A Phenomenological Analysis of Complex Posttraumatic Stress Disorder
Lead Research Organisation:
University of York
Department Name: Philosophy
Abstract
Rationale: Phenomenology is concerned with structures of human consciousness and the way in which the world is subjectively encountered. Its method is indispensable to the philosophy of psychiatry (Ratcliffe, 2009), articulating the structure, meaning and significance of mental illness by prioritising the form and content of patients' subjective experiences. Whilst psychiatry emphasises operationalised diagnosis and neurobiological explanation, phenomenology provides a complementary perspective in identifying how shifts in experiential reality affect functioning.
Complex Posttraumatic Stress Disorder (CPTSD) has received scant phenomenological analysis, despite symptoms suggesting a range of relevant experiential changes. Whilst some phenomenologists have provided accounts of disturbances in structures of consciousness in "simple" PTSD, such insights may not be straightforwardly applied to CPTSD. Caused by repeated interpersonal trauma, CPTSD combines symptoms of PTSD with dissociation and impairment in interpersonal functioning, sense of identity, and emotional regulation (ICD-11; WHO, 2020). The broader range of dimensions affected in CPTSD indicate a need for direct phenomenological analysis, as the experience, process and impact of alterations in structures of experience is likely to differ. For example, an account of flashbacks in PTSD that draws upon Husserl's view of inner time to describe trauma memory as a collision of past and present experiencing (Larrabee, 1995) will require adapting when flashbacks are also accompanied by dissociative amnesia; perception of time being altered in plausibly unique ways when undergoing symptoms of both re-experiencing and dissociation.
Whilst one account of CPTSD (Ataria, 2016) emphasised change in embodiment, the focus on embodiment alone precluded a substantive account of its experiential reality. Given that additional structures of consciousness (e.g. temporality and selfhood) are inextricably linked and centrally implicated in CPTSD, more comprehensive analysis is required. Doing so will help delineate the ways in which CPTSD patients become prone to engaging with the world (e.g. avoiding their physical self, self-harming, or losing trust).
Aim: To provide phenomenological analysis of CPTSD. Specifically, to articulate precisely how disturbances in structures of experience are shaped, and the consequences associated with this.
Method: The project will be primarily philosophically grounded but will include an empirical component to provide raw descriptive data required for detailed phenomenological analysis. The theoretical aspect will involve mining existing phenomenological literature on the experience of trauma. In exploring experiential structures impacted by CPTSD, the work of Husserl (1966) and Fuchs (2012) are salient regarding temporality; Merleau-Ponty (2002) regarding embodiment; and Mackenzie (2009) and Ricoeur (1966) regarding selfhood. The empirical aspect will involve undertaking semi-structured interviews with fifteen CPTSD sufferers to be analysed using Interpretative Phenomenological Analysis. Ethical clearance will be sought. As CPTSD is under-researched with few documented first-person testimonies, there is a strong rationale for this.
Impact: The research will expand the knowledge base by articulating the experiential structures undergoing alteration in CPTSD and their impact upon patients' social, behavioural and emotional lives. In doing so, it will elucidate processes behind commonly misunderstood symptoms such as dissociation and provide a framework for overcoming their seeming intractability. This precise understanding of disruption to one's sense of body, self and time in CPTSD will help develop and prioritise the utility of treatments targeting these specific aspects of experience. The research will have significant practical value in informing the application of different therapeutic approaches resulting in great clinical benefit.
Complex Posttraumatic Stress Disorder (CPTSD) has received scant phenomenological analysis, despite symptoms suggesting a range of relevant experiential changes. Whilst some phenomenologists have provided accounts of disturbances in structures of consciousness in "simple" PTSD, such insights may not be straightforwardly applied to CPTSD. Caused by repeated interpersonal trauma, CPTSD combines symptoms of PTSD with dissociation and impairment in interpersonal functioning, sense of identity, and emotional regulation (ICD-11; WHO, 2020). The broader range of dimensions affected in CPTSD indicate a need for direct phenomenological analysis, as the experience, process and impact of alterations in structures of experience is likely to differ. For example, an account of flashbacks in PTSD that draws upon Husserl's view of inner time to describe trauma memory as a collision of past and present experiencing (Larrabee, 1995) will require adapting when flashbacks are also accompanied by dissociative amnesia; perception of time being altered in plausibly unique ways when undergoing symptoms of both re-experiencing and dissociation.
Whilst one account of CPTSD (Ataria, 2016) emphasised change in embodiment, the focus on embodiment alone precluded a substantive account of its experiential reality. Given that additional structures of consciousness (e.g. temporality and selfhood) are inextricably linked and centrally implicated in CPTSD, more comprehensive analysis is required. Doing so will help delineate the ways in which CPTSD patients become prone to engaging with the world (e.g. avoiding their physical self, self-harming, or losing trust).
Aim: To provide phenomenological analysis of CPTSD. Specifically, to articulate precisely how disturbances in structures of experience are shaped, and the consequences associated with this.
Method: The project will be primarily philosophically grounded but will include an empirical component to provide raw descriptive data required for detailed phenomenological analysis. The theoretical aspect will involve mining existing phenomenological literature on the experience of trauma. In exploring experiential structures impacted by CPTSD, the work of Husserl (1966) and Fuchs (2012) are salient regarding temporality; Merleau-Ponty (2002) regarding embodiment; and Mackenzie (2009) and Ricoeur (1966) regarding selfhood. The empirical aspect will involve undertaking semi-structured interviews with fifteen CPTSD sufferers to be analysed using Interpretative Phenomenological Analysis. Ethical clearance will be sought. As CPTSD is under-researched with few documented first-person testimonies, there is a strong rationale for this.
Impact: The research will expand the knowledge base by articulating the experiential structures undergoing alteration in CPTSD and their impact upon patients' social, behavioural and emotional lives. In doing so, it will elucidate processes behind commonly misunderstood symptoms such as dissociation and provide a framework for overcoming their seeming intractability. This precise understanding of disruption to one's sense of body, self and time in CPTSD will help develop and prioritise the utility of treatments targeting these specific aspects of experience. The research will have significant practical value in informing the application of different therapeutic approaches resulting in great clinical benefit.
Organisations
People |
ORCID iD |
| Matthew Ratcliffe (Primary Supervisor) | |
| Jake Dorothy (Student) |