Transference and post-traumatic stress: combat veterans' transference to the Veterans Administration Medical Center

In this paper I have discussed two types of transference manifestations to an institution; namely, the "VA Medical Center transference syndrome" (VATS) and the "VA medical center split transference syndrome" (VAST). Transference to an institution was identified as an important issue deserving the attention of psychotherapists and psychoanalysts. Two case studies illustrated the dynamics of these two transference phenomena. Moreover, as a consequence of exposure to traumatic war experiences in Vietnam, these two illustrative cases portrayed a strong tendency to splitting dynamics and fragmenting ego operations inherent in what has been referred to here as "post-traumatic borderline personality disorder" (p-TBPD). In the VATS case, the patient struggled with intense feelings of dissociated and repressed guilt over the five men killed and two severely wounded in Vietnam for which he believed himself to be responsible. Initially, the patient had denied he felt responsible and guilty over this tragic event; however, later as trust developed and intense paranoid defenses were attenuated, these painful memories were expressed in vivid detail. His affective attachment or transference to the VA Medical Center was an "instrumental transference" in that it served the purpose of giving him the sense of protection from his guilt-ridden ego and harsh, punitive superego. The task of the treatment was to first establish trust through emphasizing the "real" relationship and fostering the idealizing transference. Through the idealizing transference, the patient began to decathect from the VAMC as his sole protective object. With this patient the "real" relationship was essential in assisting him to relinquish his transference hold on the VAMC and embark on "the road to recovery" (Brende and Parson, 1985). The VAST case portrayed the situation in which the veteran "bifurcates" his transference responses--one to therapist, the other to the VAMC. As in the VATS case, it was essential to emphasize the real relationship, maintaining an active intervening stance, while fostering the idealizing transference.(ABSTRACT TRUNCATED AT 400 WORDS)