridicule.  He was bullied.  He was called a “white boy.”  He got into fights to show he was tough.  His parents didn’t notice his academic problems.  He was “faking it.” I lived a “double life.”  Home was not a haven, his stepfather, “Yelled.”  Ironically, he found solace by attending night school which enabled him to graduate high school in 31/2 years.  He did not attend college immediately after graduation, but moved to a factory town in Massachusetts to be with his grandfather.  He worked in a factory, manufacturing toys.  Eventually, his parents and friends persuaded him to attend college, where he majored in Sociology and graduated.  He was living with a woman who bore him a son, although he did not marry her.  He taught in a public school.  The second traumatic exposure occurred at age 30.  He reports witnessing a pickpocket attempt to lift another man’s wallet.  “The police jumped on the guy…the guy had a bottle in his pocket.  The bottle broke, the shards pierced his throat.” At age 36, he was a witness to the death of a friend.  He “was standing and waiting for the light to change.  A drunk driver hit him.” 

        At this time, he is in a committed relationship, but his greatest passion is soccer.  He hopes his son will be a pro-baller.  Although “I gave up art.  I started to write poetry, songs.  I wrote love poetry in Spanish and songs on and off.  Recently, he started taking guitar lessons.  “I’ll be a happier person if I can play an instrument.  A person who can play an instrument is never alone.”

        The Schoolteacher tends to normalize his traumas.  Although he was molested by a caregiver, he normalizes it by saying it is common in his culture.  Yet, he takes especial care to be sure this is not visited on his son.  He was also witness to serious violence,where the normal routine was instantaneously replaced with chaos and a lack of respect to personal freedom.  He was bullied in school, and was a passive spectator at the death of a friend. He also meets the criteria of exposure to multiple traumatic stimuli while not being impaired  by PTSD, perhaps due to his active engagement in creative processes. This optimistic, positive outlook  does not mean he identifies with the aggressors of his past.  He recognizes that this was pathological and moves on.  Normalizing experiences is an active way of not allowing traumatic experiences to define one’s life. He experiences at least a minimum level of environmental support in both his past and present and  demonstrates resilience and alloplastic adaptation.

DISCUSSION:

        Overall, these seven case studies of adults recruited from a non-clinical population support statistics indicating exposure to traumatic stimuli may be common in the United States, while becoming significantly impaired with a psychiatric post-traumatic disorder is relatively rare.  Participants’ mean scores on the LOC were average, which suggest that participants take charge of events that they realistically can expert to control.  All participants pursued creative hobbies.  All participants had prior traumatic exposures.  No participants were psychiatrically impaired. This study was designed to be a qualitative study of the hypothesis.  However, the conclusions are limited by the low number of participants successfully recruited.  Furthermore, the experimenter lacked the funds to recruit a control group of psychiatric patients diagnosed with PTSD to compare the key independent variables.  Although limited, these case studies may indicate that locus-of-control status could be predictive for risk of impaired emotional functioning after traumatic exposure.    Most participants scored in the Average range of the LOC, which suggests that they take charge of events that they realistically can expert to exert some control over, and do not expand energy over events that they do not control (weather, actions of others, accidents).    Future research may wish to strengthen the inverse correlation between LOC and PTSD symptomatology by using a clinical sample and assessing their scores on the LOC.

        Engaging in creative expression, though devoid of extrinsic rewards, may also mitigate future risk of impairments.  All  participants reported traumatic exposures; none evidenced psychopathology..  All participants reported a childhood which supported creative expressions and an adulthood where they voluntarily pursued creative outlets.  None reported any serious substance abuse issues or serious mental health issues.  None reported a history of traumatic brain injury.  Future research is needed to determine if both average LOC combined with creative expression are necessary to reduce the risk of psychiatric impairment.        

        An unexpected (and interesting trend) was the number of participants who volunteered negative feelings for their biological fathers. The role of fathers in adult functioning needs to be further investigated.

        Additionally, the low scores obtained by the participants on the Remote Associates Test may indicate this measure lacks validity as an appraisal of creativity for the adult population.  The RAT is predicated on the participant finding a common word which links three other key words.  The assumption is that creativity can be measured by the “ability to see relationships between things that are only remotely associated.” (Mednick, 1968). The RAT was last updated over half a century ago.  Many of the word associations are no longer common in the United States—for example, the words:  call, pay, line, and are linked with phone.  The words man, wheel, high are linked with chair.  The words house, village, and golf are linked with green.  Furthermore, creativity is usually considered a divergent thought process.  Finding one best answer is a convergent process.  An inventory which rewards participants with points when they offer the one secret right word seems to lack face validity.

        These cases offer evidence for the utility of Ferenczi’s construct of alloplastic adaptation. Despite exposure to traumas, all participants functioned and engaged in a variety of work and interpersonal relationships.   Alloplastic adaptation may offer “mastery of trauma…mental pathological products is not…incapable of regeneration...” (Ferenczi 1930, p. 400).  But the one-two punch of being able to survive using alloplastic adaption requires a minimal level of constant environmental buttressing as a concrete structure which unites the fragments. These trends also align well with Freud’s statement that “the fading….depends….[on] whether there has been an energic reaction to the event that provokes an affect.” (Breuer & Freud, 1895, p.8).  These healthy individuals all maintained an active and voluntary engagement in extracurricular pursuits despite exposure to or experience of negative life events which might have caused traumatic disorders in others.  What both these psychoanalysts hinted at was not only does resiliency happen, but it has clear childhood precedents.  No normal society leaves children alone to deal with anxiety and distress.  Ferenczi’s furor sanadi means we never leave people alone in their great distress and then expect that fragments will spontaneously and therapeutically unite.

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Table 1:  Traumatic Exposures and Risk of Post-Traumatic Stress Disorder

Trauma Statistic

Total (%) of US population

Traumatic Exposures

(Sidran Institute, 2013; USDVA, 2013)

50-70

Lifetime Risk of PTSD

(APA, 2013)

  8.7

Risk of developing PTSD

(USDVA, 2013)

  5.0

Sex Differences: 

                                  Females

                                  Males


 10.0 

  5.0


Table #2:  Participant Summary Statistics:

M. Age:  42.4 years

Education: 13+ years

Employment:  Professional 

 

 

n:          %

Sex:

     Female 

     Male                               

 

2              29

5              71

Personality Factors:

     Current Substance Abuse

     History of TBI

 

0                0

0                0

Marital History

      Divorced

      Married

      Single

 

3              43

1              14

3              43

Reproductive History:

      Children

      Childless

 

2              29

5              71

PTSD eligible

2              29


Table #3:  Mean scores of Objective Measures Utilized :

Inventory

M

Range

Interpretation

RAT

    5.7

       1-20

           ns

PLC-C

  26.0

     17-36

           ns

LOC

  13.0

     10-21

        Average