THE
PSYCHOANALYSIS OF VIOLENCE
Peter Fonagy,
PhD, FBA
Let me begin by summarising
our model of the normal and abnormal experience of psychic reality. Both
clinical and cognitive research evidence have shown that a normal
awareness of the relationship between internal and external reality is not
universal, but rather a developmental achievement (Fonagy & Target,
1996; Target & Fonagy, 1996). A child normally moves from an
experience of psychic reality in which mental states are not related to as
representations, to an increasingly complex view of the internal world.
This more complex view has as its hallmark the capacity to mentalise: to
assume the existence of thoughts and feelings in others and in oneself,
and to recognise these as connected to outer reality (but only loosely).
Initially, the child's experience of the mind is as if there was an exact
correspondence between internal state and external reality. We call this
mode "psychic equivalence", to emphasise that for the
young child mental events are equivalent in terms of power, causality and
implications, to events in the physical world. Equating internal and
external is inevitably a two-way process. The small child will equate
appearance with reality (how it seems is how it is), but also thoughts and
feelings, distorted by phantasy, will be projected onto external reality,
unmodulated by any awareness of this distortion.
Perhaps because it can be
terrifying for thoughts and feelings to be experienced as concretely
'real', the small child develops an alternative way of construing mental
states. In "pretend mode", the child experiences feelings
and ideas as totally representational, or symbolic, as having no
implication for the world outside. His play forms no bridge between inner
and outer reality. Only gradually, and through safe closeness to an
attachment figure who can simultaneously hold together the child's pretend
and serious perspectives, does the integration of these two modes give
rise to a psychic reality in which feelings and ideas are known as
internal, yet related to what is outside (Dunn, 1996).
The background of
security and a theory of self development
We have suggested that the
emergence of mentalising is deeply embedded in the child's primary object
relationships, principally in the mirroring relationship with the
caregiver. We suggest that the infant only gradually realises that he has
feelings and thoughts, and slowly becomes able to distinguish these. This
happens mainly through learning that his internal experiences are
meaningfully related to by the parent, through her expressions and other
responses. Primary representations of experience are organised into
secondary representations of these states of mind and body (Fonagy &
Target, 1997). The experience of affect is the bud from which eventually
mentalisation of affect can grow, but only in the context of at least one
continuing, and safe attachment relationship.
The parent who cannot think
about the child's mental experience deprives him of the basis for a viable
sense of himself (Fonagy & Target, 1995). This is a familiar idea in
psychoanalysis (see Bion, 1962; McDougall, 1989, p. 169; Winnicott, 1956).
The absence or distortion of this mirroring function may generate a
psychological world in which inner experiences are poorly represented, and
therefore a desperate need is created to find alternative ways of
containing psychological experience and the mental world. Clinically this
would mean that the child who has not received recognisable but modified
images of his affective states, may later have trouble in differentiating
reality from fantasy, and physical from psychic reality. This may restrict
him to an instrumental (manipulative), rather than signal (communicative)
use of affect. This instrumental use of affect is a key aspect of the
tendency of violent patients to express and cope with thoughts and
feelings through physical action, against their own bodies or in relation
to other people. Such physical action may well come to involve various
forms of self-harm or aggression towards others (Fonagy, Moran, &
Target, 1993; Fonagy & Target, 1995). Not being able to feel
themselves from within, they are forced to experience the self from
without.
We know that trauma plays a
significant role in the psychogenesis of violence (e.g. Johnson, Cohen,
Brown, Smailes, & Bernstein, 1999). When perpetrated by an attachment
figure, we suggest that trauma interferes with the developmental process
described above. Evidence of this can be seen in severely abused children:
(a) the persistence of a psychic equivalence mode of experiencing internal
reality; (b) in their propensity to continue to shift into a pretend mode
(dissociation); (c) a partial inability to reflect on one's own mental
states and those of one's objects. We are suggesting that these ways of
thinking persist into adulthood, and play a vital role in acts of enraged
violence. I would now like to elaborate these ideas in the context of a
psychoanalytic case report. I hasten to add that my purpose in doing this
is not to recommend that intensive psychotherapy should be used with
individuals such as my patient. Rather, I think the treatment highlights
the value of psychoanalytic treatment as an important observational tool
in our quest to understand the deep psychological mechanisms of the
horrifying problems of violence that surround us.
A psychoanalytic
treatment of a murderer
Henrietta, a young woman,
referred herself to a forensic psychiatrist colleague for counselling.
Strangely, the referral on to me mentioned nothing about a forensic
history, but described repeated suicide attempts, unstable but intense
relationships, and abuse of her medication. The referral did not prepare
me adequately, however, for the paranoid, almost psychotic but in fact
dissociated, episodes with hallucinations and some thought disorder, which
were to be so striking in my work with her.
There are two facts that
make Henrietta's history unusual. The first is that she was a murderer;
not of her internal objects, her self-representation, her thinking and
feeling or other parts of her and her object's mind, although she is
undoubtedly guilty of all these - but of her boyfriend. She stabbed him in
the course of a violent quarrel. She pleaded self-defence and that the
stabbing was accidental. She was charged with manslaughter and was freed
with a suspended sentence. About four years into the analysis she
confessed to me that the stabbing had not in fact been an accident. While
not premeditated, it had certainly been intentional. She had felt driven
by violent, blinding rage. By that time, four years into the therapy, I
was familiar with Henrietta's violent tendencies and her vicious explosive
attacks of rage. I was not really surprised by her revelation.
The second fact was her
experience of abuse. She described having first been sexually abused by
her alcoholic father, then as a teenager by a teacher in her boarding
school. Both experiences included intercourse. Her father also beat
Henrietta for various misdemeanours at least once a week, and more
severely, usually for "answering back", at least once a month.
The abuse by her father remained a secret between them until his death
shortly before the start of her treatment. The relationship with the
teacher became public, and the man concerned was dismissed.
Why would someone like
Henrietta come into therapy? She seemed never to have had an understanding
relationship. She said she wanted to get help with the terrifying dreams
which had started with the death of her father. She came to the first
interview in a strident mood, demanding a brief period of counselling. She
did not know that I was a psychoanalyst and, on noticing the couch some
time into the interview, she said "So, this is where you fuck your
patients?". A feeling of fear washed over me. Rather than reacting
directly to her combative intrusive manner, I was aware of the
vulnerability and enormous anxiety behind her need to strike out and hurt.
I said, aiming to be reassuring, "You must feel quite brave that you
dared to come and see me". She said, continuing her contemptuous
tone, "You shrinks are abusers. It's just a power trip". I said,
now more confident of my countertransference response, "I think it is
your own power to destroy and abuse that frightens you about
therapy. You feel much more confident about being able to cope with
me". She stopped short and asked me what I meant by
"therapy".
She arrived on time to the
session, sat in a chair and said she felt upset, and looked at me
challengingly without speaking further. I said "I don't understand.
You need to tell me what upset is for you at the moment". She said
that she had had another dream about her father which had upset her. In
the dream, he had asked her to put her head up his backside and she did
not want to do it. She was ready to follow through with a string of
obscene images depicting the sexual life between her father and herself. I
interrupted "I think you are upset because you are frightened that I
will make you bury your head in messy thoughts here". She stopped in
her tracks, told me in a rapid sequence I could hardly follow, that she
was lost, that her mother didn't understand, she wasn't trying to hurt
anybody, that the death was an accident, that she tried to resuscitate
him, to give him the kiss of life, but failed, and now I was trying to
kill her. There was a gradual acceleration of tempo and intensification of
affect. By the end I was in the room with an apparently angry, yet
basically terrified person. It was unclear what these feelings were about.
She seemed terrified by violence, her own or mine. She expected to be
killed by a raging jealous object or to kill an invading, threatening one.
I said, trying to calm her by stepping outside the fray: "It seems
that you feel driven by a terror that you might lose me in this violence.
You feel you have to constantly resuscitate me, to breathe life into me
just to keep me alive for yourself". She was silent. Eventually she
responded, somewhat more calmly, that she was frightened of being a
person. She preferred being empty; people only attacked you if they knew
you were somebody. I said, "I agree. I think you feel safer with me
when you feel empty. It feels even safer if you feel you have emptied me
too". Her terror that I might kill her and the even greater fear that
she might kill me, intentionally or accidentally, overrode all other
concerns.
This brief vignette raises
several issues. I did not presume to know what 'upset' meant for Henrietta
at this time. Most patients would have been aware that their therapist was
not going to know what was upsetting them, but for a patient working in
psychic equivalence mode, the therapist already knows what she knows
(perhaps better than she does) and does not need to be told. After my
intervention, Henrietta immediately shifted into pretend mode, starting to
talk about the dream images. Unlike the situation with a neurotic patient,
for whom the exploration of a sexual fantasy might be therapeutic, for a
patient like Henrietta it seemed vital to interrupt her retreat into
something that she represented as unreal. The therapist's task in such a
situation is to find something felt as real within that unreal image,
which may be deeply obscure. I therefore focused on the anxiety about the
confusion which having to talk about her thoughts and feelings evidently
confronted her with. That in itself provoked more anxiety in the patient
than it contained. Suddenly, the fantasies became real: she shifted into a
psychic equivalence mode and seemed almost to feel that her life was in
danger. This panic escalated until somebody else contained it. Somebody
was going to get killed. The aim of this sort of cathartic outburst is
not, I suggest, a wish to be contained, nor (certainly) a wish to work
through an experience, but rather an emptying of the self which quite
consciously feels like pre-empting an imminent attack. In such a
situation, the countertransference response is often a sense of emptiness
on the part of the therapist; this is not seen as the result of an
intentional destructive attack by the patient on the therapist's thinking,
but rather as an attempt to relieve anxiety by reducing both people to an
equally unthinking state.
Henriett'a thoughts did not
feel owned by her mind, but rather were experienced almost as if spoken
and thus made externally real. We see this as one consequence of equating
inner experience with outer reality. It took me some time to realise that
in my conversations with her there was often a third presence: a voice
inside her head, someone she felt was her, but not her at the same time,
an alien aspect of her often dissociated state. Her thoughts seemed to
possess a concreteness and immediacy that was difficult to appreciate
fully. Fleeting ideas or images were experienced as disembodied voices,
sometimes friendly but mostly persecutory and vicious. While clearly not
the same as hallucinations in a schizophrenic patient, nor were her
thoughts felt to be coming from her own mind. Her verbalisations at these
times were responses to what she 'heard' as much as they were responses to
her dialogue with me. This posed an interesting challenge for my work in
the transference. Eventually, I began to address this voice more directly.
For example, one session
she was upset, she buried her head in the pillow and started to sob
violently; "I am so confused. I feel so bad. I am told I am fine, but
I feel hopeless. Please tell me what is wrong with me". I replied
with the intention to enter into her mental world, but at the same time to
insert the analyst's voice as another perspective which could eventually
become therapeutic. "You feel that because I ask you to come here for
only 50 minutes on a particular day, so I can't possibly understand what
your needs really are. I think you have a voice inside your head telling
you 'you are fine'. And it sometimes sounds like my voice". She
calmed down a bit and then she seemed to suffer something like an allergic
response to contact with me. She suddenly said, as if unaware of the
contradictions, "I don't need help. I am fine. I am sick. I want to
throw up". Then a pause, "I want to throw up when people get too
close. You get taken over. You must understand me. You don't understand
me. Do you understand me?". I said, trying to identify the source of
anxiety, "You are terrified of what I do understand. It must
be so sickening that I have to throw you out". She said, still
sobbing, "It's the sex. It's so wrong. I am so frightened you might misunderstand.
I am trying so hard to make something happen this time". I said,
regarding the reference to sex as defensive, aiming to distract us from
the immediate source of her anxiety: "You hope for something good to
happen here, but you are also frightened because you hear a voice telling
you to spoil it by confusing and misleading me".
The understanding that I
had to hold on to over these early years was that alongside her craving
for anything which might give a sense of order to her psychic chaos, she
desperately fought the truth of any idea, not for its specific
contents, but because of the intolerable sickness which the closeness of
two human minds engendered. There was something that felt sickening and
disgusting about genuine feelings and ideas; there was an abhorrence of
communication and reflection. She had tried to repudiate her capacity to
conceive of mental states, in herself and in me, leaving her with rigid,
schematic representations.
Therapy was an obscene
seduction because thinking about mental states was an incestuous act,
experienced as the intrusion of an object into a space far too small to
contain it. Her adaptation to trauma entailed the disavowal of conceiving
of feelings and intentions, in herself and in all others close to her. The
primary thoroughfare for sharing psychic reality, symbolic thought, was
blocked. The transference could not be referred to as an 'as if'
experience; at this stage perhaps, I needed to work partly within the
frame of reference of psychic equivalence, notwithstanding my immense
countertransference resistance against entering that frame of reference
with somebody whose thoughts were terrifyingly violent and confused. It
was my task to make the capacity for the representation of her internal
states safe. This is what a parent needs to be able to do with a small
child, but to identify with the perspective of a violent, uncontrolled
adult is far more threatening and disturbing than doing the same with a
child, even a child with similar violent feelings.
Ideally, the parent accepts
the child's experience when the child is in a mode of psychic equivalence,
rarely confronts it directly, but at the same time behaves in a way that
implies that the parent does not have the same experience. A small child
may be too frightened to sleep because the dressing gown hanging behind
the door seems to be a man waiting to jump out when he shuts his eyes.
This is experienced as real to the child at those times, and the feeling
of terror is correspondingly compelling. The parent does not simply tell
the child that the dressing gown is not a man, or that it is silly to be
frightened, but removes the dressing gown in a way that recognises the
reality of the frightening idea, but without showing fear, instead
communicating safety . Thus, the parent both enters into and provides the
possibility of distance from the child's perception, introducing a
different perspective. This is parallel to the introduction of alternative
perspectives through playing and pretending with the child, but this time
in a 'serious' mode.
This is what the therapist
is engaged in with violent patients. I respected the reality of her terror
of closeness, but in doing so also introduced the idea that this was a
belief rather than reality. No technical innovation is implied here. This
is the very ordinary thing that psychotherapists do.
In Henrietta's sessions the
affect was intense. The terror and the distress were real: a desperate
hunger for understanding only matched by her desire to empty her mind of
all contents. The counter-transference was brimming with discomfort and
confusion. She acted dangerously, threatened to take her life regularly
and got into violent quarrels with both friends and strangers for which I
was made to feel culpable. She frightened me with the threat of litigation
for negligence and gave me a letter of complaint which she had drafted for
my professional association where my "incompetence" was
carefully documented: any change of appointment, cancellation, lateness,
confusion about times, misremembering of names - all were listed and
dated. I was criticised for speaking and then ridiculed for my silences.
At other times I was made to feel her savior. The fluidity of her psychic
reality meant that much of the time I could not know what I was doing,
beyond the basic effort to appreciate what her psychic equivalence exposed
me to, and then to attempt to communicate that awareness to her. At other
times, of course, she was quite dissociated, lost in silences that carried
no meaning. Perhaps a key part of dissociation as a phenomenon is the
re-emergence of the pretend mode, in which the very young child fully
enters a separate psychic world, and cannot simultaneously maintain
contact with ordinary reality.
The alien self
I now want to talk more
specifically about a concept related to psychic reality: that of the sense
of self. The lack of a stable sense of self is a central difficulty for
violent patients. The symbolic representation of mental states can be seen
as an essential prerequisite of a sense of identity. The patient lacks an
authentic, organic self-image built around internalised representations of
self-states. The absence or weakness of such a self-image leaves the
child, and later the adult, with affect which remains unlabelled and
confusing. This will create a desperation for meaning, and a willingness
to take in reflections from the other which do not map onto anything
within the child's own experience. It will lead to the internalisation of
representations of the parent's state rather than of a usable version of
the child's own experience. This creates what we term an alien experience
within the self: ideas or feelings are experienced which do not seem to
belong to the self. The alien self destroys the sense of coherence of self
or identity, which can only be restored by constant and intense
projection. Clinically, the projection is not motivated by guilt, but by
the need to reestablish the continuity of self experience.
Let me illustrate this with
another example. With Henrietta, dreams were like small oases in a cruel
desert of enactments and manipulations which all but destroyed the
possibility of reflectiveness. The dreams were vivid and varied, but I
gradually noticed a consistent theme. There was always something within
something else - and the thing within was absolutely dependent - almost
parasitic - upon the thing without. For example, there was a dream about a
lizard with a fly buzzing inside its stomach. Another about a skyscraper
which had a yard with a semi-detached (little) house with its own tiny
yard. She had a particularly unpleasant recurrent dream of a beetle having
created a larva which was growing inside her brain.
Henrietta represented an
experiential inner world which depicted a self which, in its turn,
contained a self. I began to understand her problem as one of a
self-representation distorted by containing within it a representation of
the other. This representation of the other would be internalised in early
infancy when the mother's reflective function at least partially failed
the infant. The infant, trying to find herself in the mother's mind may
find, as Winnicott (1967, p.32) so accurately put it, the mother instead.
The image of the mother would come to colonise the self.
The residue of maternal
non-responsiveness (Tronick & Gianino, 1986), this alien other,
probably exists in seed form in all our self-representations. It comes
into its own when later trauma calls it forth as part of a defensive
manoeuvre: identifying with the state of mind of the abuser, in an attempt
to restore a feeling of control. The alien other within the self, once
abuse has given it form and shape, can be unmasked by the absence of
reflective function. Normally, parts of the self-representation which are
not rooted in the internalised mirroring of self-states are nevertheless
integrated into a singular, coherent self-structure by the capacity for
mentalisation. This process preconsciously works to lend a coherence and
psychological meaning to one's life, one's actions, and our sense of
ourselves. Henrietta lacked the capacity to understand the experience of
the buzzing fly inside her self-representation, or to metabolise the
feelings and ideas that she experienced as having been placed there, like
a larva in her brain. Henrietta could learn little about herself through
interpretations of this kind, yet the mental language of my communications
strengthened and enhanced her reflective capacities which was her only
route to the recovery of the integrity of the self.
Let me illustrate what I
mean by elaborating on the two unusual 'facts' of Henrietta's life. First,
Henrietta's experience of having been abused. Henrietta's mother, probably
herself a 'survivor', had a prolonged postnatal depression after the birth
of her second child when Henrietta was two. She withdrew almost completely
from both Henrietta and Henrietta's father, and eventually left the
family. This probably exacerbated his already considerable drug problems
and he began to seek solace from at first cuddling, then rubbing against
and finally vaginally and then anally penetrating his daughter. I suspect
this happened when she was about seven and went on for at least four
years. Henrietta recalls initially welcoming his attention (even
encouraging it) and gradually, when "the pain" started, going
blank and this helped him get inside her. She describes imagining herself
as one of her lifeless dolls. The essential part of this description is
the lack of attribution of mental states to the self and other
representations. The strategy of inhibiting her mentalising, and thus
creating a dissociated state, is critical. It was impossible for her to
understand how her father could contemplate hurting her as part of what
grew out of an act of affection. The disavowal of mental states was an
adaptation. It distanced her from a mind with truly malevolent ideas about
the fragile child. As she turned away from mental states in him, and in
herself, she was forced to fall back on the non-reflective organisation
within the self - the alien other.
The alien other is not
entirely a creation of trauma. It is an infantile structure internalised
in place of, yet also as part of, the self. Henrietta's mother was
incapable of satisfying her infant's essential need for reflecting her
distress and nascent states of intentionality. Normally, the
internalisation of the mother's mirroring becomes the core of the
representation of the psychological self. Henrietta, neglected or
unrecognised as a small child, internalised an image of absence or
vacuousness as the representation of her state of distress. Not
surprisingly, it was this state which was re-activated in moments of the
acute distress of seduction. Not surprising, since it too was an
experience of feeling unrecognised. Reflectiveness temporarily abandoned,
the self-other boundary destroyed, the abusing father's cruelty was
internalised into the alien self-representation through a process which
may be related to the mechanism whereby the victim identifies with the
aggressor. Thus, the alien part of the self became torturing as
well as vacuous. Her experience of abuse at boarding school, after the age
of eleven, simply reinforced this deeply pathological self organisation.
Her real, or what may be called constitutional, self was experienced as
tiny in relation to the monstrous other (the tiny house in the back yard
of the skyscraper). Yet, she also felt herself a monstrous lizard because
this other, was also her self.
Finding others to be a
vehicle for this torturing part of her self-representation became a matter
of life and death. Her experience of self coherence depended on finding
someone willing to torture her. The teacher was perhaps the first. A line
of severely sado-masochistic relationships testified to the fact that he
was certainly not the last. The transference was a lived instance. In
contrast to the 'role-responsiveness' model of
transference-countertransference (Joseph, 1985; Sandler, 1976) where an
aspect of the self-other relationship is externalised, a self-self
transference evolved, where the therapist became a temporary home to the
alien aspect of Henrietta's self-representation. These instances are
pervasive for two reasons. First, as we have already seen, the normal
binding of alien aspects of the self by mentalisation does not occur, and
therefore aspects of the self-representation are more likely to be
externalised. However, even more critically, once these experiences are
created they are actually far more compelling for these individuals
because they are experienced in a mode of psychic equivalence.
Over its fourth year, her
treatment began to take on a tragic quality and the dramatic outbursts had
receded. She was functioning somewhat better but the sessions came to be
dominated by expressions of bitterness. Hatred for her father began to
emerge, together with a genuine and deep dislike of me. The transference
could now become sexualised and, at times, she explicitly asked me to
molest her whilst she was angry with me. She came in one Thursday evening
and recounted a particularly ghastly episode of allowing herself to be
used and abused by "an old friend" who regularly visited her as
his needs dictated. My mind was filled with bizarre and perverse
associations. I said that I suspected that, for some reason, it was
particularly important to feel that she could control me by exciting me or
worrying me and I suspected that she had felt the same vital sense of
control in relation to her "old friend".
She responded that she
hadn't been going to tell me but that she had had a dream about me where I
had offered her my penis, suggesting that she should take it in her mouth.
She was revolted by it because it was smelly and dirty. She was frightened
because she knew I was going to beat her unless she submitted. She paused,
waiting for me to say something. I remained silent. She said that she
thought that I was probably extremely clean since I always wore
well-ironed white shirts. But in the dream my shirt was deep red. She
added, speaking particularly calmly, that red was the colour of anger.
I said that I understood
very well how important it was for her to feel that she was in control
because she was terrified that I would be angry and displeased with her
for what she had done with her friend. The dream was like an offering - an
appeasement - because she could not really bear me thinking badly of her.
If she sensed that I was, it was almost better for me to be dead. I added
that red was also the colour of blood.
Her body shook as if an
electric current had passed through it. "I think that is why I had to
kill him" she said. "I couldn't bear him thinking I was
disgusting". The story which unfolded in that session, and in many
others that followed, was a tragic one. She regularly had allowed herself
to be maltreated by her boyfriend. Normally, she somehow felt
"cleansed" by the experience, particularly by his sense of shame
about his own actions. But this time she saw contempt in his eyes. This,
she could not tolerate. She screamed and shouted at him. He ridiculed and
disparaged her. She picked up the knife and as he moved towards her, still
mocking and sneering, she stabbed him. And with it she hoped to have
killed the threat to her self-representation, her self-hatred and
humiliation.
My work with Henrietta has
now ended. She improved enormously in terms of both structural and
symptomatic criteria - yet horror and despair were never far away right
until the end. I often feel grateful to Henrietta who I feel has taught me
more about violence, borderline functioning and the unconscious than most
other patients.
An understanding of
murderous violence
There are at least three
crucial processes that link violence to a significant failure of
mentalization. First, individuals without a well established sense of
their own identity, which only awareness of one's mental states can
provide, may readily feel that they are not responsible for their action,
because they are genuinely deficient in a privileged human capacity - the
one which links intention to action, and creates a sense of agency. For
such a sense of agency to be generated, the attachment figure in infancy
and beyond must have been present to perceive the intentions of the infant
and to assist a physically relatively incompetent individual to complete a
partial action, so that the impact of the action upon the environment can
complete a causal circle and link action to antecedent intention via the
impact it creates. Thus is a sense of agency forged. Henrietta lacked such
a sense that her thoughts, feelings and beliefs, and her actions, were at
some level inextricably connected. This increased the risk of her
performing acts (both of violence and self harm) of which she could not
feel ownership.
Second, mentalizing
capacity is crucial in anticipating the psychological consequences of an
act upon the other. Henrietta, as we have seen, could not rely on knowing
how others might feel, or could readily remove such knowledge from her
conscious or unconscious awareness. As we shall see, this was a selective
loss, which applied particularly to attachment relationships and made
these brittle, physical encounters, rather than the coming together of two
human beings imbued with feelings and thoughts.
Third, limitations in
mentalizing cause a certain fluidity within the representational system,
specifically in relation to mental states. Feelings or thoughts are not
experienced as real or meaningful. They are changeable, they can be cast
away, and a dissociative state which perhaps is the mirror image of
mentalisation is the observed consequence. Dissociation was crucial to
Henrietta, both in separating herself from ideas and feelings, experienced
as too painful, but also in liberating her mind to perform acts that would
normally be inevitably linked with intense distress or pain. She had a
remarkable self-serving capacity to reinterpret unacceptable conduct as
acceptable, both her own and other people's. None of these factors cause
murder, but all are essential preconditions for the performance of violent
acts.
So what turns the failure
of mentalisation into violence? To understand this, we need to appreciate
the disorganised representational structure that therapy revealed in the
course of Henrietta's treatment. In Henrietta's self, there was an other.
Perhaps initially, this was a vacuous state of emptiness, a depressed,
unresponsive other, internalised in the course of her infantile attempts
at representing a self-state. Perhaps produced by her projected infantile
rage, perhaps developed later in the course of her abuse, this alien self
came to contain her sense of rage, hatred and fear, her object's image of
her as terrifying and unmanageable. In adulthood, her disorganised
self-representation manifested as an overwhelming need to control the
other. She repeatedly established relationships in which her partners
could act as vehicles for her intolerable self-states. She also
externalised these states into her body and wished to destroy it, or
manipulate others into destroying it, in the unconscious hope that with
this destruction she could achieve an everlasting state of self-coherence.
She resorted to violence to
destroy a mental state, a mental state that was hers and yet not hers at
the same time. She wished to disown it, but felt no control over it and a
murderous act was the only solution to the problem. At the moment of the
murder, her object turned from feeling her shame, to become shaming, a
feeling she was desperate to disown. She felt a terror that the coherence
of the self would be destroyed by the return of what had been externalised.
The act of violence performed a dual function. First was the unconscious
hope, that through its dramatic destruction it would be gone forever.
Perceiving the terror in the eyes of her victim, she felt strangely
reassured. But the terror she created also helped her to recreate and
re-experience the alien self within the object.
The lack of a capacity to
mentalise reveals the alien self as much as it creates it. It also reveals
a mode of thinking where feelings and thoughts feel real and only one
version of reality is possible. The impact of her boyfriend's affect could
not be reinterpreted through the mediation of mentalisation. Her primitive
experience of psychic reality, that equated external with internal, made
her into a laughable figure, actually threatened the destruction of her
'self'. Humiliation attacks the self and psychic equivalence makes this
into a life or death encounter. What ensued was a frenzied and prolonged
sadistic act that was crucially not lacking in empathy. It seemed
essential that she saw his reaction and, within that, something which she
would otherwise have to experience as part of herself. His struggle,
bleeding and suffering, were vital features of this experience. Her rage
was not at all 'blind'. There were subtle and specific links between the
emotional states she found intolerable, and the emotions she attributed to
her victim during her attack. At this moment, there was a merger of
subjectivities, an experience which I think has recently been the focus of
interest of psychoanalysts with an interpersonal orientation.
It is hard to feel empathy
for Henrietta's actions. Yet, in a sense, given the reality of her shame
in the mode of psychic equivalence, we may say that she killed in self
defence. Violence is a defence against the destructive actuality which
humiliation and shame experienced in the mode of psychic equivalence
generates. She had no resources other than violence to protect her self
representation crucially weakened by her impaired mentalizing capacity. At
the moment of murder Henrietta felt alive, she felt coherent and real, out
of reach of the deadly rejections, insults and taunts, momentarily once
again feeling vital self-respect. Superficially, her act may have been
perceived as cathartic, but the restoration of equilibrium I believe is
less to do with drive discharge than to do with the acquisition of an
inner gestalt, the creation of an inner peace, an odd kind of tranquillity.
I do not have time to
describe the model of therapeutic action which follows from these ides.
Put simply, the interpretations in the classical psychoanalytic sense play
little part. Clarification of moment to moment changes in the patient's
mental state is the therapeutic goal. Enactments cannot be interpreted as
they carry no symbolic meaning beyond wishing to create a specific state
in the therapist. The recovery of mentalization is the goal. It should
suffice for the therapist simply to elaborate on the emotional state in
the patient which might have triggered an enactment, in other words the
patient's current feelings at the time. The therapist should aim to retain
in a part of his mind the patient's mental state and enable the patient to
perceive his understanding, notwithstanding the concurrent massive
projective processes which he must also accept (Target & Fonagy,
1996). This kind of dual function is not easy, yet within it lies, we
believe, the patient's salvation. Psychotherapy promotes the gradual
transformation of a non-reflective mode of experiencing the internal world
which forces an equation of internal and external to one where the
internal world is treated with more circumspection and respect, as
separate and qualitatively different from physical reality (Fonagy &
Target, 1996). The internalisation of the therapist's concern with mental
states enhances the patient's capacity for similar concern towards his own
experience. Respect for minds generates respect for self, respect for
other and ultimately respect for the human community. It is this respect
which drives and organizes the therapeutic endeavour with violent patients
and speaks with greatest clarity to our psychological heritage.
References
Bion, W. R. (1962). Learning from Experience.
London: Heinemann.
Dunn, J. (1996). The
Emanuel Miller Memorial Lecture 1995. Children's relationships: Bridging
the divide between cognitive and social development. Journal of Child
Psychology and Psychiatry, 37: 507-518.
Fonagy, P., Moran, G. S.,
& Target, M. (1993). Aggression and the psychological self. International
Journal of Psycho-Analysis, 74: 471-485.
Fonagy, P., & Target,
M. (1995). Towards understanding violence: The use of the body and the
role of the father. International Journal of Psycho-Analysis, 76:
487-502.
Fonagy, P., & Target,
M. (1996). Playing with reality: I. Theory of mind and the normal
development of psychic reality. International Journal of
Psycho-Analysis, 77: 217-233.
Fonagy, P., & Target,
M. (1997). Attachment and reflective function: Their role in
self-organization. Development and Psychopathology, 9: 679-700.
Johnson, J. G., Cohen, P.,
Brown, J., Smailes, E. M., & Bernstein, D. P. (1999). Childhood
maltreatment increases risk for personality disorders during early
adulthood. Archives of General Psychiatry, 56: 600-605.
Joseph, B. (1985).
Transference: The total situation. International Journal of
Psycho-Analysis, 66: 447-454.
McDougall, J. (1989). Theaters
of the Body: A Psychoanalytic Approach to Psychosomatic Illness. New
York: W.W. Norton and Co.
Sandler, J. (1976).
Countertransference and role-responsiveness. International Review of
Psycho-Analysis, 3: 43-47.
Target, M., & Fonagy,
P. (1996). Playing with reality II: The development of psychic reality
from a theoretical perspective. International Journal of
Psycho-Analysis, 77: 459-479.
Tronick, E. Z., &
Gianino, A. F. (1986). The transmission of maternal disturbance to the
infant. In E.Z.Tronick & T. Field (Eds.), Maternal Depression and
Infant Disturbance (pp. 5-11). San Francisco: Jossey Bass.
Winnicott, D. W. (1956).
Mirror role of mother and family in child development. In D. W. Winnicott
(Ed.), Playing and reality (pp. 111-118). London: Tavistock.
Peter Fonagy, PhD, FBA
Freud Memorial Professor of Psychoanalysis, UCL
Director, Sub-Department of Clinical Health Psychology, UCL
Director of Research, Anna Freud Centre
Co-ordinating Director, Child and Family Center and Center for Outcomes
Research and Effectiveness, Menninger Foundation
Address for correspondence:
Psychoanalysis Unit
University College London
Gower Street
London WC1E 6BT
E-mail: p.fonagy@ucl.ac.uk.
Peter Fonagy's Website
Paper presented to the Dallas
Society of Psychoanalytic Psychology, March 15th, 2001.
To comment on this paper, contact
Peter Fonagy, PhD, FBA p.fonagy@ucl.ac.uk
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