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Articles- Part XXV
THE TWO ANALYSES OF MR. Z
Heinz Kohut
INTRODUCTION
Although hardly more than a dozen years old, the psychoanalytic psychology
of the self has now reached a point in its development when, for the
benefit both of those who understand it thoroughly, and are used to
applying the new concepts in their clinical work and in their research,
and for the benefit of those who are seriously trying to learn more
about this new step and want to form a judicious judgement about it,
we need to summarize our theoretical conclusions and to demonstrate
their usefulness in our clinical work. The first--a summary of the
present state of our theoretical insights--was attempted in the summarizing
statement which appeared recently in this Journal (Kohut & Wolf,
1978), the second--the demonstration of the clinical usefulness of
the new viewpoint--was undertaken with the publication of The Psychology
of the Self, A Casebook (Goldberg, 1978). The present case report
belongs, of course, in the second realm: it aims at showing the relevance
of the new psychoanalytic insights in the clinical field.
Two considerations determined my choice
of this particular case within the context outlined above: First,
the structure of Mr Z's personality illustrates with great clarity
the explanatory power of the psychology of the self. Second, this
purpose is also served, and perhaps even more unambiguously, by the
fact that Mr Z's analysis took place in two installments, each conducted
five times a week and lasting about four years, which were separated
by an interval of about five and a half years. During the first installment
I was viewing analytic material entirely from the point of view of
classical analysis. But the second installment started when I was
writing `Forms and Transformations of Narcissism' (1966) and ended
when I was deeply immersed in the writing of The Analysis of the
Self (1971). The second installment, then, coincided with the
time when I was beginning to test a new frame of references-a new
viewpoint, which, to state it briefly, allowed me to perceive meanings,
or the significance of meanings, I had formerly not consciously perceived.
This case thus allows me to demonstrate that the change in my theoretical
outlook that had taken place during this time influenced decisively
the focus of my perception of Mr Z's psychopathology and enabled me,
to the great benefit of the patient, to give him access to certain
sectors of his personality that had not been reached in the first
part of his treatment.
CLINICAL DATA
When Mr Z consulted me for analysis he was a graduate student in his
mid-twenties. He was a handsome, well-built, muscular man. His pale
and sensitive face, the face of a dreamer and thinker, stood in noticeable
contrast to his athletic appearance. He was soft-spoken, his speech
often halting.
The patient lived with his widowed mother
in very comfortable financial circumstances because the father, who
had died about four years earlier, had not only been a highly successful
business executive but had himself inherited a considerable fortune.
Mr Z was an only child.
The disturbances for which he sought
relief seemed at first quite vague. He complained of a number of mild
somatic symptoms-- extrasystoles, sweaty palms, feelings of fullness
in the stomach, and periods of either constipation or diarrhoea. And
he also mentioned that he felt socially isolated because he was unable
to form any relationships with girls. Although his academic work,
as measured by his grades and the reaction of his teachers, was good,
he expressed the opinion that he was functioning below his capacities.
He tried to relieve his loneliness by reading and by going to movies,
the theatre, and concerts-either alone, or with an unmarried friend
with whom he had been close since high school and who also seemed
to have had some trouble in his relations with women. Not infrequently,
the two friends were accompanied by the patient's mother, a woman
with a variety of artistic interests (she painted and she wrote poetry).
It was my impression that however pathological and unsatisfactory
this mode of life might have been for an intelligent and handsome
young man in his midtwenties, the balance he had achieved in his relationship
to mother and friend had spared him the full impact of a confrontation
with his inhibitions, and I wondered what specific event might have
prompted him to seek therapy at this time. As I found out later, there
was indeed an event that had upset the balance which the defensively
established threesome had provided a few months before the patient
consulted me, his friend had become attached to a much older woman.
He not only excluded the patient from the relationship to this woman-Mr
Z never met her nor did he even know her name` he also became much
less interested in seeing Mr Z. He no longer participated in the social
and cultural activities that had included Mr Z's mother, although
he did retain some contact with both of them by telephone.
The revelation of the details of Mr
Z's problems proceeded at first very slowly and against resistance
motivated by shame-it was particularly difficult for the patient to
reveal not only that he masturbated frequently, but that the masturbatory
fantasies were masochistic. In his fantasies-he had never tried to
enact them-he performed menial tasks submissively in the service of
a domineering woman. He always reached sexual climax after spinning
out a story of being forced into performing the sexual act by a woman
whom he imagined as being strong, demanding, and insatiable. At the
moment of ejaculation he typically experienced the feeling of desperately
straining to perform in accordance with the woman's commands, similar,
as he explained, to a horse that is made to pull a load that is too
heavy for its powers and that is driven on by the coachman's whip
to give its last ounce of strength, or similar to Roman galley slaves
whipped on by their overseer during a sea battle.
The genetic data obtained during the
first phase of the analysis can be divided into two groups: material
from Mr Z's childhood; and material from his preadolescence and early
adolescence.
There was every indication, both from external evidence and from the
overall flavour of Mr Z's personality, that the unremembered earliest
part of his life, perhaps the first year or year and a half, had been
a happy one. However severely distorted the personality of his mother
basically might have been, as will be discussed later on, she was
quite young when the patient was born, and the intense relationship
with her male baby might, as long as he was still small and the interweaving
of her with him still phase-appropriate, have brought out her healthier
attitudes. At any rate, to all appearances, he was the apple of her
eye, and the father, too, seems to have been pleased with him--at
least as far as could be judged from entries in a baby book and snapshots
and home movies that had been taken by the young couple. Whether his
picture was taken as he was held by his mother or occasionally, by
the father, his facial expression and general demeanour seemed that
of a happy healthy baby. And, to anticipate, although in the second
analysis we came to see the significance of many of the data from
childhood in a quite different light, our impression concerning the
earliest part of his life remained unchanged: there was a core of
vitality, playful vigour, and enterprisingness in Mr Z's personality
that had survived from earliest times despite the distortions it underwent
later.
When the patient was about three and
a half years old, certain events of far-reaching significance took
place. Mr Z's father became seriously ill and was hospitalized for
several months. The father's illness by itself would undoubtedly have
been upsetting. What was of even greater importance, however, was
that during the hospitalization the father fell in love with the nurse
who took care of him, and after his recovery he decided not to return
home but to live with the nurse. During the time of this relationship,
which lasted about a year and a half, the father seems only rarely
to have visited his family. Still, there was no divorce and, when
the patient was 5-years-old, the father, according to his mother's
accounts, broke off with the nurse and returned home. Although the
family was thus externally re-established, there can be no doubt that
the parents' marriage was an unhappy one thereafter. (A modicum of
affection seems to have become rekindled between the parents during
the last year of the father's life when, during his final illness,
Mr Z's mother took care of him.)
The theme that was most conspicuous
during the first year of the analysis was that of a regressive mother
transference, particularly as it was associated with the patient's
narcissism, i.e. as we then saw it, with his unrealistic, deluded
grandiosity and his demands that the psychoanalytic situation should
reinstate the position of exclusive control, of being admired and
catered to by a doting mother who--a reconstruction with which I confronted
the patient many times--had, in the absence of siblings who would
have constituted pre-oedipal rivals and, during a crucial period of
his childhood, in the absence of a father who would have been the
oedipal rival, devoted her total attention to the patient. For a long
time the patient opposed these interpretations with intense resistances.
He blew up in rages against me, time after time-indeed the picture
he presented during the first year and a half of the analysis was
dominated by his rage. These attacks arose either in response to my
interpretations concerning his narcissistic demands and his arrogant
feelings of ` entitlement' or because of such unavoidable frustrations
as weekend interruptions, occasional irregularities in the schedule,
or, especially, my vacations. In the last-mentioned instances, it
might be added, the patient also reacted with depression accompanied
by hypochondriacal preoccupation and fleeting suicidal thoughts. After
about a year and a half, he rather abruptly became much calmer and
his insistent assertion that his anger was justified because I did
not understand him lessened conspicuously. When I remarked approvingly
on the change and said that the working through of his own narcissistic
delusions was now bearing fruit, the patient rejected this explanation,
but in a friendly and calm manner. He said that the change had taken
place not primarily because of a change in him but because of something
I had done. I had, he said, introduced one of my interpretations
concerning his insatiable narcissistic demands with the phrase 'Of
course, it hurts when one is not given what one assumes to be one's
due'. I did not understand the significance of my remark at that time--at
least not consciously--and continued to believe that the patient was
now giving up his narcissistic demands and that his rages and depressions
had diminished because of the cumulative effect of the workingthrough
processes concerning his narcissism. And I told myself that it was
in order to save face that the patient had attributed the change to
the, as it seemed to me, innocuous and insignificant phrase with which
I had recently introduced an interpretation. I remember that I even
considered pointing out to the patient that by denying the effectiveness
of my interpretation he was putting up a last-ditch resistance against
the full acceptance of the delusional nature of his narcissistic demands.
But luckily--as I see in retrospect--I decided not to go through with
this move, since I did not want to disturb the progress of the analysis,
which seemed now to be making headway in new directions and was moving,
as I then thought, towards the central area of his psychopathology.
The centre of the analytic stage was
from then on occupied, on the one hand, by transference phenomena
and memories concerning his, as I then saw it, pathogenic conflicts
in the area of infantile sexuality and aggression-his Oedipus complex,
his castration anxiety, his childhood masturbation, his fantasy of
the phallic woman, and, especially, his preoccupation with the primal
scene-and, on the other hand, by his revelation that, beginning at
the age of 11, he had been involved in a homosexual relationship,
lasting about two years, with a 30-year-old high school teacher, a
senior counsellor and assistant director of the summer camp to which
he had been sent by his parents.
My perceptions with regard to the firstmentioned
themes need little further explanation here, since they were fully
in tune with the classical outlook of psychoanalysis. As the patient's
main resistances, I saw his defensive narcissism and the mechanism
of denial. I attempted to demonstrate to him that he had, from way
back, denied the fact that the father had indeed returned home when
the patient was still only four-and-a-half or 5-years-old and that
his insistence--as enacted in the transference--that he did not have
an oedipal rival, that his pre-oedipal possession of his mother had
remained total after the father's return, was a delusion. In other
words, I interpreted the persistence of defensive narcissism as it
protected him against the painful awareness of the powerful rival
who possessed his mother sexually and against the castration anxiety
to which an awareness of his own competitive and hostile impulses
towards the rival would have exposed him.
Two sets of memories emerged in response
to these interpretations : one cluster--first announced in dreams--concerned
his observation of parental intercourse, the other revealed his childhood
masturbation and the elaborate set of fantasies which accompanied
it. I might add at this point a fact which became intelligible only
years later, during Mr Z's second analysis, that the childhood masturbation
did not subside during latency, stopped only temporarily during his
relationship with the counsellor, and continued from then on. The
fantasies that accompanied the masturbation remained in essence--though
not in. their specific content--unchanged from childhood to adulthood.
They disappeared during the second half of the first analysis.
Mr Z undoubtedly had witnessed his parents'
sexual intercourse from the time he was about 5 until about the age
of 8, when he was assigned a separate bedroom. Up to the time of the
father's return he had slept next to his mother in the father's bed.
After that, a couch was moved into the parental bedroom, placed crosswise
at the foot end of the parents' beds in such a way that the apparently
fairly high footboards prevented him from seeing the parents if he
did not raise himself up, yet so closely placed that the vibrations
of the parental bed were transmitted to the couch.
We talked a great deal about the impact
which these experiences must have had on him: the frightening noise,
the anxious sexual stimulation. And we concentrated, in particular,
on the fact that memories concerning the frequent serious quarrels
between his parent which the child witnessed and memories of the primal
scene emerged in many of his associations in temporal sequence, allowing
the reconstruction that he had experienced the intercourse not as
lovemaking but as a fight.
His own sexual activity, the masturbation
in childhood, began, as far as he could remember, at about the time
of the father's return and continued, with increased intensity, after
he assigned his own bedroom. The content of hi masturbation fantasies
in childhood, as far back as he could remember, was masochistic. W
could not recover any hints of a masculine assertive competitive content
from which these fantasies might have been said to constitute a defensive
retreat, motivated by castration anxiety. Defined in the terms of
a complementary series of regression and fixation (Freud 1933, p.
126), the masturbatory activity seemed to be due to pre-oedipal and
pregenital fixation (with a mixture of oral and anal drive elements
and a preponderance of passivity), but not to regression. For although
according to his memories the masturbatory activity began around the
time of the father's return, its content was from the beginning rooted
in the, pre-oedipal, pregenital period when he had the sole possessor
of his mother. Specifically, as far as he could recapture, the masturbatory
fantasies were always more or less extensive elaborations of themes
taken from Uncle Tom Cabin, a book which Mr Z's mother had
real aloud to him on numerous occasions during his early childhood
years, either at bedtime or when he was ill. In the fantasies which
occurred invariably from age 5 to age 11 he imagined himself a slave,
being bought and sold by women and for the use of women, like cattle,
like an object that had no initiative, no will of its own. He was
ordered about, treated with great strictness, had to take care of
his mistress' excrements and urine--indeed, in one specific, often
repeated fantasy, the woman urinated into his mouth, i.e. she forced
him to serve her as inanimate vessel such as a toilet bowl.
In my interpretative-reconstructive
attempts, I moved in two directions: I tried, more or less successfully,
to address myself to the elements of pregenital fixation as they related
to the infantile
sexual ties to his pre-oedipal mother; and, increasingly, but with
scant success, I tried to discern and to interpret to him the motivations
for his clinging to pregenital drive aims--or even regressing to them--namely,
that the fear of taking a competitive stance vis-a-vis the
father had forced him to return to the earlier developmental level,
or, at any rate, that castration anxiety prevented him from making
the decisive forward move.
All in all, my approach to Mr Z's psychopathology
as it was mobilized in the analysis can be said to have been fully
in tune with the classical theories of psychoanalysis. His masochism,
in particular, I explained as sexualization of his guilt about the
pre-oedipal possession of his mother and about his unconscious oedipal
rivalry. And I said that by creating the imagery concerning a domineering
phallic woman he fought his castration anxiety in two ways. Via the
denial in fantasy of the existence of human beings who have no penis,
i.e. had lost their penis, and by the assertion that his mother was
more powerful than the father, i.e. that the father need not be feared
as a castrator, that his mother could effectively protect him against
the father because she possessed a more powerful penis than he, was
stronger than he.
We also investigated, of course, Mr
Z's homosexual relationship during his preadolescent years. Although
the patient had talked about it off and on from the beginning of therapy,
the memories about this theme were especially prominent rather late
in the analysis. He described these years as extremely happy ones--they
might well have been the happiest years of his life, except perhaps
for his early years when he possessed his mother seemingly without
conflict. The relationship to the counsellor appeared indeed to have
been a very fulfilling one. Although overt sexual contact between
them occurred occasionally--at first mainly kissing and hugging, later
also naked closeness with a degree of tenderly undertaken manual and
labial mutual caressing of the genitalia--he insisted that sexuality
had not been prominent: it was an affectionate relationship. The boy
idealized his friend. During the summer, in camp, he admired him not
only in his function as an expert outdoorsman who taught his charges
various skills but also as a spiritual leader who infused the boys
with his own deep, almost religious, love for nature. Later on, when
the two continued their contact in the city, the boy's admiration
continued but now shifted to the friend's moral and social philosophy
and his knowledge and love for literature, art, and music. All in
all it was my impression, at that time, that the relationship in its
deepest layers was a reactivation of the bliss of the pre-oedipal,
pregenital relation to the idealized mother, especially in view of
the fact that, during this period, the boy was for the first time
in his life to all outward appearances emotionally completely detached
from his mother. The friendship with the counsellor ended when Mr
Z approached puberty, i.e. when his voice changed, when he began to
develop a beard and body hair, and when his genitals began to mature.
The last months of their relationship were clearly the worst. The
rapidly progressing pubertal changes apparently removed the psychological
basis of their friendship--at least we could never discover any other
reason for its coming to an end. The affectionate bond between them
seemed to dissolve, while simultaneously--and for the first time--gross
sexuality entered into the picture. On one occasion the counsellor
tried to penetrate the boy anally (the attempt failed), and on another
occasion--it was the first and only time in the two years of their
friendship--he had an ejaculation when the boy caressed his penis.
Soon after these events they ceased to meet.
Mr Z felt no resentment against his
friend and spoke warmly about him whenever he mentioned him during
the analysis. He felt that their affection had been genuine and that
their friendship had been mutually enriching. Although they hardly
saw one another after the breakup, they never lost contact altogether,
even to the present. (The man, it might be added, is now married in
what appears to be a happy marriage. He has several children and is
successful in his career.)
After this two-year enclave of comparative
happiness, Mr Z's existence became troubled and unsatisfactory. Puberty
did not bring about any genuine interest in girls. Instead, he 'experienced
an increasing sense of social isolation, and he gradually again became
more and more tied to his mother. The father, so far as we learned
in the first analysis, remained a distant figure for him. His mother
seems to have engaged in a social life of her own and, for a while-preceding
the time when Mr Z attached himself to the counsellor--was intensely
involved with another man, a married friend of the family--a liaison,
it might be added, to which the father apparently did not object.
The patient's sexual life from the time
of the termination of his homosexual friendship to the present was
restricted to frequent, addictively pursued masturbation, always accompanied
by fantasies of masochistic relationships with women. The fantasies
contained no homosexual elements. Indeed, although I was of course
alert to the possibility of homosexual propensities, I could not,
with the exception of an anxiety dream toward the end of analysis,
discern any unusual homosexual tendencies in Mr Z, or any unusual
defensive attitudes concerning homosexual stimulation, either in the
first or in the second analysis.
To put the symptomatic and behavioural
results of the first analysis in a nutshell: Mr Z's masochistic preoccupations
disappeared gradually during the second half of the analysis and were
almost nonexistent at the end. He made, furthermore, a decisive maturational
step by moving from his mother's house to an apartment of his own.
And, finally, he not only began to date but had also several sexually
active, brief relationships with girls of approximately his own age
and of his own cultural background and educational level. During the
last year of the analysis, while pursuing a research project, he became
acquainted with a professional woman, about a year older than he,
with whom he consulted about certain aspects of his investigations
that lay outside his own field but were in the area of her competence.
He pursued her actively, had satisfactory sexual relations with her,
and entertained thoughts of marrying her, although at the time of
the termination of the analysis he had not yet come to any decision
concerning this step.
More important to me in evaluating the
effectiveness of the treatment than these improvements, however extensive
they obviously were, was the fact that I felt that they had come about
as the direct result of the mobilization and the working-through of
Mr Z's nuclear conflicts. During the early part of the analysis, his
grandiosity and narcissistic demands had been taken up and were worked
through, both in so far as they were the continuation of his fixation
on the pre-oedipal mother and in so far as they were clung to as a
defence against oedipal competitiveness and castration fear. These
themes did not, of course disappear abruptly but their frequency and
intensity abated. And what seemed to me to even more significant as
an indicator of the genuineness of the termination of the analytic
process was the fact that it was preceded by a shift in the dominant
themes with which the patient was dealing. Pari passu with
a gradual lessening of associations concerning Mr Z's pre-oedipal
mother attachment, there was a gradual increase of allusions that
a repressed oedipal conflict was being activated. At any rate I consistently,
and with increasing firmness rejected the reactivation of his narcissistic
attitudes, expectations, and demands during the last years of the
analysis by telling the patient that they were resistances against
the confrontation of deeper and more intense fears connected with
masculine assertiveness and competition with men. The patient seemed
indeed to respond favourably to this consistent and forceful pursued
attitude on my part: the narcissistic features receded, the patient's
demands and expectations became more realistic, and he began to be
increasingly more assertive in career-directed activities and vis-a-vis
women. In the transference, too, he reported aggressive thoughts towards
me and expressed some curiosity concerning my private life, including
my sex life.
The most significant sign of his advance
in facing what I then believed to be his deepest conflicts was a dream
which occurred about a year before the termination. In this dream--his
associations pointed clearly to the time when the father rejoined
the family--he was in a house, at the inner side of a door which
was cracked open. Outside was the father, loaded with giftwrapped
packages, wanting to enter. The patient was intensely frightened and
attempted to close the door in order to keep the father out. We
did a good deal of work on this dream, to which he had many associations
referring to present experiences (including the transference) and
to the past. Our conclusion was that it referred to his ambivalent
attitude towards the father. And, in view of the overall image I had
formed of the construction of his personality and of his psychopathology,
I stressed in my interpretations and reconstructions especially his
hostility toward the returning father, the castration fear, vis-a-vis
the strong, adult man; and, in addition, I pointed out his tendency
to retreat from competitiveness and male assertiveness either to the
old pre-oedipal attachment to his mother or to a defensively taken
submissive and passive homosexual attitude toward the father.
The logical cohesiveness of these reconstructions
seemed impeccable, and in view of the fact that they were entirely
in line with the precepts about the unfolding of an analysand's conflicts
and about the ultimate resolution of these conflicts brought about
in a well-conducted analysis--precepts that were then firmly established
in me as almost unquestioned inner guidelines in conducting my therapeutic
work--I had no doubt that Mr Z's vast improvement was indeed based
on the kind of structural change that comes about as a result of bringing
formerly unconscious conflicts into consciousness. To my analytic
eye, trained to perceive the configurations described by Freud, everything
seemed to have fallen into place. We had reached the oedipal conflict,
the formerly unconscious ambivalence toward the oedipal father had
come to the fore, there were the expected attempts at regressive evasion
with temporary exacerbations of pre-oedipal conflicts, and there was
ultimately a period of anticipatory mourning for the analyst and the
relationship with him, abating towards the very end, as the dissolution
of the bond of trust and co-operation was in the immediate offing.
It all seemed right, especially in view of the fact that it was accompanied
by what appeared to be the unquestionable evidence of improvement
in all the essential areas of the patient's disturbance.
What was wrong at that time is much
harder to describe than what seemed to be right. Yet, I believe that,
although both the patient and I must have known it preconsciously,
we failed to acknowledge and confront a crucial feature of the termination
phase. What was wrong was, to state it bluntly, that the whole terminal
phase, in stark contrast to the striking contents that we transacted,
was, with the exception of one area, emotionally shallow and unexciting--noteworthy
because the patient was not an obsessional personality, was not inclined
to split ideation and affectivity. On the contrary, he had always
been able to experience and to express strong emotions. He had always
experienced shame and rage with great intensity and often felt deeply
upset about setbacks and wounds to his self-esteem; and he could also
react with a warm glow of triumphant satisfaction when accomplishment
and success enhanced his selfesteem. To draw specific comparisons
: nothing in the terminal phase-neither his experiences in real life
nor his experiences in the analytic sessions came anywhere near equalling
the emotional depth with which in earlier phases of the analysis he
had talked about his idealization of the pre-oedipal mother and his
admiration for the counsellor. Only the feelings concerning the parting
from the analyst appeared to have real depth; and his ultimate acceptance
of the fact of having to give up the analytic relationship seemed
hard-earned and genuine.
After the analysis had ended with a
warm handshake and the expression of gratitude on his part and of
good wishes for his future life on mine, I had hardly any contact
with Mr Z for about five years. About three weeks after our last session,
a brief letter came with his last payment. In this letter he again
expressed his gratitude and stated that, while the termination of
our relationship was still emotionally difficult for him, he was handling
it all right. He also mentioned that he had decided not to marry the
woman he had dated during the last year, but that he would look elsewhere.
I also accidentally met the patient on two occasions: once in the
theatre and once at a concert. In each case he was in the company
of a young woman--a different one each time--whom he introduced to
me, and each time we had a brief but friendly social chat. From what
I could glean from these conversations he was doing well enough in
his profession and, while not overly vivacious, he did not appear
to be "depressed.
I was surprised when, about four and
a half years after the termination of his analysis, Mr Z let me know
that he was again experiencing difficulties. His message was contained
in a Christmas card which, he wrote, he was sending me in order to
congratulate me concerning a professional office I was currently holding.
(I heater discovered that he had learned about this from a newspaper
notice more than half a year earlier, without then writing to me.)
He closed by wishing me a happy holiday. It was only seemingly as
an afterthought that he added the crucial information that he had
been doing less well recently and that he would probably contact me
in the near future. In acknowledgement, I told him he should get in
touch with me if he continued to feel the need to do so. Shortly thereafter
he set up an appointment.
My very first impression when he came
to see me was that he was under some strain. But he talked freely
and openly as he filled me in on the events of the intervening years
and explained the reasons for contacting me at this point. There was
little overt change in his life. He still lived alone, in an apartment
of his own. He was at the present time not attached to any particular
girl, but until recently he had had a succession of affairs. He was
always sexually potent--a mild tendency to ejaculatio praecox that
had developed some time ago did not appear to pose any serious difficulties--but
he had progressively become aware of the fact that the relationships
in which he engaged were emotionally shallow and, in particular, that
his sex life gave him no real satisfaction. He then mentioned, in
quick succession--a manifest non sequitur which, as I assumed,
indicated a latent causal relationship--that there had been no recurrence
of the former addictive masturbation with masochistic fantasies and
that, although outwardly he was doing reasonably well in his profession,
he did not enjoy his work but experienced it as a necessary routine,
a burden, a chore. I remember that I immediately suspected, on the
basis of the juxtaposition of his statement concerning the non-recurrence
of his sexual masochism and the complaint about the burdensomeness
of his work, that, contrary to my hope, the first analysis had not
achieved a cure of his masochistic propensities via structural change,
but that they had only become suppressed and had now shifted to his
work and to his life in general. This impression, I might add, was
amply corroborated by the information we obtained in the course of
the second analysis.
He then told me that the masochistic
fantasies had indeed never completely disappeared, but that he had
often called them up actively during intercourse with his girl friends.
He did this, he said, as an antidote to premature ejaculation and
in order to experience the sexual act more keenly. Finally, during
the last few months after breaking up with his most recent girl, I
had become alarmed about an increasing sense of social isolation and
especially--he reacted like a former addict threatened by the danger
of succumbing again to his addiction--about the temptation, so far
resisted, to buy pornographic books and to masturbate with masochist
fantasies.
Although I misinterpreted its significance
as a factor in Mr Z's return for treatment at that time, I dimly realized
that the most important bit of information he gave me during the first
two interviews concerned the fact that Mr Z's mother, at that time
in her middle fifties, had about a year and a half ago undergone a
serious personality change. After Mr Z had moved away from her (about
five years ago) she had become increasingly isolated, leaving the
house more and more rarely, and, as became ultimately unmistakable
about two years ago, she had developed a set of circumscribed paranoid
delusions. I wondered immediately whether the mother's serious emotional
disturbance was not in some way causally related the worsening of
Mr Z's condition and to his turning to me for help. Was he being confronted
with the loss of a still unrelinquished love object from childhood
or with guilt feelings about having abandoned her and having thus
caused her illness? He had, himself, considered these possibilities;
and he was indeed aware of some feelings of loss and of guilt. He
did not realize however--we achieved this surprising insight the course
of the second analysis--that paradoxically, the mother's serious emotional
disturbance had not been deleterious for dragging him back into his
former illness, rather, as will be explained later, a wholesome one
propelling him toward health.
Although it became immediately apparent
that Mr Z required further analysis, it would have been very difficult
for me to start with him at that time. Since, as he said in the second
interview, he felt much better after the first contact with me-indeed,
the change in appearance and demeanour was striking: his face had
been tense and pale; now it was relaxed and his colour had returned;
he held himself more upright and was bouncier in all his movements;
his speech was more lively--he accepted without hesitation my suggestion
that we postpone the beginning of further analysis for about half
a year. He also agreed with my suggestion that I would see him now
and then, if he should feel the need for an appointment. As a matter
of fact, Mr Z did not make any further appointments after the initial
visits, but wrote to me once, about half-way through the waiting period,
confirming his expectation that we would start again at the date that
we had set and stating that, in the meantime, he was now doing reasonably
well. I might add at this point, that I suspected that his increase
in well-being after seeing me again was an aspect of the transference
he had established, and wondered whether his improvement was analogous
to the well-being that he had experienced much earlier in his life,
at the time when he had turned from the mother to the camp counsellor.
I began to assume in other words--a hypothesis that I had not entertained
during the first analysis--that he was establishing an idealizing
transference.
When we began the second analysis as
planned, this hypothesis was confirmed by the patient's first dream
(dreamed during the night that preceded the first session). The meaning
of certain aspects of the very simple manifest content were almost
immediately understandable, the full depth of its meaning, however,
became intelligible only much later. The dream contained no action
or words. It was the image of a dark-haired man in a rural landscape
with hills, mountains, and lakes. Although the man was standing there
in quiet relaxation, he seemed to be strong and confidence-inspiring.
He was dressed in city clothes, in a complex but harmonious way--the
patient saw that he was wearing a ring, that a handkerchief protruded
from his breast pocket, and that he was holding something in each
hand--perhaps an umbrella in one hand, and possibly a pair of gloves
in the other. The figure of the man was visually very plastic and
prominent--as in some photographs in which the object is sharply in
focus while the background is blurred. The associations showed
that the figure was a condensation of (a) the camp counsellor (certain
features of the landscape referred to the location of the summer camp);
(b) his father (the hair); and (c) the analyst (umbrella, gloves,
the handkerchief, the ring). The relationship to an idealized object,
the establishment of an idealizing transference, was portrayed by
the impressive appearance and proud bearing of the man and by the
tone of admiration with which the patient described him. I did not,
at the time, understand the meaning of the multifaceted richness of
the figure, especially as portrayed in the way he was dressed. The
fact, however, that in his associations the patient recalled briefly
the dream of his father, loaded with packages, trying to intrude into
the house, established a link with the terminal phase of the first
analysis--announcing as it were that the second analysis was a continuation
of the first one, that, as I came to see later, it took off from the
very point where the first one had failed most significantly.
As is characteristic for cases of the
type to which Mr Z belongs, the initial phase of idealization was
of short duration. In harmony with my then newly acquired insights
about the analyst's correct attitude vis-a-vis a narcissistic
transference in statu nascendi (cf. Kohut, 1971, pp. 262-4),
I did not interfere with the unfolding of the patient's idealization
of me. Still, after about two weeks, it gradually began to subside,
in accordance with the spontaneously unrolling sequence of transferences
that is determined by endopsychic factors--i.e. by the structure of
the patient's personality and psychopathology--to be replaced by a
mirror transference of the merger-type (cf. Kohut, 1971, pp. 137-42).
The glow of well-being and inner security that he experienced in consequence
of feeling himself within the milieu provided by the idealized analyst
faded away, and in its stead the patient became self-centred, demanding,
insisting on perfect empathy, and inclined to react with rage at the
slightest out-of-tuneness with his psychological states, with the
slightest misunderstanding of his communications. This phase in the
second analysis was quite similar to the corresponding one in the
first. What was different, however, was my evaluation of the psychological
significance of his behaviour. While in the first analysis I had looked
upon it in essence as defensive, and had at first tolerated it as
unavoidable and later increasingly taken a stand against it, I now
focused on it with the analyst's respectful seriousness vis-a-vis
important analytic material. I looked upon it as an analytically valuable
replica of a childhood condition that was being revived in the analysis.
This altered stance had two favourable consequences. It rid the analysis
of a burdensome iatrogenic artifact--his unproductive rage reactions
against me and the ensuing clashes with me--that I had formerly held
to be the unavoidable accompaniment of the analysis of his resistances.
And--a reliable indication that we were now moving in the right direction--the
analysis began to penetrate into the depths of a certain formerly
unexplored sector of the patient's personality and to illuminate it.
Formulated in the traditional terms
of early object relations, we would say that this phase of the analysis
revived the conditions of the period when, in early childhood, he
had been alone with his mother, who was ready to provide him with
the bliss of narcissistic fulfillment at all times. We would, in other
words, look upon this stage of the transference as a revival of an
early situation when he was spoiled by his mother, when a condition
of overgratification had prevailed which, in turn, led to the fixation
that hampered further development. But this traditional pattern of
explanations fails to do justice to two significant features of Mr
Z's personality that I could discern, even during this phase of the
analysis: an underlying chronic despair which could often be felt
side by side with the arrogance of his demandingness; and, par
excellence, the sexual masochism that had reappeared and stood
in stark contrast to his self-righteous claims for attention.
It is not easy to describe the subtle
but decisive differences between this phase in the second analysis
in which the reactivation of Mr Z's early relationship to the mother
dominated the picture and the corresponding phase in the first analysis.
Fundamental to all the other aspects of the change is the fact that
between Mr Z's first and second analysis my theoretical outlook had
shifted so that I was now able to perceive meanings, or the significance
of meanings, that I had formerly not consciouly perceived. More important,
however, than my broadened perception was the subtle effect which
the change in my theoretical outlook exerted on my attitude vis-a-vis
Mr Z. However mitigated by considerations that in everyday parlance
one might refer to as patience or human kindness or tact, and that,
to speak in theoretical terms, had been an outgrowth of my respectful
attention to the fact that structural changes come about only as the
result of a great deal of working-through, I had in the first analysis
looked upon the patient in essence as a centre of independent initiative
and had therefore expected that he would, with the aid of analytic
insights that would enable him to see his path clearly, relinquish
his narcissistic demands and grow up. In the second analysis however,
my emphasis had shifted. I had acquired a more dispassionate attitude
vis-a-vis the goal of maturation, and, assuming that growth
would take care of itself, I was now able more genuinely than before,
to set aside any goal-directed therapeutic ambitions. Put differently,
I relinquished the health- and maturity- morality that had formerly
motivated me, and restricted myself to the task of reconstructing
the early stages of his experiences, particularly as they concerned
his enmeshment with the pathological personality of the mother. And
when we now contemplated the patient's self in the rudimentary state
in which it came to view the transference, we no longer saw it as
resisting change or as opposing maturation because it did not want
to relinquish its childish gratification but, on the contrary, as
desperately--and often hopelessly--struggling to disentangle itself
from the noxious selfobject, to delimit itself, to grow, to become
independent.
It was in the context of our focus on
the struggles of his feeble self to define itself that we came to
understand the significance and effect of Mr Z's mother's recent psychosis.
In the first analysis I had seen the patient's persistent attachment
to the mother as a libidinal tie that he was unwilling to break. His
idealization of the mother, which was still much in evidence during
the first analysis, I had understood as the conscious manifestation
and accompaniment of his unconscious incestuous love for her. But
now we saw the personality of Mr Z's mother and the nature of his
relation to her in quite a different light. The picture of the mother
that Mr Z had painted for me in the first analysis was that of the
image which she portrayed successfully to people outside the family.
Those intimately involved with her, however, especially, of course,
the patient and the patient's father, knew better, even though they
were not able to raise this knowledge to a level of awareness which
would have allowed them to share it with each other. They knew that
the mother held intense, unshakable convictions that were translated
into attitudes and actions which emotionally enslaved those around
her and stifled their independent existence. True, when Mr Z reported
in the first analysis that the mother had responded to him with gratifying
enjoyment, he had not misrepresented her. What had been missing from
his reports was the crucial fact that the mother's emotional gifts
were bestowed on him under the unalterable and uncompromising condition
that he submit to total domination by her, that he must not allow
himself any independence, particularly as concerned significant relationships
with others. Mr Z's mother was intensely and pathologically jealous;
and, it may be added, not only father and son but the servants, too,
were under her strict domination.
His father's attachment to the
nurse and his decision to live away from home, constituted, as Mr
Z came ultimately to realize, a flight from the mother. It was also
an abandonment of his son, as the patient must have preconsciously
experienced the behaviour of his father in childhood-the conscious
acknowledgement of this feeling was reached only during his second
analysis. As the patient saw it: the father had tried to save himself,
and in doing so he had sacrificed the son.
The description of Mr Z's relation to
the mother filled many hours of his second analysis. The emergence
of his memories, however, and, especially his acquisition of gradually
deepening insights into the essence of his relation with the mother,
above all his recognition of the serious distortion of the mother's
personality which determined the nature of their relationship, was
accompanied by great anxiety, often leading to serious resistances.
The flow of his revelations would then be interrupted and he retreated
from the pursuit of the analytic task, voicing instead serious doubts
whether his memories were correct, whether he was not slanting his
presentation to me. As we discovered--a dynamically extremely important
insight without which progress would surely have ultimately been halted--his
fears concerned the loss of the mother as an archaic selfobject, a
loss that, during this phase of remembering and working through the
archaic merger with the mother, threatened him with dissolution, with
the loss of a self that at these moments--and they were more than
moments--he considered to be his only one. His doubts, his tendency
to take back what he had already recognized and revealed, were due
to a temporary repression of his memories, or rather, in most instances,
to the fact that his intense disintegration anxiety reestablished
the dominance of the disavowal that had already in childhood prevented
him from fully acknowledging what he in fact experienced and knew.
I would like here to draw attention
to a feature of this phase of Mr Z's analysis that I have found in
all similar cases: the remobilization of childhood experiences in
the analytic situation did not lead to sustained transference distortions
of the image of the analyst. Transference distortions did, of course,
occur--almost always as the elaboration of a nucleus of a real perception
concerning the analyst, i.e. concerning some attitude or action of
the analyst which he correctly but oversensitively perceived as being
similar to those of the pathological mother. But they usually disappeared
quickly, to be replaced by childhood memories concerning the mother.
It is my impression that the comparative underemphasis of transference
distortions in such cases is not a defensive manoeuvre but that it
is in the service of progress. In order to be able to proceed with
the task of perceiving the serious pathology of the selfobject of
childhood, the patient has to be certain that the current selfobject,
the analyst, is not again exposing him to the pathological milieu
of early life.
Let me now turn to certain concrete
details of the mother's behaviour, to provide the data that will allow
us to understand the pathological nature of their relationship. Mr
Z's memories here did not emerge directly. They were recalled only
after he had first re-examined certain features of their relationship
such as the mother's reading to him, playing with him, talking with
him, and spinning out fantasies with him about what his future would
be like, that he had already described during his first analysis.
At that time these aspects of the mother's attitude towards him were
seen by us in the light of his then prevailing idealization of the
mother, and we had both taken them as manifestations of the mother's
love for him. Now, however, feeling supported by the analyst, he began
to question the formerly unquestionable. And as he gradually became
able to rid himself of the sense of the sacrosanctity of the outlook
on their relationship with which the mother had indoctrinated him,
he began to recognize a certain bizarreness of even these seemingly
so normal and wholesome activities of the mother. He began to recognize,
for example, that she had by no means been in empathic contact with
the needs of his self for an anticipatory resonance to its future
power and independent initiative when, in her imagery about him as
a grown man, she had always taken totally for granted that, however
great his successes in life, their relationship would never be altered,
he would never leave her.
After the slow and painful process of
freeing himself from the idealized outlook on his relation with the
mother had gone on for some time, enabling him for the first time
to recognize that the sector of his self that had remained merged
with her since childhood was neither all of his self nor even its
central part, he began haltingly, and against surges of severe resistance
motivated by disintegration anxiety, to talk about some of the mother's
more overtly abnormal activities when he was a child and adolescent.
Three examples of Mr Z's mother's behaviour during the patient's early
life, namely her interest in his faeces, her involvement with his
possessions, and her preoccupation with small blemishes in his skin,
constitute representative aspects of her attitude towards him--an
attitude which, as we came to see more and more clearly, manifested
her uneradicable and unmodifiable need to retain her son as a permanent
selfobject.
No direct memories emerged during Mr
Z's analysis that referred to his toilet training. It seemed to have
taken place fairly early during the second year of his life, apparently
created no serious problems, and resulted in reliable sphincter control.
There was no encopresis and only a single unusual incident of enuresis,
shortly after he was moved from the parental bedroom to another room.
Despite the fact that his development in this area appeared to have
been in itself uneventful, Mr Z's associations and memories led us,
in the context of his overall struggle to reassess the mother's personality,
to a specific abnormal feature of her behaviour. He recalled now (this
topic was especially active during the early part of his second analysis)
the mother's intense interest in his faeces. She insisted on inspecting
them after each of his bowel movements until he was about six. At
that point she abruptly ceased the inspections and almost simultaneously
began to be preoccupied with his skin, particularly the skin on his
face.
It is remarkable that this striking
feature of, the patient's childhood had never become a prominent topic
during the first analysis. It had emerged briefly on a number of occasions,
but was never recognized by us as the important indicator of the mother's
serious personality disorder that in fact it was. We had looked at
it only in the context of what we had then considered to be the patient's
defensively clung to narcissism. The mother's behaviour, in other
words, had served us as an explanation of his tendency to overvalue
his `productions '--his statements in social conversations and to
the analyst, his written work in school, etc.--and I can still remember
the slightly ironical tone of my voice, meant to assist him in overcoming
his childish grandiosity, when I pointed out to him how his mother's
interest in every detail of his physical and mental 'excretions' had
brought about a fixation on an infantile pride in them, leading to
his current oversensitivity to shortcomings in himself and in what
he produced, and ultimately to his propensity to react to criticism,
and even the mere absence of praise, with depression or rage.
In contrast to the first analysis, the
second one focused on the depression and hopelessness that the mother's
attitude evoked in him. She was not interested in him. Only
his faeces and her inspection of them, only his bowel functions and
her control over them fascinated her--with an intensity, a self-righteous
certainty, and adamant commitment that allowed no protest and created
almost total submission.
As I mentioned earlier, her preoccupation
with his faeces stopped, apparently abruptly, when he was about 6
years old; she then became as obsessed with his skin as she had been
with his bowels before. Every Saturday afternoon--the procedure became
an unalterable ritual, just as the faeces-inspections had been--she
examined his face in minutest detail, in particular--and increasingly
as he moved toward adolescence--with regard to any developing blackheads
she could detect.
Mr Z began to talk about the skin-inspection ritual after telling
me about the faeces inspections; but, even though he was now dealing
with events of later childhood and adolescence, it was harder for
him to give me a clear picture of what had happened during one period
of his life and what during another. The events had become telescoped
and the chronology blurred. As I would judge now in retrospect, this
blurring of time relationships was to some extent defensive. It might
well have been that it was especially hard for him to acknowledge
how strong a hold his mother's pathological influence had had on him,
even as comparatively recently as his late teens.
Be that as it may, the complete ritual
consisted of two phases. During the first phase--the emotionally most
trying one for Mr Z--she described disapprovingly in great detail
what she saw. The second phase closed with the, often quite painful,
removal of the ripest of the blackheads. The mother, who frequently
expressed her pride in her long and hard fingernails, described to
her son its extrusion and showed him the extracted plug of sebum--a
faecal mass in miniature--with satisfaction, after which she seemed
gratified, and Mr Z, too, experienced some temporary relief. The worst
occasions were those when either no ripe blackhead was found or when
an attempted removal failed.
Another cluster of Mr Z's associations
and memories that emerged during the early part of the second analysis
concerned the mother's intense involvement with her furniture and
the art objects and bric-a-brac that she collected and displayed in
their home. One would be inclined to call her concern with these possessions
an obsessional character trait, to be explained as due to anal fixations,
just as one would, of course, be inclined to explain the ritual of
the blackhead-removal sessions under the same diagnostic heading as
a displacement of anal-sadistic drive aims. I have little doubt, however--and
not only because she had developed a paranoid psychosis after the
patient moved away from her--that a diagnosis of obsessional neurosis,
i.e. a diagnosis based on drive--criteria, would, even if not wrong,
be irrelevant. She was, in essence, a ' borderline case '. (See Kohut,
1977, p. 192, for the definition of this diagnostic category.) The
psychotic core, the central pre-psychological chaos of her personality,
the central hollowness of her self was covered over by a rigidly maintained
hold on and control over her selfobjects whom she needed in order
to shore up her self. Although to superficial acquaintances she presented
a picture of normal emotionality, even outsiders soon felt the lifelessness
that lay underneath the appearance of normality. Thus none of Mr Z's
classmates and acquaintances, either from primary school or later,
liked to visit his house, which contributed to his social isolation.
Even though a room was finally assigned to the boy, he enjoyed no
privacy. The mother insisted that his door be kept open at all times
and often entered suddenly and unexpectedly, disturbing whatever conversation
or other activity might have developed between the patient and a visiting
friend by a chilling look of disapproval (cf. the description of the
similar behaviour of Mr B's mother in Kohut, 1971, pp. 81-2.)
We are again confronted by the puzzling
question why this crucial material had not appeared during Mr Z's
first analysis. To be sure, it had indeed appeared, but--what is even
more incomprehensible--it had failed to claim our attention. I believe
that we come closest to the solution of this puzzle when we say that
a crucial aspect of the transference had remained unrecognized in
the first analysis. Put most concisely: my theoretical convictions,
the convictions of a classical analyst who saw the material that the
patient presented in terms of infantile drives and of conflicts about
them, and of agencies of a mental apparatus either clashing or co-operating
with each other, had become for the patient a replica of the mother's
hidden psychosis, of a distorted outlook on the world to which he
had adjusted in childhood, which he had accepted as reality--an attitude
of compliance and acceptance that he had now reinstated with regard
to me and to the seemingly unshakable convictions that I held.
The improvement which resulted from
the first analysis must therefore be considered in essence as a transference
success. Within the analytic setting, the patient complied with my
convictions by presenting me with oedipal issues. Outside the analytic
setting, he acceded to my expectations by suppressing his symptoms
(the masochistic fantasies) and by changing his behaviour, which now
took on the appearance of normality as defined by the maturity morality
to which I then subscribed (he moved from narcissism to object love,
i.e. he began to date girls).
Was the success of the second analysis
based on a similar mechanism, it may be asked. Did .he, in other words,
simply shift to a new compliance with the new convictions to which
I now adhered? I do not think so. Not only was his need to comply--particularly
the fears that stood in the way of non-compliance--extensively investigated
and worked through; the intense emotions which accompanied his struggles
with the issues that were activated now and the zest with which he
ultimately turned towards life had a depth and genuineness that had
been absent during the first treatment.
But let me be specific. Mr Z's increasing
awareness of the mother's psychopathology and his understanding of
its pathogenic influence on him could not be maintained without a
great deal of emotional toil. The emergence and analytic illumination
of this material was interrupted time and again by serious resistances
in the form of doubts motivated by the nameless fear, to which (Kohut,
1977, p. 104)1 have referred as `disintegration anxiety.' Which reality
was real? His mother's reality? The reality for which the first analysis
had stood? Or the present one? Over and over, he struggled with these
questions. And many times, particularly in the beginning of this phase
of the analysis, he turned in his search for certainty to the fact
that the mother had now developed a set of delusions which demonstrated
without question that her outlook was distorted. And over and over,
he remembered his reaction when he had first fully realized that the
mother was mentally ill, that she harboured a set of delusions. His
immediate reaction--deeply puzzling to him at that time but now becoming
intelligible--had been one of a quietly experienced, intense inner
joy. It was the expression of his sense of utter relief about the
fact that he now, potentially at least, ha witnessesed that he was
not alone in knowing that the way the mother saw the world particularly,
of course, the way she had behaved toward him during his childhood,
was pathological.
It was after overcoming surges of resistance
of this type that the most significant progress was always made, i.e.
that he was able to take another step towards freedom, away from the
enmeshment with the mother. Although this process came to full fruition
only much later in the analysis, the lessening hold of the merger
enmeshment with the mother allowed us to take a fresh look at two
important sets of childhood experiences which, during the first analysis,
I had interpreted as manifestations of a fixation on and/or regression
to infantile modes of pleasure gain through the gratification of pregenital
drives. We now saw the significance of his childhood masturbation,
with the fantasies of being the slave of a woman who unconditionally
imposed her will on him and treated him like an inanimate object that
had no will of its own, and the significance of his involvement with
the primal scene--of material, in other words, around which the working-through
processes of the first analysis had taken place (which we thought
had led to a cure)--in a totally different light. Where we had formerly
seen pleasure gain, the sequence of drive demand and drive gratification,
we now recognized the depression of a self that, wanting to delimit
and assert itself, found itself hopelessly caught within the psychic
organization of the selfobject. We realized not only that neither
his masturbation nor his involvement in the primal scene had ever
been enjoyable, but that a depressive, black mood had pervaded most
of his childhood. Since he could not joyfully experience, even in
fantasy, the exhilarating bliss of growing self-delimitation and independence,
he tried to obtain a minimum of pleasure--the joyless pleasure of
a defeated self--via self-stimulation. The masturbation, in other
words, was not drivemotivated; was not the vigorous action of the
pleasure-seeking firm self of a healthy child. It was his attempt,
through the stimulation of the most sensitive zones of his body, to
obtain temporarily the reassurance of being alive, of existing.'
I remember in particular the time during
this phase of the analysis when Mr Z recovered the following two interconnected
memories. In the first, he recalled how during childhood and latency
he would often drag himself through a joyless day by telling himself
that night would come and he would be in bed and could masturbate.
I shall not attempt to describe the emotionality that surrounded this
memory, poignantly presenting the utter dreariness of a child's existence
whose only solace in the face of the almost total lack of the joyful
sense of growth and independence open to healthy children, is the
thought that he could stimulate his lonesome body in endlessly prolonged
masturbatory activities--yet even then unable to rid himself of the
awareness of his lack of self
delimitation, as the accompanying masochistic fantasies demonstrate.
In the second memory--it belonged to the deepest layer of the unconscious
uncovered during this period--he recalled not only that, before the
construction of his masochistic fantasy system, he had for a brief
time engaged in anal masturbation but also-this aspect of his recall
was initially accompanied by the most intense shame-that he had smelled
and even tasted his faeces. As I said, the recall of these memories
was at first extremely painful and the reactivation of his childhood
sadness or shame seemed at times of overwhelming intensity. Still,
in the context in which the recall took place, Mr Z's experiences
were well within tolerable limits because he had come to understand
for the first time, in empathic consonance with another human being,
that these childhood activities were neither wicked nor disgusting,
but that they had been feeble attempts to provide for himself a feeling
of aliveness, manifestations of that surviving remnant of the vitality
of a rudimentary self which was now finally in the process of firm
delimitation. He understood, in other words, that to be separate from
the mother was neither evil nor dangerous but the appropriate assertion
of health.
We also re-evaluated the primal-scene
experiences and ultimately grasped their essential significance only
when we saw them as belonging to the depression that had pervaded
his childhood. His involvement with the primal scene, in other words,
was not a manifestation of the healthy sexual curiosity of a firmly
consolidated, investigative self--a healthy curiosity that may come
to grief if the prohibitions from and fears of the loved-hated incestuous
objects create conflicts that the child is unable to solve and therefore
represses. For Mr Z, the primal scene was ab initio an unempathically
overstimulating experience, understood by him as a demand to be absorbed
by the activities of the mother. And he submitted to this demand via
the masochistically sexualized relinquishment of his independence.
The second phase of the second analysis
cannot, of course, be neatly separated from the first, but, taken
as a whole, it differed from the first in its feeling tone. The depressive
elements receded, and active yearnings, intensely felt and vigorously
expressed demands, an increasingly prominent vitality, buoyancy, and
hopefulness were now in evidence. And simultaneously, the content
of his communications shifted; he turned from the previous almost
exclusive preoccupation with the mother to thoughts concerning his
father.
He still talked about his parents' sexual
relations, for example. But whereas in the preceding phase he had
hardly considered his father's participation--and my attempts to emphasize
that mother and father had been engaged in intercourse had
evoked no significant response from him--his associations (direct
memories and, occasionally, transference fantasies about the analyst's
sex life) now began to turn spontaneously more and more to his father's
role. At first the affect that accompanied the analytic work in this
area was, again, one of depression and hopelessness--the mood, in
other words, that had been prevalent during the first phase was still
the same. But his hopelessness was now not as diffuse as it had been
before--it related increasingly to a distinct preoccupation: that
his father was weak, that the mother dominated and subdued him. At
this time he also reminisced briefly about the old schoolfriend who,
by turning from him and his mother (see p. 4), seemed to have brought
about the psychic imbalance that had prompted him to seek analytic
help in the first place. Despite the importance which the support
he had obtained from the relationship with this friend had had for
him, and despite the fact that we could understand its nature without
much difficulty--it was in essence a mutually supportive twinship--this
theme did not remain active for long and the significance of its emergence
at this point remained unclear. It was replaced by period of strong
transference involvement, in the specific form of the need to know
more about me. Side by side, in other words, with continuing references
to the primal scene and complaints about the weakness of his father
and of his father's lack of interest in him, he began to express intense
curiosity about me. He wanted to learn about my past, in particular
about my early life, my interests, my education. He wanted to know
about my family, the nature of my relationship to my wife and whether
I had children. Whenever I treated his inquiries as a revival of infantile
curiosity and pointed out the associative connections with the sex
life of parents, he became depressed and told me I misunderstood him.
No serious analytic impasse developed, however. Although I did not
accede to his demands for specific information about me, but told
him that his wish to get to know me was surely rooted in an old wish
or need, I did concede that, after listening to further and watching
his reactions, I had to agree with him that the term 'curiosity' that
I had been using had not been right--that what he was experiencing
now was not a revival of sexual voyeurism of childhood but some different
need. And I finally ventured the guess that it was his need for a
strong father that lay behind his questions, that he wanted to know
whether I, too, was weak--subdued in intercourse by my wife, unable
to be the idealizable emotional support of a son. The result of this
shift in my interpretative approach was dramatic lessening of his
depression and hopelessness. He dropped his demands that supply him
with information about me--as a matter of fact he ultimately saw the
friendly firmness with which I had refused to accede to his demands
as an asset of my personality, a sign of my strength--and he made
do with certain bits of information which he had obtained either accidentally
or via inference--my interest in art and literature, for example--and
talked about his impression that, in my case at least, the love of
the world of the mind was not a retreat motivated by inability to
compete in the real world, but compatible with masculinity, with courage.
And when he talked again about the camp
counsellor, he spoke as in the first analysis, of his friend with
affection and respect, expressed no regrets about the homosexual activities
in _which they had engaged, but saw his relationship to him as an
enriching friendship with a strong and admired man. On the whole,
I tended to concur with Mr Z's assessment. Different, in other words,
from the understanding of the friendship that I communicated to the
patient during the first analysis--namely, that it had represented
a regression to the phallic mother--I now agreed that his friend had
been the yearned-for figure of a strong fatherly man, perhaps the
admired older brother he had never had. I disagreed with him, however
(I did not expand on this view, mentioned it only once, briefly) about
the innocuousness of the sexual aspect of the relationship. I thought,
in other words--and I continue to incline toward this view--that Mr
Z would have obtained more lasting benefits from the friendship with
this man who, as far as I can judge, was indeed a remarkable person,
if their closeness had remained free of sexual contacts. (The fact,
it may be added, that no homosexual conflict became activated during
the transference revival of the relationship could well be taken as
evidence that I am wrong and that the patient was right.)
Be that as it may, the analysis took
a new turn at this point: it fastened for the first time directly
on Mr Z's father, who had remained a shadowy figure up to now, despite
my interpretative efforts during the first analysis to penetrate resistances
which, as I then believed, shielded his narcissistic delusions from
the awareness of a powerful oedipal rival. For the first time now--and
with a glow of happiness, of satisfaction--Mr Z began to talk about
positive features in his father's personality.
This was, as can be judged in retrospect,
the crucial moment in the treatment-the point at which he may be said
to have taken the road toward emotional health. But the road was not
an easy one. As the analysis moved towards the next waystation, the
unfolding of the principal theme--the recovery of the strong father--was
interrupted by recurrent attacks of severe anxiety, including a number
of frightening, quasi-psychotic experiences in which he felt himself
disintegrating and was beset by intense hypochondriacal concerns.
At such times he dreamed of desolate landscapes, burned-out cities,
and, most deeply upsetting, of heaps of piled-up human bodies, like
those in pictures of concentration camps he had seen on T.V. The last
image was especially horrible because, as he reported, he was not
sure whether the bodies were those of dead people or of people still
barely alive. It should be added here that during this phase of the
analysis neither the patient nor the analyst was as concerned about
a possible irreversible or protracted disintegration as one might
perhaps expect in view of the alarming content of many of the sessions.
There is no question that our tolerance for the upsetting material
was in essence connected with our always present and continuously
deepening understanding of its meaning and significance: that Mr Z
was now relinquishing the archaic self (connected with the selfobject
mother) that he had always considered his only one, in preparation
for the reactivation of a hitherto unknown independent nuclear self
(crystallized around an up-to-now unrecognized relationship to his
selfobject father).
Only once did the mother appear in any
of these dreams. Although the visual content of this dream was simple
and in itself innocuous--a starkly outlined image of the mother, standing
with her back turned toward him--it was filled with the deepest anxiety
he had ever experienced. Our subsequent work, pursued for several
sessions, illuminated the dream in considerable depth. On the most
accessible level there was this simple meaning: the mother was turning
her back to him; she would now abandon him because he was moving closer
to his father. Without going into the details of his associations,
I should add that, in connection with this interpretation of the dream,
which was suggested by the patient without any prompting from me,
Mr Z gave several examples--memories from childhood and later--of
the mother's icy withdrawal from him when he attempted to step towards
independence, in particular toward independent maleness. In former
times the patient had always responded to this signal by an emotional
return to the mother.
The deeper meaning of the dream was
contained in its invisible part : it concerned the unseen, the unseeable
frontal view of the mother. When he tried to think about it, to imagine
what it would show, he experienced intense anxiety; and he was never
able to find words for what he might see. When I suggested the horror
of castration, of the sight of the missing external genital, of fantasies
of blood and mutilation which children form by combining the sight
of the menstrual blood and of the vulva, the patient brushed these
suggestions aside. While he agreed that the imagery of mutilation,
castration, and blood was related to the unnamed horror, he was sure
that this was not the essential source of the fear. Although he himself
was never able to formulate his fear in a concrete way, when I suggested
that the mother may not have lost her penis but her face, he did not
object but responded with prolonged silence from which he emerged
in a noticeably more relaxed mood. Thus although I believe that the
archaic fear to which he was exposed defies verbalization, I think
that my attempt to define it came sufficiently close to the psychic
reality of his experience to allow him a degree of mastery. All in
all, expressed in more objective terms, the conclusion which we ultimately
reached was that the unseen side of the mother in this dream stood
for her distorted personality and her pathological outlook on the
world and on him--of features, in other words, that he was not only
forbidden to see but whose recognition would in fact endanger the
structure of his self as he knew it. The dream expressed his anxiety
at the realization that his conviction of the mother's strength and
power--a conviction on which he had based a sector of his own personality
in intermeshment with her--was itself a delusion.
For the sake of clarity and in order
to avoid unnecessary complexity, I shall now describe the process
of the reinstatement of Mr Z's childhood relationship to his father
during the analysis as if it had had a clearly defined beginning at
a point when the working through of the aforementioned anxiety and
of the resistances that were mobilized by it had come to a clearly
defined completion. In reality, of course, Mr Z's move toward his
father and the recovery of memories about him took place step by step,
each step being preceded and followed by renewed and intensified fears
and resistances. In view of the fact that the relation between transference
analysis and the recall of genetic data is well known, there is also
no need to describe the details of the transference phenomena in the
restricted meaning of this term that were in evidence during this
period. Suffice it say that the emergence of the decisive, positively
toned childhood memories about the patient's father was preceded and
accompanied by his idealization of me--including, as one would expect,
the idealization of my professional proficiency. And, also unsurprising
in the context, Mr Z expressed at that time the wish to become an
analyst--a wish, it may be added that soon faded spontaneously.
In the memories which now emerged, he
dwelt particularly on a two-week skiing vacation he had taken with
his father in a Colorado resort at the age of 9 (probably because,
at the time, the mother was involved with her own mother's terminal
illness). These memories are of decisive significance because they
concern two crucially important topics: his discovery that his seemingly
weak and shadowy father possessed indeed certain rather impressive
assets embedded in a well-defined personality, and his increasing
realization that he harboured an intense need from childhood to find
out something about his father, to clear up a specific, mystifying
secret.
With regard to his father's positive
features, about which he spoke now with an increasing glow of joy,
it must be said that, as far as I could judge, Mr Z did not describe
any outstanding qualities and there was clearly some discrepancy between
Mr Z's emerging enthusiasm and objective fact. But Mr Z's father seems
indeed to have been a good skier and also something of a man of the
world. He had a way with the waiters and chambermaids, and was soon
surrounded by a circle of followers who were fascinated by his stories
and appeared to look up to him. From listening to his telephone conversations
and hearing his comments when he read the papers, the patient also
got a glimpse of his father's business activities; and he came to
admire his resoluteness, perceptiveness, and skill in this area. The
psychological essence, however, of this phase of the analysis lay
not in the patient's discovery of any surprising qualities of his.
father, either at the time in his early life of which he spoke, or
in his retrospective evaluation, but in his recovery of the intensely
experienced awareness that his father was an independent man who had
a life independent from the life of the mother--that his father's
personality, whatever its shortcomings, was by no means as distorted
as that of the much more powerful mother. I will add here that my
interpretations during this phase, both as they concerned the idealizing
transference and the recovery of his father's positive features, were
focused on the meaning that these two sets of experiences had for
the patient. I did not confront him with the reality of either my
own or of his father's shortcomings, but restricted myself to giving
expression to my understanding for his need--in childhood and as now
revived in the transference--for an idealized man to whom he could
look up, of whom he could be proud.
The content of this phase of the analysis
(Mr Z's detaching himself from the mother and turning toward his father)
and, especially, the intensity of anxiety and resistance that we encountered,
had been unexpected. I was, however, even more surprised by what followed.
After speaking again briefly, mainly in associations to dreams, about
the primal-scene experiences when he was 5 or 6, he began to complain
of how little he knew about his father. Following a brief period of
transference fantasies, he suddenly expressed the suspicion that his
father had had a woman friend and that this woman had been present
during the Colorado vacation. Although we were never able to ascertain
beyond doubt whether this suspicion was justified, I believe, and
Mr Z agreed, that the evidence does indeed speak for it. The patient
had, with a single exception, no direct memory of any particular woman
to whom his father might have been attached. The exception concerned
a small but notable event. There were no manifest indications that
the emergence of this memory was opposed by resistances; it is, however,
surely significant that it appeared only after all the other memories
about the stay in Colorado had been communicated. As the patient remembered
it, it was on the last day of their stay at the hotel that his father,
for the first and only time, took the boy along to the bar in the
evening. Although his father was in general not a heavy drinker, he
seemed to have become somewhat high on this occasion and--the son,
despite some embarrassment, reacting to his father's capers with pride--at
one point joined the small orchestra and took over for their regular
male singer. There was applause from the other guests, and his father
received many congratulations, especially from one particular woman
who came to their table and had a brief chat with the boy. Mr Z thought
now that this woman might well have had a special relationship with
his father; and he even speculated whether she could have been the
nurse who had taken his father away from the family when the patient
was a small child.
Be that as it may, the patient never
mentioned the episode to the mother when, after their return, he responded
to her inquiries about the vacation. Although his father had never
explicitly asked him to refrain from mentioning the episode, he felt
that there was a silent understanding between them that he would be
quiet about it. Most suggestive, and perhaps the only piece of positive
evidence with regard to Mr Z's suspicion that the significance which
the woman at the bar had for him was not simply due to endopsychic
falsifications but that she was in fact the ` other woman' in his
father's life, was that he now recalled a specific image which had
appeared fleetingly in several dreams of his first analysis, dreams
that now took on a new significance and became understandable. The
only thing these dreams had in common was that they contained the
image of an unknown woman. When Mr Z reported these dreams during
the first analysis he had never been able to produce any illuminating
associations to this figure, except that the woman was thin-similar
in appearance to the woman in Colorado-and-dissimilar to the woman
in Colorado-, being dressed like a working-class girl, that she was
not of their own social group. My own conclusion during the first
analysis had been that the woman represented the debased image of
the patient's mother, that the patient, when he came closest to incestuous
sexual fantasies, produced a degraded image of herapproximately corresponding
to the splitting of the man's love aspirations that Freud (1912) described.
There is little more that needs to be
said about this period of the analysis--a period whose end marked
the beginning of the termination phase. It might not be amiss, however,
to emphasize my view that, in spite of the fact that at the time of
the episode at the resort Mr Z was already 9 years old--i.e. drive-psychologically
classified in a period of latency--this material represents, in terms
of the structure of Mr Z's personality, the deepest layer of the repressed.
I am basing my opinion on the fact that, as I mentioned before, this
cluster of memories was the last one in the course of the analysis
to which Mr Z gained access, that it was reached after overcoming
the most formidable resistances we encountered, and that the end of
the processes of recall and working-through concerning it signalled
the beginning of the termination phase of the analysis. No doubt it
might be maintained by some that these memories were no more than
derivatives: a cover for even more deeply unconscious material from
the oedipal period--that the triangle at the age of 9 was nothing
but a relatively harmless replicaa of the triangle experienced four
years earlier. I considered this possibility, of course. But I came
to the conclusion, as I have indeed in several analogous instances
in other, similar cases, that no pathogenic oedipal conflicts still
lay in hiding. And, unlike the feeling-tone that we recover in the
reactivation of the oedipal experiences in structural neuroses, Mr
Z's memories were not accompanied by a sense of hopeless rivalry with
his father, but by a feeling of pride in him. Further, there was no
depression and sense of inferiority, outgrowths of the child's feeling
defeated by the adult male but a glow of joy and the invigorating
sense of having finally found an image of masculine strength--to merge
with temporarily as a mean of firming the structure of his self, of
becoming himself an independent centre of strength and initiative.
As is usual in such instances, no early oedipal material from Mr Z's
childhood emerged in the analysis, and the competitive fantasies that
arose related to the analyst, not to his father. And they were not
accompanied by hopelessness and anxiety but by a sense of optimism
and vitality. The analyst-father was experienced as strong and masculine,
and so did the analysand-son now experience himself.
The actual onset of the terminal phase
was marked by the patient's returning to the analogous moment of his
previous analysis, namely, to the dream that had set in motion the
processes that ultimately led to the termination of the first analysis,
the dream of his father's return, loaded with packages containing
gifts for the patient, in which the patient had desperately struggled
to shut the door against the father's pressure. To my great surprise
the patient now presented associations that threw a totally different
light on the meaning of this dream. In the previous analysis, as will
be recalled, it had seemed to us that we had here the unambiguous
manifestations of the ambivalence of the child towards the oedipal
rival who he feared, would--Timeo Danaos et dons ferentes--end
his near-exclusive possession of the mother, and destroy him. Now
the memory of this old dream emerged, not in order to start
us on a period of working through, but as a result of successfully
carried out working-through processes. Its emergence constituted a
bonus, so to speak: confirmatory evidence that the material with which
we had been dealing in the preceding year had indeed been of crucial
significance. It is in harmony with this view that the unrolling of
the process by which the re-analysis of this dream took place was
hardly based on associations or slowed down by resistances. True,
there were associations presented in the session in the second analysis
in which he returned to this dream. And there were also, in subsequent
sessions, interspersed with additional reflections about this dream,
associations--including currently dreamed fragmentary dreams--that
dealt with fleeting transference-fears with regard to me, i.e., to
be exact, with regard to the image of the analyst. But otherwise the
emergence of all this material was virtually unopposed. It was as
if all the decisive work leading up to the present significant insights
had already been done, and that the associations were therefore not
stepping stones on the way to the new insight but supportive evidence
for an already preconsciously established new explanation.
The new meaning of the dream as elucidated
by the patient via his associations, to put his message into my words,
was not a portrayal of a child's aggressive impulse against the adult
male accompanied by castration fear, but of the mental state of a
boy who had been all-too-long without a father; of a boy deprived
of the psychological substance from which, via innumerable observations
of the father's assets and defects, he would build up, little by little,
the core of an independent masculine self. When the father suddenly
returned to take his position in the family, the patient was indeed
exposed to a frightening situation. The danger to which he was exposed
was not, however, to his body but to his mind. A traumatic state arose
of which the dream constitutes only a tame replica--a traumatic state
that had threatened not the boy's physical but his psychological survival.
Having been without his father during the period when a male self
is phase-appropriately acquired and strengthened via the male selfobject,
the boy's need for his father, for male psychological substance, was
enormous. No independent self had gradually formed; what psychological
existence he had managed to build was rooted in his attachment to
the mother. In his enslavement he managed to gain some drive-pleasure--but
not the exhilarating joy of the experience of an active independent
sexual self.
His father's return had exposed him
suddenly to the potential satisfaction of a central psychological
need. Just as a correct but unempathically overburdening interpretation
may expose the analysand to a traumatic state (see Kohut, 1971, pp.
232-5), so he had been exposed-but a thousandfold-to a traumatic state
by being offered, with overwhelming suddenness, all the psychological
gifts for which he had secretly yearned, gifts which indeed he needed
to get. The father, loaded with packages, trying to enter, the son
defending himself desperately against his father's entry-despite the
fact that some of Mr Z's associations touched briefly on intermediate
systems of psychological material relating to homosexual themes, particularly
with regard to his homosexual attachment in preadolescence, this dream
deals in its essence with the psycho-economic imbalance of major proportions
to which the boy's psyche was exposed by the deeply wishedfor return
of his father, not with homosexuality, especially not with an oedipally
based reactive passive homosexuality.
Since I am familiar with the propensity
of the psyche to respond to traumatic states by various forms of sexualization--by
sexualizing the overburdening psychological task (see Kohut, 1971,
pp. 69-73, esp. p. 72n. and p. 168)--I was alert to the possibility
that Mr Z might have developed wishes or fantasies of anal penetration
by his father, i.e. of obtaining male psychological substance by passive
means. I could obtain no evidence for the existence of such fantasies,
however, either in the transference or via the recall of memories
from his childhood or adolescence. The manifest content of his dream--the
multiplicity and spatial distribution of the gifts with which his
father was loaded, a feature which, as I said earlier, invites comparison
with the richly elaborated description of the appurtenances of the
father figure in the first dream of the second analysis (see p. 11)--and
the actual mode of bodily contact with the counsellor--holding and
being held, kissing, smelling--indicate that his need for the firming
of an independent self had become focused mainly on the absorption
of the selfobject via the skin and, to a lesser extent, via the respiratory
apparatus and the mouth. (I might add here, in passing, that in the
analysis of homosexuals the nature of the relationship to the selfobject
and thus the type of transference--mirror, twinship, or idealizing--is
usually easily deduced from the patient's description of the homosexual
practices he engages in or wishes for.)
It is not difficult to see in retrospect
what turn Mr Z's psychic development took at this point. Unwilling
to resign himself to giving up an independent self for good, yet finding
himself confronted by the impossible task of performing the work of
years in a moment, he began to experience himself in two different,
separate ways--his personality established a vertical split. Ostensibly
he remained attached to the mother, presented a personality that remained
enmeshed with hers, and--to express a host of fantasies with the aid
of a single representative specimen, possibly the replica of a fantasy
held by the mother--submitted to the role of being her phallus. And
next to this sector of his personality that was part of the mother
and of her pathology--the sector which openly displayed a grandiosity
that was bestowed upon him by the mother so long as he did not separate
himself from her--was another one, separated by a wall of disavowal.
In this quiet but allimportant sector he had preserved the idealizations
that maintained a bond to his father, had hidden away the memories
of his father's strength on which they were based. These idealizations,
in other words, acquired in later childhood as the result of his not
totally unsuccessful attempt to detach himself from the mother and
to build, belatedly, an independent male self, had, on the whole,
gone into repression.
It is of theoretical importance to emphasize
at this point that the relatively successful encounter with his father
when Mr Z was 9 was, of course, not the first relationship with a
selfobject that led to the laying down of self structure in this sector
of his personality. While there are all indications that it was indeed
the most important one of his early life, that it was, in other words,
not just a screen for or derivative of a more important earlier one,
the outlines of an independent self had been drawn much earlier in
life. The vicissitudes of the rudimentary self that was tentatively
formed during the first years of life played no significant role in
Mr Z's analysis. Still, we can deduce from the information we obtained
about his earlier childhood that not only his father and maternal
grandfather but that even the mother, especially when he was quite
young, had contributed to the formation of the nuclear self that lay
inactive in repression in this split-off sector of his personality.
The event when he was 9 was important because his independent self
obtained at that time sufficient strengthening to permit its psychoanalytic
liberation and activation. It may be added here that in most instances
of telescoping (see Kohut, 1971, p. 53) the event that becomes the
representative of earlier and later events of analogous significance
is the one through which a structure is almost successfully established,
yet still not firm enough to assert itself through actions.
The needs which were active in his horizontally
split-off, i.e. repressed, layer of the psyche, and the memories of
experiences that were associated with these needs, came to the fore
only twice: during preadolescence in Mr Z relationship to the counsellor
which--as I am inclined to believe, because of its sexualization--did
not lead to truly structure-building, wholesome results; and during
his second analysis when transmuting internalizations gradually achieved
via the extensive working through of his idealizing transference,
led to the it is hoped, permanent and reliable completion of a process
that had remained unfinished in childhood.
The terminal phase of the analysis was
comparatively brief and uneventful. While we had a year earlier tentatively
agreed that this might well be the last year of the analysis, the
definite decision to end our work with beginning of the summer vacation
was made only three months earlier. The substantial regressions that
we have come to expect at the end of long analyses did not come about
in Z's case: neither did Mr Z's old symptoms (in particular his sexual
masochism) return, nor did he experience serious anxiety concerning
the loss of my supportive presence. There was a brief period, perhaps
three weeks, when he felt some sadness about losing me, side by side
with the regret, never before fully expressed, concerning the fact
that his father was dead and that the chance for developing a friendly
relationship with him, to make him proud of him and his achievements,
was gone. And for a few sessions he also expressed considerable anger
toward me for having originally failed him, like his father in childhood;
that his analysis had therefore taken longer than it should, that
he was now older than he should be at the stage of development he
had finally reached. The Iast months of the analysis were, however,
entirely filled by retrospective themes; there were also thoughts
about the future--plans about his work and about the possibility of
getting married and of having children. Imagery about a relationship
to a son dominated in this context--he did not talk much about the
kind of wife that he hoped to find and about the life that he might
lead with her.
During the last few weeks of his analysis
I was very impressed by his expanded empathy with and tolerant attitude
towards the shortcomings of his parents. Even with regard to the distortions
of the personality of his mother which had exerted such a deleterious
influence on his development, he could now express a modicum of understanding
and even compassion. And he was also able to see, without a trace
of the idealizations with which he had begun his first analysis, the
positive features of her personality. Without any merger propensity,
but on the firm basis of his separateness and maleness, he could acknowledge
that, despite her serious psychopathology, she had given him a great
deal. Not only did he conjecture that during his early infancy she
might have been a good mother whose mirroring acceptance of him had
provided him with the core of vitality that, much later, had allowed
him to persist in the pursuit of emotional health despite the serious
obstacles that stood in his way, he also acknowledged that many of
his greatest assets, implanted into his personality much later in
his childhood, including those that enabled him to be competent, indeed
creative, in his work, had come from her. We both came to assume in
this context that his mother had undergone a silent but malignant
personality change-perhaps in response to a beginning deterioration
in her relationship to Mr Z's father--but that, despite the serious
distortions of her personality we discovered during Mr Z's second
analysis, she had preserved throughout her life, even after she developed
an encapsulated paranoid psychosis, not only a healthy and lively
mind with regard to areas outside of her distorted interpersonal perceptions,
but also a modicum of firmness, truthfulness, and realism.
On the whole I believe that I now understood
how the structure of Mr Z's self as it became clearly outlined during
the last weeks of the analysis was genetically related to the personalities
of his parents. His most significant psychological achievement in
analysis was breaking the deep merger ties with his mother. But despite
this break he not only retained his most significant talents and skills,
which now enabled him to be proficient in his profession, but also
the specific content of his ambitions and ideals which had determined
the choice of his work and made it emotionally meaningful to him--even
though these talents, skills, ambitions, and ideals had arisen in
the matrix of the now abandoned merger relationship with the mother.
Neither his most important skills
and talents nor the content of his ambitions and ideals were thus
primarily influenced by his father's personality. Yet all three constituents
of his self were decisively changed during the analysis. The working
through of his transference relationship to me enabled him to reestablish
a link with his father's maleness and independence, and thus the emotional
core of his ambitions, ideals, and basic skills and talents was decisively
altered, even though their content remained unchanged. But now he
experienced these assets of his personality as his own, and he pursued
his life goals not in masochistic compliance--as had been the case
following his first analysis--but joyfully, as the activities of an
independent self.
When the analysis came to its end, the
patient was in a calm and friendly mood. He was not involved in any
significant relationship at that time; indeed, throughout the second
analysis there had been no strong or significant involvements with
people, even though he had engaged in a number of relationships with
women and his sexual experiences were satisfying. But he spoke little
about that; the analytic work which led to the crystallization of
his autonomous self absorbed him fully. I learned, of course, a good
deal about his everyday life during the years of his analysis, but
much more about his professional work than about his contacts with
people. During the last year of his analysis he talked from time to
time about his plans for a major work that he wanted to undertake,
plans which, I learned later, came to fruition and established him
as a promising contributor in his field. Thus, even though I thought
when the analysis was over that the area of interpersonal relationships
would never play the dominant role in his life that it does for the
majority of people and that it would not provide him with his most
fulfilling experiences, I felt that the narcissistic-creative sector
of his personality, with its rich endowment, was sufficiently freed
and securely enough established to justify the confident hope that
he would be able to lead a satisfying and joyful life.
A number of years have now passed since
the end of the analysis and, except for friendly Christmas cards (one,
about a year and a half after termination, saying he had recently
married; another, several years later, announcing the birth of a daughter),
I have heard nothing from Mr Z directly. I did obtain some indirect
information about him from a patient currently in analysis with me
who works with Mr Z in a subordinate position. This young man, who,
it should be added, does not know of my having been Mr Z's analyst,
admires Mr Z greatly. But since his relationship to Mr Z constitutes
at times a collateral idealizing transference, his reports cannot
be taken at face value. I do know from this source however, that Mr
Z's work is recognized as outstanding in his field and that he is
an inspiring teacher. Via another informant I have learned a good
deal about the personality of the woman whom Mr Z married. She appears
to be a well-balanced, warm-hearted, socially outgoing person, without
a trace of the paranoid certainty and need to control that had characterized
Mr Z's mother. Even though she works in Mr Z's field, she is more
what one might call an out-of-doors type than an intellectual. I concluded
that Mr Z had chosen a partner who possessed his father's best features
embedded in a matrix of femininity. And I concluded that he had made
a good choice.
SUMMARY
As I stated initially, the preceding report was presented in order
to buttress the claim that the new psychology of the self is helpful
in the clinical area, that it allows us to perceive meanings, or the
significance of meanings, that were formerly not perceived by us,
at least not consciously. This is not a theoretical presentation of
the psychology of the self--the theoretical knowledge needed will
have to obtained elsewhere (see, in particular, Kohut 1971, 1972,
1977 and Kohut & Wolf, 1978). In order to assist the reader I
append a diagrammatic summary of the psychopathology of Mr Z as it
was perceived by me in his two analyses. For the rest I hope that
this case report will speak for itself.

REFERENCES
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