| Psychoanalyzing the Body Jane G. Goldberg, Ph.D. Bodily dysfunctions and diseases may be caused by what is termed “soul displacement.” The author traces the etymological root of the word “psyche,” to mean “soul,” but then points out an earlier use of the word, to mean “butterfly.” When the psyche is freed, like a butterfly, it is enabled to fly; thoughts and feelings flow through the body and the psyche with ease. Bodily disturbances result when an individual begins to live from a place in his psyche which is not consonant with his soul. A false self arises, and thoughts and feelings are no longer free to fly. Case vignettes illuminate the author's conception of “soul displacement.” When this young man started therapy, he was just married and had to figure out some way of earning a living. His first job was as a karate teacher. That job did not work out too well because he had conflicts with the owner of the school. His next job was as a shoe salesman. But, again his anger got the better of him, and he did not last too long at that job either. Soon enough he was pounding the pavement again. This young man was extremely personable, so it was always easy for him to get jobs. The difficulty was in keeping them. Next, he got a job as a T-shirt salesman. That lasted about six months, and again his rage built up toward his superiors and he quit that job as well. Then he worked as a paramedic, a position that took two- years of school in preparation, not a position that one would give up without a lot of thought. Yet this job too proved to be unfulfilling. Finally, today he is finishing up another two year educational program to be a massage therapist. He wants very much to feel that being a massage therapist is, finally, going to do the trick and give him the sense of fulfillment that he has been searching for. I have the feeling that if Harry wants to have a feeling of hope, then I want to help him to have that feeling. My definition of a narcissistic transference is just that—giving the patient the feeling that what he wants and the way he understands the world are the same for the analyst as they are for him. It should feel to the patient like a warm bath. I spent a few days several years ago at a hot spring in northern California. There was a pool of water that was very hot, a pool of water that was body temperature, and a pool of water that was cold. Everyone there spent the day going from hot to cold to warm to cold to hot. It was wonderful—feeling all that variation on my skin. That is what an advanced analysis should feel like; it should have great variety, covering the full range of sensation. But, for the narcissist, this variety would be deadly, intolerable. For the narcissist, early in the analysis, the only pool of water is that one that is body temperature, so that there is not so much difference between his/her body and what is outside. Without understanding how to develop, nurture, and sustain a narcissistic transference, that is, how to develop it, nurture it, and sustain it, all of the diseases of narcissism—and they are manifold, including addictions, impulse disorders, psychosomatic disorders, in short, all of the preverbal, preoedipal conditions— remain untouched and uncured. Once the patient has accepted the analyst within the defensive walls of his narcissism—it's as though there is a moat, with no bridge across it, separating the person from the rest of the world—the analyst is able to wander around the castle at will. This is when the real work of poking around and pushing out the outer boundaries of the patient's narcissism begins. Eventually the outer boundaries become wide enough that other human beings, a world outside of the narcissistic world of self- involvement, can become a frame of reference for the patient. So Harry and I, who are in the midst of a narcissistic transference and countertransference, both ask—no bad news today about his professional future. But I won't ask about his chances of success for get another reason. What struck me as I thought about Harry's life is that each of his jobs involved the body. Either he was using his body, or he was clothing the body, or he was saving the body from the throes of death; or, now, as a massage therapist, he is making the body feel good. There must be a message in all that attention to the body. I decided to ask my patient to tell me the meaning of all this body stuff. He told me that he was raised according to the principle that only silk was good enough to touch his skin. He was raised to be a king. His only problem in life has been that his parents had not provided him with a kingdom. Imagine the frustration if you were a king in search of a kingdom. Your talents are not being used adequately. You are not heard, for the world is not listening to you, a world that would be an infinitely better place to inhabit if the planet could hear what you had to say. There would be no venue in which to spread out your riches. Being a king without a kingdom is surely a painful position to be in. Such is the life, from moment-to-moment, of my patient. He rails at his impotence, he rages at those who do not listen to him, he hates those who stand in the way of his goodness and essential generosity, and most of all, he cannot stand his railing, his rages and his hatred. I am not proud of this fact, that after seventeen years of analysis, this young man is not cured of his anxiety attacks, the original symptom which brought him into therapy. We have accomplished many things in therapy. He is a grateful patient and will tell you that there is no doubt in his mind that I saved his life, that his analysis cured him of a drug addiction that surely would have killed him, and that his analysis has transformed him from a hateful iconoclast into a man who can tolerate relatively well the stresses and strains of living with another adult—his wife—and two children with one more on the way. Yet, there is this intractable body problem that we just cannot make any headway with, his panic attacks. Harry will be sitting in his paramedic unit waiting for the next heart attack, or the next stabbing victim. Maybe he will have just finished his lunch, or maybe he will be cruising around the neighborhood. Suddenly, out of the blue, for no apparent reason, his heart starts beating widly out of control. He starts gasping for breath, and he is utterly convinced, without one moment of doubt, that he is dying. It feels like he is dying. Since these attacks spring up on him unexpectedly, he lives every day with a threat. Sometimes the anticipation itself is more than he can bear. My patient has been checked out medically 1000 times. There appears to be nothing wrong physically. We have tried the nutrition angle. But no luck there. My patient is convinced that I can cure him of his affliction, and so in spite of all these years of failure we keep plugging away at it. Some might say that this is asking too much of psychoanalysis, that it was never meant to be a treatment for hard-core body symptomatology. These critics argue that it was devised strictly as a treatment for the mind, and it is hubris to attempt otherwise. Actually, these critics are wrong about their understanding of the origins of psychoanalysis. Psychoanalysis was not devised as a treatment for the mind. It was devised as a treatment for the soul. The psychoanalyst Bruno Bettelheim (1982), whose original tongue was German, painstakingly read Freud's work in the original German. He pointed out the deliberation with which Freud chose the term psychoanalysis. The etymology is, of course, from the two root words in Greek, psyche and analysis. Freud, ever the dualist, had a dichotomy in mind when he chose those two words to put together. The two words strongly contrast to one another. Analysis connotes reason and logic. It suggests a kind of attentive mindfulness, a scientific taking-apart in order to see and understand component parts. Psyche, on the other hand, means soul. It suggests just the opposite, a kind of etherealness, a softer endeavor. Soul is a decidedly unscientific concept. It is with great intelligence that we, as modern analysts, say that cure lies in the ability to verbalize all of our thoughts and feelings. It is in keeping with Freud's original idea that psychoanalysis is both a study and an experience, that it is both eminently rational and completely irrational, that it is both heavy and weighty and grounded, and light and airy and spacious. What else can be said about this word psyche that means soul? Bettelheim discovered, in looking at the translations of Freud, that every time Freud used the word psyche, instead of translating it as soul, the translators used the word mind. Quite a difference. A mind has a place. It resides somewhere in the head. It is easy to associate mind with brain, an actual physical entity. A mind has a function on which we all agree: a mind thinks and reasons. Soul is quite a different kettle of fish. We do not even all agree that we have souls, much less where they are or what they do. Soul is a much more difficult concept to embrace in our overly medicalized culture (and do not forget psychoanalysis was imported into America by medical physicians). Mind was a good choice for medical doctors because it gave them a precise disease entity. Why all this soul business? There is yet another meaning, an earlier meaning, that the root word psyche had. This earlier meaning helps to elucidate why Freud chose such an evocative term to name his innovative treatment. The Greek word psyche also means butterfly. The soul is a liberated being. It flies. It is not bound by the earthly restraints of the body. So the question must be asked, do we need to get in touch with our souls in order to be free from the agonies that our bodies can put us through? Freud was not a religious Jew. If anything, he was prescient of the modern scientific man. He believed that science could heal. In fact, he believed that chemical therapy would ultimately outlast and be more effective than psychoanalysis. So when Freud used the term soul, he did not have in mind all the religious connotations for the word. He meant, I believe, what is distinctly human—the core of our being, the “actual me,” as Whitman said. I think of my most difficult patients, the ones likes Harry, as having something like a soul displacement. Their souls are out of sync with the rest of them. Their souls do not sit on top of who they are. Rather, their souls are off-center or off-kilter. I see a visual metaphor for our humanness. It is concentric circles, each one a little bigger than the one on top of it, each representing a different aspect of man. In our soul-lost patients, these circles no longer lie on top of one another. There is not a convergence of meaning for them. These are the people who did not become who their natures would have led them to become. They were dislodged from the people they should have been. They live their lives in the soul, or body, or mind of someone else. When people leave their souls, or when they are out of sync with their souls, what they have done is taken a side road and tried to make it a main road. But it was never meant to be a main road. They often do their best to pretend that it is the right road, but on some level there is awareness that it is not. They suffer for the displacement, and they suffer for the delusion. They are not in their souls, and thus they are not in their bodies. One cannot have anxiety attacks, as Harry does, if one is centered in his or her soul. In fact, I do not believe that anyone can develop a psychological condition that manifests itself in the body if one lives in the soul. Psychic symptoms that lodge themselves in the body are manifestations of a displaced soul. When a person finds soul, she finds the body, and in so doing the body is enabled to become a fountain of pleasure instead of a source of pain. One of my cancer patients was brought up on a kibbutz and had only intermittent, structured time with her mother, as this was the policy of the kibbutz. She is a brilliant writer, and her thinking is clear, her intuition quick. This woman should be living the life of a heavyweight in some profession. She should be a person to contend with on a serious level, with accomplishments to back up her talent. Yet, instead of success, she struggles daily with the question of how important her life is, whether or not she wants to live, whether she has it in her to commit herself to any profession. This patient was brought up with a lot of thought control. She was not supposed to miss her mother, she was not supposed to have selfish thoughts, she was not supposed to feel better or prettier or smarter than anyone else. So, in spite of the fact that her core being felt all those things, they were relegated to the unconscious because of their unacceptability. Her thoughts and her feelings took widely divergent paths. Though her feelings represented her real self, she lived from her thoughts. She lived from a false self, and thus became soul-less or soul-lost. This is, I believe, at the root of her cancer, which, by the way, has been completely under control since she started analysis. I mention this patient in particular because she is paradigmatic of the kind of cancer patients that I see in my practice. They typically have histories where they simply never found a home in their selves. They seem apart, or lost from their souls. There is no sense of safety or rest for these soul-lost patients. This phenomenon is prevalent so much in cancer patients because, when the cancer has psychosomatic components, then the damage usually has occurred very early in life. It is a narcissistic disorder; it occurs in the developmental phase when a stable sense of self-identity should be developing. A true self never emerges. Something that may look like a self develops. This is why cancer patients are, on the surface, so pleasant to be around. The false self that they allow others to see has nothing to do with their own authentic, internal needs or desires. The false self exists only to please others. They have taken one of those alternate paths, a back road instead of the main road. There is no “actual me” from which they live. Scientific research reveals the way a psychosomatic cancer patient leaves his soul. These people are typically extremely constricted when it comes to consciously experiencing their anger. But we, as modern analysts, know that anger and hate and vindictiveness, the wish to hurt and harm as well as the wish to be hurt and be harmed, are part of what it means to be human. If we are to live from our soul, we will live from all these feelings—the dark, ugly ones as well as the sweet, pleasant ones. And we remember, too, that butterflies, the symbol of soul-living were once ugly, wormy larvae. One would never predict, without foreknowledge, that a thing of such beauty could be transformed from a thing of such ugliness. We cannot be so quick to reject all those ugly, wormy things in our psyches. From them may develop wondrous creatures of great beauty that can fly. Modern analysis, more than most contemporary psychotherapies, embraces the ugly, wormy larvae. I treat some spill-over patients who have worked with other therapists. Although it is impossible to really know how other therapists conduct therapy, I do glimpse from these spill-over patients how the practice of modern analysis is quite different from what most other therapists do. There is a fair amount of ego-supportive therapy. Therapists generally like their patients to like them, probably in hopes that the patient will continue with the therapy. And indeed, I have gotten a lot of spill-over patients who liked their therapists a lot. They liked them, but did not feel particularly helped by them. Usually these patients, out of fondness for the therapist, will say something very inoffensive about the therapy, like: “I just felt I needed a break from therapy for a while.” Or, “We had gone as far as we could go together.” I am not saying that modern analysis is not ego-supportive and caring and warm. As a modern analyst, I may be any of those things, or I may, at any given moment, be none of them. The point is that modern analysts, like their patients, have souls. If we are working well with our patients, we are working from our souls. That does not mean all-loving. It means centered; it means using induced feelings; it means differentiating one's own self from the other; it means using thoughts and feelings to stimulate in patients their own thoughts and feelings. The first cancer patient that I mentioned, the Israeli, has, I believe, begun to re-find her soul; in doing so, we have become soulmates. She will tell you that her cancer was almost incidental to her illness, that it was just a way of her manifesting her death drive, and that once she stopped making decisions that were propelling her toward self-sacrifice, toward repressed rage, toward self-hatred, in short toward death, that her cancer receded and the life forces in her body took over. One of the manifestations of her death drive was to stay hidden, to live her life close to home, in spite of a burning desire to be in the world, the “big world,” as she calls it. A few months ago she told me that she had decided to speak at a national cancer conference, to share with three hundred people her experience in fighting cancer. I genuinely regretted that I was going to be out of town and would not be able to hear her, and told her so. She expressed surprise and was visibly moved, then asked why I wanted to hear her. There were many reasons, and I named a few, and then said that I wanted to hear her most of all because I love her. She said: “It has taken me ten years to believe that.” Then she said that she feels that a bird inside her has taken flight. When a patient and an analyst meet on a soul-level, they can fly together, and the flight is exhilarating. Flying is a new feeling for depressed, anxious and psychosomatic patients. Modern analysts are always happy when a patient experiences a new feeling. A new feeling means that an old resistance has been resolved. It turns out that science confirms Freud's wisdom in naming his new discipline with a term whose meaning held an inherent contradiction. This contradiction mirrors the human brain. Humans have both an old and new brain, and a left and right hemisphere in the brain. So you see, when modern analysts tell their patients to put into words all their thoughts and feelings, they are really telling the patients to exercise all aspects of their brains. Talking with both thought and feeling connects old and new brain, left and right hemispheres in the brain, love and hate, passion and reason, conscious and unconscious, spoken and unspoken. The modern analyst's instruction to the patient to put all thoughts and feelings into words is actually an invitation to go back in time before the formation of character. The resolution of resistance is when this time travel is successful. One has arrived there—and what I mean by “there” is home, in the center of your soul (or psyche)—when there is a release of feeling, the body is energized, the psyche feels lighter, and thought has clarity. The soul is centered squarely on top of the body and mind. I once treated a terminally ill cancer patient. She was definitely a soul-lost person. She was Catholic and had three children in rapid succession even though the pregnancies and child-rearing exhausted her. But she wanted to be a good Catholic and a good wife. She did not do a very good job of raising her children—how could she have when she did not know who she was? This is background information. Her son is the focus. This young man related a rather remarkable story a few months after his mother's death. He had started therapy with a Catholic priest when he was fifteen. The therapy consisted of his having sex with the therapist. They continued this sexual/therapy relationship—his parents, of course, believing that he was in the best of hands—for ten years. When Gary first started therapy with me, he assured me that he was a willing participant in the sex. He said that the relationship and the sexual aspect of it were the best things that ever happened to him. He explained that he had had no real relationship with anyone, ever, until then. This was his first authentic relationship, the first time he cared for someone and was cared for in return. When I asked if he would have benefitted equally had they had the emotional closeness without the sexual closeness, he assured me that he would not have. He presented a compelling case and frankly, in spite of my moral and intellectual misgivings about the whole thing, I found myself almost believing him. Our therapy proceeded for a few years, and this part of his history was not talked about too much over those years. Mostly what Gary feels is foggy and unclear. He said to me the other day: “I reach out my hand to touch reality, and it passes right through space as though reality were a hologram.” About a month ago, Gary started talking again about his friend. They are still in contact with one another. In spite of his friend's assurances to Gary that Gary is gay, Gary realized about five years ago that he is not. And, in spite of his friend's assurances that they are soulmates and meant for one another, Gary no longer believes this. So when Gary said something to me the other day about his friend's “loving him,” I pounced. I said, “What do you mean, he loves you? Why do you call it love when he has tried to convince you that you are gay when you are not? Why do you call it love when he will not let you go, and ties you to him through guilt by telling you that you are his one and only forever more?” Now these may seem like obvious questions to ask. Most anybody would be able to think of these questions. They are really comments in the guise of questions. But without a concept of narcissistic transference a therapist is likely to get it all wrong. These things could not have been said five years ago, or even five months ago. Gary's narcissistic walls were too impenetrable. An effective therapist knows when to pounce. An analyst pounces only after the patient has lowered the bridge over the moat. Otherwise the analyst will, at best, have no effect on the patient, and, at worst, alienate the patient and destroy the treatment. I thought these comments to Gary were timed correctly, but to make sure, I asked him in his next session how they had made him feel. This was new territory for us. I had never before so boldly challenged his ideas about his perceptions and assumptions. He told me that he had never thought of the relationship in that way, but that hearing it made him feel calmer and clearer. Reality seemed a little less like a hologram. In other words, my communication to him made the concentric circles of his self a little more in line with one another. Here is one more quick example. One of my spill-over patients told me she left her last therapist because the therapist advised her to divorce her husband. Any reasonable person would have concluded that she should divorce her husband. He had moved out of their apartment, but was carrying on a charade that he was still living there. He would sneak into their apartment early in the morning, get dressed, and leave for work. Everyone they knew thought they were still living together. She knew that he was having an affair. He was not going to great lengths to hide it from her. In spite of this ridiculous arrangement, there was one thing that I knew not to tell this patient, and that was that she should divorce her husband. Just like Gary had me convinced for a while that having a sexual relationship with his previous therapist was a good thing, and just like Harry has me convinced that his next profession is going to make him a happy, fulfilled man, this patient had me convinced that she should not divorce her husband. That is, she had me convinced that she should not divorce him until, five years after beginning treatment with me, she was ready to divorce him. When she got ready to divorce him, I got ready to see that she should divorce him. She is now happily divorced, and she and I have a fine narcissistic transference that was allowed to stay intact as long as it was needed. When one loses soul, what is needed to re-find soul is always to think, feel and say the very thing that feels so utterly impossible to think, feel and say. Perhaps it means breaking the symbiosis with the children, and taking time for oneself. But some people cannot give themselves permission to do this, because they are so terrified of repeating their history with their children and giving them the kind of awful mothering experience that they had. So guilt and fear tie them, and they exhaust themselves, they sacrifice themselves, they give up all identity except the one as mother. Soul is lost, and no amount of reason or will can change their mind that this is the only kind of mother they can be. This may feel like murder, or a death. To do the impossible—to separate from the children in order to give to oneself—would feel like jumping off a cliff, unless the resistances are resolved first. Then it feels like flying. The soul can fly. Or perhaps re-finding soul means finding a lost connection to other humans. One of my patients complains about stomach aches after each group therapy session. She struggles weekly with spending an hour and a half feeling her aloneness, her isolation and her essential strangeness to the rest of humanity. She says that the way other people feel about spiders, tarantulas and rats, which she collects as pets, is the way she feels about other people. She knows her soul only through her artwork, which probably saved her from schizophrenia. Or, perhaps re-finding soul means learning to talk the way one sings. A patient of mine is extremely wealthy—a self-made millionaire at the age of 30. But he suffers chronic headaches and feels there is a connection. He hates everything about his father, but the one lesson he learned but good from his father was the importance of money. The only time he feels truly himself is when he is singing—the one area of his life about which his father had nothing to say. Oliver Sachs, who is doing research now on music, has found the same thing. He has found neurologically impaired patients who cannot walk, cannot take a single step, but who can dance. And he has found patients who cannot talk, but who can sing. He describes these patients as being “activated” by the sound of music. Music is helping them to re-find their souls, even when access to their self-identity has been hampered by neurological damage. Harry has decided that in order for him to get better he has to give up some of his grandiosity. He is considering ending his search for a kingdom, and just plain settling down into the world, miserable as it is, as he finds it. This idea would have been foreign to him a few years ago. It would have been a quick jump into a pool of water that was much too cold or hot for him to tolerate. He would have jumped right out. Now it feels almost like a warm, relaxing bath. Harry tells me that I may be missing something by not including body work in my job as a psychoanalyst. He finds this body work incredibly powerful. Let me end by saying this about the power of words to the soul and to the body. It is not just that I am lazy and do not want to go to massage school at this point in my life. I can do, as a psychoanalyst, what he can do as a body worker. Words can cure the body. Words as healers come from a long history. In premodern cultures the verbs “to name” and “to be” are the same. Naming a thing with a word gives it existence. The Judeo-Christian culture tells us that first there was light, but after that, the whole rest of the world was created through God's speech. “In the beginning was the Word.” Words are divine; words give birth to life. The Greeks, too, recognized the immense healing power of words. Revered even more than the physician, who could heal the body, was the person who could bring “cheering speech” to the soul. Freud (1891) was interested in the unspoken word even before he discovered the unconscious and psychoanalysis. His first interest was in aphasia, a breakdown in the accessibility of words because of a lesion in the brain. When he decided to use free association as a technique, he discovered another kind of unspoken word. He found that if we silence the normal operations of our everyday conversational speech, if we temporarily cast aside reason and logic and our almost instinctual inclination to judge our thoughts and feelings, another language presents itself to us, the language of the unconscious. The unconscious is our inner speech. The unconscious connects us to our soul. This inner speech is the province of psychoanalysis, the speech we aspire to reach. Psychoanalysis is the process of revealing to ourselves and to another our inner speech, the speech that represents who we are in the darkest, deepest depths of our being, the center of our being. It is a ritual of telling one's story. One tells someone else these secrets of one's soul because telling another facilitates telling oneself, and because the other, the analyst, has clearer vision about what has not yet been said, about what it would feel like jumping off a cliff to say it. The analyst knows how to resolve resistances to make the soul fly. References Bettelheim, B. (1982), Freud and Man's Soul. New York: A.A. Knopf. Freud, S. (1891), On the Conception of the Aphasias: A Critical Study. Vienna. Goldberg, J.G. (1995). Psychoanalyzing the Body. Mod. Psychoanal., 20:79-90 |
 | |  | |  | |  | |  | |  | |  | |  | |  | |  |
