Midterm

59

CHAPTER THREE

Reflections on the Nature of Evidence in Psychoanalysis

One cannot approach the problem of proper termination and cure in analysis unless one first circumscribes the nature of the disturbance that is being treated. And one cannot convince anyone about the accuracy of the definitions of certain psychic disorders to be ameliorated or cured through analysis unless one has first succeeded in demonstrating that the framework into which these definitions are placed—in the present context, the framework of a psychology of the self—is both valid and relevant. The claim that a psychology of the self does indeed fulfill these criteria cannot be satisfactorily supported, however, through logical argument alone. Without empirical data, one can hardly do more than demonstrate the internal consistency of one’s views.

Before I undertake arguing the case, on the basis of the examination of empirical data, that psychoanalysis does indeed need a psychology of the self, I would ask anyone wishing to make the serious attempt of evaluating the explanatory power of this new step in theory first to set aside his established convictions that all psychological illnesses can be adequately explained within the framework of mental-apparatus psychology in general, and of modern structural-model psychology (ego psychology) in particular—or even on the maturational level of the Oedipus complex. In other words, the explanatory power and the heuristic value of a new theory, of a new way of viewing the empirical data in the field of complex mental states, can be gauged only if the evaluator can accept the difficult task of temporarily suspending his convictions to the contrary in order to expose himself to new configurations. (I am omitting here the issue of specific emotional resistances and am addressing myself only to the reluctance to give up the security provided by habitual modes of cognitive mastery.) The evaluator must be able to put aside the traditional way of seeing the data frequently enough and for sufficiently prolonged periods so that he can become familiar with the new theory.

Any beginner could of course tell me , for example, that Mr. M. broke off his analysis atex cathedra the point when it really should have started, i.e., at the point when the yearning for the merger with the idealized father would have turned into oedipal competitiveness accompanied by castration fear. Clearly, I cannot deny with complete certainty that oedipal pathology was hiding behind Mr. M.’s narcissistic disturbance. I can only state that, while I remain open to considering such a possibility, it does not, on the basis of extensive clinical experience seem likely—although occasionally one is indeed surprised to discover that a centrally located oedipal pathology has been covered over by what seemed at first to be a primary disturbance of the self.

Further investigations of the various relations existing between self pathology and structural pathology must, of course, still be undertaken. But they will be able to shed new and perhaps unexpected light on human psychology only under the condition that the investigator’s mind is not closed to the idea that a whole sector of human psychology is in essence independent of the child’s oedipal experiences and that the Oedipus complex is not only the center of a certain type of psychological disturbance, but that it is a center of psychological health as well—that it is a developmental achievement.

The assessment of the comparative significance—with regard to normal development and psychopathology—of the child’s experiences with the objects involved in the oedipal drama, on the one hand, and of the child’s experiences with the self-objects involved in the drama of the formation of the self, on the other hand, warrants a return to concentrated, unprejudiced clinical observation. Clinical descriptions given in essays and books, however, even in the form of extensive case histories, can rarely by themselves supply convincing proof for the correctness of specific interpretations of specific psychological data, and they can never by themselves supply sufficient evidence in support of the claim that one viewpoint is more adequate, more encompassing, more accurately discerning than another. The enormous number of variables contained in the psychological field dooms a purely cognitive approach to failure. The refined empathy of the trained human observer, however, constitutes a potentially adequate instrument for the performance of the first step—understanding—of the two-step

C o p y r i g h t 2 0 0 9 . U n i v e r s i t y o f C h i c a g o P r e s s .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE AN: 518385 ; Heinz Kohut.; The Restoration of the Self Account: s4194587.main.ehost

60

procedure—understanding-explaining—that characterizes depth psychology. The fact that I consider the trained observer’s empathy to be the irreplaceable step that leads to the meaningful grasp—understanding—of the psychological field will illuminate two closely related features of the1

present work (and of some of my other writings): the use of personal expressions—such as, “I have become increasingly convinced”—and the emphasis in my clinical descriptions on the analyst’s responses to the material—the various closures at which he arrives, the gradual conviction that one of them rather than any of the others is correct. My clinical data are meant to be evocative. I want to2

demonstrate my viewpoint and offer it to my colleagues for experimental use in the laboratory of their own practice. Analysts will be able to acquire a solid conviction about the relevance and the vitality of a psychology of the self only as they employ it in their own work. The fact that the presentation of a case has succeeded in dispelling the reader’s doubts about the correctness of the writer’s thesis is a testimony to the writer’s skill and intelligence—it is not a proof of the correctness of his thesis. An analysand can give fifty well-fitting associations whose ideational content would lead to a specific interpretation of the material—yet his tone of voice, the message emanating from the mood portrayed by his gestures and bodily posture will tell the analyst that the significance of the material lay elsewhere.

How, then, do analysts arrive at a valid understanding of the material under their observation? Depth psychology, after all, cannot support its claims with the kind of evidence available to such sciences as physics and biology that study the external world via sensory observation. Valid scientific research in psychoanalysis is nevertheless possible because (1) the empathic understanding of the experiences of other human beings is as basic an endowment of man as his vision, hearing, touch, taste, and smell; and (2) psychoanalysis can deal with the obstacles that stand in the way of empathic comprehension just as other sciences have learned to deal with the obstacles that stood in the way of mastering the use of the observational tools—sensory organs, including their extension and refinement through instruments—they employed.

The possibility of achieving valid results in our field must be evaluated against the background of two principles: one concerning the emotional state of the empathic observer, the other the cognitive aspect of his task. One might call the first of these the Emperor’s-New-Clothes principle; it is the embodiment of the view that fact-finding in psychoanalysis requires at times the naïve courage of the observer rather than a very highly developed cognitive apparatus. The second principle—let us refer to it as the Rosetta-Stone principle—embodies the view that the validity of newly discovered meanings (or their significance) must be established in analogy to the validation procedure employed in the deciphering of hieroglyphics. If the observer-decipherer can demonstrate to himself that an increased number of phenomena can be combined to spell out a meaningful message when seen from a new point of view, that a broader range of data can now be understood and interpreted meaningfully, then one can indeed say that his conviction about the new mode of interpretation has become stronger.

The essential focus of interest of the psychoanalyst, furthermore, concerns the meaning and the significance of the material under scrutiny, rather than causal sequences. His comprehension of human experience is thus no more accessible to cause-effect considerations in time and space than is the validity of the assertions of a decipherer of hieroglyphics. Stated in different terms, the depth psychologist pursues psychological truth by three methods: by persistently examining empirical data via empathy from as many different viewpoints as he can discover; by singling out the specific empathic stance that allows him to see the data in the most meaningful way; and, last but not least, by removing obstacles to empathy—predominantly in himself, but also, through example and encouragement, on the one hand, and through repeated demonstration to his colleagues, on the other, that a new empathic stance will allow them to discern heretofore not recognized psychological patterns.3

The following illustrative clinical episodes—the purpose of their presentation and certain features of the form in which they are given—should be evaluated against the background of the preceding remarks. They are meant to demonstrate that the meaning and significance of certain clinical phenomena are more broadly and deeply understandable when viewed within the framework of the psychology of the self than when viewed within the framework of drive psychology, of the structural model of the mind, and of ego psychology.

Clinical Illustrations

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

61

The Psychoanalyst’s Child

In my practice I have, especially in recent years, encountered several patients who were the children of psychoanalysts. They consulted me for reanalysis because they felt that their previous analyses had4

been failures. They were afflicted by a vague sense of not being real (often in the form of their inability to experience emotions), and they experienced an intense (yet conflictual) need to attach themselves to powerful figures in their surroundings in order to feel that their life had meaning, indeed, in order to feel alive. Their disturbance, as I came to see, was genetically related to the fact that their parents had from early on communicated to them, frequently and in great detail, their empathic insights about what they (the children) thought, wished, and felt. As far as I could judge—and there were instances in which I have cause to feel on firm ground with regard to this conclusion—these parents were in general neither cold nor rejecting. They did not, in other words, cover over an underlying rejection of the child with the aid of, in essence, hostile interpretations. These repeated interpretations did not result in the child’s feeling rejected. Nor did they give the child the feeling that he was responded to. Theoverly pathogenic effect of the parental behavior lay in the fact that the parents’ participation in their children’s life, their claim (often correctly made) that they knew more about what their children were thinking, wishing, feeling than the children themselves, tended to interfere with the consolidation of the self of these children, with the further result that the children became secretive and walled themselves off from being penetrated by the parental insights. The decisive issue, however, in the present context is the following. In the previous analyses, their analysts had regarded their strong reluctance to reveal themselves and their inability to give themselves over to free association either as a non-transference obstacle to the establishment of a therapeutic alliance or as a transference resistance opposing the emergence of incestuous libidinal wishes or as the manifestation of an object-instinctual negative transference—as a way of frustrating (defeating) the rival parent. In the first instance, the analysts seem to have reacted by exerting—in more or less subtle ways—a degree of moral pressure on the patients, exhorting them to commit themselves to the analytic task; in the second and third instances they had tried to deal with the problem by, as they saw it, appropriate interpretations.

One might easily surmise that these patients’ ultimately achieved conviction that their previous analyst had been mistaken is no more than a manifestation of a positive transference to the subsequent analyst. The way the relevant material emerged, however, speaks against this conclusion. As a matter of fact, for a long time in the analysis with me, these patients did not complain about their previous analyst, but tended to take his approach for granted—just as they had never questioned the appropriateness of the parental intrusions. These had been a way of life with them when they were children; and the analyst’s pressures and/or interpretations were, as far as they recognized, similarly accepted by them as appropriate. In fact, it was against considerable resistance that the patients began to realize—without any suggestion on my part: indeed, at first to my surprise—that it was a deep fear of the dissolution of the self that had prompted them to wall themselves off against the danger of being understood.

The previous analysts of these patients were in all instances that I encountered competent, experienced, and well-regarded members of the profession who were undoubtedly in tune with the constructive aspect of the resistances on which I am focusing here, or at any rate who recognized that resistances are unavoidable and must be treated with respect. I think, however, that the majority of even these analysts would tend to see the resistance displayed by these patients as a reaction to a deficiency of an ego that was damaged because it had been overtaxed in early life. There is an essential and decisive difference between this outlook and the one I am advocating. The conceptualization of a defective ego (whose boundaries have not been firmly established) prompts the analyst to take on a commendable attitude of cautiousness (in order to preserve the ego boundaries still present), followed by an educational approach (the attempt to establish cognitive mastery of the relation between ego and object [cf. Federn, 1947]).

The conceptualizaton of an ego defect, in other words, leads of necessity to an educational rather than a psychoanalytic approach—however psychoanalytically informed this educational approach may be. In view of the fact that the mental apparatus itself is not an experiential content for the analysand, the analyst who conceptualizes the patient’s illness as due to a defect of the ego can do no more than teach the patient to recognize the malfunctions of his defective psychic apparatus. And the patient in turn can

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

62

do no more than attempt through conscious effort to resist certain existing pathological trends (such as the tendency to believe that others know his thoughts) by the strained activation of opposing forces (by laying stress upon his conscious knowledge that others know his thoughts).don’t

The conceptualization of a specific psychopathology of the self, on the other hand, leads to a psychoanalytic rather than educational approach. It leads to the emergence of the pathognomonic experiential contents, specifically to the re-experience of the claims of old psychic constellations—claims that had gone into hiding because they had been unempathically disregarded by the self-objects—and it permits these constellations to be re-experienced in the transference—in fact, to become the very center of the psychoanalytic process. The conceptualization of a pathology of the self leads in these cases to the recognition that the patient’s resistance against being analytically penetrated is a healthy force, preserving the existence of a rudiment of a nuclear self that had been established despite the parents’ distorted empathy; it also leads to the recognition that this nuclear self is becoming increasingly reactivated, i.e., the analyst witnesses the revival of the analysand’s archaic conviction of the greatness of his self—a conviction that had remained unresponded to in early life and had thus not been available for gradual modification and integration with the rest of the personality; and, finally, it leads to the recognition that a working-through process is being mobilized which concerns the claims of the reactivated nuclear self in one (or several) of the varieties of a self-object transference. This working-through process begins in most instances with the mobilization of archaic needs for mirroring and for merger; as working through is maintained, it gradually transforms the patient’s ideas of archaic greatness and his wishes for merger with the omnipotent objects into healthy self-esteem and wholesome devotion to ideals.

I have no doubt that the central psychopathology in the cases under consideration concerned the insecure cohesion of the self (or other forms of self pathology). It was this central disturbance that formed the core of the self-object transference (a “mirror transference in the narrower sense” [see Kohut, 1971, pp. 115–125]) that established itself spontaneously in the psychoanalytic situation. The fact that the parents of these patients had continued to intrude via selectively empathic perceptions into their children’s minds during the later, verbal stages of their development—i.e., long after the preverbal stage when near-perfect parental in-tuneness with the content of the baby’s mind (the baby’s needs and wishes) is indeed the prerequisite for the formation of the baby’s rudimentary self—proves beyond doubt that they were out of tune with their children’s maturational needs (that is, with the requirements of the child’s whole self), even though their empathic grasp of certain details of their children’s mentation was often quite accurate. The development of the child’s self—its clear delineation—was5

therefore hampered. What the child had needed were not fragmentation-producing interpretations concerning specific ideational and emotional contents of his mind, but interpretations leading to his increasing awareness of his persisting need for cohesion-enhancing responses to his total self. It was the childhood need for such responses (frustrated in childhood and thus intensified) that was revived in the self-object transference; and it was this need that required interpretation. The analyst should not have rejected the resistance against self-revelation as an untoward attitude to be overcome, the sooner the better, in the service of analysis (as the patients began to see it in retrospect, for the enhancement of the parent-analyst’s self-esteem), but interpreted it without censure as an important shield against being penetrated by interpretations—a shield with which the patient was attempting to protect a small, coherent sector of his self. It was this barely maintained, secretly safeguarded, comparatively intact sector of the self, however, and not incestuous drive-wishes that now, after its existence had been acknowledged by the analyst’s interpretation, became reactivated in the self-object transference. Slowly and against strong resistances, it offered itself to the analyst’s view: wanting to be admired and confirmed in order to gain a sense of its reality and, secondarily, aspiring to carry to completion a frustrated developmental step, to expose itself to working-through processes (optimal frustrations) that would allow its integration into the patient’s mature personality.

From the Analysis of Mr. W.

And now to another set of more detailed illustrations in support of the claim that a broadening of our focus—relinquishing exclusive reliance on conflict psychology and the structural model of the mind—to include the conceptual framework of a psychology of the self, will in certain instances allow

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

63

us to see the psychological data in a new light and increase our ability to activate and maintain specific beneficial working-through processes in the area of our patients’ narcissistic disturbance.

Mr. W., a single man in his late twenties, after trying a number of different jobs, had in recent years6

been quite successful as a journalist. He had been analyzed before but wanted now to be reanalyzed. He said his first analysis (which had ended about three years earlier) had helped him a little by diminishing his pervasive restlessness. He felt, however, that it was not primarily the insights provided to him during the former treatment that had been responsible for the amelioration of his condition, but the steadying influence of his former analyst—a predictable, devoted, kindly, older man.

Although his complaints when he presented himself for reanalysis were quite vague—he experienced a general dissatisfaction with his life and said that he felt restless and generally “nervous” at times—I can say in retrospect, on the basis of insights gradually obtained in the course of his analysis, that he suffered from that sense of inner uncertainty and purposelessness concerning widespread sectors of his life so characteristic of diffuse disturbances of the self. And the more specific complaint of recurrent increases in his restlessness and nervousness can also in retrospect be seen as referring to episodic exacerbations in the weakness of his self-cohesion. Altogether, the most characteristic manifestation of Mr. W.’s psychological disturbance was the recurrence of a syndrome of irritability, hypochondria, and confusion.

On the basis of what we learned during the analysis about the meaning of Mr. W.’s episodically increased restlessness—especially with regard to the effect of separations from the analyst—there can be no doubt that these reactions had always occurred—before, during, and after his previous analysis—in response to events that gave him the feeling that he had been abandoned. At the beginning of the reanalysis, however, and for most of the first year of this analysis, the patient was completely unaware of any emotional responses to actual or impending separations from the analyst and, so far as could be ascertained, had never before been aware of such reactions either in his previous analysis or outside of treatment. Gradually, however, not only was it possible to establish that he was indeed strongly affected by such experiences, but the meaning of the psychological features of his reactions became increasingly understandable.

The initial clue was provided in a dream that occurred toward the end of the first year of the analysis, a few days before the analyst was to be away for a week—in New York, as the patient had learned by chance. In the dream, the patient was in an airplane flying from Chicago to New York. He was occupying a window seat on the left side of the plane, as he mentioned, looking out toward the south. When the analyst pointed out the inconsistency in his report of the dream: that, going from Chicago to New York, he would be looking north, not south, from the left side of the plane, the patient became utterly confused and spatially disoriented—to the point that he literally could not tell right from left for a short time. (I might add here that the spatial disorientations from which he suffered at such periods were not always as harmless as this one. Once, during the second year of the analysis, again in anticipation of a separation from the analyst, he exposed himself to considerable danger when he made a wrong turn into an expressway against fast-moving traffic—a turn, it must be emphasized, he had made correctly many hundreds of times before.) The associations to the spatial disorientation revealed by his dream led him to recall repeated incidents of his adult life and later childhood (of which he had never spoken earlier, although these memories had clearly not been repressed) when he had become spatially disoriented in unfamiliar places—with the dreadful feeling that he would never find his way back to familiar surroundings.

The analysis of Mr. W.’s dream opened the first significant path to the genetic-dynamic understanding of the core of his personality disturbance. When he was about three and a half years old his parents had been forced to leave him, their only child, for the span of more than a year. During that period the patient, who up to this time had known only the big-city surroundings of Chicago, lived on a farm in Southern Illinois with unfamiliar people, distant relatives of his mother. They seemed to have been conscientious people who took care of his physical needs but who otherwise paid only scant attention to him. He did not see his father at all during that year, and had only a very few brief visits from his mother. As the analysis progressed, each of the leading symptoms with which he reacted to separations in the transference led to the recall of significant precursor experiences from that fateful period of his early life.

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

64

Before separations and, in the earlier part of the analysis also in response to situations and events he experienced as emotionally analogous to separations—especially when the analyst (occupying the emotional position of the foster family on the farm) seemed distant or unempathic —Mr. W. filled the7

sessions with more or less anxious descriptions of various physical sensations he was experiencing and accounts of illnesses he believed he was developing. Prominent among his preoccupations was concern about his eyes (which he thought were not focusing properly) and about his hemorrhoids. At such times during the early part of the analysis, he consulted ophthalmologists and proctologists and even considered surgical interventions. He never actually underwent surgery, but managed to exteriorize his obsessional doubts by finding experts who gave him opposing advice concerning treatment. Gradually, as the analysis progressed and made the patient more and more aware of the relation that existed between his hypochondriacal worries and the psychological effect of impending separations from the analyst, he began to recall the crucial mental states from his childhood that were the precursors of the present ones.

As soon as Mr. W. suffered the loss of the self-object analyst, he was deprived of the psychological cement of the narcissistic transference that had maintained the cohesion of his self. And, in consequence, he felt threatened by the fearsome perception that various parts of his body were isolating themselves and were beginning to be experienced as strange and foreign, and by the loss of the secure feeling of being a unit in space, a continuum in time, and a center for the initiation of actions and for the reception of impressions.

The choice of symptoms during these episodes was not determined by specific unconscious wish fantasies as are the somatic symptoms of conversion hysteria, but preexisting minor physical defects to which the patient paid little attention when the cohesion of his self was not threatened became the foci of his attention when his self began to fall apart. The essential psychopathology in such instances is not the emergence of intensified specific sexual and aggressive fantasies in somatic form, but the diminution of the cohesion of the body-self in the absence of the mirroring self-object. The experience of the total self decreases while the experience of the fragments of the self increases—apari passu painful process that is accompanied by a mood of diffuse anxiety. But while the somatic symptoms do not express any specific meaning that could be verbalized and interpreted, the choice of symptoms is not entirely random: certain body parts become the carriers of the regressive development from the patient’s yearning for the absent self-object to states of self-fragmentation and will, therefore, especially lend themselves to becoming crystallization points for hypochondriacal worry. Fantasies, for example, of a yearning to take in the absent self-object through the eyes and anus might at first have been transitionally experienced by a still cohesive self during the precursor stage in childhood when the hypochondria first occurred. But it is of crucial importance to realize that the eyes and the anus soon cease to serve as the executive organs of a still cohesive self that is longing to see the lost self-object or that wants the lost self-object’s ministrations to the anal area. After the self has broken into fragments, the residual part of the self that experiences its own fragmentation, has no other power left to it as it alarmedly seeks some aid in its attempt to reconstitute itself, but to attach its anxieties and complaints to this or that fragment of the body.

We now turn to the deterioration (and temporary loss) of certain of Mr. W.’s basic mental faculties: his ability to orient himself in space, to differentiate right from left, to think precisely, and to express himself clearly. How can we explain these malfunctions as they occurred in the clinical situation and elsewhere—and as they had occurred during the crucial period of his childhood when the basic pathogenic foci were established in his personality? On gross inspection and in terms of social psychology, we could say that in the clinical situation these defects were caused by his being deprived of a symbiotic relationship with a care-taking person (the analyst) who had up to this point functioned as an auxiliary personality. And a similar statement could also be made with regard to other situations in his adult life that imposed an analogous deprivation on him, and with regard to his experiences at the age of four when he had been deprived of his parents at a time when they still performed certain mental functions for him. The empathic stance of the depth-psychological observer of the details of the transference, however, allows us to add a crucial new dimension to explain the patient’s behavior. Careful observation of the regressions that took place in the self-object transference demonstrated that the hypochondriacal state always preceded the tendency to disorientation and confusion; that the

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

65

hypochondriacal preoccupation with fragments of the body-self had to reach a certain intensity before the patient became liable to lose his orientation in space and to experience difficulties in verbal expression. Fragmentation of the self preceded deterioration of ego functions. And the same sequence appears to have occurred during the patient’s childhood: the loss of the specific mental faculties that had occurred at that time also required a preceding step, the fragmentation of the self. These deficits were not the direct result of the separation, they were indirectly brought about via the temporary and partial fragmentation of his self. As was true in the transference, first came the absence of the self-object, then followed the fragmentation of the (body-mind) self (in the form of hypochondria and of the other symptoms to be discussed shortly), and finally followed the deterioration of the specific mental faculties mentioned before. This sequence in the causal chain is in harmony with the tenet that there exists a mutually supportive relation between self-cohesion and the optimal productivity and creativeness of the personality, a tenet that is corroborated, though in a pathological and distorted form, by the attempt made by some patients faced with serious self-fragmentation to prevent the total crumbling of the self with the aid of a temporary, frantic increase of various mental and physical activities.

It was in the context of the attempt to understand the bleakness in the patient’s outlook on himself and his existence while the analyst was away—there had been no clear-cut change in his mood (he had not been depressed), but his life had seemed impoverished, his mind was not creative, and he had pursued his activities without zest —that he began to speak about a tendency to lie awake for hours8

during the first part of the night—a tendency that increased during the analyst’s absence. And it was in the context of assessing the change in his over-all condition that his greater understanding of his hypochondriacal preoccupations and of his insomnia converged and led to memories of the time when he was alone in the country and was unable to fall asleep because he felt vaguely threatened in an environment he experienced as nonsupportive (nonempathic) and therefore inimical.

There can be no doubt that lacking an empathic environment, the boy had felt threatened by a beginning fragmentation of his body-self and that he was therefore unable to give up conscious control (was unable to go to sleep) because of the fear that if his vigilance ceased his body-mind self would break apart, never to mend again. A fantasy game which he played for hours at such times9

demonstrates one of the countermeasures he employed to allay his fragmentation fears. As he lay awake, he imagined making long excursions on his body. Starting from his nose, he would imagine himself walking over the landscape of his body down to his toes, then back again to his navel, shoulder, ear, etc.; thus reassuring himself that his body had not fallen apart. His trips from one part of his body10

to another reassured him that all the parts were still there and that they were still held together by a self that inspected them. The hypochondria repeated these early experiences: By talking in detail about his anus and about his eyes, he not only gave expression to his anal and visual incorporation needs and to the worry that these and other parts of his body were beginning to be experienced as not part of the self, but he also tried to maintain control over the totality of his body-self by focusing his attention on the parts that were becoming estranged from him.

Decisively important though the experiences on the farm were, the question can be raised whether they would have resulted in the lifelong disturbance of self-cohesion from which Mr. W. suffered had it not been for the influence of still earlier experiences—experiences that were not directly recalled in the analysis. What I have in mind is the influence of the mother’s personality on the child in the years before the crucial separation took place. The mere fact that she could let go of the small boy for such a long period might be taken as indicative of a flatness of her maternal feelings; and her behavior during her visits—her apparently abrupt comings and goings—might be understood in a similar way. I would, however, not put too much stock in the reliability of these reconstructions on the basis of the patient’s direct memories from childhood. And even the evidence that was obtained from the transference experiences—certain phases of the merger-mirror transference when the analyst was felt to be nonresponsive, unpredictable, and of a nonhuman, stony quality—was only suggestive, not conclusive. The mother’s behavior during visits with the patient while the analysis was in progress, however, and the inconsistency of her behavior toward children, which the patient observed and reported to the analyst, allowed a more reliable assessment of her personality. The analyst concluded that, while her attitude had been one of dutiful caretaking, of a fulfillment of obligations, she had not been able to

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

66

relate to the child with calming emotionality. She emerged as a woman who, deeply insecure about herself—especially about her own body—was also insecure and clumsy about her handling of others, particularly children—and was therefore unable to provide the kind of emotional support to a small child that sets up the central nucleus of self-acceptance and security that a mother with self-acceptance and free maternal emotionality is able to provide for her children.

As stated before, the worry about his physical defects and his appeal for the help of physicians were the adult replicas of the anxieties of childhood and his need for the attention of the missing self-objects. The remedial attempt enacted in his fantasy game, however, had no direct replica in adult life. The only adult behavior that, as analyst and patient came to view it, appeared distantly related to the body-game of childhood was his tendency, when he felt abandoned by self-objects in adult life, to engage in pleasureless sexual activities and to become compulsively interested in obscene photographs. The significance of these activities appeared to lie in the attempt to stimulate himself erotically in order to regain the sense of the aliveness and reality of his body-self. I might add here, even though it probably goes without saying, that, in many instances, the sexual activities of people who are away from home are not primarily due to the temporary diminution of the influence of the superego; they are rather, as in Mr. W.’s case, attempts to stimulate and thus to bring alive a lonely, threatened self.

The second symptom with which Mr. W. responded to separations from the analyst was great irritability. He was, for example, prone to becoming involved in angry arguments and ugly confrontations with comparative strangers—in restaurants, while driving his car, with neighbors. At first the analyst surmised that the irascibility (and the fact that Mr. W. actually provoked a number of bitter verbal arguments and confrontations) was due to an upsurge of aggressiveness (specifically, of death wishes directed against the analyst). But repeated observation of certain features of his mental state and careful scrutiny of his behavior during such times, to be described shortly, led to the conclusion that his mood and his reactions (both in the transference and, under emotionally analogous circumstances, in his childhood when he was temporarily abandoned by his parents) were manifestations of a traumatic state—of a mental condition, encountered with great frequency during the analysis of patients suffering from narcissistic personality disorders, in which he considered himself unsupported and overburdened and felt that his emotional powers were overtaxed. Two of these reactions were in fact quite typical for the condition of psychological overburdenedness that is the essence of a traumatic state. (In the later stages of his analysis, Mr. W. himself began to recognize them as signs indicating that a traumatic state was imminent.) The first of these behavioral manifestations was that the patient overreacted to strong sensory stimuli (in particular, he reacted with great irritability and anger to noises, smells, and bright lights), the second that he became sarcastic—indulging in cutting jokes and an annoying tendency to punning. The most conspicuous behavioral manifestation of Mr.11

W.’s traumatic state the clinical situation was his irascibility—his tendency to become involvedoutside in arguments.

Mr. W.’s state of psychological overburdenedness—the inability of his mental apparatus to handle the stimuli intruding from the surroundings and to cope with external problems of average complexity—was due to the fact that, in consequence of the loss of the self-object, he was not sustained by the experience of a strong central self. His aggression was not (unconsciously or preconsciously) directed at a specific object, but the expression of a tendency to lash out indiscriminately against the whole environment, which had become strange and unsupportive (unempathic) and which he therefore experienced as an impersonal potential attacker. Among the fragmentation products appearing under these circumstances was not only aggressivity in general but aggressivity as it related to specific erogenous zones. His aggression was, in other words, expressed on a variety of drive levels. Anal aggression (e.g., the impulse to flatulate in social situations) was often prominent; but oral and phallic aggression (the former through biting verbal attacks; the latter as provocative exhibitionism, e.g., “fuck-you” signs at drivers who annoyed him) was also frequently in evidence. Because his fragmenting self did not function as effectively as before as the organizing center of his activities, did not adequately provide him with the synthesis required for efficient functioning, the patient was hard pressed on two counts: he confronted an unfamiliar environment which, in a revival of the crucial childhood experiences, was not empathically in tune with him and thus became anxiety-provoking; and his capacity to cope with his environment was much reduced—the mental mechanisms he usually

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

67

employed had become disorganized. The patient’s insecurity vis-à-vis his surroundings was further diminished because the emotional powers he could still muster were now deflected from the task of dealing with the environment and had to be committed to the task of holding the self together. External demands were therefore an unwelcome drain on his energies, and he reacted to them, whatever their content, as inimical intrusions.

In addition to irascibility, Mr. W. at these times of separation displayed obsessive-compulsive characteristics. When, in the beginning of the analysis, the analyst first became acquainted with the appearance or increase of obsessive-compulsive features in Mr. W.’s ideation and behavior, he formulated a tentative explanation in object-instinctual terms. He thought that the patient, when faced by the analyst’s leaving him, became angry at him and wished him dead, but that, in order to preserve the analyst’s life, he tried to deflect his anger onto others and erected defenses against the magical power that he unconsciously attributed to his death wishes by developing obsessional symptoms. But—analogous to the dynamic essence of his irascibility—the obsessive-compulsive features of Mr. W.’s ideation and behavior that appeared when he faced a separation from the analyst were not the manifestations of defensive psychological maneuvers designed to stem the tide of object-instinctual aggressions, not the manifestations of a countermagic which the patient had mobilized against the magical power of his unconscious death wishes toward an unfaithful love-object, i.e., toward the analyst.

The significance of one pseudo-obsessive-compulsive symptom was discovered almost accidentally in the course of an analytic session that took place several months after the one in which the analyst first witnessed Mr. W.’s becoming disoriented in space. The preceding hour had seemed especially devoid of content, and the analyst, who admitted that he had been bored, assumed quite naturally that the patient was on strike against analysis or—a mode of dealing with the trauma of abandonment frequently seen inside and outside the analytic situation—that he was closing shop before closing time. In view of the facts that this was again a session which took place shortly before an interruption of the analysis and that some important work had been done in the preceding sessions, it was not surprising that the patient appeared to be unwilling to tackle new, emotionally taxing analytic tasks. His thinking, however, had taken on the obsessional cast of which I spoke before; and, despite the insights with regard to the significance of his hypochondria that had previously been gained and that had again been substantiated in some recent sessions, he continued to ruminate about his physical health. True, his worries were not quite as poignant and his preoccupations not quite as intense as they had been during the first year of the analysis. Nevertheless, the analyst assumed, as he listened to him droning on endlessly about seemingly irrelevant details, that the emotional impact of the forthcoming interruption, and/or the need for a respite after some difficult analytic work, accounted for the present stagnation.

It was in the course of this dull session that Mr. W. began to talk about the several items he kept in one of his trouser pockets. The analyst (who happened to have his consultation with me shortly after he had seen Mr. W.) gave me a vivid description of his own reactions. He had listened to the patient’s account with bored resignation, just as he had done in the past when, under similar circumstances, he had been annoyed by similar accounts, which, however, he had hardly noticed and which, at any rate, he had soon dismissed from his mind. And he thought again today that he was simply witnessing yet another manifestation of a preinterruption and/or post-progress resistance. He concluded, furthermore, that the patient’s detailed enumeration of the various contents of the pocket was quite in tune with the generalized obsessional quality that characterized his thinking whenever he felt under stress. I recall that, listening to the analyst’s report, I pondered the question whether the locus of the patient’s preoccupations, so close to the genitalia, might indicate the presence of castration anxiety or—”everything is still there”—of a defense against it, and I therefore asked the analyst whether the patient’s behavior or his tone of voice suggested the presence of some underlying anxiety. The analyst said he did not think so, adding after further reflection that, on the contrary, he had been struck by the quiet calmness of the patient’s voice as he gave the inventory of his pocket, and by the fact that the secure finiteness of the complete listing of the details the patient presented to him (the exact number of coins; a piece of crumpled-up note paper; a small ball of woolly fuzz he had preserved; etc.) stood in strong and remarkable contrast to the general shiftlessness, hurry, restlessness, and insecurity that characterized Mr. W.’s emotional state at this time.

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

68

I remember that, following the description of Mr. W.’s behavior, the analyst and I sat for a while in silent contemplation. Somewhat unaccountably, although I had no inkling of the specific meaning of the patient’s behavior, the impression grew on me that we were not witnessing a manifestation of the patient’s negativism about the analysis but that his account expressed a positive attitude. Judging by the analyst’s report, it seemed to me that the patient spoke about the contents of his pocket with the simplicity of a child who calmly and unhurriedly talks to a grownup about something he knows, and who is pleased with himself as he does so. I communicated my impressions to the analyst who said he could not supply any further data that would throw new light on the patient’s symptom. He was, however, inclined to believe that I had put my finger on a possibly significant issue. Luckily, the patient continued his behavior in an almost unmodified way during the next session, and the analyst now listened not as if he were being exposed to boring gibberish, but perhaps to a potentially important message. Indeed, after a while, he felt prompted to tell the patient that it seemed to him that he heard a child’s proud account to a grownup—just as it had been formulated during the preceding consultation. The analyst was rewarded by the patient’s presenting him with some surprising insights and the recall of some important memories. Put succinctly, the psychological significance of Mr. W.’s preoccupation was that, in a world that had become insecure, unpredictable, unfamiliar—as fragmented as his fragmented self—he had taken refuge in an enclosed space which his mind was able to master completely because he knew everything about it and because everything that was within it was familiar and under his control. And in connection with these insights concerning the ongoing transference, a number of childhood memories began to emerge concerning the time when he was first on the farm, when no one had paid attention to him, and when he was often alone while everyone was working in the fields. It was at such times, when his unsupported childhood self began to feel frighteningly strange to him and began to crumble, that he had in fact surrounded himself with his possessions—sitting on the floor, looking at them, checking that they were there: his toys and his clothes. And he had had at that time a particular drawer that contained his things, a drawer he thought about sometimes at night when he could not fall asleep, in order to reassure himself. His preoccupation with the contents of this drawer might well have been the precursor of his preoccupation with the contents of his trouser pocket.

How can we be certain that our explanation of the observational data from Mr. W.’s analysis was correct? Could we not have understood the same data in a different way—for example, by seeing them in the light of oedipal psychopathology? What can the analyst do to avoid errors in his struggle to get nearer to the truth?

All analysts are surely aware of the danger of a possible skewing of their empathic perception by expectations arising from a matrix of learned (or otherwise acquired) theoretical views. But we also know that there is one attitude that, after it has become an integral part of our clinical stance, provides us with an important safeguard against errors arising in consequence of our instinctive commitment to established patterns of thought: our resolve not to be swept away by the comfortable certainty of the “Aha-experience” of intuited knowledge but to keep our mind open and to continue our intrial empathy order to collect as many alternatives as possible. Whereas empathy is the scientific analyst’s greatest friend, intuition may at times be one of his greatest enemies—from which it follows that, while the analyst must of course not relinquish his spontaneity, he should learn to mistrust explanations that suddenly surge up in him with unquestioned certainty.

Although analysts are aware of the multiplicity of factors that can lead to an amelioration of a patient’s condition and are therefore loath to adduce “cure” as proof for the correctness of explanatory formulations, I can say, in support of the correctness of our understanding and of the treatment strategy pursued in Mr. W.’s analysis, that the patient benefited from the treatment. True, neither the disappearance of symptoms nor even a broad change from maladaptive to adaptive behavior patterns constitutes proof that the insights gained in an analysis were correct, that the assessment of the structure of the personality of the analysand was accurate. But a gradual disappearance of symptoms and a gradual change in behavior patterns with increasing insight are indeed highly suggestive ofpari passu the relevance and correctness of the latter. Mr. W. became a more firmly organized person: he became more thoughtful and deliberate and less inclined to act rashly, on the basis of impulse and hunch. To give an illustration: one area in which he was inclined toward rash action was in his financial dealings.

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use

69

Although he had for a long time occasionally invested in high-risk stocks, the ups and downs of the impulse to do so could be studied during the analysis. The increased urge to undertake risky stock market transactions occurred always when he felt deprived of the relationship to self-objects (e.g., the analyst). These swings are explained genetically in terms of the psychology of the self by the threat to his experience of the continuity of his self along the time axis whenever he lost the self-object, just as the experience of the continuity of the self, and thus the basic experience of normally unrolling time, had been disrupted in childhood when he was deprived of the presence of his parents and exposed to the unpredictable visits of his mother. By gambling with high-risk stocks he asserted defensively a magical control over the future at the very time he felt that his capacity of experiencing himself as a continuum in time, as a self that had a future, was slipping away. The increasing understanding of the connection between the disruptive impact of the loss of the self-object and his defensive assertion of omniscient control over the future led to a diminution of the latter need. (To be exact: it was not only the tendency to engage in risky action that decreased—his obsessional ruminations about the possibility that he might engage in such actions also decreased, leaving his mind free to engage in productive pursuits.)

Then, too, Mr. W.’s hypochondriacal preoccupations disappeared almost completely in the course of the analysis. I would again lay stress not so much on the fact that an important and bothersome symptom was ultimately dissolved, but rather that it receded gradually, giving with theway pari passu working-through processes with regard to the insights obtained about the significance of the loss of the self-object in the transference and during his childhood.

EBSCOhost - printed on 3/22/2022 3:49 PM via BOSTON COLLEGE. All use subject to https://www.ebsco.com/terms-of-use