Πέμπτη 23 Οκτωβρίου 2014

Sexual Abuse: The Significance of Self-Abuse to Psychic Equilibrium





[…] One can consider the way in which self-inflicted abused turns a passive trauma into an active one for the sexual abuse survivor who is attempting to gain mastery over early trauma and its aftermaths. Through self-destructive behaviours, the survivor regulates the timing, pace and severity of her victimizations, paradoxically experiencing a sense of empowerment. Ostensibly no longer at the mercy of an external perpetrator, the patient assumes control of her abuse. […] (p.130)

Most survivors who engage in violent enactment are aware of wanting to punish themselves. These patients, at their core, are convinced that they are unfit human beings. Filled with shame, they experience themselves as profoundly defective and horribly toxic[…] Frequently told by their abuser that they provoked and wanted the sexual attacks, survivors see themselves as malevolently powerful. As adults, when some internal or external event evokes a sense of having been “bad”, survivors may physically attack themselves or take life threatening risks to punish themselves.

Although being victimized is painful for the survivor of childhood sexual abuse, it is also familiar. Often being a victim is the most secure identity the survivor has. To initiate self-protective behaviour as an adult means to loosen the survivor’s attachment to her internalized objects and to her most familiar organisation of self. In addition, at an often deeply unconscious level, continued victimization in adulthood validates for the survivor the reality of the violations of the past; […] (p.131)

Always juxtaposed alongside the survivor’s identification as a victim, running parallel to it-though less consciously available-is her equally strong identification with the perpetrator of her abuse. The ruthlessness and icy sadism survivors can display toward their own bodies and minds and emotions are shocking to witness. In part, this often represents an identification with the abuser’s blatant lack of regard for his or her child victim. The enacting survivor takes up where the perpetrator left off, turning fury and frustration against herself in appallingly vicious ways.

The patient’s identification with her abuser preserves relational bonds to the internalized and often external victimizer, as well as to other nonabusing but unavailable early figures. […]Even if the survivor is no longer in contact with her victimizer, a strong attachment to the internalized object is tenaciously protected and preserved. […] In addition to preservation of relational bonds, the survivors' identification with the perpetrator protects her from contacting the helplessness and vulnerability of her victimized self.[…] Identifying with her perpetrator, the survivor experiences this illusory empowerment, denying that her self-abuse is hurtful.[…] Like their victimizers, they successfully spit of a sense of themselves as vulnerable, scared and out of control.

To help a survivor recognize that she has incorporated and identified with aspects of her abuser is difficult work.[…] The more the idea that she is in any way like her perpetrator is anathema to her. Interpretation of this element of enactments must be handled sensitively, lest the survivor’s already potent sense of toxicity and malevolence be intensified unbearably. (p. 132) 

If survivors are loath to acknowledge that their enactments betray an identification with their abusers, they are equally reluctant to recognize that their behaviors convey thoughts, feelings or fantasies about current figures in their lives including the therapist.[..] Terrified of the imagined power of envious, rageful, hateful feelings, survivors may deny the interpersonal implications of these affect states, instead turning them against themselves. As children they introjected their abuser’s badness and projected their own goodness onto others to preserve the hope o eventually receiving love and care. Now adult survivors continue this process, they deny the relational failings of others, assuming the mantle of responsibility for making relationships work. When someone the survivor loves or needs disappoints or angers her, these feelings are often turned back on the self. At the core of this process may be a dreadful fear of abandonment […]

Most difficult for survivors to acknowledge is that, once they are in treatment, their violent enactments almost always contain a transferential component, the acting-out element of enactment. Like their parents once were, the therapist becomes a needed figure depended on by survivors to see them through the terrifying and painful working –through of their abuse and its consequences. As survivors loosen their grip on real and internalized objects and are confronted with those losses, the therapist assumes an even greater importance in their lives.

 As they once protected their parents from their mistrust, terror and rage, they also deny negative reactions to the therapist and instead, act them out, often self-destructively. Sometimes, the enactment represents a vicious attack on the therapist’s ability to contain and to heal, a ruthless attempt to disrupt the interpretative and integrative work of treatment. At other times, the enactment speaks for the survivor’s bitter hurt, voiceless rage and desperate envy (p. 133)

Davies, J. & Frawley, M (1994) Treating the Adult Survivor of Sexual Abuse: A Psychoanalytic Perspective, United States of America: Basic Books

Τρίτη 22 Ιουλίου 2014

Donald Winnicott: Fear of Breakdown

Eric De Kolb, Nervous Breakdown
On the whole the word can be taken in this context to mean a failure of a defence or organization. But immediately we ask: a defence against what? And this leads us to the deeper meaning of the term, since we need to use the word “breakdown” to describe the unthinkable state of affairs that underlies the defence organization […]

In the more psychotic phenomena that we are examining it is a breakdown of the establishment of the unit self that is indicated. The ego organizes defences against breakdown of the ego-organisation and it is the ego organization that is threatened.[…] in other words we are examining a reversal of the individual’s maturational process. 
 
[…] I content that the clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organisation which the patient displays as an illness syndrome.

[…]There are moments, according to my experience, when a patient needs to be told that the breakdown, a fear of which destroys his or her life has already been. It is a fact that is carried round hidden away in the unconscious[…] In this special context the unconscious means that the ego integration is not able to encompass something. 

[…]It must be asked here: why does the patient go on being worried by this that belongs to the past? The answer must be that the original experience of primitive agony cannot get into the past tense unless the ego can first gather it into its own present time experience and into omnipotent control now assuming the auxiliary ego-supporting function of the mother [analyst] In other words the patient must go on looking for the past detail which is not yet experienced. This search takes the form of a looking for this detail in the future. 

[…] the breakdown has already happened, near the beginning of the individual’s life. The patient needs to “remember” this but it is not possible to remember something that has not yet happened, and this thing of the past has not happened yet because the patient was not there for it to happen to. The only way to “remember” in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference. This past and future thing then becomes a matter of the here and now, and becomes experienced by the patient for the first time. This is the equivalent of remembering, and this outcome is the equivalent of the lifting of repression that occurs in the analysis of the psycho-neurotic patient.  

 Winnicott, D. W. (1974). Fear of breakdown. International Review of Psychoanalysis, 1, 103-107.

Fear of Breakdown, Fear of Death & Suicide



Egon Schieles, Agony the Death Struggle
I content that the clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organisation which the patient displays as an illness syndrome

[...] the breakdown has already happend, near the beginning of the individual's life. The patient needs to "remember" this but it is not possible to remember something that has not yet happened, and this thing of the past has not happened yet because the patient was not there for it to happen.  The only way to "remember" in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference. 

[…] Many men and women spend their lives wondering whether to find a solution by suicide, that is sending the body to death which has already happened to the psyche.[…] Death, looked at this way as something that happened to the patient but which the patient was not mature enough to experience has the meaning of annihilation

I now understand for the first time what my schizophrenic patient (who did kill herself) meant when she said : "All I ask you to do is to help me to commit suicide for the right reason, instead of for the wrong reason." I did not succeed, and she killed herself in despair of finding the solution. Hear aim (as I now see) was to get it stated by me that she died in early infancy. On this basis I think she and I could have enabled her to put off body death till old age took it toll.   

Winnicott, D. W. (1974). Fear of breakdown. International Review of Psychoanalysis, 1, 103-107.

Fear of Breakdown & Feeling of Emptiness



Martin Barré, Displaced Objects 1969
Martin Barre, Misplaced Objects

Ι content that the clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organisation which the patient displays as an illness syndrome. 

[...] the breakdown has already happend, near the beginning of the individual's life. The patient need to "remember" this but it is not possible to remember something that has not yet happened, and this thing of the past has not happened yet because the patient was not there for it to happen.  The only way to "remember" in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference.

In some patients emptiness needs to be experienced, and this emptiness belongs to the past, to the time before the degree of maturity had made it possible for emptiness to be experienced.

To understand this it is necessary to think not of trauma but of nothing happening when something might profitably have happened. It is easier for a patient to remember trauma than to remember nothing happening when it might have happened. At the time the patient did not know what might have happened, and so could not experience anything except to note that something might have been. 

[…] Now, emptiness is a prerequisite for eagerness to gather in. Primary emptiness simply means: before starting to fill up. A considerable maturity is needed for this stat to be meaningful. Emptiness occurring in the treatment is a state that the patient is trying to experience, a past state that cannot be remembered except by being experienced for the first time now. 
 
In practice the difficulty is that the patient fears the awfulness of emptiness and in defence will organize a controlled emptiness by not eating or learning or else will ruthlessly fill up by a greediness which is compulsive and which feel mad. When the patient can reach to emptiness itself and tolerate this state because of dependence on the auxiliary ego of the analyst, then, taking in can start up as pleasurable function; here can begin eating that is not a function dissociated (or split off) as part of the personality; also it is in this way that some of our patients who cannot learn can begin to learn pleasurably. 
 
The basis of all learning (as well as of eating) is emptiness. But if emptiness was not experienced as such at the beginning, then it turns up as a state that is feared, yet compulsively sought after. 

 Winnicott, D. W. (1974). Fear of breakdown. International Review of Psychoanalysis, 1, 103-107.