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Tri-bar mental structure in masochistic perversion.

Introduction

This paper aims to document some observations concerning the diagnostic and treatment difficulties experienced with perverse patients. The paper will argue that masochistic patients experience a core anxiety in which merger with the object and separation from the object are simultaneously desired and feared. In order to resolve this core complex (Glasser, 1998) patients alternate between two subjective states. On the one hand, violence is enacted in order to produce sensation-laden bodily symptoms offering a perverse connection with the object. On the other hand, an intellectualised and rigid deadness prohibits genuine relational contact. These two subjective states come together in an illusory apex of self-deception, which ironically maintains both core complex anxieties and the subjective states designed to alleviate these anxieties.

In order to capture this dynamic, the metaphor of the Tri-bar visual illusion will be employed as a way of organising the clinical eccentricities of violent perverse patients. The Tri-bar triangle, also known as the Penrose Triangle (Penrose & Penrose, 1958), is an optical illusion in which the triangle's apex is mathematically impossible but visually achieved. The achievement of the apex is 'possible' because of the onlooker's perspective. Looking at the Tri-bar triangle is a derealising experience because the gestalt juxtaposes perceptual and rational capacities antithetically. This causes an endless slippage between two mutually exclusive experiences of the same thing. The image can never settle in the mind of the onlooker--it is always incomplete and unresolved because thinking and perceiving are set against each other. Either the object is seen or it is understood, never both simultaneously. In relating to this object there is an experiential dynamism which we describe as an intimate alienation: as compelling as the Tri-bar third is, the observer cannot ever be fully reconciled with it. It is this irreconcilability that suggests it as an apt metaphor to describe the symptom structure, as well as the transference dynamics, of masochistic patients.

The paper begins with consideration of some of the themes emerging from the vast psychoanalytic literature on masochism and perversion, with the aim of relating these themes to the conceptualisation of a Tribar mental space offered in this paper. A clinical case study is then presented which illustrates how the metaphor of the Tri-bar triangle offers a formulation of the patient's symptom structure. Implications for transference and countertransference, and for the organisation of affect, are then explored.

The concept of perversion

Much like the experience of viewing the Tri-bar triangle--and, we argue in this paper, the experience of being in touch with a perverse patient--reading the vast literature on perversion can sometimes feel like searching for a shape that never quite materialises. Since the drive approach to understanding perversion developed by Freud (1905; 1910; 1919; 1924a; 1924b; 1927), there has been a great deal of psychoanalytic interest in understanding the perversions (Eshel, 2005). Noting how the concept has substantially changed over time, Stein (2005, p. 775) ventures only so far as to define perversion as 'a complex notion that resists simple definition and eludes stabilisation'. Significantly, though, the continued theoretical development of perversion may be 'the latest frontier in psychoanalysis' (Fogel & Myers, 1991 in Stein, 2005, p. 776). A full exploration of the shape of existing psychoanalytic literature on perversion is beyond the focus of this paper; instead, specific themes are explored because of their relevance to the formulation offered here. Specifically, we wish to examine perversion as it relates to sexuality and hostility, object relatedness, and the psychodynamics of the perverse symptom.

Perversion and sexuality

Beginning with Three Essays on the Theory of Sexuality (1905), Freud proposed that perverse sexuality is a developmental norm whereby component drives, coalescing around the erogenous zones of the body, are eventually organised, under the forces of repression, into a coherent expression of genitally-led heterosexuality. Aberrations in adult sexuality are understood by Freud as deviations in the partial drive (from the genital to the oral or the anal) and deviations from the heterosexual object. Thus perversion in adulthood is an untransformed and recalcitrant version of infantile sexuality. In the Three Essay Freud makes the point that 'To begin with, sexual activity attaches itself to the functions serving the purpose of self-preservation, and does not become independent of them until later' (Freud, 1905, p. 181). This offers a particularly valuable idea when considering the traumatogenic origins of the severe perversions: right from the developmental outset, sexuality is linked to self-preservation and survival.

In 1919 Freud turned his attention to the perversion of masochism, in particular addressing the question of how pain and punishment could be implicated in the pleasure-seeking impetus of sexuality. Using the Oedipus complex (1910) and its vicissitudes, Freud understood that punishment is recruited for the purposes of alleviating the guilt experienced by the daughter for her forbidden sexual wishes. The paper also introduced the idea that perversions may serve a defensive function. Freud (1924b) took up the question of masochism again in 1924, this time implicating the death drive as the source of masochism. This is an important addition in the theoretical terrain of the perversions because the derivatives of the death drive (such as aggression, hostility and hatred), so prominent in the clinical manifestation of masochism, had no longer to be accounted for in the libidinal economy exclusively (Deutsch, 1932; Glover, 1933; Stoller, 1986). As Caper (1999) states, perversion can be best understood as a hijacking of sexuality by aggression, or in Stoller's (1986) terms, an erotic form of hatred.

In later work Freud (1927; 1938) introduced the idea that certain perversions involved a splitting of the ego in order to deny a traumatic sexual reality. Although referring to fetishism and not masochism, the partial detachment of the ego from disturbing aspects of reality via the defence of disavowal and ego-splitting is a crucial idea for the metaphor informing this paper. For Freud this mechanism was seen in relation to the Oedipus complex and castration anxiety, representing the pervert's triumphant defence against the anxieties produced by sexual difference. This idea has been fruitfully taken up in other conceptualisations of perversion, most notably by Chasseguet-Smirgel (1985) and Stoller (1986). Splitting of the ego as a defence in perversion is also described by Welldon (2011). Splitting of the ego through dividing the mental apparatus is a defensive operation related to managing something unbearable. It is as though the masochistic patient has duplicated and altered the other mental picture of her torment in order to remember or forget as required for psychic survival. Wurmser (2003) makes a similar point with regards to the splitting of the ego in the character perversions. He states that it is an archaic defence which is the 'phenomenological outcome of denial and the setting up of a countervailing pseudo-reality' (p. 229). The predominance of this defence produces a 'radical doubleness of self and object representations' (Wurmser, 2003, p. 229). For Wurmser (2003), the defence is orchestrated in relation to an archaic superego resulting from the internalisation of early infantile trauma.

Perversion and the disturbing object of infancy

Departing from drive perspectives, a number of theorists have turned to infantile trauma as an explanation for perversion (Eshel, 2005). Klein (1946), for example, saw the ego-destructive mechanisms in perversion as relating to earlier phases of development, implicating orality and the psychotic processes of infancy. Glover (1933), who drew directly from Klein, made this point specifically in relation to the perversions. Object relations theorists extended understandings of perversion and masochism by exploring the link made by the perverse symptom between the operations of the internal world and the objects that inhabit it. The approaches of Glasser (1979; 1986; 1996; 1998), Khan (1969; 1979), Socarides (1974) and Welldon (1988; 2011) are of particular relevance to this paper.

Glasser (1979; 1986; 1996; 1998) locates the mechanism of identification--or, more accurately, a lack thereof--as central to the understanding of the perversions. He defines identification as 'the process in which the subject modifies the self-representation in such a way as to be the same as one or more representations of the object' (Glasser, 1986, p. 11). For Glasser, the perverse psyche emerges because the pervert cannot identify with his primary objects. The reason for this is that the earliest bodily relationship and its accompanying affects are unbearable because the mother overstimulated, intruded upon and/or deprived her child. The child had an affective and bodily experience of her as annihilatory and destructive. The infant's response to this problem, and the mental structure that results, is described by

Glasser in the form of the 'core complex' (Glasser, 1979). He describes the core complex as a:

deep seated and pervasive longing for the most intense and intimate closeness to the object, amounting to a complete 'merging' or union. It is as if the pervert has a memory of primary identification and is trying to regain it. Not only total gratification and safety from abandonment or rejection is longed for; also desired is a secure containment of his intense, primitive rage and the consequent dangers of disintegration of self and the destruction of the object (Glasser, 1979, p. 163).

In the face of the traumatic experience with the primary caretaker, the infant responds with an aggressive negation of her, a state that Glasser describes as a 'narcissistic withdrawal' (Glasser, 1986, p. 9). This withdrawal stimulates terrible isolation, fear and abandonment since the object is also essential for survival. This renews the wish for contact and produces the cyclical and insoluble dilemma of the core complex.

Although Socarides (1974) utilises a different theoretical framework to conceptualise the perversions of sadism and masochism, he too locates the anxieties feeding into the perversions as coming from the earliest developmental stages of life. Similarly, his 'nuclear complex' involves the oscillations between the dread of merger and the desire for it. He regards masochism as a 'submissive enactment of the dreaded destruction and engulfment at the hands of a 'cruel mother" (Socarides, 1974, p. 186). McDougall (1995) also focuses on the earliest infantile trauma in the aetiology of the perversions. Her emphasis, as is the case with Greenacre (1953), is on the psychotic fear of bodily disintegration the infant experiences in traumatic separation.

Khan (1969) similarly understands the perversions as occurring because of a fundamental matemal/environmental failure in infancy: 'Thus dependency becomes translated into compelling the object to adapt. Neither absorption in the relationship nor pleasurable satisfaction is possible. Intrapsychic and developmental conflicts are transmuted into ego-interests' (Khan, 1979, p. 52). In other words the ego's fundamental work becomes tied up with trying to negotiate a self-other configuration that is dangerous and damaging. Because of these serious problems in the primary relationship, the infant internalises a dissociated primary object in the form of what he terms a 'collated internal object' (Khan, 1969). This experience of self, which is inextricably bound to infantile auto-eroticism and the body-ego, can only be regained through specific perverted sexual acts in which the patient continually searches for 'a relationship in which dissatisfaction, anxiety, sadness and loss can be experienced and psychically assimilated by the ego' (Khan, 1979, p. 53).

What links all of these understandings of early infantile impingements is the intensity and irreconcilability of trauma-produced affects (Fonagy, Gergely, Jurist & Target, 2004; Schore, 1997). Wurmser (2003) argues that these intense affects are not simply experienced but have a profound influence on the structure of the perverse psyche. Firstly, the ego is split or fragmented as irreconcilable affects and ideas are separated. Secondly, the superego is pathologically impacted. Wurmser (2003) argues that the shame-based, guilt-ridden and pain-saturated aspects of self become the precursors for an archaically destructive superego. Garza-Guerrero (1981) and Kernberg (1992) offer similar accounts of the aetiology of a perverse archaic superego.

These explications imply an important link between the disturbing internal object and structural understandings of perversion: the disturbing internal object imagos of early trauma continue to serve directing, prohibiting and punitive functions. The primitive superego present in the severe masochistic perversions directs the patient in accordance with a culture of violence; a superego morality in which violation is veracity and torment is the truth. Two important implications can be extrapolated for the structural account of masochistic perversion offered in this paper. Firstly, the superego is involved in directive mental functions, the most important of which is to control overwhelming affect floods which are experienced as superego-dystonic (Wurmser, 2003). The pervert's superego does this by orchestrating several defences including sexualisation, dissociation and the defensive use of aggression. Secondly, the superego, based on the disturbing object, links to at least two separate facets of the fragmented ego, producing different kinds of mental phenomena including distinct forms of symptomatic expression. It is to the psychodynamics of the perverse symptom that attention now turns.

The psychodynamics of the perverse symptom

In Alienation in Perversions, Khan (1979) identifies seven ways in which the pervert acts out symptomatically. Here Khan is using a greatly expanded version of Freud's (1914) definition, which Khan relates exclusively to the analytic process. He suggests that acting out serves the following functions for the pervert. Firstly, it allows the ego to maintain an executive function by displacing and externalising the intrapsychic conflict so as to achieve mastery in external reality. Secondly, acting out neutralises shame and guilt through the involvement of another object, whilst the sexual excitement associated with the action diminishes depression and psychic pain. Thirdly, imaginative excitement ameliorates the deadness of the internal world. This deadness comes about because excessively utilised archaic defences are relied upon to protect against excessive instinctual affects (sadism and aggression). Fourthly, the reparative and libidinal aspects of sexual acting out provide an opportunity to repair relations with an actual object, thereby partially mediating the impoverished and deprived nature of the internal object. Fifthly, by temporarily escaping his constrictive internal world through acting out, the pervert rescues the ego from collapse and psychotic decomposition. Sixthly, the pervert who acts out sexually is able to partially bind and neutralise the intense, archaic sadistic and aggressive impulses. Finally, acting out functions as the pervert's rudimentary attempt to communicate with a nonreceptive other who is not separate from the self.

Welldon (1988; 2011), like Khan (1969), underscores dissociation in the production of the perversions. She prefers the term encapsulation rather than dissociation, describing it as the defining mechanism that the pervert uses to manage a ubiquitous mortal anxiety. This mortal anxiety she describes as 'the dreaded black hole of depression hiding away suicidal ideations or just plain suicide' (Welldon, 2011, p. 28). In addition to encapsulation, Welldon understands perversion to be defined by several factors. These are compulsion and repetition in the perverse sexual act; the use of the body for perverse action; part-object and dehumanising ways of relating to the other; the emotional interference of hatred in the sexual relationship; sexualisation which replaces a capacity to think; a fixated and restricted sexual repertoire; hostility; extreme fears of being trapped or engulfed; a need for omnipotent control; deception; risk-taking; and an inability to mourn (Welldon, 2011).

Of all of these factors we wish to highlight deception for the purposes of this paper. Welldon regards deception as the defining feature of perversion and understands divisions of the psyche as the cause of the deception: 'Perversion implies a private lie that tantalises, allures, and teases in an agonising way. In my opinion, deception is not only at the core of perversion but it is also its distinguishing feature' (Welldon, 2011, p. 35). She accounts for the deception structurally, indicating that the pervert's ego is constantly under pressure from the id to engage in sexual acting out. Eventually the ego is corrupted and the overwhelming sexual urge becomes partially ego-syntonic in order to relieve the unbearable anxiety which is subsequently acted out. Hostile sexual anxiety is dispelled and the sexual impulse once again becomes ego-dystonic, ushering in guilt, shame and depression. The hostility that is released is related to vengeful feelings for an early trauma in the mother-child relationship. This trauma, for Welldon (2011), is specifically related to gender humiliation. Welldon (1988) also highlights the differences between the male and female perversions, showing that women and girls tend to act out against themselves (and their children who are experienced as part of the self), directing their violence against the humiliating pre-oedipal mother who is experienced as being in possession of the pervert's body and mind as well as her feelings. The body and the baby are treated as dehumanised partobjects.

Glasser (1986) describes a defensive sequence that accompanies the intense and unbearable affects of the core complex. This defensive sequence, consisting of aggression and sexualisation, plays a constitutive role in later symptom formation. In response to the anxiety stimulated by the core complex, the infant responds with defensive aggression, the aim of which is to negate the annihilating experience. This primary defence, however, only serves to heighten anxiety because the object is needed for survival. The next defensive operation that is marshalled in response to losing the object is to sexualise the aggression, which transforms it into sadism. The function of sadism is to hurt, violate and omnipotently control the object. Thus the object is retained albeit under violent conditions. Masochism is understood here as the defensive sexualisation of aggression when the infant is in a state of narcissistic withdrawal. Because the infant is isolated, she directs the sexually transformed impulse against herself; a situation that Glasser refers to as 'masochistic invitation' (1986, p. 9). Kernberg (1992) also refers to the defensive sexualisation of aggression in perversion.

Perversion as a concept

Despite differences between the theoretical contributions explored above, we would like to draw out three convergent themes. First, perversion can be understood as a survival strategy that negotiates early infantile trauma related to a problematic mother-infant relationship. The contours of this relational problem involve oscillations between a wish for merger with the primary object and a dread that the object will annihilate the integrity of the nascent ego. The disturbing object is also the basis for the archaic superego that continues to play a directive role in the psychic economy of the pervert's mind. Second, the main defensive operations that inform the development of the perversions are the sexualisation of aggression and hostility, the splitting of the affectively overwhelming self-experience into irreconcilable parts, and the disavowal and encapsulation of these contradictory mental states within the structure of the self. Third, the infantile, pre-symbolic and bodily nature of the pervert's disturbance results in an expression of the psychic dilemmas in concrete, fixated, repetitive and compulsive actions. Speaking, symbolising, thinking and feeling are antithetical to the pervert's symptomatic intention. The pervert must remain malevolently mindless.

The Tri-bar metaphor: Symptom structure

Each of these themes inform the structure of the Tri-bar as a metaphor for understanding perverse masochistic patients. We offer a visual representation of the Tri-bar metaphor (see below) in order to foreground the interactions between the different proposed elements. The base Vector represents the insoluble emotional dilemma with a destructive object/superego, in which both merger and separateness are equally terrifying and desired. We retain Glasser's (1979) term 'core complex' to describe this vector. Vectors One and Two represent the pervert's response to the core complex anxieties. They represent two split, encapsulated and dissociated subjective states that bear the hallmarks of intense, somatic enmeshment on the one hand (Vector One) and, conversely, rigidity and lack of affect (Vector Two). The illusory apex is intended to convey the pervert's deeply embedded tendency to compulsively deceive the other for the sake of her survival. This deception forecloses upon the capacity to relate and communicate symbolically.

The Tri-bar illusion offers one way of understanding the symptom structure of masochistic perverse patients, as well as the sometimes insoluble transference and countertransference dynamics evoked. Each will be explored in relation to the case of L.

We have chosen as the starting point the pervert's symptom structure in order to highlight that the perverse symptom is the privileged way in which the patient communicates her emotional dilemmas. We will consider a case vignette of a violent and perverse patient treated by the first author, a patient whose 'body-dreams' (Khan, 1979) took the Tribar form. Khan's (1979) formulation of perversions expresses something of the experience of this patient:

Perversions are more akin to dreaming than neurotic symptom-formation. The technique of intimacy is the vehicle to this type of dreaming and acting out is its preferential mechanism of psychic functioning. The ego of the pervert acts out his dream and involves the other person in its actualization. It is possible to argue that if the pervert dramatizes and actually fulfils his body-dreams with a real person, he also cannot wake out of them (Khan, 1979, p. 30).

L, a woman in her mid-twenties, was referred to therapy because she was abusing alcohol. It quickly emerged that her emotional difficulties were tied up with a set of volatile and intense relationships with her mother and her four female siblings, who she experienced as unsympathetic to her feelings of boredom, loneliness and isolation. She felt harshly rejected by the women in her family who refused to entertain her wish to return home from her university residence. In L's mind, as in the sessions, it was difficult to tell her female relatives apart. 'Mother' was easily confused with 'sister' and in her linguistic slips she sometimes called her mother by her own name. Her idealised father had divorced L's mother when L was an infant and had remarried and started another family. He had very little contact with L. She felt abandoned by him, but idealised him nevertheless and fiercely protected him from the vitriolic commentary of her mother and siblings.

Drinking excessive amounts of alcohol functioned as a way of dealing with overwhelming and unbearable feelings of isolation and loneliness when she was away from her female relatives, and the tormenting experience of her own rage when at home with them. L would drink until she lost consciousness. Her loss of consciousness was frequently accompanied by destructive sexual acts with men. She would describe in great detail the damage done to her bruised, bleeding and brutalised body. My countertransference to these descriptions was powerfully visceral and I felt nauseous and revolted. The unknowable quality of the sexual trauma she experienced when unconscious also fuelled my own fantasies of how sinister and perversely violent these abusive interactions were. Early in the therapy there was always a question for L and me as to whether these acts had been rape or not. As the therapy progressed it became clearer that these acts were indeed sexual assaults which she perversely orchestrated against herself. In the days after these sexual assaults, L would descend into a profoundly dissociated state. She responded to these states by cutting her arms in order to 'feel herself and bring herself 'back to reality'. My attempts to explore these disturbing sexual events and her cutting were largely futile, with L being unable to think about these events beyond the fact that they were somehow related to how trapped she felt.

In other sessions L would present buoyantly, accounting for herself and her life through astrology. She would speak about her star sign and that she was being subject to this or that astrological force. In these sessions she was emotionally distant and subtly dismissive of the therapeutic process. Previous difficulties were accounted for in astrological terms, or via explanations which focused on the 'normal' stressors of student life. I felt great frustration and anger in these sessions, and I often struggled to curtail my derisive and dismissive emotional reactions. Reflecting her emotional distance or interpreting the defensive/evasive quality of the process made very little impact.

Two dreams typified her internal emotional dilemmas. The first was a nightmare in which L was a circle that endlessly fell into another (a dream capturing the Tri-bar quality of one reality falling endlessly into another). This was a terrifying dream for L and made her afraid to sleep. When I interpreted that the dream seemed to be pointing to some kind of emotional dilemma with another, L responded by digging her nails into her arm. The second was about a puppy which was locked outside of a house, where it was dark and terrifying. The puppy would scratch on the door to come inside. Eventually, frightened, tired and lonely, the puppy was let inside only to be thrashed by an evil woman.

We will discuss each of the elements of L's case material that we regard to be constituent of the Tri-bar symptom structure.

Base Vector: The desired and dreaded other of the core complex

The Base Vector connotes the fundamental emotional dilemma concerning a violent and inescapable relationship to an internal object. This internal object is also the basis of the pervert's archaic superego. This object, represented in L's dreams as an engulfing circle and an evil woman thrashing a helpless puppy-self, seemed to be made up of a set of frightening, hurtful and enraging experiences with her mother, and subsequently her female siblings. The lack of object differentiation between her female relatives, and between her mother and herself (as evidenced in the linguistic slips in which she confused her mother with herself), also underscores this inescapable enmeshment. The infantile nature of her core complex dilemma is well illustrated by L's presenting concern, her alcohol abuse. L would describe drinking as much as she could, as quickly as possible so that she could become unconscious. She described this process as 'getting fucked' and becoming 'motherless'. This experience involved 'forcing the shit down' her throat and feeling like she was ingesting 'poison' and 'razor blades'. The noxious and violent quality of the taking-in experience as well as the condensation of oral, anal and phallic introjective metaphors is striking. This recalls Chasseguet-Smirgel's (1985) notions of perversion, in which she describes how the perverse patient 'faecalises' her object relations, and how anal themes (omnipotent control and negation of difference) tend to contaminate oral and genital activities. The act of becoming inebriated appeared for L to reproduce an experience of taking in something dangerous and poisonous into the body through the mouth--objects and experiences that in other circumstances would be urgently voided from the body and mind for fear of the damage they could do. This process of 'getting fucked' was consistently precipitated by an overwhelming emotional experience with her mother and female siblings, either because they were agonisingly absent and abandoning, or because they were painfully present and intrusive.

In the face of the core complex dilemma, that being the violent inescapability of the object, L seemed to split, dissociate and encapsulate her subjective experiences into two distinct formations. The first, linked to Vector One, involved a violent reproduction of the experience of the core complex relationship in her body, culminating in a cessation of consciousness and awareness (through binge drinking or cutting). The second, linked to Vector Two, concerned a distancing of herself from any meaningful emotional contact with herself and with others.

Vector One: Sensation-laden bodily symptom

Vector One of the Tri-bar represents one of the symptomatic paths out of the dilemmas of the core complex. Clinical experience leads us to believe that it is achieved by ablating the emotional experience of the core-complex such that it is reproduced as a sensation-laden bodily experience in which there is no conscious knowledge of the object relation it implies. In the case of the masochist this may involve symptomatic sexual behaviour that is predominated by some form of masochistic destructiveness. In other perverse patients (as with L), this vector can also take other forms of somatised destructiveness such as self-mutilation and substance abuse. These communications are characterised by their thoughtless, compulsive and repetitive quality, the relief they bring to patients, and by their split-off and separate existence from other parts of the patient's life and mind.

In the case of L, Vector One symptoms include her binge drinking, the destructive masochistic sexual acts accompanying her loss of consciousness and her cutting. The relationship between the core complex anxieties and self-harm is well illustrated as L responds to the interpretation about the circle dream by moving away from thoughtfulness via self-inflicted pain--digging her nails into her arm. Likewise, her binge-drinking seems to follow the same sequence: momentary awareness of core complex anxieties translates into self-harm. This sequence turns awareness of core complex anxieties into a somatic form of the distress that can remain unknowable, or consciously unthinkable to L. A relationship to the distress is maintained in the form of a bodily sensation; however, the knowledge of the core complex relationship that produces this mental distress is lost. Mental anguish is defensively transmuted into bodily sensation. Perhaps in this way the relationship to the tyrannical mental object can be maintained by not allowing it to exist in the realm of the mental: by splitting off and denying its mental representation through an obliteration of its emotional linkages.

There is a constellation of Vector One type symptoms that occur around L's sexual assaults. Firstly, there is the orchestrated sexual assault itself. Then there are the two reactions to the sexual assaults. One of these is how L uses her body in the discussion of her physical damage in the sessions after her sexual assaults. The other is observable in her self-mutilation when dissociated after the sexual assaults. The sexual assaults themselves were the most disturbing feature of L's therapy.

They were disturbing not only because there were terrifying acts o f violence that she subjected herself to, but also because they were repetitive and recalcitrant to any form of meaning-making process that therapy had to offer. L would describe choosing particular locations for the purposes of getting drunk. L was aware that these contexts were unsafe and known for their 'date-rape' risk. She would frequently return to the same places where sexual assaults had previously occurred and would be consciously aware that she was getting drunk with men who had, or would, rape her. Putting herself in harm's way by becoming inebriated ('getting fucked'), and then becoming unconscious and literally 'fucked', were the defining features of a core complex enactment with a violently intrusive and dangerous other that she could not bear to be conscious of. Yet at the same time she forcefully and repetitively maintained her relationship with this object through the sensation-laden, bodily, sensory symptom.

As L was unconscious during these assaults, her contact with these disturbing experiences was read from her body. L's body, post the assaults, was one which bled and had bruises, was infected, one which was used and completely disregarded by the other. These sickening narrations produced nauseating and unbearable somatic countertransferences, including, in moments, a distressing sexual arousal. I felt as though I were being identified with L's rapists via the damaged body being narrated to me. A frightening pastiche of revulsion, hatred, anger and intimate sexual contact permeated these sessions, making it difficult to distinguish between what was helpful and therapeutic, and what was perverse and corrupt. It was virtually impossible to think meaningfully about L and the countertransference dynamics until after the session. L's somatic communication of her emotional dilemma with a terribly abusive object was communicated directly to my body without my being able to link my sensations to thoughts.

Perhaps the pinnacle of L's attempts at a symptomatic solution to the core complex problem lies in obliteration of her consciousness. As a solution to the threat of sadistic annihilation, it seems to achieve reconciliation with the abusive object (necessary for emotional survival); while at the same time absolutely severing contact with the object. Like the Tri-bar, this solution operates because it savagely splits the bodily/perceptual/sensational contact with the object from the cognitive/conscious contact with the object. These illusory contacts safeguard the necessary ever shifting illusion of contact and preserve L from the full realisation of the treachery of her mental state. This partial or illusory contact with the object can never be realised without exposing the patient to the full treachery of her mental state.

Vector Two: Communicating self through affectless cognition

The second symptom vector is a highly rigid and intellectual mode of expression. In this mode of self-representation the patient communicates an account of her experience that necessarily excludes genuine thoughtfulness or any affect. As with the first vector, these symptoms are concrete, recalcitrant and compulsive.

L's terrifyingly destructive turns were alternated by lengthy periods in which she would make no emotional contact at all. Cutting off from the emotional contact in periods of grave difficulty was initially experienced as a relief by both L and me. Initially welcome, these periods would become tedious and produce considerable frustration in the countertransference. At these times she distanced herself from the horror of her destructive sexual life, her alcoholism and her self-mutilation by regarding these behaviours as a consequence of normal university stressors. 'Normal university stressors require normal intervention' she would say when I challenged her reading of her destructive behaviour.

A specific example of L's Vector Two symptom concerned her use of astrology as a cognitive orientation to her life. Initially, the astrology reminded me of a 'prosthetic third' (van der Walt, 2011) in the sense that she was taking a complex semiotic system and using it to shape her experience and her interactions. Her use of astrology, however, was superficial and 'chatty' as opposed to detailed and structured, as would be the case in the prosthetic third. Her star sign was Pisces and she would get daily updates from different internet sites offering her astrological predictions. From these, she would infer meaning regarding her previous destructive episodes. The deadliness of the Vector One symptom was counterpoised by the deadliness of this or that moon or planet--a terrifyingly remote force that could violently impinge upon her. Despite the frightening resonance of these forces with the core complex experience, L narrated these without feeling. She would constantly tell me various astrological 'truths' about herself, all completely resistant to emotional exploration. Her responses to my thoughts would usually be dismissive and passive and she would insist that things would unfurl 'according to the stars'. The other potentially significant astrological fact that L would constantly invoke was the dyadic nature of her Piscean condition. She would often refer to the Piscean icon of two interwoven fish heading in different directions. This appeared to me to depict something of the condition of being torn between two different directions, an image which deeply resonates with the Tri-bar dilemma. When I shared this interpretation with L she regarded me with piteous disdain and reflected that I knew nothing about astrology.

These periods with L were frustrating. L would often refer to me as 'not knowing', 'reading too much into things' and being 'overly sensitive'. I experienced L as hard, cut-off and cruel in these moments. In these Vector Two type interactions, as with the Vector One type, I felt powerless to say anything that would make meaningful contact with L, or to change our compulsively concrete way of interacting. Despite there being no discernible emotional contact, any discussions of ending the therapy, or me taking a holiday break, would evoke pronounced levels of anxiety. I understand this to indicate that despite the feeling that there was no real emotional exchange in the Vector Two forms of interaction, our interaction nonetheless served a vitally important function. This function seems to involve a relational dynamic in which L could be looked at and engaged with from an emotional distance--a relationship in form, but without consummated interactional content.

Transference and countertransference

Powerful and sometimes conflicting transference and countertransference states thus characterised my work with L. In recent literature on perversion, the transference and countertransference relationship is stressed as the primary vehicle by which perversion can be conceptualised and treated (e.g. Eshel, 2005; Etchegoyen, 1978; Jiminez, 1993; 2004; Ogden, 1996; Stein, 2005).

Etchegoyen (1978) was one of the first authors to address the notion of a perverse transference directly. He regarded the transference as consisting of a narcissistic type of object relationship in which the patient attempts to negate the separateness between herself and the clinician in order to create a symbiotic unity. Secondly, he describes how the patient alternates between evoking overwhelming excitations, on the one hand, and deadened exclusory boredom on the other. Finally, he points out that these operations are linked to the splitting of the ego and, following Meltzer (1973), closely associated with infantile dissociative defences. Owing to the early infantile nature of the pervert's psychic disturbance, the relational mechanism utilised by the patient in perverse clinical encounters is that of projective identification. Projective identification can be understood as a mechanism whereby the ego splits off 'intolerable experiences by dividing itself, and locating parts of the self in external objects' (Hinshelwood, 2005, p. 1338). As a function of this defence, the clinician is interpolated in ways that are pre-symbolic, somatic and characterised by the 'compulsively enacted desire for ritualised trauma' (Eshel, 2005, p. 1070).

There are two discernable transference-countertransference patterns in my work with L. The first involves a symbiotic perverse excitement, associated with Vector One symptoms; the second, a dismissive and frustrating deadness, associated with Vector Two symptoms.

Symbiotic perverse excitation

Reactions of symbiotic perverse excitation were primarily related to Vector One symptoms in which I was sickeningly aroused by the way L narrated the bodily violations. In the analytic encounter I was flooded with an array of fantasies about what had happened to L. My fantasies always involved a gang of violent, marauding rapists who brutally misused L's lifeless and limp body. My own sexual arousal in some of these fantasies was a distressing somatic component in which I felt implicated as one of her rapists; uncontrollably excited by my sadistic assertion of power over L. Simultaneously I would feel great shame and an overwhelming wish to abruptly end our contact. I often imagined myself screaming for L to stop torturing me. When these moments passed I would fiercely ablate the terrible experience by resolving never to think or speak about it. I would continue the session as though nothing had happened; pretending that what was going on was just an ordinary exchange between a clinician and a patient. I became false and wooden in my demeanor.

I believe that what I was experiencing in these times was the projectively identified experience of being symbiotically related to an annihilating, torturing other. A number of features are salient. Firstly, my fantasies of a marauding gang of rapists perhaps arose from L's attempt to communicate an experience of being assaulted from everywhere and intruded upon in every orifice. The omnipotent power of the gang is sharply juxtaposed against the absolute weakness of L, an all powerful object in relation to a helpless baby. I am reminded here of L's puppy dream in which the puppy is thrashed by the evil woman. Secondly the sexualisation of the countertransference turns what should have been empathic distress, and an aggressive wish to protect L, into sadistic, voyeuristic excitation. This is in keeping with Glasser's (1979) and Jiminez's (1993; 2004) observations about the use of violent eroticisation as a relational defence that maintains the proximity to the object. Thirdly, my wish to stop the engagement identifies me in the position of the helpless self who screams for the torture to end. The desperate need to end the contact, I believe, is related to L's ultimate solution of rendering herself unconscious in relation to the object. Finally, my pretence that an ordinary exchange was underway in the session may suggest my own countertransferential pull towards self-deception. This self-deception, resulting in the intentional splitting of my subjective reality (what Welldon (2011) calls encapsulation), communicates the essence of L's perverse relationship to her trauma: one part that knows, and one part that wilfully hides this knowledge. As Welldon (2011) says, the right hand knows what the left hand is doing in the perverse psyche. This deception is connoted in the Tri-bar's illusory apex.

The projectively identified experience also communicates L's internal structure in relation to her infantile trauma. A violent sadistic 'gang' constellation in her ego (Steiner, 1993) mercilessly torments a helpless violated part of her. Steiner's notion of the inter-relatedness between various pathological organisations in the psyche suggests that there is a perverse cooperation between aspects of the self, generated in order to survive trauma. It is possible to read L's digging her nails into her arm as a regressive attack on any potential understanding of her mental state. In other words, the annihilating gang threatens L's helpless baby if the perverse status quo is disrupted. This status-quo, although a pathological psychic retreat (Steiner, 1993), is a last ditch attempt to save the pervert's mind from psychotic decompensation, morbid despair (Welldon, 2011) and psychic deadness (Ogden, 1996).

In structural language, we believe Steiner is referring to the experience of a violently imposing superego which defends against unmanageable affects by imposing brutal negations upon the ego (Wurmser, 2003). In the archaic superego of the masochist, violence and aggression are the legitimate solutions to the shame and threat of having no control.

Deadness

Feelings of frustration, lifelessness and deadness appeared to accompany Vector Two symptoms. The affectless and cold quality of the relationship in these moments is denoted in the dream of two circles falling into each other. The depiction, which I believe to be suggestive of a dangerously fused state between L and her mother, is sanitised of its affective intensity and presents as an illusory geometric calm. Like my false calm and my deadened wooden presentation post the perverse symbiosis described above, the geometric calmness is an illusion. Thus L described herself as just a 'normal student' suffering from 'normal stressors' or accounts for her problems through astrology.

Despite there being no authenticity in this relational position, I would sometimes find myself feigning interest or forcing myself to find intellectual meaning in her utterances. I experienced the distance from L in my somatic reactions. I would feel enormously hungry after sessions, I would not be able to sit comfortably in my chair, and I would feel very cold. As my frustration mounted, my wish was to interpret aggressively or threaten L with termination of the treatment. It may be the case that I was projectively identifying with the experience of being abandoned, uncomfortable, cold and hungry. Closely aligned with these somatic identifications was the wilful deception undertaken by L and I as we tried to 'act' as though therapy was meaningful and intellectually interesting.

Discussion: Affects and mentalisation

L's violence, her symptomatic acts, and her transference dynamics, all seem to hinge on the mental problem of unbearably overwhelming affects: firstly, in the experience of unnameable, foreboding experiences with threatening primary objects, and secondly, in relation to an archaic superego which orchestrates aggressive negations of the affected ego in order to return a sense of control of her mental life. Wurmser (2003), referring to the work of Krystal (1988), says of repetitive, severe infantile trauma that 'it leads to the standstill, usually partial, of affective development: the differentiation, verbalisation and desomatisation of the emotions are blocked' (p. 226). For L, feelings cannot be distinguished, spoken about, or even separated from her body. L's feelings are by definition dysregulated and unthinkable. Fonagy et al. (2004) understand affect regulation to be 'a process of crafting mental states in accordance with a sense of agency' (p. 436). An ability to regulate affects is a component of a general capacity to think about feelings, or what he and others term mentalisation (Fonagy et al., 2004). This capacity is related to one's own mind as well as the ability to imagine the minds and intentions of others (Fonagy et al., 2004). It is also implied in the ability to distinguish between inside mental states and the highly complex relationship of those states to external reality (Fonagy & Target, 1996).

Failure to mentalise results from poor affective mirroring in the primary caretaking relationship (Fonagy, 2001), leaving the child with poorly conceived, inaccurate representations of herself and others. In addition, the highly charged, unmodified emotional content inherent in the traumatically impinged-upon mind is often dispelled through violent action because affect is used instrumentally rather than expressively or communicatively (Fonagy, 2001). This is clearly the case with L, whose symptomatic presentation typifies that of a borderline, non-mentalising patient. In particular, her symptomatic and transferential dynamics align with two separate ways of organising subjectivity: pretend mode and psychic equivalence (Fonagy et al., 2004). Psychic equivalence is characterised by mind-world isomorphism is which negative affects are experienced as dangerous things that pose a threat to the integrity of the self (Allen, Fonagy & Bateman, 2008). In this state negative affect becomes utterly unbearable and the mind is experienced as intolerable. I believe that this relationship to affects is typified by L's perverse expression in her bodily Vector One symptoms as well as by the perversely stimulating counter-transference dynamics. It may be argued that the disturbing and intolerable affects aroused in relation to a dangerous internal persecutor, experienced in psychic equivalence, resulted in the expression of that affect concretely, somatically and instrumentally.

Pretend mode refers to an organisation of subjective experience in which there is a decoupling between inner reality and outer reality such that the one is experienced as having no bearing upon the other (Bateman & Fonagy, 2006). In this mode, patients like L experience a sense of profound emptiness and subjective deadness. We would argue that this way of organising affectivity was dominant in L's Vector Two symptoms and in her empty, affectless transference. Thinking about her feelings and herself in the pretend mode may well be described as 'pseudo-mentalisation' (Fonagy et al., 2004).

In order to be able to think about feelings in the self and in others, the processes of pretend mode and psychic equivalence must be linked (Bateman & Fonagy, 2006). This allows a person to experience emotion without being overwhelmed by it, but at the same time be able to experience the affective state as meaningfully linked to the world and a sense of personal agency (Fonagy et al., 2004). In L's case, it appears that she was unable to link these modes of experience. What is more, her material is suggestive of a distinct severing of these functions such that they occupied different realms of the mind, or different parts of the split ego. In this regard we offer an additional reason a patient like L might split her ego: it may also be a way of defending against the full affective knowledge of the disturbing experience within. In this assertion we are moving in a slightly different direction to a more traditional understanding of mentalisation. We suggest that in addition to there being a developmental arrest, a split psyche with unintegrated modes of organising experience may serve as a defence against the disturbing object of the core complex. It may also be a way of retaining the object by only ever knowing about it in truncated affective snapshots: a disturbing mindless body encounter, or an emotionless, empty cognitive encounter, never both simultaneously. To integrate these subjective modes of the object would usher in a more complete mentalisation of the disturbing experience of the core-complex object, resulting in a catastrophic emotional unravelling.

Conclusion

In this paper we have suggested that the mind that beholds the disturbing internal core-complex object is severed into two different subjectivities, a split in the ego. This is done in order that the disturbing object can only be known in pieces, fragments masquerading as an illusory three-dimensional whole object. Two separate minds each relate to the disturbing core-complex superego in different ways: a Tribar mind. It has been argued that the Tri-bar mind emerges because of severe, traumatogenic developmental arrests, in which the disturbing core complex object is paramount in the mental life of the pervert. This object remains in the mind of the masochistic pervert as an archaic superego that functions malevolently, producing terrifying overwhelming affects that the patient has to manage. The developmental arrests also produce two distinct and unintegrated mechanisms for dealing with this affect, those being psychic equivalence and pretend mode. Keeping these modes of managing affect and organising subjectivity separate may also serve defensive functions against those overwhelming affects. Psychic equivalence produces a sensation-laden bodily expression of the affect (Vector One); and pretend mode produces an affectless, concretely cognitive negation of affect (Vector Two). The affective currents of the psychic equivalence and the pretend modes were also described in relation to the transference and countertransference. In one mode the transference and countertransference feelings were perversely stimulating and bodily, in the other, dead and relationally distant. Thus, the Tri-bar split of the mind includes a stark split in the two strategies for managing torturous affect. It is this split that maintains the Tri-bar dilemma, simultaneously dead and alive, perversely related to both a sensation-laden body and a deadened mind. This paper has offered a model for understanding this simultaneity of the experience of perverse masochism in the hopes that the therapist, confronted with apparently irreconcilable opposites, may link what the patient cannot, and thereby have some way to hold the totality of experience in mind.

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Clinton Michael van der Walt

University of the Witwatersrand

Carol Long

University of the Witwatersrand

Clinton van der Walt is a psychoanalytic psychotherapist in private practice in Johannesburg. He is currently completing a PhD at the University of the Witwatersrand.

Carol Long is an Associate Professor in the Department of Psychology at the University of the Witwatersrand. She is the author of Contradicting Maternity: HIV-positive Motherhood in South Africa (Wits University Press, 2009) and co-editor of the journal Psycho-analytic Psychotherapy in South Africa. She is a practising clinical psychologist.
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