Int J Qual Stud Health Well-being. 2012; 7: 10.3402/qhw.v7i0.19540.
Published online 2012 December 27. doi: 10.3402/qhw.v7i0.19540
Learning from tinnitus patients' narratives—A case study in the psychodynamic approach
Nicolas Dauman, PhD1 and Soly I. Erlandsson, Professor2
Tinnitus, according to literature within the neurological field, is assumed to "be the perception of sound that results exclusively from activity within the nervous system without any corresponding mechanical, vibratory activity within the cochlea, and not related to external stimulation of any kind" (Jastreboff & Hazell, 2004). Patients often describe their tinnitus as buzzing or ringing sounds that can increase in loudness and change in pitch, sometimes day-by-day (Stouffer & Tyler, 1990). Epidemiological studies have shown that approximately 8% of the population regard their tinnitus as somewhat disturbing and 1–2% of cases regard it as a serious threat towards quality of life. Sounds can become intrusive when someone who finds them unbearable is forced to listen to them as in the case of an annoying tinnitus that demands constant attention. When tinnitus makes it impossible to live your life the way you feel would be normal, it signifies an important psychological message.
According to Heidegger (1962), intense anxiety can be characterized as an experience of disintegration that, at times, can control a person's life in a way that includes all areas in which this person is involved and life becomes unmanageable.
The fear of breakdown, as written by Winnicott (1989), is the inner perception of a trauma that the psyche is unable to integrate as a past event, and therefore perceive as a breakdown to come.
We emphasize strongly that the patient's physical suffering is not dismissed in the present approach rather that we have tried to explain that physical suffering can awake forgotten memories of a hidden trauma. This is not unusual when someone is affected by a long-standing tinnitus. Carrying the burden of tinnitus is challenging and troublesome if you also are trying to balance memories of traumatic events by keeping them under the surface (Fagelson, 2007). The distinction between the symptom phenomena and the suffering needs to be clarified. No one talks about it in the same way—it is a subjective phenomenon. What is physical suffering? You can suffer from pain in your body but this experience is not the same as someone else's experience who also suffers from pain.
For a long time, psychological literature on tinnitus has associated annoying tinnitus, to a significant level, with anxiety (e.g., Erlandsson & Persson, 2006; Hesser & Andersson, 2009; Wilson & Henry, 2000). However, in the scope of the habituation model, such anxiety is to be considered as a distorted and maladaptive perception of tinnitus (Hallam & McKenna, 2006; Sweetow, 2000). Therefore, the model states that this emotion should be corrected with educational and/or behavioural techniques. In the psychodynamic scope, when the anxiety appears to be an overreaction to an event or to a physical condition, it is the psychologist's duty to try to understand this anxiety from the patient's viewpoint.