Why so painful now?

One of the questions clinicians ask almost automatically is, “Why now?” A young person has reached adolescence and suddenly becomes frightened by something that happened years earlier. A childhood memory begins to feel sinister. An ordinary event acquires a strange emotional heat. Parents search for a recent trigger, while the young person struggles to explain why something that once seemed unimportant has become impossible to leave alone.

Sometimes there has been a new event. At other times, the new development is the adolescent themselves.

The psychoanalytic idea of Nachträglichkeit offers a way of thinking about this. It is usually translated as deferred action, although I prefer afterwardsness. Deferred action can sound as though an experience was quietly waiting to release a fixed effect. Afterwardsness carries something more active. The past is encountered again from a later position and given a meaning that was unavailable before.

This matters enormously in adolescence. Puberty alters the young person’s relationship to their body. Sexual knowledge becomes less abstract. Questions about responsibility, desire and identity take on greater weight. The adolescent can now understand aspects of earlier experience that the child could only register in fragments. Nothing new needs to happen outside for something new to happen psychologically.

Freud was already grappling with this in 1895. In the case usually known as Emma, a young woman became unable to enter shops alone. She remembered an incident around puberty in which two shop assistants had laughed while she was inside a shop. That memory led to an earlier scene involving a shopkeeper who had touched her sexually when she was a child. Freud’s interest rested upon the relationship between the scenes. The earlier experience acquired its sexual meaning only after puberty had supplied knowledge that the child did not yet possess. The later scene returned her to the first one and altered its emotional force.

Freud pursued a more ambitious version of this problem in the Wolf Man case. There he attempted to reconstruct the later significance of an alleged scene from very early childhood. The reconstruction remains controversial, and rightly so. It shows both the imaginative power of psychoanalytic thinking and its capacity to become far too certain about events that cannot be verified. Afterwardsness asks us to take time seriously. It does not give the clinician permission to manufacture history.

I often think about this when working with adolescents who have OCD. OCD has an extraordinary ability to recruit the past into a present prosecution. A memory that had once been unremarkable returns as evidence. The young person examines what they thought, what they felt and what they might have intended. Each act of remembering becomes another attempt to settle the moral meaning of the event.

Imagine a teenager who becomes consumed by the memory of pushing a younger sibling during an argument when they were seven. At the time, the incident passed quickly. Years later, after encountering stories about violence and becoming more aware of their own physical strength, the memory changes. The adolescent begins to ask whether the push revealed a hidden wish to cause serious harm. They replay the scene, question family members and inspect their emotional response while remembering it. The childhood event has entered a different psychological world.

The facts of the event may remain exactly the same. Its place within the young person’s mind has altered.

This is where afterwardsness adds something to an OCD formulation. It helps us understand why the onset of distress does not always coincide with the original experience. The adolescent is now capable of meanings that the child could not make. OCD moves into that gap and promises certainty. It says that, with enough reviewing, the young person can discover what the memory finally proves about them.

The reviewing rarely remains a straightforward attempt to remember. It becomes a compulsion. The young person checks whether the memory feels vivid, whether guilt appears quickly enough and whether their present horror cancels whatever they may have felt at the time. Parents can become witnesses for the defence. They are asked to confirm that the child was kind, that the sibling was unharmed or that children often behave impulsively. Relief follows, although it does not last.

Seen in this way, the clinical task involves more than correcting a distorted interpretation of the event. The adolescent is trying to establish a final relationship with their own past. They want the memory to stop changing. They want an account that remains innocent under every future examination.

Exposure and response prevention remains useful here. The response that needs to be prevented may be repeated reviewing, confession or asking others to reconstruct the event. The exposure may involve allowing the memory to exist without reaching a verdict about what it says. Yet the developmental meaning still matters. We need to understand why this memory became available to OCD at this stage in the young person’s life.

This guards against a familiar problem in CAMHS formulation. Services often search for a recent precipitating event because the symptoms are recent. When nothing obvious is found, the presentation can seem puzzling or biologically abrupt. Afterwardsness allows development itself to become part of the precipitating context. Puberty, a first intimate relationship or a new awareness of mortality may change the meaning of material that has been present for years.

This is especially important when a young person discloses an earlier frightening or abusive experience during adolescence. A delayed disclosure does not tell us that the experience had no effect at the time. Nor should we assume that the later account gives transparent access to exactly what the child understood then. The adolescent speaks from a mind that has changed. The memory is now held within a different body and a wider field of knowledge.

There is a clinical gentleness in recognising this. Adults often ask, “Why didn’t you tell anyone?” or “Why has this started bothering you now?” Even when asked kindly, these questions can leave a young person feeling that the timing of their distress is suspicious. Afterwardsness gives us a better position. We can accept that an experience may become speakable only when the person has enough psychological language to recognise what it was.

Jean Laplanche developed this idea further. He was interested in the messages that pass from adults to children, including meanings that the adults themselves do not fully understand. A child receives more than they can translate. Something remains unfinished and may be translated again later. For Laplanche, afterwardsness is an ongoing process of translation rather than a single delayed reaction.

I find this useful because it makes development less tidy. The young person does not simply reach maturity and discover the correct meaning of childhood. Each new developmental position creates another reading. Therapy also enters this process. A clinician’s interpretation becomes one more possible translation, which means it should be offered with care. We can help a young person think without claiming ownership of what their past truly means.

There is an apparent resemblance between afterwardsness and modern research on memory reconsolidation. Retrieved memories can become open to updating before they settle again. That comparison is interesting, although it should be handled cautiously. Reconsolidation research studies the conditions under which memory traces may change following retrieval. Afterwardsness concerns the creation of psychological meaning across development, especially where sexuality, relationships and unconscious communication are involved. They ask related questions at different levels. One does not validate the other.

The distinction matters in practice. We can become so eager to make psychoanalytic ideas sound contemporary that we translate away the very thing they contribute. Afterwardsness is useful because it disrupts the idea that clinical history is a fixed chain of events. A past experience can acquire fresh force when later development gives it another meaning. The person remembering has changed, so the remembered world changes too.

For adolescents with OCD, this may help us understand why yesterday suddenly feels dangerous. The young person is often trying to secure the past against any further reinterpretation. They search for the final memory and the final moral conclusion. Our work is to help them loosen that demand, while remaining interested in why this particular piece of the past has returned now.

The past is never wholly available to us in its original form. We meet it through the mind we have become. Adolescence makes this especially vivid. Old experiences are read with new emotional knowledge, and sometimes the symptoms we encounter are part of that reading.