Monday, July 09, 2012

I Have Poor Psychological Insight? Now, Really!

In September 1992  I underwent a two-hour psychiatric evaluation at The George Washington University Medical Center.  The initial assessment stated that my insight into my psychological difficulties was "poor."

In May 1994 I underwent a comprehensive battery of psychological tests at The George Washington University Medical Center.   The test report states:  "He expresses his feelings and conflicts using psychological metaphors and theoretical frameworks, although he has very limited insight into his difficulties."  The report suggests that I have a somewhat rebellious attitude:  "There is a tendency for him to challenge or denounce social sanctions, to a point where he may at times lose sight of his own best interests."

Be that as it may.

In a paper published in 1997 titled "The Exceptions: Structural and Dynamic Aspects" the author presents selected details from the history of an adult analytic patient who had many of the characteristics Freud describes in his essay on the “exceptions” and discusses certain dynamics of this character type.  Fernando, J. "The Exceptions: Structural and Dynamic Aspects."  The Psychoanalytic Study of the Child,  52: 17-28 (1997) (Joseph Fernando, MD, is a training and supervising Analyst at the Toronto Institute of Psychoanalysis).

The paper argues that the ego attitude of justified rebellion, which develops in some children because of early maltreatment, traumatic injury, or physical shortcoming, leads to a distortion in ego-superego interaction and interferes with normal superego maturation. The tendency to massive superego externalization, normal in early latency, is never outgrown and results in many of the characteristic features of the “exceptions.”

Fernando's patient had severely repressed demands for recompense for an injury she suffered in childhood and who for this reason was attracted to (more accurately, obsessed by) persons who displayed the character type of the "exceptions."

The patient, a young adult, had suffered a broken leg in early childhood. According to Fernando, the injury and its aftermath (parental blaming behavior) caused a disturbance in her superego maturation, and led to the character type that Freud termed the "exceptions." In the "exceptions," the early idealized parental images are never metabolized as in the normal person, and the individual's superego remains warped. Such individuals attempt to recapture in their interpersonal relations in adulthood representations of their early idealized parental images. Fernando's patient was obsessed with two persons, her only friends. The patient was not simply lonely; she wanted to affiliate closely with these two persons because they matched her internalized and idealized images of her parents.

The patient's development foundered on her inability to accomplish one of the major tasks of late adolescence: the integration of previously unresolved traumas into the character structure, or what Peter Blos calls the "characterological stabilization of residual trauma."

The relative lack of superego maturation and integration in the exceptions affects the maturation of the ego ideal.  It interferes with the deconcretization of the ego ideal and its integration into the personality as a substructure within the superego system, a process that normally takes place definitively in late adolescence. This interference was evident in Fernando's patient who found it impossible to relinquish her attachment to the idealized images of her parents and instead began a prolonged attempt, beginning in late adolescence, to recapture her ideals in concrete form in her relationship with her two friends.

The accident and hospitalization of this patient were traumatic in the narrow sense of the term. During and immediately following the accident there was a breaching of the stimulus barrier. Ego functions (motility, perception, judgment, time sense) were temporarily overwhelmed (the period of numbness). The subsequent attempts at mastery by turning passive into active and through sexualization led to a lifelong fate neurosis (repetition compulsion): Throughout her life in small ways and large the patient repeated the sequence of mounting self-confidence that preceded the accident to the point of excitement and feeling as though she were "flying," followed by a period of "numbness," and finally by a repetition of the feelings of anxiety, anger, confusion, and humiliation associated with the hospitalization. She repeated this sequence over and over in the analysis.

The ego attitude of justified rebellion or entitlement, which is characteristic of the "exceptions," develops because of early mistreatment, injury, or maternal deficiencies; such disturbed experiences lead to a distortion in ego-superego interaction and interfere with normal superego maturation.

Fernando's paper contains four fundamental themes of psychoanalytic interest: early childhood injury; development of a warped superego; the repetition compulsion; idealization in adulthood of other individuals who resemble the patient's early parental images.


Oddly enough, in October 1988 I wrote a psychoanalytic study of myself that I titled The Caliban Complex: An Attempt at Self-Analysis.

The Caliban Complex predates the paper by Fernando (discussed above) by nine years.  Footnote 1 of the writing discusses a childhood injury I suffered and speculates that the injury affected my superego development and led to a life-long repetition compulsion.  Footnote 13 of the writing discusses my idealization of certain persons and speculates that that idealization is rooted in my disturbed superego functioning.  Thus, the essential elements of Fernando's 1997 paper are prefigured in the 1988 paper that I wrote summarizing my intuitive perceptions of my unconscious mental life.



1.  The subject suffered a painful, if not serious, trauma to the mouth at the approximate age of two and one-half (a sharp object he had placed in his mouth punctured the soft palate as he fell to the floor). Undoubtedly, the injury made swallowing painful for a prolonged period, and it is plausible that the subject adjusted to a state of semi-starvation to avoid the pain of swallowing.  (It is perhaps noteworthy that the subject’s poor appetite was a continuing concern to his parents throughout early childhood.  At one point, a pediatrician who found nothing wrong physically, prescribed a tonic to enhance the appetite; the medication had no effect).  While no conclusions can be drawn, absent more complete analysis, regarding the effect of this injury on the psychological development of the subject, the incident does provide a ready and apposite metaphor, or model, of the subject’s object relations.   (“During childhood,” Erikson writes, “when man’s ego is most of all a body ego, composed of all pleasures and tensions experienced in major body regions, the alimentary process assumes in phantasy the character of a model of the self, nourished and poisoned, assimilating and eliminating not only substances, but also good [loving, idealized - divine] and bad [coercive, punishing - Mephistophelian] influences.” Erikson, Erik H. Young Man Luther: A Study in Psychoanalysis and History, at 247 (Norton: 1958) (Austen Riggs Monograph No. 4).  The association in subject’s mind between interpersonal relations and oral incorporation and, by implication, between difficulties in interpersonal relations and oral frustration, is suggested by an unintentional play on the word formula in footnote 13.  The choice of the word formula in the context of a discussion distinguishing the sister’s object relations from those of the subject may have been determined by a preconscious recognition of a more fundamental, oral, body-ego distinction between the siblings, namely, the fact that in infancy the sister was breast-fed whereas the subject was bottle-fed).  Expressed in terms of his childhood injury, one might say that the subject’s object relations resemble the behavior of a starving person who complains that he is starving but, when offered food, will thrust it aside because it hurts too much to swallow.  That is, although he is emotionally starved and craves friendship, he feels threatened by the possibility of being emotionally nourished by others.

At the very least, the incident may have had the following effects.  First, in an unconsciously-determined effort to master the trauma, the subject may repeatedly re-enact his childhood injury in symbolic form.  Under the influence of the so-called repetition compulsion "' . . . the individual unconsciously arranges for variations of an original theme which he has not learned to overcome or to live with: he tries to master a situation which had been too much for him by meeting it repeatedly and if his own accord. . . . '  [I]t sometimes happens that the experience of the 'original situation; is lost sight of, no longer comprehended, and that only the unsuccessful maneuvers devised to cope with the underlying problem are externally repeated to no avail."  Thus, the subject, attempting to master the childhood experience of oral frustration, may in adulthood arrange for variations of symbolically equivalent frustrating situations.  See Brenman-Gibson, M. Odets Odets: American Playwright - The Years from 1906 to 1940, at 636 (Atheneum: 1982), quoting Erikson, E.H. Childhood and Society (Norton: 1950).  See also Freud, S. (1920) Beyond the Pleasure Principle, passim (Norton: 1961) (Freud observes that the compulsion to repeat is not limited in all cases to active behaviors on the part of the person concerned: "We are much more impressed by cases where the subject appears to have a passive experience, over which he has no influence, but in which he meets with a repetition of the same fatality."  Id., at 16, citing Jung. C.G. "The Significance of the Father in the Destiny of the Individual."  Collected Papers on Analytical Psychology, at 156 (London: 1916)).

Also being compelled to cope with starvation at an early age may have contributed to the development of an unusual capacity to endure frustration of the satisfaction of instinctual drives.  Most people seek out relationships precisely because emotional starvation is too difficult to bear and will accommodate themselves to the potential difficulties of interpersonal relations in order to obtain the desired instinctual gratification.  For the subject, however, who became accustomed to starvation in early childhood, it has proved easier to continue to starve than to suffer the possible pain associated with interpersonal relations (speaking metaphorically, the pan of swallowing).

Further, the injury might have had an effect on later superego development and may have contributed to a predisposition to intense feelings of guilt.  (Several early psychoanalysts [Jones, Isaacs, Klein, Reik, and Alexander] held the view that “any kind of frustration, any thwarted instinctual satisfaction, results, or may result, in a heightening of the sense of guilt.”  Freud, S. (1927) Civilization and Its Discontents, at 85 (Norton 1961).  Freud himself only qualifiedly accepted this position.  Klein believed that early oral (and anal) frustrations form the prototype of all later frustration, and that the infant, incapable of distinguishing frustration from punishment (because of a lack of self-object differentiation), experiences frustration as punishment.  Grosskurth, P.  Melanie Klein: Her World and Her Work (Knopf: 1986)).  As to the effect, if any, of this injury on the subject's superego development one is moved to inquire: Does not a harsh and tormenting conscience, which gives rise in the ego to an ever-present fear of internal reproach, resemble an injury in the mouth that poses for its sufferer the ever possible risk that each mouthful of food will result in a frustrating pain?  Does not a conscience so severe that it thwarts almost all pleasure resemble a painful condition in the mouth that frustrates the swallowing of almost all food?  Perhaps the subject, like Faust, in renouncing the pleasurable in life, yet ever tormented by desire, serves his Lord (or overlord), the superego “in peculiar ways.”

In his inability to form close relationships with people without feeling threatened the subject exhibits the characteristic traits of the schizoid.  (For a discussion of the role of unconscious guilt in schizoid personalities, see Jackson, D.D. “Guilt and the Control of Pleasure in Schizoid Personalities” British Journal of Medical Psychology 31: 124-133 (1958), cited in Friedman, M. “Survivor Guilt in the Pathogenesis of Anorexia Nervosa” Psychiatry 48:25-29 (1985)).  The typical schizoid dilemma has been defined as a desperate need for love combined with an equally desperate fear of close involvement.  Storr, A. Solitude: A Return to the Self, at 101 (The Free Press: 1988).  The schizoid dilemma is illustrated metaphorically by a parable at the end of Schopenhauer’s Parerga and Paralipomena, volume II, section 396, quoted in Nietzsche, F. (1972) The Birth of Tragedy, at 134 (Vintage: 1967):  “On a cold winter day, a group of porcupines huddled together closely to save themselves by their mutual warmth from freezing.  But soon they felt the mutual quills and drew apart.  Whenever the need for warmth brought them closer together again, this second evil was repeated, so that they were tossed back and forth between these two kinds of suffering until they discovered a moderate distance that proved most tolerable.  Thus, the need for company, born of the emptiness and monotony inside them, drives men together; but their many revolting qualities and intolerable faults repel them again. . . .”  Schopenhauer might have added that the porcupine that has grown accustomed to the cold (or starvation) will make no great effort to find company in (or seek nourishment from) fellow porcupines; yet the gnawing feeling of cold (or hunger), if only experienced in an unacknowledged fashion, will remain.

* * * *

13.   By means of externalizing her guilt onto the subject on countless issues, the aunt created for herself a façade of perfection and implacable strength. She, in effect, split herself into two parts--one part despised (externalized), one part idealized. Not only did she unconsciously divide herself in this fashion, but her perceptions of others were no doubt determined by this dichotomy. Thus, one was either identified with the despised portion of her ego and became an object for externalization (i.e., the subject and his father) or was identified with the idealized portion of her ego, leading to narcissistic identifications (i.e., as with the subject’s mother and sister). The aunt displayed a strong narcissistic identification with the subject’s sister, who is six years older than the subject. The bases for the identification were that, like the aunt, the subject’s sister was female, the older of two siblings, and, perhaps most significantly, they shared the same first name. Freud has observed, “The extent to which like names produce identifications in the unconscious can scarcely be appreciated by one who has not made special study of he subject.” Freud S. and Bullitt, W.C. Thomas Woodrow Wilson A Psychological Study, at 82 (Avon Books: 1968). (Perhaps the subject himself, owing to the parallels between his sister and aunt unconsciously identifies his older and somewhat authoritarian sister with his aunt. The synergy of the subject’s identification of sister and aunt might have heightened the influence of either of these two individuals on the subject’s development, conferring on the sister the authority of an adult figure, and simultaneously, imbuing the aunt with the immediacy of a sibling [cf. footnote 3]). The aunt’s idealization of the subject’s sister may have intensified the sister’s need to deny vital aspects of her self, the expression of which in childhood would have proved to be salutary, but would have jeopardized her relationship with an aunt who needed an idealized, or “perfect,” object. Further, the aunt’s narcissistic identification with the subject’s sister may have heightened the sister’s need to comply (or impeded the development of an ability to refuse to comply), out of fear of loss of love, with others’ ideals of perfection. See Andrews, J.D.W. “Psychotherapy with the Hysterical Personality: An Interpersonal Approach.” Psychiatry 47: 211-232 (1984). (It might be noted that although the sister is phobic and suffers from chronic migraine, she will bristle at the suggestion that she leads anything but a perfect life.) The aunt’s splitting and consequent externalizations and identifications form a compellingly-elegant complement to the subject’s problems of identity loss and guilt (which may be understood as an expression of the tension, or disparity, between the ego and the claims, or ideals, of the superego) and the subject’s sister’s denial of self coupled with her need to comply with others’ ideals. (A fundamental distinction in the psychology of the subject as compared with that of his sister may be stated in the following formulae, which, incidentally, further elaborate subject’s object relations. The sister introjects the ideals of others into her superego which ideals then function in the place of what would otherwise be her own ideals; her ego then follows the dictates of the introjected ideal. The subject, on the other had, seeks out objects whose ideals match those already existing in the prescriptive portion of his superego (ego ideal); his injured ego then introjects by way of identification, the valued qualities of the object, thereby enriching the ego with those qualities, and ultimately (1) diminishing the tension, or disparity (guilt), between the ego and the ego ideal, and (2) providing the ego with a bulwark against the claims of his conscience, i.e., the prescriptive portion of his superego (see final paragraph of footnote 14). By means of identification with certain others the subject obtains a general state of emotional well-being that is fundamentally grounded in a diminution of guilt. See Freud, S. (1921) "Group Psychology and the Analysis of the Ego" (especially the following sections: VII. Identification; VIII. Being in Love and Hypnosis; and XI. A Differentiating Grade in the Ego), reprinted in A General Selection from the Works of Sigmund Freud, at 169-209, Rickman, J. ed. (Doubleday: 1989). The subject’s ego ideal is narcissistic, and his sense of well being, when it is achieved, is that of perfect narcissistic integrity recovered through the introjection of idealized objects.)

The aunt, contrariwise, whose ego ideal was also narcissistic, recovered perfect narcissistic integrity through projection onto devalued objects, deriving by this means a sense of satisfaction and well-being. See Grunberger, B. “The Anti-Semite and the Oedipal Conflict.” International Journal of Psychoanalysis 45: 380-385, at 382 (1964).

In For Your Own Good--Hidden Cruelly in Child-Rearing and the Roots of Violence (Farrar, Straus and Giroux: 1983), at 80, psychoanalyst Alice Miller discusses the “complicated psychodynamic mechanisms that need be described as splitting off and projection of parts of the self, which we encounter so often in the manuals of ’poisonous pedagogy’ [see footnote 12].” Miller indicates that through the process of externalization an individual may present an image of perfection and strength at variance with that individual's unacknowledged feelings, and she implies that externalization may provide a means of dealing with unconscious guilt (or at least its maturational antecedent, an uninternalized fear of harm).

Miller writes: “Schooling oneself to be senselessly hard require[s] that all signs of weakness in oneself (including emotionalism, tears, pity, sympathy for oneself and others, and feelings of helplessness, fear and despair) be suppressed 'without mercy.'  In order to make the struggle against these human impulses easier [individuals may seek] objects[s] to serve as the bearer of all these qualities that [are] abhorred because they had been forbidden and dangerous [i.e., guilt-engendering] in their childhood. . . . Freed from their ’bad’ (i.e., weak and uncontrolled) feelings, [individuals who externalize are able to] feel pure, strong, hard, clean, good, unambivalent, and morally right if everything they had feared in themselves since childhood [can] be attributed to [an external object]. Miller, A. For Your Own Good--Hidden Cruelty in Child-Rearing and the Roots of Violence, at 80 (Farrar, Straus and Giroux: 1983).

Being compelled, as was the subject, to be the object of another’s externalizisations can profoundly affect personality development. In “Survivor Guilt and The Pathogenesis of Anorexia Nervosa Psychiatry" 48: 25-39 (1985), psychiatrist Michael Friedman explains a process whereby one person’s externalizations can produce separation guilt, for example, in another: “Novick and Kelly [Novick, J. and Kelly, K. “Projection and Externalization.” Psychoanalytic Study of the Child 25:69-95] (1970) describe an 11-year-old boy, Tommy, who saw himself as a ’damaged, messy, stupid child’ out of compliance with his mother’s need to externalize unacceptable aspects of her own self-image. Novick and Kelly present the traditional explanation for Tommy’s reasons for experiencing himself as stupid, messy, and damaged:

The main reason for accepting the mother’s externalizations lay in the realization, at some level, that despite the mother’s distancing maneuvers she needed a devalued object and that failure to comply with her need would leave him prey to the primitive terror of abandonment [i.e., separation anxiety].

Friedman continues, “However, after Tommy worked through this primitive terror of abandonment, an entirely different kind of motivation began to emerge:”

His material centered mainly on the sadness of the mother, the chaos in the home, the madness of the family members, and, related to this, his own intense feelings of guilt. It should be noted that he was guilty not about the newly attained level of functioning per se, but about having deprived the family of a needed vehicle for externalization. To a certain extent this material related to Tommy’s own feelings, fears and fantasies, but to a marked degree it also reflected the reality,

It cannot be doubted that a central underlying factor in the subject’s life difficulties is the dual guilt surrounding his relationship with his mother vis-à-vis his aunt [see footnote 13A below]. The dual aspect of the aunt’s externalizing would tend to engender a twofold guilt in the subject. That is, the act of externalizing itself, irrespective of the content of the externalization would lead to separation guilt in that the subject would, according to the dynamic set forth by Friedman, tend to develop the fear of “[depriving] the family of a needed vehicle for externalization.” While, secondarily, that part of the content of the aunt’s externalization that centered on the issue of depletion of the mother would give rise to depletion guilt, the underlying basis for acceptance of which would be separation guilt, or the fear of depriving the family of an object for externalization. The subject’s withdrawal of love from his mother may be viewed, therefore, as a desperate, symbolic act of escape from the fear of depleting the mother, which, in turn, served only to leave him prey to guilt surrounding the act of separation, or escape, itself.

(In certain fundamental respects the subject’s psychology mirrors several essential themes found in Hugo’s novel, Les Miserables. In the novel the character Valjean, jailed for the theft of a loaf of bread (“depletion guilt”), escapes from prison (“separation guilt”). The ex-convict, under an assumed identity, then transforms himself into a successful manufacturer and transforms the stagnant local industry into a prosperous enterprise. Unable to escape his past misdeeds, he is persued relentlessly by police agent Javert (a projection of the superego), who seeks the return of Valjean to prison for the dual crimes of theft and prison break. Valjean’s imprisonment for stealing a loaf of bread might be interpreted as a penalty for attempting to gratify an oral drive wish. His later rise to success (possibly fulfilling a phallic drive wish) and subsequent downfall, mediated by the intervention of a superego figure, suggests a conflict between oral and phallic drive wishes (cf. footnote 7; see footnote 11, paragraph 2)).

1 comment:

Gary Freedman said...

It will be noted that two Akin Gump partners (both Penn State graduates) appeared to react to my writing, The Caliban Complex in October 1988.

David Callet, Esq. (the senior partner for the client Eastern Airlines for whom I worked) appeared to sneer at me after I wrote the document.

Earl L. Segal, Esq. (the partner in charge of the legal assistant program) appeared to imply that I was mentally unbalanced after I wrote the document.

Of course, a person who is truly original in his thinking will say and write things that people have never heard before. That's the nature of originality.