Abstract: This is a discussion of trauma as it was explored over the course of a woman’s four-year psychoanalysis. The paper highlights how patient and analyst (the author) engaged in a series of interactions that brought the woman’s history of abuse and abandonment, her stultified outrage, as well as her sadomasochistic fantasy life, into treatment. In exploring the main themes of her treatment – abandonment and homelessness – as well as her attachment to a seemingly mundane object, a bottle of water, I will elaborate how this woman’s fantasy life was enacted as a form of sexual surrender that allowed her access to her own historical experience of atrocity, oppression, and hope. I argue that in the interactive matrix of psychoanalytic treatment, atrocity and sadomasochistic desire may appear in the most mundane of behaviors, and that they will have multiple conflictual meanings that demand exploration rather than facile celebration or condemnation.
A patient walks into her analyst’s office. She is thirty-six years old, heterosexual, and single, a woman who lives at home with her brother and her elderly parents. She had been put up for adoption at birth by her biological mother, which set up the major themes of her treatment and her life: abandonment and a gnawing sense of homelessness. A few days after her birth, she was taken into the home of her adoptive parents. She brings with her a history – sexual and physical – of personal atrocities and their accompanying traumata. These have been perpetrated upon her in two ways: directly, in sexual and physical abuse; and transgenerationally, through her adoptive father who was a Holocaust survivor. She brings with her guilt, rage, and loneliness, and a million masochistic and suicidal fantasies. She carries the dreaded diagnostic label Borderline Personality Disorder, and a dream that through psychoanalysis she will be saved from a life of pain. She also brings a bottle of water. And of all the things that she brought, it was the most mundane one, the bottle, that was the key to unlocking everything else. In this paper, I will explore and examine that unlocking process through the lens of contemporary interpersonal/relational psychoanalysis. To understand this patient, a quick review of the way psychoanalysis looks at food and fear will be helpful.
Food and Fear: Clinical Concepts
Conventional psychoanalytic wisdom suggests that patients not be permitted to bring food or drink into their sessions. Analysts generally understand such (mundane) behavior as a defense against oral dependency needs that require analysis. Gratification of these impulses/ wishes/needs discourages their emergence in affect and transference, and so undermines vital opportunities for interpretive work on the oral stage of psychosexual development. Oral preoccupations are associated with primitive dependency needs, and especially when oral impulses are gratified by the ingestion of food, they may be associated with sadomasochistic fantasies – the sadistic chewing, biting, or gnawing upon the mother’s breast, the father’s penis, the mother’s penis, etc., and then the masochistic suffering of associated guilt and anxiety.
Anxiety in many forms of psychoanalysis, especially contemporary interpersonal and relational theory, is the primary target for therapeutic intervention and is considered a primary source of psychopathology. Selective inattention and dissociation are security operations (i.e., defenses) that, while keeping a person’s self-esteem and self-experience from being overwhelmed by anxiety, also limit that person’s overall experience of him- or herself across the dismissed domains of thinking, feeling, behaving, and interacting with others. What Sullivan (1953) called the self-system is the sum total of security operations that we build up inside ourselves to ward off overwhelming experiences of anxiety. When anxiety cannot be warded off, it results in the experience (or re-experiencing) of trauma.
An Analytic Patient?
When I met the patient, whom I call Jean, I was working at a small community mental health clinic in New York City.
Jean showed up an hour early for her first session, carrying the water bottle that would be her (our) constant companion throughout the work. She spent most of our time pleading with me to not abandon her as her birth mother (and her recent therapist) had. She revealed a long history of severe physical and sexual abuse (including a previous therapy in college with a therapist who had suggested “role-playing” a rape scene, and then in fact actually inflicted on Jean a series of actual rapes). When personal trauma becomes an everyday experience, as it was with Jean, it can devastate an individual, chronically coloring their personality with heavy doses of hypervigilance and suspicion. When personal trauma reaches this level of devastation, I believe it can be considered an atrocity, which is I use the term in instances to discuss Jean.
She described her home as a “concentration camp,” wherein she, under the totalitarian rule of her father, was allowed no freedom whatsoever – including the freedom to have a job, or relationships (especially romantic ones). In fact, she said, therapy was the only activity that her parents allowed. Jean described her father’s violence, and how she understood it to be a reaction to her and her brother’s displays of emotion during their childhoods. Jean related that her father’s history as a Holocaust survivor had left him unable to tolerate any emotional expression. She described her father telling her that the Nazis had drowned his mother in front of him and his brother as they entered the concentration camp. He had suppressed and punished emotional expression in his children, so severely that the neighbors had occasionally intervened, coming and getting the children and taking them to their home, sometimes in the middle of the night. Jean, her brother, and their mother all agreed that given the father’s horrific experiences, his intense reaction to his children’s emotions was “as it should be.” Over time, Jean revealed many incidents of abuse at her father’s hands, and the equally horrifying awareness that her mother was both unable and unwilling to stop him.
Over the first two years of analysis, Jean described a series of molestations and rapes that had been perpetrated upon her. She had vague memories of having been molested by a “faceless man” as a very young child – a man who may have been her father. Her father’s brother, also a Holocaust survivor, also molested her on a number of occasions, even though she warned her parents of his intent. Jean’s parents never confronted her uncle, although at some point they stopped leaving Jean alone with him. Starting in early adolescence, she began to get herself “unwittingly” into situations that in fact (as she recalled later) she knew to be dangerous. (This included the one that enabled the rape by her college therapist.) She became addicted to heroin, and there was a period of about five years during which she was highly promiscuous (e.g., sneaking into bars and having anonymous sex with numerous partners). She had a long-term and highly abusive relationship with an older man, and powerful fantasies and impulses about having to be a hooker on the mean streets of Brooklyn. (Jean had been off heroin for quite a number of years when I met her, though she still fantasized, and threatened, about using it, and it was the reason that her parents “let” her attend treatment).
All this notwithstanding, Jean excelled in school. She completed high school and went immediately to college. Though there continued to be problematic patterns of behavior in her life (abusive relationships, alcohol and drug abuse), she was always able to perform in the academic context, and when she graduated at twenty-two she accepted a position with the juvenile probation department.
Jean remained there for three years, having found a “true calling.” “I was made for taking care of troubled kids,” she said. She met a man who worked in her department, a fellow probation officer, and fell in love. They planned to marry.
She also became very attached to some of the children with whom she worked. She fostered their relationships with her fiancé, and encouraged them to trust him as they trusted her. She felt uneasy with his “obsession” with childhood sexual abuse (he had an entire library at home dedicated to the topic), but she felt certain that this was a work-related obsession. However, during an outing, one of the boys punched her fiancé, called Jean a “traitor,” and never spoke to her again. She recalls “putting the pieces together” in horror, and coming to the realization that she had done the unimaginable – she had lured the children she so loved “into the jaws of a wolf in the fold.”
Jean struggled for a while to come to terms with what her fiancé had done, but she was distraught. A few weeks later, while out driving with him, she attempted to jump out of the car while it was moving at top speed. He pulled over, hit her in the face, and left her on the side of the road. Jean walked home, went into the bathroom, and attempted to overdose on her father’s heart medication; she felt wretched: not so much over the horrible ending of her engagement, but over the belief that she had colluded in doing harm to children. She was hospitalized briefly, released, and referred to the clinic where we met. Over the ten years between that event and our meeting, she had sunk further and further into a state of total isolation and dysfunction, to the point where she had no job, no friends, and no activities except for her therapy.
Jean was immuring herself in her house, which didn’t feel like her home. She couldn’t go out into the world because she didn’t feel safe, but home didn’t feel safe either. She was bereft, and she described this as her personal state of “homelessness.”
She cried during sessions as she spoke about the ways that she had been abandoned and rejected by her biological mother and, recently, her therapist. “I have no home,” she whispered, and this was a primary thematic experience for her in the general context of her life. She begged me not to leave her. She told me that she would do “anything” for me if I would keep her. I tried to assure her that I had no interest in leaving her, but her pleading only increased.
At the end of one of our initial sessions, while we were scheduling the other sessions for that week, I became curious about the already-incessant presence of the water bottle that Jean brought into her sessions. Things had gone fairly smoothly in that particular session, so I thought that I might take that opportunity to explore the presence of her water bottle, especially considering that it had been thoroughly drained during the course of our forty-five minutes together (as it had been in each of her other sessions). I framed an (I thought) innocuous question, to which Jean responded curtly, “Fuck you,” and walked out. So it began.
Jean began to set up the thing she feared most, the worst form of sadism that I could perpetrate upon her masochistic self – rejection and abandonment. The enactment around the water bottle had already called up sadistic fantasies, and in fact she came into the office two days later apologizing, and promising that I could punish her in any way that I saw fit. Except by taking away her water bottle.
For a long time it went on like that. Jean and I struggled to establish a working analytic relationship, but it was rough going. Her need and her fear were in constant conflict, and after her rages at me and infuriated departures from my office would come spates of terrified phone calls and pleas that I not retaliate by abandoning her. But between, and with the help of, these sadomasochistic melodramas, some analytic work was getting done.
Throughout our time together, in every session hour, in every desperate phone call, her message repeated over and over, “Don’t leave me!” which she often stated as “Don’t kill me.” It was a nightmare but we stuck it out.
Before revealing more about the water bottle, I would like to present some theoretical descriptions of atrocity and masochism that I found helpful in making sense out of this case.
Ghosts Made Flesh: Atrocity Transmitted, Perpetuated, and Enacted
Atrocity and its accompanying traumatic underpinnings can be enacted in daily life. Freud’s (1919) thoughts on the aftermath of the First World War contain precursors of current notions of trauma:
The primitive fear of death is still strong within us and always ready to come to the surface on any provocation. Most likely our fear still implies the old belief that the dead man becomes the enemy of his survivor and seeks to carry him off to share his new life with him (242).
That is, through the transmission of trauma and through traumatic enactments, we “share” our lives with the dead – we live with ghosts in our midst.
Winnicott (1974) similarly viewed the fear of breakdown as the fear of a previous event, rather than a future one. Such haunting relates to past, current, and ongoing conditions of internalized atrocity, rather than to actual or certain future happenings. In a related vein, Sullivan (1953) delineated the interpersonal security operations that may be called into effect to inattend or dissociate the internal conditions inherent in unbearable states of preparation. When a traumatic event, such as rape, occurs, for example, the traumatized person might then be unable to recall the specific details of the event. Often when this is explored, it is clear that the emotional impact of the event has not been registered – in other words, that the emotional impact has been “inattended” or “dissociated.” These operations engage a feedback loop between primitive experience and current perception based on a dreaded and quickly approaching future event or state. All we need for the atrocity to exist inside is the belief in its possibility. It is then sustained through perpetual enactment of this preparation.
While Freud viewed difficult (i.e., psychotic/borderline) patients as “non-analyzable,” Sullivan (1962), who viewed these conditions as human processes, developed methodologies for working with such people. In fact, Sullivan’s one-genus postulate, that “everyone is more simply human than otherwise” (32), arose out of his work with such patients. He saw that the psychotic states existed at the farthest end of a continuum between mental health and mental disorder. Sullivan (1940) believed, unlike most theoreticians of his time, that human “personality tends toward the state [of] mental health or interpersonal adjustive success” (97).
Sullivan (1964), whose ideas form a cornerstone of contemporary interpersonal and relational psychoanalytic theory, posited that schizophrenia and like disorders are cultural phenomena related to early and/or ongoing failures in a person’s environment. They represent a form of acculturation to chaotic and traumatic (family/cultural) environments. He believed that such traumatic states were transmitted through empathic linkages between caretakers and infants. Winnicott (1965) echoed such thinking in his assertion that there is no such thing as a baby, only the infant-mother (or mothering one) pair – the “self” as inseparable from the interrelationship of “self and other.” In an unbreakable linkage like this, when atrocity occurs, there is no escape.
The Masochistic Surrender
Emmanuel Ghent is an interpersonal/relational psychoanalyst who has challenged traditional notions of sadomasochism by considering masochism as a form of surrender, as opposed to submission. Underlying such a surrender is the deep desire/need that people have to be known by another. In counterpart, sadism is the activity of the knower, in the penetrative and often painful process of gaining access to the other’s inner experiences. Ghent (1990) says that
surrender has nothing to do with hoisting a white flag; in fact, rather than carrying the connotation of defeat, the term will convey a quality of liberation and expansion of the self as a corollary to the letting down of defensive barriers…There is [in the masochist] deeply buried or frozen, a longing for something in the environment to make possible the surrender (108-109).
Ghent describes the longing of masochists to give up their defensive barriers – to be recognized and known, accepted for who they really are. According to Ghent, and Winnicott before him, the wish to be recognized is universal, but people in certain situations of danger can realize it only masochistically. This may be the absolute risk that a traumatized person can take in the presence of a potentially dangerous other. It is a game of chance that will either confirm (required submission in the interaction – repetition of the earlier trauma) or disconfirm (the accepted surrender – breaking the cycle of repetition) their experience of the environment as being wholly malevolent.
Freud (1924) viewed masochism as an expressive of early drive derivatives, or a superego phenomenon. Later, psychoanalysts viewed it as a defensive reaction of the ego (Horney, 1935; Reich, 1933). More recently, Stolorow and Lachman (1980) have suggested that “masochistic activities may…represent abortive (and sometimes primitively sexualized) efforts to restore and maintain the structural cohesion, temporal stability, and positive affective coloring of a precarious or crumbling self representation” (30). Taking all these factors into account, Ghent (1990) suggests that masochistic submission
holds out the promise, seduces, excites, enslaves, and in the end, cheats the seeker-turned-victim out of his [or her] cherished goal, offering in its place only the security of bondage and an ever amplified sense of futility…[Yet] the intensity of masochism is a living testimony of the urgency with which some buried part of the personality is screaming to be exhumed (pp. 115-116).
Bromberg (1998) suggests that “the drastic means an individual finds to protect his or her sense of stability, self-continuity, and psychological integrity, compromises the later ability to grow and be related to others” (6). Along these lines, Ghent considers the masochistic tendency as a means of shoring up a lack of cohesion in the self and argues that this lack requires a form of patterned impingement from the environment in order to stabilize. For Ghent, “impingement” is very similar to “penetration,” and “the deeper yearning, which remains invisible behind compulsive masochistic activity (in itself needed to forestall chaos and disintegration) is the longing to be reached and known, in an accepting and safe environment” (118).
It is also possible that masochism is a person’s way of letting parents off the hook. By taking parental failures in as an expression of the badness inside themselves, traumatized people can both take on the care-taking responsibilities themselves, and simultaneously hold out for a better caretaker in the future. Of course, the only way to test out the new caretaker is to repeat the submit/surrender chance game – a cyclic system. Masochism may be the way that this caretaker self keeps what is essential, what is absolutely necessary for the self to survive – what feels core, real, and intact – safe until it can found by a caring other. Considered in this fashion, masochism may be a powerful expression of hope: masochism was home for Jean, until she could find a home that didn’t require it. It was the placeholder of home in her life. Thus the seeking, waiting, hoping endeavor may be a person’s best shot at self-cure while waiting for the unlikely appearance of another person, a relationship, a world, in whose context those essentials will be safe to come out.
The Secret Lover’s Unshared Tryst
One day Jean came in, lay down on the couch, and wept for fifteen minutes, saying finally, “You might as well know the sad truth, I am dying.” She went on to tell me how everyone would be better off if she were dead.
After listening to her enumerate the reasons that the world would be a better place without her, I said, “Your dying is a cause for major celebration? Perhaps, then, we can sing and dance around the room.”
She replied, “I know you want me to have an emotional reaction to the thought of my own death, you want to convince me that I am not dead already. But I’m not going to give it to you. I hate you. I won’t give you the satisfaction.”
“You hate me,” I replied, “because I see what’s alive in you.”
“Yes…and everyone who sees that tries to kill it. And if you see that, you can see what else is in there, and will lock me up forever.” With that, she left, leaving behind a trace element that would be brought to life in the following (and final) sessions of our work together.
In the next session she presented a dream: “You and I were wrestling…I couldn’t tell if we were fighting or playing…it seemed physical…sexual.” Jean felt thrilled and terrified when she woke up. She associated this dream with a painful but erotically charged experience that she had had during a colonoscopy in the preceding week. She described the dream as a “soft porno show.” As she described her feelings of sexual desire, her mood shifted, she seemed startled at the frankness of her associations and she shrieked, “These are crazy thoughts, and you are Judas!”
In the next session, Jean began by asking if I was angry with her. I replied that there might be some comfort in seeing me as someone who was mad at her. She then said softly, “I hate you,” and was silent for five minutes.
She then whispered, “I have been more disoriented lately. I suspect that you know what it’s all about…”
Therapist: What what’s all about…?
Jean: I would be mortified, embarrassed…
Therapist: You’re talking about the crazy thoughts?
Jean: For all my life I have been trusting people, they have been throwing it all in my face. I have been having this experience here. It started with weird thoughts…it’s sick…you know about the bottle and will lock me up. I drink water, I always drink water. I drink to fill my bladder, I hold it until it becomes painful, almost unbearable, I contract my muscles, you know, down there. It gives me something like an orgasm…like we are having sex here, together, alone…but together. I’m ashamed. You will lock me up now [she begins weeping]. I’d rather have regular sex…with a person…with a man who’s not you and not me. Sex is unbearably painful for me…
Therapist: Is this experience unbearably painful for you?
Jean: Not until now.
Therapist: Why now?
Jean: Because you know I’m crazy. I will walk out. I can’t stand it that you know. But I didn’t want you to accuse me of avoiding it. I was never going to tell anyone.
Therapist: And now we have to hold it together.
In her next session, she told me that she was embarrassed, but that she believed we could hold her experiences together. She then revealed a dream from the night before:
I’m Dorothy from the Wizard of Oz with ruby shoes. I said, “I have no home.” The scarecrow said, “I gave you away because I didn’t want you,” the tin man, “You’re nobody’s child,” and the lion, “You were a mistake.” They left me alone.
She woke up crying. After the last session, she said, she had felt that she did have a place. She recalled her life as a singular event, a torture in which she did not belong because no one had ever made room for her as she was, with all of her “hang-ups, quirks, and idiosyncrasies.”
“Where was the good witch?” I asked.
“I’m not sure there is such a thing,” Jean replied, “but come hell or high water, I was going to see you today. I’ve always wanted you to know that I’m in really bad shape. I always wanted you to help me. I needed to know that it was safe to let you in. The only way I could know was to let you in… You know, let you in.”
Rather than interpreting our interchange over the previous sessions as an expression of some archaic id impulse, I accepted it as an interpersonal risk, a surrender that was necessary for Jean if she was going to be able to feel known and accepted – at home.
When Jean had said “fuck you” that first time we met, I had understood it only vaguely as an invitation into a sadomasochistic enactment that would develop and unfold over the course of our time together, and represent the atrocities that she had experienced, internalized, and repeated. I could not have guessed the powerful enactments that would emerge through that water bottle.
In her analysis with me, as in virtually all of Jean’s other relationships and experiences, she had recreated the internal atrocity site – the place of maximum vulnerability, the place that others had abused, raped, humiliated, and abandoned, leaving her in a state of psychic homelessness. She took a valiant risk to share this lonely place, initially symbolized by the bottle (bladder) full of water, representing her clandestine sexualization of the analytic relationship, as well as her hope for actual physical and emotional contact with another person. She shared this in the only way she knew how – by enacting a primitive, somatic sexuality that had heretofore existed in isolation, and that needed to be experienced with the one person she felt could destroy (or save) her. She did this by taking a masochistic gamble: Would our relationship, like so many others, require her submission to the sadistic impulses of a recreated, and so familiar, other? Would I use this information/experience to humiliate her, lock her up, or disavow the importance of the risk that she had taken to trust that our relationship would contain her “craziness?” Or would she finally be able to surrender her suffocating defenses and be welcomed back home, to the place where she could feel known and accepted as she was?
As Jean told me that day, she had begun to feel that this could happen, that we could contain her “craziness” and make a safe place for her with all her quirks and all her fears. What more could we build on this breakthrough experience? We both imagined, as we began to explore this issue, that time would tell. It is with immense sadness that I must relate that time told us nothing more.
During our entire four years together, Jean had almost never missed a session. When she missed all four sessions the next week due to illness, I knew that it was serious. She showed up on the following Monday barely able to speak, struggling with pneumonia. Later that week I learned that the pneumonia had won. According to her doctor, her heart just “gave up.”
It had felt as if we had finally been able to create together a facilitating environment wherein we could safely enact the surrender that Ghent has so compassionately described. Jean had finally been able to give voice to her internal isolation and her life-long experience of internalized atrocity. She had surrendered herself to yet another imminently dangerous interpersonal situation, and, in so doing, she continued her ongoing struggle to be known and loved – right up until the very end of her life. Her untimely death left me to wonder how she might have expanded this process into other areas of her life.
Dostoyevsky (1955) asked, “Who says human nature is capable of bearing this without madness?” (46). This – the thought of death. As if in answer to Dostoyevsky’s question, Bromberg (1998) says that “finding a voice for what may drive the self mad if it speaks is no easy matter to negotiate. But unless it is found, the patient will die without having lived” (135). I believe that Jean had just begun to find such a voice – to live – in the very final moments of her life, and to know that it is true: There’s no place like home.
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Author: Mark B. Borg, Jr.,is a practicing psychoanalyst and community/ organizational consultant working in New York City. He is a graduate of the William Alanson White Institute’s psychoanalytic certification program and continues his candidacy in their organizational dynamics program. He is co-founder and executive director of the Community Consulting Group. His primary area of interest and research is the exploration of psychoanalytic/community psychology intersections.