fliercanletgo

FugitivesFromGuilt:PostmodernDe-MoralizationandtheNewHysterias*byDonaldL.
Carveth,Ph.
D.
&JeanHantmanCarveth,Ph.
D.
OneofthemanyimportantlessonsFreudlearnedfromCharcotduringhisperiodofstudyattheSalpetriere(Oct.
1885–Feb.
1886),wasthatmalehysteriaexists.
"WhatimpressedmemostofallwhileIwaswithCharcot,"Freud(1935)writesinhisAutobiographicalStudy,"werehislatestinvestigationsofhysteria,someofwhichwerecarriedoutundermyowneyes.
Hehadproved,forinstance,…thefrequentoccurrenceofhysteriainmen.
…"(p.
13).
ButwhenFreudbroughtthenewsofmalehysteriabacktoViennahegotacoldreception.
Hewrites:"Oneofthem,anoldsurgeon,actuallybrokeoutwiththeexclamation:'But,mydearsir,howcanyoutalksuchnonsenseHysteron(sic)meanstheuterus.
Sohowcanamanbehysterical"(p.
15).
Butthefactisthatmencertainlycanbehysterical,asFreudknewfromthecasewithwhichhewasmostfamiliar:himself(hisfamoushystericalfaintingepisodesprovidemerelyoneexample).
Althoughheoftentriedtoconceptualizehispersistentsymptomsasarisingfromwhathecalledanactualasdistinctfromapsychoneurosis,aconditionofanessentiallysomaticordersupposedlywithoutpsychologicalmeaning--theconceptoftheactualneurosiswasdroppedbysubsequentpsychoanalystsbecausenocasesofitwerefound.
Atothertimes,FreudwasabletoacknowledgebothtohimselfandothersthehystericalandPage1of62FugitivesFromGuilt03/02/2007http://www.
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htmpsychoneuroticnatureofcertainofhissymptoms.
Buttheresistancetorecognitionofmalehysteriapersisted.
TheconceptreceivedlittleattentioninFreud'sownlaterwork,orinthatofhiscolleaguesand,asElaineShowalterhaspointedout,despiteitsearlyrecognitionofthefactofmalehysteria,psychoanalysiscameessentiallytocolludewiththewiderculturalfeminizationofhysteriainwhichamanmightbesaidtobehystericalifhewashomosexual,butotherwisehishysteriawouldberedefinedas"shellshock,""battleneurosis,""post-traumaticstressdisorder,"orsomeothermore"manly"condition.
Inspeakingofhysteria,werejectsuchfeminizationandseektoreinforceFreud'sandCharcot'soriginaldiscovery.
Whileitsfeminizationisasignificantaspectofourcultureofinteresttosociologistsandfeministtheorists,hysteriaitselfisnotagender-specificdisorder.
Weseerampantevidenceofmalehysteriainourpractices.
Itisbecauseweourselves,likemostpeopleweknow,havesufferedandattimesstilldosufferfromhystericalsymptoms,thatwechoosetospeakof"we"ratherthan"them"whenwerefertohysterics(andsufferersfrompsychosomaticconditionsaswell).
WhatthenishysteriaWithoutignoringanxietyhysteria(phobia,panicattacks,etc.
),weareconcernedprimarilywithconversionhysteria,aconditioninwhichwepresentsymptomsthatmimicthoseoforganically-basedmedicalillnesses,butthathavenoorganicbasis.
Theclassicexampleofthisistheso-called"gloveanesthesia"inwhichtheparalysisofthehanddoesnotfollowknownnervepathwaysbutcorrespondsinsteadtoourmentalconceptofthehand(asdistinctfromthewristortherestofthearm).
Hystericsarenotmalingerers:wedonotconsciouslyfakeorganicillness,weunconsciouslymimicit.
HysteriaisnottobeconfusedwithPage2of62FugitivesFromGuilt03/02/2007http://www.
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htmpsychosomaticdiseaseinwhichwesufferfromagenuinemedicalillnessordysfunction,butonebelievedtobecausedtoasignificantextentbypsycho-emotionalfactors.
Psychosomaticillnessisnot"onlyinone'shead";itisclearlyinone'sbodyasevidenced,forexample,inthebleedingulcersthought,insomecasesbysomeanalysts,toarisefromchronic,internalizedangerandrage.
Butwhatevertheircauses,theulcersthemselvesarereal,notmimicked.
Bycontrast,hystericalsymptoms,althoughpsychologicallyrealandpainfulenough,havenoorganicbasis:theyareproductsofmimesis.
Becausetheirsymptomsarenotconsciouslyfaked,butunconsciouslymimicked,hystericsarenotmalingerers,butneuroticsufferers.
Thesymptomsofbothconversionhysteriaandpsychosomaticdiseasearepainfulandtormentingtopatientssufferingfromthem(and,ofcourse,therearecasesreflectingamixtureofthetwo,asinthecaseofMr.
B.
,describedbelow).
Why,thepsychoanalystmustask,dowebringsuchsufferingandtormentuponourselvesTheanswer,webelieve,isthatwe(bothhystericsandpsychosomatics)haveanunconsciousneedforpunishment.
ButwhydoweunconsciouslyseekpunishmentWedosobecauseourunconscioussuperego(notourconsciousconscience)judgesusguiltyofsomerealorimaginedcrime.
Thepunishmentweseekmaytakeoneoftwoforms:eithertheconscioussufferingentailedinhavingtobearguilt;ortheunconsciouslyself-inflictedsufferingentailedinhysterical,psychosomaticandotherneuroticsymptoms.
Thoseofuswhoconsidertheadmissionofsinandwrongdoinganintolerableinsulttoournarcissismandfindconsciousguiltunbearable,areforcedtoresorttosymptom-formation.
Thesufferingentailedinoursymptomsgratifiesthesuperegoneedforpunishmentand,atthesametime,evadesunbearableconsciousguilt.
However,thepriceofPage3of62FugitivesFromGuilt03/02/2007http://www.
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htmthisrefusaltorendersuperegojudgmentconsciousislossoftheopportunitytosubjectittorationalassessmentleadingeithertoconsciousacceptanceandthebearingofconsciousguilt,ortoconsciousrejectionandsuperegomodification.
Itispreciselytoavoidthequestion(whydowebringsuchsufferinguponourselves),andtheanswertowhichitleads(anunconsciousneedforpunishment),andthefurtherquestiontowhichthisanswergivesrise(whatisourrealorimaginedcrime),thatweresistsovociferouslytheverypremisethatgroundsthisunwantedseriesofquestionsandanswers:theideathatwedoinfactbringsuchsufferinguponourselves.
Ifwearetoevadetheissueof"crimeandpunishment,"wemustevadethefundamentalideathatwearetheagents,ratherthanvictims,ofourhystericalandpsychosomaticmisery.
Torepresentourselvesessentiallyaspassivevictimsoftheseafflictionsratherthanasagentsinflictingthemuponourselvesforunderstandablereasonsisto"de-moralize"ourunderstandingofsuchconditionsandourselves.
Buthowevermuchweseeksuchde-moralization,bothassufferingindividualsandasaculturalcommunityincreasinglycommittedtoade-moralizingpostmoderndiscourse,thefactremainsthat,likeitornot,thereisamoralistaliveandwellineachofus,andanoftenharshandsadisticoneatthat:ourunconscioussuperego.
De-moralizeasmuchaswelikeconsciously;denyagency,responsibilityandguiltasmuchaswewill.
Allthatappliesonlytoconsciousness.
Unlessitisanalyzed,confronted,renderedconsciousandmodified,theunconscioussuperegowillcontinuetoaccuseandtodemanditspoundofflesh.
Thede-moralizingculturalandpersonaldiscoursesthatrepressorotherwiseevadeagency,responsibilityandguilt,endupproducingthedemoralizingconditions(depression,masochism,hysteria,paranoia,psychosomaticdisease)thatresultfromtheactivityofthePage4of62FugitivesFromGuilt03/02/2007http://www.
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htmunconscioussuperegothatthesediscoursesdeny:de-moralizingleadstodemoralization.
Inourexperience,mostofus,toonedegreeoranother,arefugitivesfromguilt—whetherourguiltevasiontakesanhysterical,apsychosomatic,orsomeotherpsychopathologicalform.
Weclingtothede-moralizingdiscoursesthatwefabricateforourselves,sometimeswiththehelpofde-moralizingtherapists,andthede-moralizingdiscoursesofferedbyourpostmodernculture,inadesperateattempttobelievewearevictimsofmysteriousafflictionsratherthanmoralagentsafflictingourselveswithsufferingforourrealorimaginedcrimes.
Andwedothisbecausewerefusetheburdenofmoralagency:theneedeithertoconsciouslybearguiltorconsciouslyconfrontandmodifytheaccusingsuperego.
Itmatterslittlewhetherourhysteriatakestheold-fashionedformoftheparalyses,ticsandfaintingepisodes,etc.
,thatcharacterizedthehysteriasofthelatenineteenthandearlytwentiethcenturies,orsuchmorecontemporaryformsasso-called"environmentalillness,""multiplechemicalsensitivity,""chronicfatiguesyndrome,""fibromyalgiasyndrome,"etc.
(readersoftheNewYorkerwillbekeptuptodateregardingthenewesthystero-paranoidmanifestations),thedynamicsremainessentiallythesame.
HowevermuchwhatEdwardShortercalls"thelegitimatesymptompool"mayvaryfromtimetotimeandplacetoplace—forexample,alegitimatesymptominoneculturalsituationistheKorocomplaintthatsomeonehasstolenorreducedthesizeofone'spenis—theunderlyingdynamicsremainconstant:unconscioussuperegoaccusationforrealorimaginedcrimes,leadingtoaneedforpunishment,thattakestheformofhysterical,psychosomatic,paranoidandotherformsofpsychologicaland/orphysicalsuffering.
Page5of62FugitivesFromGuilt03/02/2007http://www.
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htmWhatdoescharacterizethenew,asdistinctfromtheoldhysterias,istheirmoreobviousrelianceupondefensiveexternalizationand,hence,theparanoidelementintheirstructure.
Itisforthisreasonthatweemploythetermhystero-paranoidtodescribestatesoffeelingpersecutedbysupposedenvironmentalagents(toxins,molds,parasites,etc.
)ormolestationbysataniccultsorbyaliens.
Theroleofhostility,itsprojection,anditsreturnintheformofdelusionsofexternalorinternalpersecutionisemphasizedinourpaperpreciselybecausethesefactorshavebeenunderemphasizedinmostpreviousdiscussionsofhysteria.
***InHystories:HystericalEpidemicsandModernMedia,ElaineShowalter(1997)exploresarangeofconditions—chronicfatiguesyndrome;multiplepersonalitydisorder;recoveredmemory;satanicritualabuse;alienabduction;GulfWarsyndrome—thatsheviewsasmodernformsofhysteriaasdistinctfromtheoldconversionandanxietyhysteriascharacteristicofthelastfin-de-siecleandexploredbyCharcot,Janet,BreuerandFreud.
Againstthewidespreadclaimthathysteriaisathingofthepast,havingdisappearedduetotheriseoffeminismoralevelofpsychologicalsophisticationincompatiblewiththeformationofhystericalsymptoms(exceptperhapsamongculturally"backward"populations),Showalterarguesthat,onthecontrary,farfromhavingdied,hysteriaisaliveandwellintheformofthepsychologicalplaguesorepidemicsof"imaginaryillnesses"and"hypnoticallyinducedpseudomemories"thatcharacterizetoday'sculturalnarrativesofhysteria(pp.
4-5).
Page6of62FugitivesFromGuilt03/02/2007http://www.
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htmAlthoughsheprovidesarichdescriptionofthenewhysterias—the"hystories"orhystericalstoriesofchronicfatigue,alienabduction,etc.
—Showalterdoesnotpretendtoofferadepthpsychologicalaccountofthepsychodynamicsunderlyingtheseconditionsbeyondidentifyingtheroleofsuggestiononthepartofphysiciansandthemediaintheircreationanddissemination.
Herdefinitionofhysteriaas"aformofexpression,abodylanguageforpeoplewhootherwisemightnotbeabletospeakoreventoadmitwhattheyfeel"(p.
7)andas"aculturalsymptomofanxietyandstress"arisingfromconflictsthatare"genuineanduniversal"(p.
9)isaccurateenoughasfarasitgoes.
Fromapsychoanalyticpointofview,however,itdoesnotgofarenough.
WhileshedoesnotappeartoshareMitchell's(2000)insightintothefactthat"thereisviolenceaswellassexualityintheseductionsandragesofthehysteric"(p.
x),Showalterdoescallattentiontothecentralityofexternalization(i.
e.
,projection)intheseconditions.
Shewrites:"Contemporaryhystericalpatientsblameexternalsources—avirus,sexualmolestation,chemicalwarfare,satanicconspiracy,alieninfiltration—forpsychicproblems"(p.
4).
Insocallingourattentiontotheparanoidelementinhysteria,albeitwithoutexplicitlytheorizingtheconnectionsbetweenhysteriaandparanoia,Showaltercontributestotheevolutionofadeeper,psychoanalyticunderstanding.
Inthefollowing,wewillfastenuponthisexternalizingfeatureandofferapsychoanalytic,moreparticularlyamodernKleinian,understandingofhysteria—includingso-calledmultiplechemicalsensitivity,environmentalillness,andfibromyalgiasyndrome—assub-typesofwhatweviewasamoregeneralhystero-paranoidsyndrome.
Page7of62FugitivesFromGuilt03/02/2007http://www.
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htmWhereastraditionalpsychoanalyticaccountshaveemphasizedtheroleofoedipalandpreoedipalsexualwishesandconflictsinhysteria,seldomassociatingitwithaggressionandparanoia,wewillarguethatsuchoverlookedpsychologicalfactorsasunconsciousaggression,envy,hostility,malice,destructivenessandtheresultingpersecutory"guilt"andneedforpunishmentoccupyacentralplaceinboththeoldandthenewhysterias.
[1]FollowingCarveth's(2001)conceptionoftheunconsciousneedforpunishmentasadefensiveevasionofunbearableconsciousguilt,ratherthanaguilt-equivalent(asinFreud'sview),weviewhysterical,psychosomatic,depressive,masochisticandotherself-tormentingconditionsasdefensivealternativestofacingandbearingconsciousguilt.
WhileouranalysishasmuchincommonwithbothShowalter's(1997)HystoriesandShorter's(1992)FromParalysistoFatigue,weatthesametimeseektocorrecttheiroccasionalblurringoftheimportantdistinctionbetweenhysteriaandpsychosomaticconditionsandtheiruseoftheterm"somatization"inthedescriptionofboth.
Showalter,forexample,evenwhilecorrectlynotingthat"Onthewhole,Freudiansmakestrictdistinctionsbetweenhystericalsymptomsandpsychosomaticsymptoms"(p.
44),refersto"psychosomaticconversionsymptoms"(p.
36).
Shemuddiesthewatersfurtherbydescribingtheconversionsymptomasaparticularformof"symbolicsomatization"(p.
44).
Butpsychosomaticsymptomsresultfromaprocessofsomatizationinwhichpsychologicalandemotionalforcescontributetothedevelopmentofgenuineorganicdiseaseandinwhichsymbolization,ifitisoperativeatall(andwebelieveitoftenis),takesasomewhatdifferentformthanitdoesinconversion.
ShowaltermakesnosecretofherPage8of62FugitivesFromGuilt03/02/2007http://www.
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htmdifficultywiththeseconcepts:"Howpsychiatriststellthedifferencebetweenhystericalandpsychosomaticsymptomsishardforalaymantofigureout"(p.
44).
Butinmanyinstancesitisn'thardatall:psychosomaticsymptomsaresymptomsofobjectivemedicaldisease:organictissuepathologyisevident.
Suchdiseaseisthoughttoresultfromthesomatizationofpsychologicalandemotionalforcesaffectingtheimmunesystemandoperatinginconjunctionwithvariousorganicandconstitutionalpredispositions.
Bycontrast,hystericalsymptomsinvolvenoobjectiveorganicpathologybutentailmimesis:theunconsciousmimicryoforganicdiseaseanddysfunction,asdistinctfromtheirconsciousimitationasinmalingering.
Whereasmanywritersonpsychosomaticdiseaseseeitasentailingthefailureorforeclosureofsymbolization,webelieveasymbolizationprocessmayyetbeatworkinit,asthefollowingcasevignettesuggests:CASE1:Mr.
A.
Mr.
Ahadbeensufferingforsomeyearsfromanobjectivelyobservable,painfullytormentingrashcoveringmuchofhisbodysurface.
Ithadprovedresistanttoamyriadofmedicaltreatments.
Recently,inaddition,hehadbeenexperiencingfrequent"accidents,"afewofwhichhadbeenlife-threatening.
Itturnedoutthatforyears,astheeldestsonPage9of62FugitivesFromGuilt03/02/2007http://www.
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htmofalargefamily,hehadbeensaddledwiththesoleresponsibilityforlookingafterhisagingparents,hischronicallydepressedmotherandhisbitter,manipulative,narcissisticfather.
Hisownbusinesswassufferingduetohisneedtomakefrequenttripstoanothercountrytoattendtheirrealandimaginedneeds.
Hissiblings,inthemeantime,wereleadingtheirownlivesandquitecontenttohavethepatientfreethemfromtheirownresponsibilitiesvis-à-vistheparents.
Whenaskedinthefirstsessionwhetherheeverfeltangryoverthisstateofaffairs,Mr.
A.
lookedcuriousandreportedthathisfriendshadsometimesaskedhimthat.
OverthenextfewsessionsMr.
A.
proceededtobecomeangrierandangrierandashedidsohisrashbegantodiminish.
HehadbeenraisedwithinaparticularlyconcreteandmagicalversionofOrthodoxChristianity.
Therash,itturnedout,hadmadehimfeelhewas"burninginhell"inpunishmentforhishithertounconsciousdeathwishestowardhisparentsandthesiblingswhosaddledhimwiththeresponsibilityforlookingafterthem.
Ashisrageanddeathwishesbecameconsciousandbegantosubsideashestartedtotakeconstructiveactiontoendhismasochisticsubmissiontoexploitation,therashgraduallydisappeared.
ButbecauseMr.
Awasunabletoexperienceandbearconsciousguilt,hisrashwasquicklyreplacedbyotherformsofself-sabotageandself-punishment.
Asaresultofclinicalexperiencesofthissort,wearenotatallconvincedthatthedifferencebetweenconversionandsomatizationboilsdowntothepresenceofsymbolismintheformeranditsPage10of62FugitivesFromGuilt03/02/2007http://www.
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htmabsenceinthelatter,thoughitispossiblethatdifferenttypesorlevelsofsymbolizationmaybeinvolvedinthetwoconditions.
ShowalterquotesMarkMicalewhowritesthat"hysteriais'notadisease;ratheritisanalternative,physical,verbal,andgesturallanguage,aniconicsocialcommunication'"(p.
7).
Psychosomaticillnessisdisease—butit,too,appears,atleastsometimes,toinvolveinterpretableunconsciousmeaning.
AccordingtoMitchell(2000),"hysteria'smanymanifestationshaveshownsomestrikingsimilaritiesthroughouttheages—sensationsofsuffocation,choking,breathingandeatingdifficulties,mimeticimitations,deceitfulness,shock,fits,deathstates,wanting(craving,longing)"(p.
13).
Underthecategoryofmimeticimitationsfallsthehystericalutilizationofthebodyinthesimulationoforganically-baseddiseaseandsomaticdysfunction.
Inthetheatricsof"conversion"physicalillnessisdramaticallymimicked—onceagain,unconsciously,notconsciouslyasinmalingering—andsomaticdysfunction(difficultyswallowing,paralysis,contracture,non-organiclimp,paraplegia,etc.
)lackinganydiscoverableorganicbasisisdisplayed.
Thetypeofhysteriaknownashypochondriainvolvessubjectivesufferingandtheconvictionthatoneismedicallyillintheabsenceofobjectiveevidenceofdiseaseorinjury.
Psychosomaticillnessinvolvessomatizationasdistinctfromconversionormimeticimitation.
Insomatization,manifestpsychologicaldistressofvarioussorts(suchasMr.
A'srage,deathwishes,andconsequentneedforpunishment)isfoundbythesubjecttobeunbearableandconsequentlyisforeclosedandsomehowchannelledintothebody,resultinginrealorganicdisease(suchasPage11of62FugitivesFromGuilt03/02/2007http://www.
yorku.
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htmhisobjectivelyobservableburningrash)whichfunctionsasaself-punitiveandpersecutoryalternativetounbearableconsciousguilt.
Theforeclosureofconsciousdistressdoesnotalways,wewouldargue,entailaforeclosureofsymbolization.
ThepainarisingfromhisorganicrashsymbolizedtoMr.
A.
thathewas"burninginhell"forhissins,hisfailureto"honour"motherandfatherandhisCain-likemurderousragetowardhissiblings.
Althoughalldiseaseinvolvespsychologicalfactorstosomedegree,whatdistinguishespsychosomaticdiseaseispreciselytheprominenceofpsychologicalfactorsinitsaetiology.
McDougall(1989)employsthetitleTheatresoftheBodyforabookdealingprimarilywithpsychosomaticdiseaseratherthanhysteria.
Butthereisnodoubtthattheatricsaremoreobviousinthedramaofhystericalconversionthanintheoftenobscuresomatizationprocessesunderlyingpsychosomaticdisease.
ThisisinnowaytosuggesttheabsenceofsymbolizationinwhatMcDougallviewsasthe"archaichysteria"ofpsychosomaticdiseaseasdistinctfromthetheatrical"neurotichysteria"(p.
54)inwhichitissoobvious.
Thepointisonlytosuggestthatthesymbolizationentailedinsomatization(asdistinctfromconversion)maytakethearchaicformthatSegal(1957)describesas"symbolicequation"ascontrastedwiththemoreelaboratedsymbolizationprocessesentailedinwhatshecalls"symbolicrepresentation.
"Farfromseeingmeaninginhysteriaandonlyaforeclosureofmeaninginpsychosomaticdisease,webelievethatinbothconditions,whateveradditionalfactorsmaybeinplay,weseeunconsciousaggressionandanunconsciousneedtosufferasanalternativetoanddefenseagainstunbearableguilt.
Butwhereasthemimicryandtheatricsofhysteriaembodyanhystero-paranoiddefenceagainstandsubstitutefortheexperienceofPage12of62FugitivesFromGuilt03/02/2007http://www.
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htmunbearableguilt,inpsychosomaticconditionstheneedtosufferfindsanall-too-realandconcreteoutletinthedevelopmentoforganicdiseaseanditsattendantdiscomfort,painandtorment.
BothclassicalFreudianandpost-Freudianpsychoanalysishaveemphasizedtheroleofsuchfactorsasforbiddensexualwishes,unresolvedoedipalconflicts,castrationanxiety,theneedforattachmentandthecompulsiontopreserveneededobjecttiesortheneedtopreserveathreatenedsenseofselfinhysteria.
Insodoingtheyhavetendedtolosesightoftheroleofaggressionandguilt—justasinvariousbranchesofcontemporarypsychoanalyticthoughtthedynamicsofthesuperegohavebeenlostsightof.
[2]Itisnotourintentinthefollowingtodenytheroleofsexuality,attachment,objectrelationsorissuesofidentityandtheself,butmerelytore-focusattentionuponfactorsweregardascentralbutwhich,foravarietyofreasons,havesuccumbedincertainbranchesofcontemporarypsychoanalysistowhatJacoby(1975)hasreferredtoasthe"socialamnesia"inwhich"societyrememberslessandlessfasterandfaster"andinwhich"thesignofthetimesisthoughtthathassuccumbedtofashion"(p.
1).
Evenwhile"listeningwiththethirdear"(Reik,1948)tothelatentmeanings,messages,motivesanddynamicsunderlyingmanifestsymptomsandexperience,Freudwassocentereduponsexualityatthetimewhenhewasmostconcernedwithhysteriathathetendedtooverlookordownplaytheroleofaggressioninthiscondition.
AlthoughinhisdualinstincttheoryFreud(1920)eventuallymadeaggressionasfundamentalassexualityinhismetapsychology,heneverreworkedhispsychologyofhysteriainthislight.
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htmMitchell(2000)hasrecentlyarguedthatanotherreasonfortheneglectoftheroleofaggression(and,hence,ofguilt)inhysteriahastodowithFreud'sandsubsequentpsychoanalysts'relativeretreat(itwasnevercomplete)fromCharcot'sandFreud'sownearlierrecognitionofthefactofmalehysteria.
Despitethisrecognition,Freudandhisfollowerscametocolludewiththewiderculturalequationofhysteriawithfemininity.
Whilehysteriacouldbeacknowledgedinthe"effeminate"malehomosexual,instancesofhysteriainheterosexualmenwereredefinedas"shellshock,""battlefatigue,"etc.
,whiletheeverydayinstancesofmalehysteria—dizzyspells;fainting(suchasFreud'sfamousfaintsinJung'spresence);organicallyungroundedorthopaedicdysfunctions;andsuchpsychosomaticphenomenaassensitivebreastsandswollentummiesinmenwhosewivesarepregnant,etc.
—aresomehowoverlookedordiscounted.
Butwhilelisteningwiththethirdeardoesnotguaranteerecognitionoftheaggressionunderlyingmanifestsuffering,withoutthisdistinctivelypsychoanalyticlisteningcapacitythereissimplynowayitwillbedetected.
Asaconsequenceofthisfailure,theobjectsofsuchsuffering,likeCarolWhiteinthefilmSafe(seenextsection),remainunempoweredbythediscoveryoftheirunconscioussubjectivity.
Forfarfrombeingsimplevictimsofmysteriousafflictions,inrealitytheyareunconsciousagents—sadomasochisticagentsinfact—inflictingsuchsufferinguponthemselvesforunderstandablereasons.
ThisistheliberatingdiscoverymadebythemembersofCarol'sgroup,butnotbyCarolherself.
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htm***InToddHaynes(1995)film,Safe,CarolWhite(JulianneMoore)isanaffluentbutboredsuburbanhousewifewhoappears,attheoutset,tobesufferingfromapersonalitydisorderofaschizoidtypecharacterizedbyidentitydiffusion,anhedonia,diffuseanxietyandemptinessdepression.
Obsessivelypreoccupiedwithmaintainingandenhancingherspacious,tastefullyfurnishedanddecoratedhome,sheseemsotherwiseunoccupiedandlost.
Sheseemscuriouslydetachedfrombothsexualityandaggression.
Herstepson'svivid(albeitpoliticallyincorrect)essayongangviolenceoffendsher;sheasks"Whydoesithavetobeso'gory'"InanotherscenethecameraplaysoverCarol'scuriouslyblankandemotionallydetachedfaceasherhusbandperformsintercourse(onecannotcallthismakinglove);shepatshisbackdistractedlyashereachesorgasm.
Gradually,inadditiontohervagueanxiety,joylessnessanddetachment,Carolbeginstodeveloparangeofmysteriousphysicalsymptoms(nosebleeds,coughingfits,difficultybreathing,etc.
)forwhich,afterextensiveinvestigation,herdoctorisunabletofindanyphysicalbasis.
Herefersherforpsychiatrictreatment,despitehersuppressedbutyetevidenthostilitytowardandblandresistancetotheideathatpsychologicalfactorsmightbeattherootof"symptoms"thatbynowhaveledhertowithdrawentirelyfromsexualinvolvementwithherhusband.
Asfrustratingashefindsthissituation,hestruggles,notentirelysuccessfully,tosuppresshisirritation.
But,despitehisfather'sstrictures,Carol'sstepsonstillPage15of62FugitivesFromGuilt03/02/2007http://www.
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htmmanifestshisangertowardher;socializationintothefamilycultureofpolitenessandnon-aggressionhasnotyetfully"taken"hereitseems.
Encouragedbythesuggestionsofafriendandaflierfoundinahealthfoodstorefroman"alternativehealthcare"organizationthatshelatercontacts,Carolherselfcomesincreasinglytoattributeherproblemstoanenvironmentthatshebelievescontainstoxinstowhichsheischemicallysensitive.
Wewitnesstheworseningofher"environmentalillness"(EI)or"multiplechemicalsensitivity"(MCS)assheretreatsfromherhomeandfamilytoasupposedlychemically"safe"environmentprovidedbythisgroupintheruralsouthwestandthen,whenthisprovesinsufficient,toaspeciallyengineered,igloo-likehabitationdesignedtoprovideevenmoreeffectiveprotectionagainstaworldtowhichsheseemsincreasinglyallergic.
ThroughoutmostofthisfilmthedirectormaintainsaneutralattituderegardingthestatusofCarol'saffliction,aschemicallybasedassheinsists,orashystericalorpsychosomatic,asherphysiciansseemtothink.
Buttowardstheendthereisagroupencountersessionattheretreatledbyitsresidentguruinwhich,onebyone,herfellowpatientspainfullyacknowledgethattheirEIhadarisenasakindofunconsciouslyself-punitivealternativetoconsciouslyfacing,bearingguiltandmakingreparationfortheirhithertounacknowledgedhatred,bitterness,longingsforrevengeandinabilitytoforgiveothersandthemselves.
Carollistensdistractedlybutappearsunmovedbytheserevelations.
Her"illness"intensifies.
Attheendofthefilmweseeherrecoilanxiouslyfromhervisitinghusband'spartingembrace,Page16of62FugitivesFromGuilt03/02/2007http://www.
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htmapparentlya"reaction"tothecolognehewaswearing,asheandhersonpreparetoflyhome.
Withwhatappearstobeanoddlycontentedlookonherface,sheheadsbacktoherisolatedandhermeticallysealedcapsule.
OneoftheaspectsofthefilmmostinterestingtotheclinicianconcernsthewayPeterDunning,theresidentguru/therapist,isdepicted.
Initiallyatleast,heandhisorganizationappeartoadvocatetheideathat"environmentalillness"isagenuinemedicalconditioncausedbytoxinsthatofficialmedicinehassofarfailedtoidentify.
Butovertimewedetectasubtleshiftinthemessageshecommunicatestohis"patients":heincreasinglysuggeststhattheirsufferingisaconsequencelessoftoxicchemicalsthanoftoxicemotions.
AlthoughDunning'sdirectionsto"thinkpositive"andreplacehatredwithlovehaveadistinctly"NewAge"flavorandstrikethepsychoanalyticallysophisticatedviewerasnave,theoveralltherapeuticstrategyofhisretreatcouldbeviewedasingenious.
Insteadofdirectlyconfrontingthepatientwiththehystericalandparanoidnatureofhisorherdisorder,headoptswhatfollowersofHymanSpotnitz's(1969;1976)"modernpsychoanalysis"refertoasthetechniquesof"mirroring"and"joining.
"He"mirrors"theirconditionhimself:hetoosuffersfromanimmunedeficiencydisease.
Andinsteadofattackingtheresistancetoawarenessoftheemotionalcausesoftheirsuffering,he"joins"thisresistanceandgivestheappearance,initiallyatleast,ofsharingtheirunderstandingofitascausedbyatoxicenvironment.
(MuchlaterhewillinsistthatsufferersfromEIhavemadethemselvessickbyattackingtheirownPage17of62FugitivesFromGuilt03/02/2007http://www.
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htmimmunesystems,thusmakingthemselvesvulnerabletoenvironmentalfactors.
)Likemanypsychoanalystswhoworkwithhighlyresistant,personalitydisorderedandpsychoticpatients,Dunninghastheclinicalwisdomnottoattempt,attheoutsetandperhapsforaverylongtime,todifferwithorchallengethepreferredself-understanding(theillusionsanddelusionsifyouwill)ofhispatients.
Butunlikethosetherapistswhonevermovebeyondempathyandthevalidationofexperienceandwhothereforecolludewiththeverypathologytheyshouldbetreating,Dunning,likeSpotnitzandhisfollowers,eventuallycomesoutofthetherapeuticcloset,asitwere,andinviteshispatientstofacethemuchresistedemotionalbasisoftheirafflictions,whichheregards(aswedo)asrootedinthedynamicsofunconsciousself-attack.
Wedon'tknowwhatbecomesofCarol.
Perhapssheeventuallybecomeswillingtosetasideherparanoidevasionofresponsibilityandbeginstocallherselfintoquestion.
Butwedoubtit,forwethinksheismorethan"halfinlovewitheasefuldeath.
"Butwhatarethesins,realorimagined,forwhichsheseemstohavejudgedherselfdeservingofself-executionWhereasthehatredpoisoningthepsycheofNell,oneoftheotherpatientsinthegroup,ishotandthereforeunmistakable,Carol'siscoolandeasilymaskedbyherapparentmeeknessandsuffering.
Beingonlyelevenand,inthegreattraditionofeleven-year-olds,asyetuncivilized,herstepsonRoryseesit—andhatesherback.
Page18of62FugitivesFromGuilt03/02/2007http://www.
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htm***CentraltoShowalter's(1997)argumentistheobservationthatthehysteriainvestigatedbyBreuerandFreudwasnottheisolatedproductofacertainhistoricalperiod.
Rather,thesame"illness"hasmutatedintocontemporaryformscorrespondingtochangesinculturalcontext.
Thus,thelate-twentieth-centurysyndromesshedescribes(chronicfatiguesyndrome;multiplepersonalitydisorder;satanicritualabuse;alienabduction;GulfWarsyndrome)aremodernformsofthehysteriaoncediagnosedinupper-classVictorianwomen;andtheyare"psychologicalepidemics"(p.
1).
ToShowalter'slistofnewhysterias,wewouldadd:CarolWhite'smultiplechemicalsensitivityorenvironmentalillness;fibromyalgiasyndrome;aswellascurrentpopularconcernswithintestinaltoxins,parasiticinfestationandcoloniccleansing(Gold,2000)andwithmolds(Belkin,2001).
Webelieveitmakessensetoclassifyalloftheaboveassubtypesofamoregeneralhystero-paranoidsyndrome.
[3]Showalterdefineshystoriesas"theculturalnarrativesofhysteria"(p.
5).
Innowayissheaccusingpatientsofmerelyfabricating,pretending,seekingattention,ormalingering.
Norisshestatingcategoricallythatthereisabsolutelynoorganicbasisfortheperceivedsymptoms,although,asshepointsout,noneofthehundredsofstudiesinvestigatingthisclaimhaveproducedanyconclusiveevidence.
Despitethisabsenceofevidence,sufferersaggressivelymaintainanunyieldingconvictionthattheirsymptomsareorganicallybased.
[4]Page19of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmInHysteria:TheElusiveNeurosis,Krohn(1978)writes:"Itshouldbestressedthathystericsarenotfaking,playinggames,orsimplyseekingattention.
.
.
Thehystericisneitheramalingerernorapsychopathinthatthesortsofpartsheplays,feelingsheexperiences,andactionsheundertakeshavepredominantlyunconsciousroots—heisusuallynotawareoftryingtofoolordeceive"(p.
162).
Yet,asKrohnobserved,suchillusionsmaydisplaycertainstandardsofconventionalityandreality-testing:"Thefacilitywithwhichthehystericcanutilizerolesconsideredacceptablebyhiscultureatteststohissensitivitytothenormsoftheculture,thelimitsofacceptability,interpersonalresourcefulness—inshort,hiscapacityforgoodrealitytesting,impulsecontrol,andinterpersonalsensitivity"(pp.
161-62).
Itisahallmarkofthosesufferingfromthenewerformsofhysteriatoinsistontheexistenceofobjective(asdistinctfromsubjectiveorpsychologicalandemotional)causesoftheirperceivedsymptoms:viruses(asyetneitherisolatednoridentifiedbymedicalresearchers);toxin-producingfecalmatterimpactedinthebowels;radiationemittedbyvideodisplayterminals;moldsgrowingonorinthewallsofhouses;long-repressedmemoriesofsatanicritualabuse;abductionbyaliens;etc.
Indeed,thousandsofpeopleinNorthAmericaandWesternEuropearepresentingwithlonglistsofseeminglyinexplicableandunrelatedsymptoms:extremefatigue,soremuscles,swollenglands,headaches,stomachtroubles,rashes,memorydysfunction,depression.
SovehementaretheconvictionsofmanyofthesepatientsthattheirconditionshaveobjectiveratherthansubjectiveoriginsthatShowalterhasbeenroundlyattackedforPage20of62FugitivesFromGuilt03/02/2007http://www.
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htmsuggestingthatpsychologicalandsocioculturalfactorsmightbeinvolved.
Similarly,withrespecttoso-called"fibromyalgiasyndrome"(widespreadbodypainofunknownorigin,oftenaccompaniedbyothersymptoms,suchas,forexample,irritablebowelorchronicfatigue),neurologistThomasBohrwhowithpsychiatristArthurBarsky"contendsthatevenhonouringthisbundleofsymptomswithamedicallabelmaybedoingmoretomakepeoplesickthantocurethem"(Groopman,2000,p.
86),"hasreceivedmorethantwohundredpiecesofhatemail,andhasbeenlambastedbyfibromyalgiaadvocatesontheInternetandinnewsletters"(p.
91)—despitethefactthat"thesedoctorsdon'tclaimthatthesymptomsoffibromyalgiaarenotreal,onlythattheiroriginliesinthemindandnotintheperipheralnervesofthebody"(p.
86).
Showalterremarksthattheferocityofthesereactions"hasonlyconfirmedmyanalysisofhystericalepidemicsofdenial,projection,accusation,andblame"(p.
x).
Nevertheless,challengingAmericanMedicalAssociationpositionpapers,somephysicianslendsupporttotheobjectifyingclaimsofthesepatients,maintainingthattheyaresufferingfromgenuineillnessestowhichnamessuchas"chronicfatiguesyndrome,""fibromyalgiasyndrome,"and"multiplechemicalsensitivity"havebeenappended.
Itisforthisreason,Showalterasserts,thattheproliferationoftheseconditionsdependsbothonthemedia"narratives"thatdosomuchtogeneratethem(hencethe"stories"of"hystories"),andonthecollusionofphysicians,researchersandpsychotherapists,whoeithertakeatfacevaluethepatientclaimsPage21of62FugitivesFromGuilt03/02/2007http://www.
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ca/dcarveth/Hysteria.
htmwithwhichtheyarepresentedor,insomecases,operatingfromtheirowntherapeuticagendas,actuallyhelpmanufacturethemaladiesinquestionthroughprocessesofsubtleandnotsosubtlesuggestionandinterpersonalinfluence(pp.
17-18,122).
Inthisconnectionitissignificantthattherheumatologistwhofirstcodifiedtheso-calledfibromyalgiasyndrome,FrederickWolfe,nowwisheshecouldmakethisdiagnosisdisappear:"Foramomentintime,wethoughtwehaddiscoveredanewphysicaldisease,"hesaid.
"Butitwastheemperor'snewclothes.
Whenwestartedout,intheeighties,wesawpatientsgoingfromdoctortodoctorwithpain.
Webelievedthatbytellingthemtheyhadfibromyalgiawereducedstressandreducedmedicalutilization.
Thisidea,agreat,humaneideathatwecaninterprettheirdistressasfibromyalgiaandhelpthem—itdidn'tturnoutthatway.
Myviewnowisthatwearecreatinganillnessratherthancuringone"(Groopman,2000,p.
87).
Thefactthathystericalsymptomsastheyarepresented"haveinternalsimilaritiesorevolveinsimilardirectionsasthey'reretold"(Showalter,1997,p.
6)doesnotnecessitatetheconclusionthatanobjectiveeventororganicdisorderunderliesthem:"Patientslearnaboutdiseasesfromthemedia,unconsciouslydevelopthesymptoms,andthenattractmediaattentioninanendlesscycle.
Thehumanimaginationisnotinfinite,andweareallbombardedbytheseplotlineseveryday.
Inevitably,weallliveoutthesocialstoriesofourtime"(p.
6).
Showalter'sliterarytrainingalsoservesherwellinPage22of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmhercriticalanalysisofthesimilaritiesthatbelieversfindsocompelling:Literarycritics.
.
.
realizethatsimilaritiesbetweentwostoriesdonotmeanthattheymirroracommonrealityoreventhatthewritershavereadeachother'stexts.
Likeallnarratives,hystorieshavetheirownconventions,stereotypes,andstructures.
Writersinheritcommonthemes,structures,characters,andimages.
.
.
Weneednotassumethatpatientsareeitherdescribinganorganicdisorderorelselyingwhentheypresentsimilarnarrativesofsymptoms(p.
6).
AsShowalterobserves:"AcenturyafterFreud,manypeoplestillrejectpsychologicalexplanationsforsymptoms;theybelievepsychosomatic[andhystericalorsomatoform]disordersareillegitimateandsearchforphysicalevidencethatfirmlyplacescauseandcureoutsidetheself"(p.
4).
ThevalidityofShowalter'sobservationisbornoutbythevociferousinsistenceofhystericpatientsthemselves,whodemandthattheirsymptoms,howeverindefiniteandvariable,beacknowledgedasgenuine,organically-basedconditions.
Forexample,rejectinganysuggestionthatpsychologicalfactorsmightbeinvolvedinhersufferingandinsistingonthemedicalobjectivityofso-calledfibromyalgiasyndrome,onepatienttoldGroopman(2000):"Iwon'tseeanydoctorwhoquestionsthelegitimacyofwhatIhave"(p.
87).
Showalterobservesthatsuchpatients"liveinaculturethatstilllooksdownonpsychogenicillness,thatdoesnotrecognizeorrespectitsreality.
Theself-esteemofthepatientdependsonhavingthephysiologicalnatureoftheillnessaccepted"(p.
117).
ItwouldseemthatthisdisrespectforPage23of62FugitivesFromGuilt03/02/2007http://www.
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htmpsychogenicillnessissharedbythosephysicians,includingsomepsychiatristswho,despitethelackofsupportingscientificevidence,neverthelessseektovalidatesuchexternalizingclaims.
Insofaraslargesegmentsofpsychiatryitselfforegoespsychologyforbiology,psychodynamicsforneurochemistry,itmightitselfbeseenashystericalandresistanttopsychoanalysis.
Inordertomeettheobjectiveofplausiblyestablishing"causeandcureoutsidetheself,"patientsmustworkwithintheparametersthattheculturewillallow,forallculturesmaintaintheirrespective"legitimatesymptompool[s],"anditisahallmarkofhysteriato"mimicculturallypermissibleformsofdistress"(Showalter,1997,p.
15).
ThistendencyofhysteriatoremainwithincertainboundsofconventionwasalsodescribedbyKrohn(1978):"Hysteriamakesuseofdominantmyths,assumptions,andidentitiesofthecultureinwhichitappears.
Thehystericmayplayoutasomewhatcaricaturedversionofanacceptedroleinanefforttoenlistcaring,attention,help,ortosatisfyotherneeds;however,herarelygoesfarenoughtobeconsideredsubstantiallydeviant.
.
.
thehystericcharacteristicallyformshissenseofhimselfaroundanidentitygrantedahighdegreeofapprovalintheculture"(p.
160).
Thus,whilesymptomschange,andcontemporarysymptomsare,naturally,congruentwithcurrentculturalconcernsandpreoccupations,thefunctionofthe"symptoms"isthesameasitwasinthenineteenthcentury:tomanifestanallegedlyphysicalcondition"thatfirmlyplacescauseandcureoutsidetheself"or,moreprecisely,thatsolidlyplacescauseandcurewithinthebodybutoutsidetheself,therebyexpressingpainandconflictin"acceptable"Page24of62FugitivesFromGuilt03/02/2007http://www.
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htmformsofbodilyillness(Showalter,1997,p.
4)withoutthetaintofpsychologicalforcesatwork.
Thisdifferentiationbetweenconditionsthatareinthebodybutnotoftheself—thatistosay,inthepatientbutnotofthepatient—isanimportantone.
TheadaptivecharacterofhysteriaisalsodescribedbyShorter(1992)who,inFromParalysistoFatigue,writesthat"hysteriaoffersaclassicexampleofpatientswhopresentsymptomsasthecultureexpectsthem,or,betterput,asthedoctorsexpectthem"(pp.
8-9).
Buttoexplainthisflightfrompsychologysimplyintermsoftheculturalstigmatizationofillnessrecognizedaspsychogenicistooverlookthedeeperreasonsforthisverystigmatization.
Ifcauseandcurelienotoutsidebutwithintheself,thensuch"illnesses"areinsomewayunconsciouslyengineered(notconsciouslyasinmalingering)bythepatientsthemselves.
Hence,weareledtoaskwhyhysterics(andweareallhystericalattimesandtovaryingdegrees)feeltheneedtobringpainandsufferinguponthemselvesinthesewaysThereisnodoubtthat,asFreudwouldsay,suchphenomenaare"overdetermined,"butamongtheirmultiplecauses(suchastheneedtosuffertomaintainimportanttiestointernalorexternalobjects)wethinktheroleofaggression,guiltandtheunconsciousneedforpunishmenthavereceivedinsufficientattention.
Fortheseareconceptsthataredistinctlyunpopularamongmanypostmodernintellectuals,includingthosepost-Freudianandpost-Kleinianpsychoanalystswhohavecometoconceptualizepsychopathologylessintermsofintrapsychicconflictthanintermsofstructuraldefectsanddeficitsarisingfromparentalfailure,andtherapylessasanalysis,insightandself-masterythanasreparativeprovisionofallegedlymissingpsychicstructurethroughprocessesofinternalizationandidentificationwiththetherapistasakindofPage25of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmsubstituteparent(Carveth1998).
Whileitismostlikelythecasethatthehystero-paranoidfugitivefromguilthasalwaysbeenwithus,thevarietiesofcontemporarypsychoanalysisinwhichthediscourseofguiltandself-punishmentisdownplayedarepoorlypreparedtocometogripswiththedynamicsthatunderliethistypeofsuffering.
Inotherwords,apsychoanalysisthatisitselfinflightfromguiltisinnopositiontounderstandthehystero-paranoidfugitivefromguilt,fortodosoitwouldhavetounderstandandcureitself.
Needlesstosay,itistheaimofthispapertocontributetosuchcurativeself-understanding.
***Ofwhatarearguablythethreemostimportantrecentbooksonhysteria—ElaineShowalter's(1997)Hystories:HystericalEpidemicsandModernMedia;ChristopherBollas's(2000)HysteriaandJulietMitchell's(2000)MadMenandMedusas:ReclaimingHysteria—Bollas'sworkisnotableforitssingle-minded,earlyFreudianemphasisuponsexualityanditsrelativeneglectoftheroleofaggressioninhystericalconditions.
FreudhimselfneverrevisitedhisearlyworkonhysteriainlightofhislaterpositingofThanatos(anditsoutwardmanifestationasanaggressivedrive)asthe"immortaladversary"ofErosinahumannaturedrivenbythesetwo"HeavenlyPowers"(Freud,1930,p.
145).
[5]ForBollas,asforFreud,"theheartofthematter"ofhysteriais"thehysteric'sdisaffectionwithhisorhersexuallife"(p.
12).
Page26of62FugitivesFromGuilt03/02/2007http://www.
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htmBollasargues,Ithinkcorrectly,that"Hysteriahasdisappearedfromcontemporarycultureonlyinsofarasithasbeensubjectedtoarepressionthroughthepopulardiagnosisof'borderlinepersonalitydisorder'"(frontispiece):"…thinkingthehystericthroughthetheoreticallensesoftheborderlinepersonalityhadbecomesomethingofatragedy"(p.
2).
Hesetsouttorecoverandelaborateuponanearlierpsychoanalyticunderstandingofhysteria.
Butinsodoinghelosessightoftheelementsofthisconditionthatwereatleastbroughtintofocusthroughthetheoreticallensoftheborderlineconcept,whateveritsinadequaciesinotherrespects:namelytheparanoid-schizoiddynamicsofsplitting,projection,sado-masochism,disavowedaggressionandhostility,andtheresultingunconsciousneedforpunishment.
BollaspraisesShowalter'sworkandendorsesherviewthat"hysteriaisaliveandwellintheformofattention-deficitdisorder[actuallynotaddressedbyShowalter[6]],chronic-fatiguedisorder,alien-abductionmovementsandthelike"(p.
178),aswellasheremphasisupontheroleofbothcliniciansandthemediaincreatingsuchconditions.
"Itismorethansad,"hewrites,"thatthehysteric'scapacitytofulfilltheother'sdesirehasmeantthatmanypeoplehavededicatedtheirlivestoromanceswithclinicians,presentingnew'sexy'diagnoses—suchasmultiplepersonalitydisorder—whichinevitablyearnaccoladesforthecliniciansfoundinganewtermorre-foundinganoldone,nowrendereddramaticallypotent"(p.
178).
(RecallinthisconnectionFrederickWolfe'sregretathavingpioneeredthe"fibromyalgiasyndrome"diagnosis.
)ButwhereasShowalterdoesnotshrinkfromtheevidenceofthedynamicsofhatredandparanoidprojectioninthenewhysterias,Bollashimselfwritesalmostexclusivelywithinapre-Page27of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htm1920Freudianismthat,howeverenrichedbylaterobject-relationalandLacanianperspectivesandinsights,focusesalmostexclusivelyonsexuality.
Hesummarizeshistheoryofhysteriaasfollows:"Thehystericspecifiesthebodyastheagentofhisorherdemisebecauseitsbio-logicbringssexualmentalcontentstomind"(p.
178).
Ifthehysterichasbeenrepressedinrecentdecadesbytheborderline,inBollastheborderline(schizo-paranoid)isrepressedbyanold-fashioned,pre-1920,viewofthehysteric.
Incontrast,likeShowalter,JulietMitchelldrawsattentiontothedynamicsofaggressioninhystericalconditions.
Shedoessobyre-focusingourattentionupontwosetsoffactsthat,althoughrecognizedbyFreud,werelaterdownplayedbothinhisownworkandinthatofhisfollowers.
ThefirstisCharcot'sandFreud'searlyrecognitionoftheexistenceofmalehysteria.
Mitchellcitestwomainreasonsforthefactthatwhile"thecriticalclaimthatinauguratedpsychoanalysiswasthatmencouldbehysterical…psychoanalysistooslippedfromexplainingtoendorsingitsproclivityinwomen"(p.
x).
First,thereis"thenon-elaborationofthehypothesisofadeathdriveingeneral,butinparticularinrelationtohysteria.
"(Here,by"deathdrive"weunderstandMitchelltobereferringtoaggression,violenceandhostility.
)Shewrites:"aswithfeminists'accountsofhysteria,whatismissing[inpsychoanalyticaccountssuchasBollas's]isthatthereisviolenceaswellassexualityintheseductionsandragesofthehysteric"(p.
x).
Thefeminizationofhysteriaextendedsexistblindnesstofemaleaggressiontothehysteric.
Inaddition,thefailuretorevisethepsychoanalytictheoryofhysteriainlightofthedual-drivetheoryintroducedbyFreudin1920,longafterhispioneeringworkonthisconditionattheturnofthecentury,contributedtoignoringtheroleofaggression,whetherPage28of62FugitivesFromGuilt03/02/2007http://www.
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htmconceptualizedasprimaryorsecondarytofrustration,inhystericalconditions.
Thesecondsetofinitiallyrecognizedbutsubsequentlydownplayedfactsconcernstheroleofsiblingrivalryinpersonalityformation,"theomissionofthekeyroleplayedintheconstructionofthepsychebylateralrelationships"(p.
x).
Mitchellwrites,"Whenasiblingisintheoffing,thedangeristhatthehero—'HisMajestytheBaby'—willbeannihilated,forthisissomeonewhostandsinthesamepositiontoparents(andtheirsubstitutes)ashimself.
Thispossibledisplacementtriggersthewishtokillintheinterestofsurvival"(p.
xi).
Inthesiblingrivalrythatinevitablyaccompaniessiblinglove,"murderisintheair"(p.
20).
Mitchellacknowledges,ofcourse,thatsuchviolencemaytakeasexualform—"togettheinterestsofallandeveryoneforoneself"(p.
xi).
Inconnectionwiththelinkbetweenviolenceandhystericalhyper-andpseudo-sexuality,weareremindedofaremarkmadebyaseasoned,oldermaleclinicianinaninitialinterviewwithanovertlyseductive,scantilyclad,hystericalyoungwoman:"Whyareyoutryingtodestroyme"JustasCarol'sstepsonRoryisnotblindtothemanipulationandpassive-aggressionbeneathhisstepmother'smanifesthelplessness,thisseasonedclinicianwasalerttothedestructioninseduction.
LikeBollasandShowalter,Mitchellaffirmsthecontinuingpresenceofhysteriainourculture,despitepsychiatricattemptstodenyit.
"Ithasbeenfashionableinthetwentieth-centuryWesttoarguethathysteriahasdisappeared.
Tomymind,thisisnonsensical—itislikesaying'love'or'hate'havevanished.
Therecanbenoquestionthathysteriaexists,whetherwecallitsvariousmanifestationsbythatPage29of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmnameorsomethingelse"(p.
6).
ForMitchell,thereisnothingintrinsicallyfeminineabouthysteria,whichsheviews,likeloveandhate,asanintrinsicpotentialofhumannatureassuch,arguinginsteadthat"hysteriahasbeenfeminized:overandoveragain,auniversalpotentialconditionhasbeenassignedtothefeminine;equally,ithasdisappearedasaconditionaftertheirrefutableobservationthatmenappearedtodisplayitscharacteristics"(p.
7).
LikeShowalterandKrohn,Mitchellemphasizeshysteria'sadaptationtothesocioculturalsurround:"Hysteriamigrates.
Supremelymimetic,whatwasoncecalledhysteriamanifestsitselfinformsmoreattunedtoitsnewsocialsurroundings.
Whatwasonceasubsidiarycharacteristicbecomesdominantandviceversa"(p.
ix).
Nevertheless,"hysteria'smanymanifestationshaveshownsomestrikingsimilaritiesthroughouttheages—sensationsofsuffocation,choking,breathingandeatingdifficulties,mimeticimitations,deceitfulness,shock,fits,deathstates,wanting(craving,longing)….
Ifthetreatmentsandconceptualizationsvary,mimetichysteriawilllookdifferentatdifferenttimesbecauseitisimitatingdifferenttreatmentsanddifferentideasabouthysteria"(p.
13).
[7]ReferringtotheintroductioninDSMIIandIIIof"histrionicpersonalitydisorder"toreplace"hysteria,"Mitchellcommentsthat"Theironyofthistriumphofthediagnosticisthatthedoctorswhonolongerrecognizehysteria'sexistencecontinuetorefertoitdaily.
"Shecomments,"giventhehistoryofhysteria,onemustsurelyask:Isithysteriaitselforitsclassification—psychiatric,medicalorpsychoanalytic—thathasbecomeredundant"(p.
15)[8]Page30of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmCASE2:Mr.
BDuringthesecondyearofhisanalysis,Mr.
B.
,athirtyyearoldacademicwithaflamboyantlyrebelliousculturalandpoliticaloutlookwhoenteredanalysisduetoworkinhibitions,relationalproblemsanddiffuseanxietyandunhappiness,suddenlystartedexperiencingdizzyspells.
Forexample,hemightbeinasupermarketwhen,suddenly,hewouldhavetoclutchhiscarttostopfromfallingoverasthestoreseemedtoslowlybegintomoveandspinaroundhim.
Althoughsuspectingthatthiswasasymptomofanhystericalorder,theanalystrecommendedacompleteneurologicalinvestigationwhichyieldednothing.
Astheanalysiscontinuedevidenceaccruedthatthedizzyspellsamountedtoakindofbodylanguageinwhichthepatientcommunicatedthedefensivemessagethathewasnotatallaphallic,competitive,oedipallyaggressivemalebut,onthecontrary,morelikeaswooningwoman.
Withthisanalysisthesymptomsdisappeared,nevertoreturn.
Someyearslater,whiletheanalysiscontinued,Mr.
B.
begantoexperienceseverepaininbothhipjoints.
Bythetimehesoughtmedicalhelpforthis,hewasattimesusingacane.
Aphysiatristx-rayedthejointsandinformedMr.
B.
thathehadsustainedseriousdamagetobothinthecourseofamysteriousillnesshehadsufferedbetweentheagesofthreeandfivethathadbeenaccompaniedatthetimebyrheumatoidarthritis.
ThephysicianinformedhimPage31of62FugitivesFromGuilt03/02/2007http://www.
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ca/dcarveth/Hysteria.
htmthatdoublehipreplacementsurgerywouldeventuallybenecessarybut,asthetechnologyinthisfieldwasimprovingatarapidpace,itwouldbeinhisinteresttopostponethesurgeryaslongaspossiblewiththeuseofanti-inflammatorymedication.
Hewasprescribedalargedailydosewhichhegraduallyreducedbyabouttwothirdsandmaintainedatthatlevelforseveralyears.
Afterviewingatelevisionreportaboutsuddenbleedscausedbysuchmedication,hedecidedheneededtogetasecondopinion.
Heretrievedtheoriginalx-raysandtookthemtotheheadoftherheumatologydepartmentatalocalhospitalwholookedatthemandexaminedhimandtheninformedhimtherewasnothingwhatsoeverwrongwithhim.
Thepatientwasdumbfounded.
Heaskedwhathewastodowithallthemedication.
Thespecialisttoldhimtoflushitdownthetoilet.
Ashehadbeentoldhewouldneverbeabletorunorplaysportssuchastennis,heaskedaboutthisandwastoldto"startgradually.
"Incredulous,hesoughttheadviceofanotherrheumatologistwhoconfirmedthediagnosisthatneithertheoriginalx-raysnorexaminationrevealedanypathologywhatsoever.
Thepatientstoppedtakingtheanti-inflammatorymedication,replacingitwithcoatedaspirinwhennecessary,andsoonevendispensedwiththat.
Therewerenosubsequentepisodesofhipjointpain.
(Hecastoffhiscrutchesandwalked.
)Inhisanalysis,thepatientrealizedthat,onceagain,hehadbeencommunicating,psychosomaticallyandhysterically,thathewasnotanintact,phallicandcompetitivemale,butawounded,infact,acrippledman.
OnecanonlyspeculateastothenatureofMr.
B'sinfantilePage32of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmillness.
ThecombinationofhighspikingfeversandrheumatoidarthritissuggestsStill'sDisease,aconditionsomeviewasanautoimmunedisorderwhichmayhaveemotionalcauses.
Thepatient'smothersufferedfromperiodicseveredepressionthroughoutherlifeandbecamerecognizablyalcoholicbythetimehewasfiveorsix.
Theillnessseemstohavemanifestedaroundthetimethataboyofthesameage,whohadbeentakenintothefamilyandraisedforayearasthepatient'sinformallyadoptedbrother,wasreturnedtohisfamilyoforiginwhentheyrefusedtoallowhimtobeformallyadopted.
Inotherwords,whatmighthavebeenStill'sDiseaseemergedwhena"sibling"whohadsuddenlyarrivedinhislife,dethroninghimfromhisstatusasonlychild,disappearedfromitjustassuddenly.
Thiswasfollowedbythepatient'sdimawarenessofhismother'sserial"illnesses"(severalmiscarriages)andhisgrowingrecognitionofherworseningdepressionandalcoholism.
Asalittleboy,thepatientappearstohaveassociatedthesemiscarriageswithmemoriesofhisfather'sburialofseveralofthefamilycanariesinlargematchboxesinthebackyard.
Inthesiblingrivalrythatinevitablyaccompaniessiblinglove,"murderisintheair"(Mitchell,2000,p.
20).
ItmaybethatMr.
B'srepetitiveneedtoenacttheroleofaswooningwomanandacastratedandcrippledmanhaditsrootsbothinhispreoedipalrelationshipwithadisturbedmotherandinunconsciousoedipal"guilt"(or,rather,anunconsciousneedforpunishment)forthe"crime"ofsurvivalandtriumphoverbothhisreal,albeittemporary,andpotentialsiblings.
Page33of62FugitivesFromGuilt03/02/2007http://www.
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htm***ThevarietiesofhysteriaShowalterdescribesexhibitanimportanttraitthatshetouchesononlybriefly:paranoia.
Manyofthehystericalsymptomssheexplorescontaindistinctlyparanoidfeatures,assheacknowledgesindescribingtheparticularvulnerabilityofAmericanculturetohystericalmovements:".
.
.
suchmovementshavecentredontheMasons,Catholicism,communism,theKennedyassassination,andthefluoridationofwater.
Inthe1990's,hysteriamergeswithaseethingmixofparanoia,anxiety,andangerthatcomesoutoftheAmericancrucible"(p.
26).
ShequotesNewYorkerwriterMichaelKelly(1995),whogivestheterm"fusionparanoia"tothemélangeofconspiracytheoriesflourishingintheUnitedStates:"Initsextremeform,paranoiaisstilltheprovinceofminoritymovements,buttheethosofminoritymovements—anti-establishmentarianprotest,thepoliticsofrage—hasbecomesodeeplyingrainedinthelargerpoliticalculturethattheparanoidstylehasbecomethecoheringideaofabroadcoalitionpluralitythatdrawsadherentsfromeverypointonthepoliticalspectrum"(Showalter,1997,p.
26,citingKelley,1995,pp.
62,64).
Furtheron,Showalterobservesthatthis"fusionparanoia"hastakenupresidenceinmedicineandpsychiatry,allowingfortheproliferationofconspiracytheoriestoexplain"everyunidentifiedsymptomandsyndrome"(pp.
26-27).
ThisobservationiselaboratedbySherrillMulhern,anAmericananthropologistcriticalofsuchrecentexcesses,whoobserves".
.
.
theemergenceofconspiracytheoryasthenucleusofaconsistentpatternofclinicalinterpretation.
IntheUnitedStatesduringthepastdecade,theclinicalmilieuhasbecomethevortexofagrowing,sociallyoperantconspiratorialmentality,Page34of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmwhichisunderminingcrucialsectorsofthementalhealth,criminaljustice,andjudicialsystems"(Showalter,1997,p.
27,citingMulhern,1994,p.
266).
Thecloseconnectionbetweenhysteriaandparanoia—andeven,perhaps,theirinterdependence—doesnotappeartohavebeenexplicatedanddevelopedbypsychoanalyticwriterswhohavetendedtoaddresseitheroneortheothercondition,treatingthem,implicitlyatleast,asdiscreteentities.
Itisduetothisinsufficientlytheorizedlinkagethatwerefertothepsychologicalconditionsweareaddressingashystero-paranoid.
Itisconsistentwiththetendencyofpsychoanalyticwriterstotreathysteriaandparanoiaasnon-relatedsubjectsthatMelanieKleinwroteextensivelyaboutthesubjectsofanxietyandparanoiabutwas"silentonthesubjectofhysteria"(Rycroft,1968,p.
64).
However,certaininsightsintotheoriginsofhysteriacanbeextrapolatedfromherwritings.
WecontendthatthereisarelationshipbetweenhysteriaandKlein'sparanoid-schizoidposition,somuchsothathysteriamaybeviewedasanoffshootofPSfunctioningwhichalmostinevitablyproduceshystericsymptoms,albeitoftenminoronesthatfrequentlygounrecognized.
Humanbeingsareneverfreefromthetaskofmanagingtheirprimalpassions,phantasiesandanxieties,includingtheiraggression,norfromthesimultaneousneedtoorderandregulatetheworldofinternalobjectsandformmeaningfulconnectionswithexternalones.
BecauseofKlein'srecognitionthatthesetasksofmentallifeareongoingandpermanentratherthanoccurringindiscretestages,themental"positions"sheexpoundedarefluid,dynamicstatesthatarepresentinvaryingdegreesthroughouteveryphaseoflife.
ThePage35of62FugitivesFromGuilt03/02/2007http://www.
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htminfant'searlypre-ambivalentparanoid-schizoidstate,characterizedbysplittingoftheobject(andtheself)intoall-goodandall-badpart-objects(andpart-selves),persecutoryanxiety,envy,manicdefenses,"symbolicequations"(Segal,1957)and"betaelements"(Bion,1962),hopefullygiveswaytothedepressiveposition'sambivalence,wholeobject(andself)relating,guilt,reparation,gratitude,capacityfor"symbolicrepresentation,""alphafunction"andcreativity.
ButelementsofPSfunctioning,bothhealthyandpathological,remainoperativeinallpersonsthroughoutlife.
Incurrentpost-Kleiniantheory,developmentisnolongerconceivedasaunilinearprogressionfromPStoD,butdialectically(PSD),withpathologybeingconceptualizedasbreakdownofthedialecticintoafixationuponeitherpole(Ogden,1986).
Itshouldgowithoutsayingthatatthisstageinthedevelopmentofobject-relationstheory,itisunnecessarytoadheretoanyliteralisticnotionofabiologically-groundedaggressivedrive,letaloneanyliteraldeath-instinct,inordertocreditMrs.
Klein'sinsightintothefactthat,evenwiththemostattunedanddevotedcaretakersimaginable,allinfantsmustencountersomedegreeoffrustrationwhichinevitablygeneratesaggressionthat,whenprojected,returnsintheformofpersecutoryanxiety.
Initsstateofcognitiveimmaturity,itisplausibletoassumethattheinfantexperiencesanyfrustrationasanattack,andanyabsenceof"good"asanindicationofthemalevolentpresenceof"bad.
"Itisasiftheinfantassumesthatitisthejobofthegoodpart-objecttoprotectandgratifyanditexperiencesanypainandfrustrationnotmerelyasanindicationthatthegoodpart-objectisfailingatthistask,butthatithasactuallyturnedintoabadpart-object—i.
e.
,apersecutor.
Needlesstosay,any"surplus"frustration,beyondtheunavoidableexistentialminimum,Page36of62FugitivesFromGuilt03/02/2007http://www.
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htmarisingfromobjectiveenvironmentalfailureofvarioustypes,willonlyaggravateaparanoiddynamicthatisinvaryingdegreesuniversal.
Inthefaceoffrustrationandfeelingsofpersecution,theinfantreactswithbothfearandaggressionwhichisitselffrighteningandthat,whenprojected,onlyaddstoitspersecutoryanxiety.
Here,intherealmofdisownedaggression,liestheparticularinsightofKleiniantheoryintothedevelopmentofhystericillness.
Thesubjectoperatingintheparanoid-schizoidpositioncannotescapethefeelingofattack,havingrepudiateditsownaggressiveanddestructiveimpulsesandsituatedthemsquarelyintheoutsideworld.
Thismovefailstodissolvetheaggression,however.
Itstillexistsinallitsstrengthontheoutside,whichisnowrenderedthreateninganddangerous.
Theensuingtangleofconflictiscompoundedwhenthesubjectalsoprojectsperceivedgoodobjectsandimpulsesinordertoprotectthemfromthecontaminationofbadnessinside,andintrojectsorevenidentifieswithperceivedexternalpersecutorsinanattempttogaincontrolofthem.
Segal(1964)commentsthat".
.
.
insituationsofanxietythesplitiswidenedandprojectionandintrojectionareusedinordertokeeppersecutoryandidealobjectsasfaraspossiblefromoneanother,whilekeepingbothundercontrol.
Thesituationmayfluctuaterapidly,andpersecutorsmaybefeltnowoutside,givingafeelingofexternalthreat,nowinside,producingfearsofahypochondricalnature"(pp.
26-27).
Hysteriamaylikewisebeinterpretedastheproductofaparanoid-schizoiddynamicinwhichindividualswhohavesplitoffanddisownedtheirownaggressiveanddestructiveimpulsessufferfromphantasiesofattackandanabidingsenseofbeingmadeillbyhostileforces,eitherwithinthebody(asin"fibromyalgiasyndrome"and"chronicfatiguePage37of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmsyndrome")oroutsideitintheenvironment(asin"environmentalillness"or"multiplechemicalsensitivity"),butinanycasefromoutsidetheself.
Wehavedescribedthetendencyofhystericpatientstoregardtheirsymptomsasresidinginthebodybutunrelatedtotheself,thatis,existingasaforeign,invadingforce,inbutnotofthepatient.
Inparanoid-schizoidfunctioning,thesubjectmaydisownorevacuatehisinternalbadselfandobjects,projectthesplit-offcontentsand,asaconsequence,perceivetheexternalworldasindependentlybadanddangerous.
Tocomplicatemattersfurther,inanattempttomanagetheexternalpersecutorsthuscreated,hemayreintrojectthem.
Segal'sobservationregardingtheintrojectionofpersecutorsandsubsequenthypochondria(inwhichthepersecutorsarefelttobeattackingfromwithinthebody)illustratestheconjunctionbetweenparanoiaandhysteria.
[9]AccordingtoSegal,"Theprojectionofbadfeelingsandbadpartsoftheselfoutwardsproducesexternalpersecution.
Thereintrojectionofpersecutorsgivesrisetohypochondricalanxiety"(p.
30).
Whiletherearegroundsformaintainingthedistinctionbetweenhypochondriaandhysteria,viewingtheformerasonetypeormanifestationofthelatter,itisreasonabletoextrapolateareciprocalconnectionbetweenparanoiaandhysteriabywayofthisconnectionbetweenparanoiaandhypochondricalanxiety.
Bothinvolveprojectionandaresultingexperienceofattackandpersecution,inonecasefromwithout,intheotherfromwithin.
Butthepsychoanalyticliteraturehastendedtotreatparanoiaandhysteriaasdiscreteconditions,andthesecitationsfromSegal(1964)maybeoneofthefewplaceswhereparanoiaandPage38of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmhypochondria,andcorrespondinglyhysteria,areexplicitlybroughttogether.
Thesplittingcharacteristicoftheparanoid-schizoidpositionproducesanaustere,one-dimensional,concretemodeofthinkingandaninabilitytorelatetoothersaswholepersons:"Wherethepersecutionanxietyfortheegoisintheascendant,afullandstableidentificationwithanotherobject,inthesenseoflookingatitandunderstandingitasitreallyis,andafullcapacityforlove,arenotpossible"(Meissner,1978,p.
13,citingKlein,1964,p.
291).
Conceivingoftheworldintermsofpart-objectsandkeepinggoodandbadthoroughlyseparatedallowsthesubjecttofeelasthoughheisprotectinggoodobjectsfromcontaminationbythebadnessinsidehim.
Butparanoid-schizoidfunctioningexactsahighpriceforthemanufactureofthisapparent"safe"zonethroughprojectionofthebadness,ifnotintheformofpersecutoryfantasies,feelingsandoutrightparanoiddelusions,theninthatofthehysterical(andpsychosomatic)disorderswhichembodythereturnofthedisavowedbadnessandsimultaneouslypunishthesubjectforitinwaysthatevadetheexperienceofunbearableguilt.
Acentralfeatureoftheparanoid-schizoidpositionisaninabilitytoachievethetypeofguiltandremorsethatareoperativeinthedepressiveposition(Meissner,1978,p.
13)andthatreflectattainmentofwhatWinnicott(1963)called"thecapacityforconcern.
"Insteadofsuchmature,"depressiveguilt"(Grinberg,1964),whatwefindinPSiseitheranintense"persecutoryguilt,"self-attackthatisentirelynarcissisticreflectinglittleornoconcernfortheobject(andwhich,therefore,aswehavearguedabove,shouldnotbedescribedasguiltPage39of62FugitivesFromGuilt03/02/2007http://www.
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htmatall),oravarietyoftormentingstates(includinghystericalandpsychosomaticconditions)thatoperateassubstitutesforanddefensesagainstunattainableorunbearabledepressiveguilt.
Inthecontextofthedepressiveposition,acontinualstateofrageandfeelingsofdestructivenesswillbeaccompaniedbysimultaneousfeelingsofconsciousguilt,concernandtheneedtomakereparation.
InPS,however,suchdestructivenessissplitoffandprojectedresultinginpersecutoryanxietyandunconsciousmasochisticneedsforexpiationthroughself-punishment(Reisenberg-Malcolm,1980).
Safan-Gerard(1998)describesapatientwhosecareerhascollapsedafterheleaveshiswifeandchildrentopursueoneofhisnumerousaffairs.
Attheendofonesessionthepatientponders,"Idon'tknowwhatchangedaftermyseparation.
BecauseIusedtomakegoodmoneybefore.
DidIchangeordidrealitychange"(p.
365).
Thispatient'senormousloadofunbearableguilt,whichheverballyacknowledgesbutreallyevadessincehecannotallowhimselftoactuallyfeelorsufferfromit,mustneverthelessbeexpiatedinsomeway.
Inthislight,thecollapseofhiscareerandhisfinancialdifficulties,eventswhichseemtobe"justhappening"tohim,maybeviewedasproductsofself-punishmentthroughself-sabotage.
Carveth(2001)hasexpoundedthetheorythattheunconsciousneedforself-punishmentisnot,contrarytoFreud'sview,amanifestationofunconsciousguilt.
Unconsciousguiltdoesnotexist.
Theunconsciousneedforself-punishmentthatFreudequatedwithunconsciousguiltservespreciselytodefendagainsttheexperienceofunbearableconsciousguilt.
Webelievetheunconsciousneedforself-punishmentisexpressedinawiderangeofpsychopathologicalconditions—includinghystericalandpsychosomaticdisorders.
ButjustasthehystericalorsomatizingsubjecttakesflightfromPage40of62FugitivesFromGuilt03/02/2007http://www.
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htmunbearableguiltintoself-tormentingsymptomsasguilt-substitutes,soade-moralizingpost-Freudianpsychiatryandpsychoanalysisrepressthedynamicsofthesuperego—i.
e.
,thedynamicsofthesoul(Frattaroli,2001)—infavorofoneoranotherformofreductionisminwhichthemeaningfulcommunicationsofthepsyche(soul)arereducedtomeaninglesssymptomsofneurochemicalmalfunctionortheresultsoftraumaanddeprivation.
Evenwhenade-moralizingpost-Freudianpsychoanalysisviewspatientsasvictimsofbadparenting,itseekstoprotectsuchparentsfromguiltandresponsibilitybyviewingthem,inturn,asvictims.
Theironyisthatevenwhenbothpatientsandtheirpsychiatrists,analysandsandanalysts,areinagreementintheirrepressionofthediscourseofsinandguilt,theunconscioussuperegoisaliveandwellandbusyinbothgroups:ittormentsthepatientsfortheirevasionofconsciousguilt;anditfindsexpressioninthemoralizingofthepsychiatristsandpsychoanalystswhoattackthesupposedabusersoftheirpatient-victims,includingthosewhowouldseethemashysterical.
***Whenself-defeatingandself-destructivepatternsandsymptomsareobservedinpatients,theyarealmostalwaysmanifestationsofaninabilityorunwillingnesstoacknowledgeguilt.
Notguiltintheanalyst'sopinion,forthatwouldinvolvemoraljudgmentsontheanalyst'spart.
Althoughthemakingofsuchjudgmentsisaninevitableaspectoftheanalyst'scountertransference,thisistobecontainedandunderstood,notacted-out.
Weareaddressingguiltasestimatedbythepatient's,nottheanalyst's,superego.
Page41of62FugitivesFromGuilt03/02/2007http://www.
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ca/dcarveth/Hysteria.
htmWhenweacknowledgethevoiceofthesuperego,makeconsciousthepainfulsenseofresponsibility,thestabofconscience,thatoursuperegohascausedustoexperience,wecanunderstandourwishesandimpulses,apologize,makereparation,andbecomestrong,notsick.
Itisourobservationthatmostpeoplecanrealisticallypromisetoliveinawaythatdoesn'trepeatwhattheirsuperegojudgesasdestructive,oncetheyrecognizetheirsuperegointrojectsandinjunctions.
Atthepointofconsciousrecognitionandapology,wecanletgoofself-torment(sickness)andmoveon.
Whenthebadness(asjudgedbythepatient'ssuperego)involvesphantasiesandwishes,theuncontrollablecreationsoftheid,ratherthanactualinappropriatebehaviors,theonlypromisewecanmakeistounderstandthedistinctionbetweenwishingandacting.
Themorethecorruptwishisallowedconsciousexpression,thelesschancethereisthepersonwillneedtoactitout.
Whenanyevilimpulseorwish(asjudgedbythepatient'ssuperego)ismadeconsciousandverbalratherthanunconsciousandactedupon,theegoisstrengthenedandsymptomsascompromise-formationsbecomeunnecessary.
Ontheotherhand,whenapatientrepressesorotherwisemanagestoremainunconsciousofhissuperego'sjudgmentthathe'sdoneorwishedsomethingimmoral,hebecomessymptomaticand/ordestructive,suicidalorhomicidal,emotionallyorliterally.
Theanalystexaminesthepatient'ssymptomstounderstandwhatthepatient'ssuperegoispressingthepatienttoacknowledgeandPage42of62FugitivesFromGuilt03/02/2007http://www.
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htmresolve.
Unfortunatelyandwithgoodintentions,psychoanalysts'avoidanceovertimeofbeinglinkedtoeithertheworldofthelawyerortheworldofthepriesthasledtoaneglectofthesuperego'sneedtoclamorforconscious(verbal)recognition—i.
e.
,fornaming,describing,acknowledgingandtempering.
Thepsychoanalysts'understandableaversiontobeingthesuperegoforthepatienthasled,inmanyareasofclinicalpracticeandtheoreticalwriting,toanaversiontoexaminingsuperegofunctioningatall.
Itispossibleinsomesituationsthatananalyst'scountertransferenceinabilitytotoleratethepainofapatient'sbadnessfinallybeingrevealed—suchbadnessbeingjudgedprimarilybythepatient'ssuperego,butsometimesalsobytheanalyst's—isanotherreasonanalystsunconsciouslysteerclearofthetopic.
Analystsaren'trequiredtojudgewhetherornotapatientshouldfeelguiltyabouthiswishesoractions.
Infact,itworksagainstthepsychoanalyticaimofmakingunconsciousconsciousforananalysttoweighinwithhisvaluesandopinionsaboutrightandwrongoverthecourseofapatient'streatment.
Forvariousreasons,manypsychoanalystsfeelthatsoothingapatient'ssuperegoispartoftheirjob.
Itisnotuncommonforananalysttocommunicatetoapatientthatheorshehasnothingtofeelguiltyabout—forexampleinthecaseofmurderousoedipalfantasieswhichare,asweknow,universal,"natural",thehumancondition.
But,eveninthecaseofreal-lifeactions,suchasignoringMotheronMother'sDay,psychoanalystshavebeenknowntoattempttode-guiltthepatient,communicatinginsomewaythatthereisnothingtofeelguiltyabout.
Page43of62FugitivesFromGuilt03/02/2007http://www.
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htmSettingasideforamomentthefactthat,accordingtothepatient'ssuperego,thereisindeedquitealottofeelguiltyabout—guiltthatmustbereckonedwith,notavoided—theactofsoothingapatient'ssuperegovoiceimpliesthattheanalysthastakenastandinregardtovaluejudgments(they'reokayifthey'renicebutapparentlynotifthey'renot)andhasbroughtherownvaluejudgmentsintothepatient'ssession.
Incontradictoryfashion,theseanalystscomedownhardonthosewhorecognizethatthepatient'ssuperego'sjudgements(e.
g.
,"youshouldfeelguilty")representanimportantaspectofthepatient'spersonalityandthereforemustnecessarilyoccupyanessentialandvalidplaceinthepatient'sanalysis.
Inanalyzingthepatient'ssuperegofunctioning,itisourbeliefthatweshouldstriveasfaraspossibletomaintaintheclassicalstanceoftechnicalneutralityinwhich,accordingtoAnnaFreud(1937),theanalysttakesupaposition"equidistantfromtheid,theego,andthesuperego"(p.
28).
Admittedly,perfectioninthismatterisimpossibleand,forthisreason,weshouldseektobeasconsciousaspossibleofourmoralbiasesassignificantaspectsofourcountertransference.
Departuresfromthestanceoftechnicalneutralitymaytaketheformeitherofinappropriatemoralsoothingorinappropriatemoralcondemnation.
Itisourimpressionthattheformerdeparturesfromtechnicalneutralityseemmoreacceptableintoday'sclimatethanthelatter.
Page44of62FugitivesFromGuilt03/02/2007http://www.
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htmSoothinggivesthepatientthemessagethathisorherbadnessshouldprobablybeconcealedfromananalystwhothinkseverythingisokay,orwhojustcannottolerateintensefeelingsofremorse.
Thepatienthideshisfeelingsofbadness.
Thistypeofanalystwillaidthepatientinfurthersymptom-formingself-punitiveness,ratherthanhelpingtobringhisunconsciousmoralconflictstoconsciousnesswheretheymightberesolved.
Condemninggivesthepatientthemessagethattheyareinthepresenceofapriestlyconfessor,notananalyst,whowill,ironically,alsoaidtheminmoresymptom-formingself-punitivenessratherthananalyzing.
Thepatienthideshisfeelingsofbadness.
Itisnotablethatalmostallunanalyzedpeopledisplay,tosomedegreeatleast,thedynamicofthemodernhysteric:murderouswish,leadingtoguiltdenied,leadingtoaninhibitedorsymptomaticlife.
Wehaverarelyencounteredpatientswhohaven'tbeenaffectedinsomewaybybeingtaughttosilenceboththeirrageandtheirremorse,withtheconsequenceofalifespentengagedinhystericalanddestructivebehavior.
CASE3:Mr.
C.
Amanwhobegananalysisatage45hashadbodilypreoccupationssincechildhood.
HeiscompelledtostareintoPage45of62FugitivesFromGuilt03/02/2007http://www.
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htmmirrorsto"seeifI'mhere.
"Hesomatizeswithvariousillnesses(suchasGravesdisease)wheneverhehates.
Thatis,hehasdevelopedunconsciouslyasystematicsomaticdefenseagainstthefeelingofhate.
Beforeheconsciouslyidentifiesthatsomethingorsomeonehasstimulatedhisrage,Mr.
C.
willhaveafever,heartpalpitations,ordiagnosablethyroidalterations.
AlongwithillnessesMr.
Chashadelectivesurgeriesforvariousailmentsleadingtovaguepost-operativemedicalregimensandprescriptions.
Hereportsthathiswife(whomhewouldliketoavoidtouching)isannoyedatnightwhenhelinesuphismultitudeofpillbottles,thenswallowstheminaritualthatdriveshertofallasleepbeforetheycanbeintimate.
Bornfourthofeightchildrentoacold,inattentive,phobicanddistractedmother,Mr.
C.
hasonlytwopleasantmemoriesofchildhood.
Thefirstisthatatagefivehecontractedanillnessthatwasseriousenoughforhimtomisstwomonthsofschoolbutnotseriousenoughtowarranthospitalization.
Abedwasplacedinthelivingroomsohismothercouldtakecareofhimwithouthavingtorunupstairs.
Thattimeofbeingill,whichhewastolddamagedhisheartslightlyandpermanently,wastheonlytimeinhislifethathehadhismothertohimself(rememberhewasoneofeightchildren).
Mr.
C'sonlyothernicememoryofhismotheroccurredwhenhisbabybrotherwasborn.
Hisbrother,thelastoftheeight,madethemotherhappierthantheothersfornoPage46of62FugitivesFromGuilt03/02/2007http://www.
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htmapparentreason.
Mr.
Csensedhismother'sunusualcalm(shewasusuallydepressedandcold)andhewasallowedtositbesideherasshefedhisbrother.
Mr.
Cfeelsaninextricablelinkbetweendiseaseandattachment.
Heexperiencesbothhorrorandexcitementatsignsofillness,ashischildhoodillnesswastheonlytimehehadamother.
AyearafterMr.
CwasbornhissisterD,thefifthchild,wasborn.
Thissisteristheidentifiedroot(nowconsciousintheanalysis)ofMr.
C'shistoryofdeniedhate,sneakysadism,guiltevasionandpsychosomaticillness,predictablyoccurringinorder:hate--->somedeniedsadisticactivity--->evasionofresponsibility--->physicalillness.
ForthefirsthalfofhisanalysishecouldrecalltorturingsisterDinmanywaysbuthedidnotknowwhy.
ThemotivationfortorturingDwasatotalmysterytoMr.
C.
Noclue,can'tsayheresentedorhatedhissister:"weallloveeachothersomuchinmyfamily.
"HecouldremembercoldlypushingDoffthebed,demeaningher,abandoningheronthebusycitystreetwhenhewassixandDwasfive.
Butallwithnoconsciousrecollectionoftheaccompanyingfeelings(laterrecalled:disgust,jealousy,resentment,murderousrage).
HismotiveswereabigmysteryPage47of62FugitivesFromGuilt03/02/2007http://www.
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ca/dcarveth/Hysteria.
htminthefirstyearsofanalysis.
Whywouldsomeone,anyone,pushhissisteroffthebedMr.
Ccouldn'tanswer.
(Longpause).
"I'mtrulypuzzled…wealllovedeachothersomuch.
"Hewasentirelyunawareofanyfeelingsofrivalry,hate,frustration,cravingorenvy.
HecouldaccessonlymemoriesoffeelingsorryforD:forneverbeingaspopularashe,forD.
developingdebilitatinganxietiesandnotbeingabletogotocollegebecauseofheranxieties,whileMr.
CwentontoreceiveaMaster'sdegree.
Typicalofthisdynamic,whenmurderousimpulsesareactedonwithcompleterepressionofaffect,responsibilityandsubsequentcontritioncanbeevaded.
Thenthestill-unconsciousaggressionisturnedagainsttheselfthatcontinuestodenyhavingactedcriminally.
Thepatientenactsthepartsofboththecriminalandthesentencingjudgeandjury.
InMr.
C'scase,though,evenhisself-tormenthasalwaysbeentingedwithanexcitementthatcanonlybedescribedassexual,thoughsuchsexualexcitementisaphysicalconsequence,nottheaimoftheviolence.
Inthesequence--deniedrage,sadisticaction,andevasionofresponsibility--heisobservedtobequitetakenoverphysically.
Hisheartfluttersandpoundsashisthyroid"kicksup.
"Hegetsflushedandbreathesheavily.
Hesweatsandsmilesweaklyashiseyesrollbackandhislashesflutter.
DuringthistheatricaldemonstrationoffallingillMr.
Cmaintainsacheerfuldemeanor,impeccablegrooming,andmeticulousorderliness.
HisanalyticgrouphasbeenperplexedwatchingthediscrepancybetweenMr.
C'salarmingmedicalsymptoms,histhrillatbeingsweptawaybythemandhisdeterminationPage48of62FugitivesFromGuilt03/02/2007http://www.
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htmtoremainperceivedascheerfulandimpeccableallatthesametime.
Psychoanalystsknowhowharditistobehysteric.
Itisoneofthemostexhaustingandoftenpermanentlydebilitatingdefensesagainstragethatwetreat.
Insummary,whatleadstohissomatizationDeniedhate.
Hehatesandisunconsciousofhishomicidalragetowardsthepersonhehates.
Someonehadbeendisrespectful;someonehadthreatenedtoleavehim;someoneturneddownaninvitation.
Mr.
Cdeniestohimselfthathe'dlovetoknocktheseoffendingpeoplerightoffthebed.
Hedoesn'tpushovertlyanymore.
Hegetssickinsteadofconscious,sickinsteadoffeelingandtalking.
TheanalystandMr.
C,workingtogetherforsevenyears,alongwithhelpfromhisanalyticgroup,havegraduallybeenabletomakeconsciousthegreatdarkragethatunderlieshisposeof"nothing'swrong,"hissneakyaggressiveactions,theevasionofresponsibilityandsubsequentself-punishmentsviaillnesses.
WhereitusedtotakeMr.
Cliterallyayearofanalysistoacknowledgetheprogressionfromragetoillness,henowidentifiesitquickly.
Infactheisnowbeginningtointerruptthehystericalsequencebysubstitutingfeelingsandwordsforsymptoms,thatis,becominghealthybybecomingreal.
ConclusionsPage49of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmWithShowalter,Shorter,Bollas,Mitchell,andothers,webelievethathysteriahasnotdisappearedbuttransformed,nowadaystakingtheformofenvironmentalillness,multiplechemicalsensitivity,chronicfatiguesyndrome,multiplepersonalitydisorder,fibromyalgiasyndrome,alienabductionsyndrome,GulfWarsyndrome,intestinaltoxinsandparasiticinfestationsyndromeand,inproxyform,attentiondeficitdisorderandattentiondeficithyperactivitydisorder,amongothersyndromes—e.
g.
,thehysteriaaroundvideodisplayterminals;MadCowDisease;theY2Khysteria;themasshysteriaaroundasbestosoraroundmolds—andthelistgoeson.
BecauseFreudneverrevisedhissex-centeredtheoryofhysteriaafterheintroducedthedual-drivetheory(Eros/Thanatos)in1920,theroleofaggressioninthisconditionwasneveradequatelyrecognized.
Aslateastheyear2000,Bollasstillviewedhysteriainlargelysexualterms.
Ontheotherhand,theKleinians,whoemphasizedtheroleofaggressioninpsychopathology,hadlittletosayabouthysteria,exceptfortheirunderstandingthathypochondria,asubtypeofhysteria,involvesaparanoidsenseofpersecutionbybadobjectsimaginedtoresideinsideratherthanoutsideofthebody.
ButtheKleiniansfailedtodeveloptheconnectionbetweenhysteriaandtheparanoid-schizoidposition—aconnectionsoprofoundthatweregardthevariousformsofhysteriaassub-typesofamoregeneralhystero-paranoidsyndrome.
Inourviewboththeoldandthenewhysteriasinvolveaparanoid-Page50of62FugitivesFromGuilt03/02/2007http://www.
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htmschizoidretreatfromanddefenseagainstthedepressiveposition—i.
e.
,aretreatfromwhatWinnicottcalledthe"capacityforconcern"fortheobjectintoanarcissisticandschizoidnon-relatedness,combinedwithrepressionandprojectionofdestructivehatredandenvyoftheobject,resultinginaparanoidstateofpersecutionbythebadobjectsintowhichthesubject'shatehasbeenprojected.
Theresultingstateofparanoidtormentservesthearchaicsuperego'sdemandforpunishmentforboththeschizoidcoldnesstowardandhatredoftheobjectworld.
Suchself-tormenthasbeencalled"persecutoryguilt"asdistinctfrom"depressiveguilt"byGrinberg(1964),butelsewhereCarveth(2001)hasarguedthatitismisleadingtorefertosuchdisparatephenomenaasparanoidself-tormentandconcernfortheobjectbythesameword,"guilt"—especiallysincetheformerservesasadefenseagainstthelatteronthepartofthoseunabletobeartheguilt,concern,anddrivetowardreparationcharacteristicofthedepressiveposition.
Carol"White"—apersonalitypurgedbyexternalizationofalldarkness—suffersfromaschizoidstateofdemoralizationresultingfromherde-moralizingflightfromconcernandguilt—i.
e.
,fromhumanrelatedness—andfromaparanoidstateofpersecutionresultingfromprojectionorexternalizationofherhostility,astateoftormentthatsimultaneouslydefendsagainstunbearableguiltandpunishesherforherevasion,irresponsibilityandhatred.
Carol'spersonaldemoralizationandthede-moralizingflightfromPage51of62FugitivesFromGuilt03/02/2007http://www.
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htmmorality—i.
e.
,objectrelations—thatcausesit,mirrorsthatofthewiderculture.
Weliveinasocietyinwhichwecansaywedisagreewithsomeone,butcannolongersaythatheorsheiswrong,letalonethatheorsheisbad.
Fromthepoliticiantotheintellectualweareallaidedinavoidingcontrition,remorse,responsibilityandtheneedtomakereparation.
OurculturalmantraisCarol's:"Ican'thelpit.
"WeareinnowayclaimingthatpeopleweremorallybetterinthepastwhentheJudeo-Christiandiscourseofsinandresponsibilitywasstillinforce.
Infact,owingtothatverydiscourse(amongotherfactors)thebrutalityoftheMiddleAgeshasbeensignificantlytranscendedinliberaldemocraticsocieties.
Itissuchmoralprogress(insofarasouractionsasdistinctfromourwishesandfeelingsareconcerned),suchanincreaseincivilizationandthestrengtheningofsuperegodemands,thatmakesitmoredifficultforustobearthediscontentsofcivilizedlife—thatis,thepowerfulguiltfeelingsarisingfromourbrutalimpulsesthatmusteitherbeenduredand,ifpossible,creativelytransformed,orevadedthroughthepatternsofunconsciousself-torment.
Onethingisclear:thede-moralizingtrendevidencedinthedemoralizationandunconsciousself-tormentseeninthenewhysteriasismirroredbythede-moralizingtrendandthedemoralizationofcontemporarypsychoanalysis.
ForunlikeitsFreudianandKleinianforbears,varioustrendswithinpost-FreudianpsychoanalysisretreatfromhelpingpatientsdiscovertheiragencyandassumeresponsibilityfortheirsufferingandinsteadcolludewiththeculturaldiscourseofvictimhoodinwhichpatientsareheldtobePage52of62FugitivesFromGuilt03/02/2007http://www.
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htmproductsoftheirtraumaticchildhoods,parentalfailures,disorderedneurochemistry,orwhatever.
Althoughsuchtherapistsarenotblamingapollutedenvironmentbuttoxicneurochemistry,notalienabductionbuttheabsentfatherorunempathicmother,theysharethedefensiveexternalizationofresponsibilitywiththeirhystericalpatients.
Furthermore,wherethesemothersandfathersarethemselvesinanalysis,theytooarehelpedtounderstandthemselvesasvictims.
WhatthenisthedirectionforwardCertainlyitisnotthepathofaninstinctualliberationthatwouldseektoreturnustothebrutalityofapre-moralera,ortobrutalinterpretationsofguilt—foritisunnecessarytobebrutalintheinterpretationofguilttohelppeopleconfrontandbearit.
Butneitherisitthecontinuationofourcurrentde-moralizingtrendsthatmerelyintensifytheunconsciousneedforpunishment.
Whatiscalledforisneitherthede-moralizingnorthere-moralizingofpsychoanalysis,butrathertheanalyzingofunconscioussuperegodynamics,sothatpatientsarehelpedtotransformunconsciousself-tormentintoconsciousguiltandtofindwaystobearit,tomakecreativereparation,andtochange.
Notes*AmericanImago,Vol.
60,No.
4(Winter2003):445-479.
Amuchearlierversionofthispaper,writtenwiththeassistanceofNaomiGold,waspresentedatascientificmeetingoftheTorontoSocietyForContemporaryPsychoanalysis,October4,2000;andinasomewhatabbreviatedandrevisedformtotheGroupforAppliedPage53of62FugitivesFromGuilt03/02/2007http://www.
yorku.
ca/dcarveth/Hysteria.
htmPsychoanalysis,UniversityofFlorida,Gainesville,February14,2002.
Thepresentversion,presentedatthescientificmeetingsoftheCanadianPsychoanalyticSociety,Vancouver,June8,2002,hasbeensubstantiallyrevisedincollaborationwithJeanHantmanCarveth,whoalsosuppliedillustrativeclinicalcasematerial.
Italsoincorporatessomeofwhatwaspresentedas"NotesontheHysterias,NewandOld"attheSeventhAnnualDayinAppliedPsychoanalysis,TrinityCollege,UniversityofToronto,October4rth,2003.
Theconceptionofunconsciousself-punishmentasanevasionofguiltratherthanitsequivalent(asinFreud'sview)thatishereappliedtotheunderstandingofhysteriawasdevelopedinanearlierpaper(Carveth2001),"TheUnconsciousNeedforPunishment:ExpressionorEvasionoftheSenseofGuilt"PsychoanalyticStudies3,1:9-21.
Availableonlinehere:Guilt.
[1]Weplacetheword"guilt"ininvertedcommasheretoindicateourbeliefthatthe"persecutoryguilt"thatGrinberg(1964)contrastswithwhathecalls"depressiveguilt"isnotreallyguiltatall:itispersecutoryanxiety.
Theterm"guilt"shouldbereserved,inourview,forwhatGrinbergcalls"depressiveguilt"orwhatWinnicott(1963)termed"thecapacityforconcern.
"AsAlexander(1925;1930;1961)wasamongthefirsttorecognize,trueguilt(inwhatKleincalledthedepressiveposition)isanegofunction:itinvolvesthinkingoftheconsequencesofourbehaviourforothers.
Inthiswayitcontrastswiththeessentiallynarcissisticnatureofthe"persecutoryanxiety"(mislabelledbyGrinbergas"persecutoryguilt")thatentailsasuperegoattackontheselfthatisnotableforitslackofconcernfortheinjuredother.
Itistheparanoid-schizoidandnarcissisticnatureofthesuperegothatenabledAlexandertodefinetheaimoftheanalyticcureasitselimination.
Page54of62FugitivesFromGuilt03/02/2007http://www.
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htm[2]Somethreedecadesago,Menninger(1973)wasalreadyaskingWhateverBecameofSinWehaveheardpsychoanalyticcolleagues,notFreudiansorKleiniansbutselfpsychologistsandsomerelationalanalysts,reportthattheyseldomifeverencounterguiltortheunconsciousneedforpunishmentassignificantdynamicsinthelivesoftheirpatients.
Atechniqueofempathicattunementtopatients'consciousandpreconsciousexperiencethatrejectsattentiontotheirunconsciousexperienceasnomorethantheanalyst'simpositionofhistheoriesmightbeexpectedtoignorethesedynamics.
[3]InkeepingwithFreud'sacknowledgementthatthe"choiceofneurosis"isoftenbeyondthepowersofpsychoanalysistoexplain,sothedevelopmentofonesub-typeofthehystero-paranoidsyndromeasdistinctfromanothermaynotbefullyaccountableinparticularcases.
[4]Somerecentevidencehasappearedthatcallsintoquestionthehystero-paranoidbasisofatleastsomecasesofso-calledGulfWarsyndrome.
LikeShowalter,wehavenoreluctancetoacknowledgeanorganicbasisforconditionssuchasmultiplechemicalsensitivity,environmentalillnessorfibromyalgiasyndrome,ifandwhenconsensuallyvalidatedscientificevidenceinsupportofsuchclaimsleadstotheirmedicalrecognitionasdiseases.
[5]Inemphasizingtheroleofaggressioninpsychopathologyweimplynocommitmenttoeitherthenotionofadeathinstinctorasomaticallygroundedaggressivedrive.
Wemerelyrecognizethefactthatfrustration(anunavoidablefeatureofhumanexistence)leadstoPage55of62FugitivesFromGuilt03/02/2007http://www.
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htmaggressionwhichthenmustbedirectedoutwardly(inconstructiveordestructiveways)orbottledupandretroflectedagainsttheself.
[6]Wewouldarguethatinthecaseofso-calledattention-deficitdisorderthehystericislessthechildsodiagnosedthantheparents,teachers,psychologistsandschoolofficialswhoredefineboredom,dreaminess,fidgetinessandpassiveaggressivenessasanorganically-baseddisorder—intheabsenceofevidenceofthe"minimalbraindysfunction"(orwhatever)thatisallegedtounderlieit.
[7]SuchdifficultiesarewelldepictedinthecaseofCarolWhiteinSafe,afilmthatoughttoberequiredstudyforphysiciansandpsychotherapistsworkingwithhysteria.
[8]Thesamemightwellbesaidfortheclassification"psychosomaticillness"whichmanydoctorsnownolongerofficiallyrecognise,butcontinuetorefertodaily.
[9]ThisdynamicasitisillustratedinaKleiniananalysisofthefilmAlien(Gabbard&Gabbard,1987)isdiscussedin"ThePre-OedipalizingofKleinin(North)America:RidleyScott'sAlienRe-analyzed"(Carveth&Gold,1999).
Thereisanunforgettablesceneinthisfilminwhich,thinkingtheyhadsuccessfullyeliminatedthealiencreaturethathadplastereditselflikeabadbreastoverthemouthofonemember,thecrewareenjoyingacelebratorymealwhenthealienstirsandbeginstomoveinsidehimandthensuddenlysmashesitswaythroughhischestcageandskuttlesoffintotheinterioroftheship.
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Page61of62FugitivesFromGuilt03/02/2007http://www.
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Carveth,Ph.
D.
GlendonCollege,YorkUniversity2275BayviewAvenueToronto,Ontario,CanadaM4N3M6Web:http://www.
yorku.
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D.
CenterforClinicalPsychoanalysis8025WetherillRoadCheltenham,PA19012Web:http://www.
jeanhantman.
com/Home|Publications|Reviews|Practice|Courses|Psychoanalysis|Existentialism|Religion|Values|LinksPage62of62FugitivesFromGuilt03/02/2007http://www.
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