cr ee tea aid daaai lated icicle Moses Laufer 0 colap® eee in the developmental process, and it is a or during adolescence. It seems that the acute breakdown at SUMMARY Adolescent pathology should be viewed as breakdown which takes place at puberty puberty is potentially the more serious eakdown ; This br in the developmental process is understood in relation to the function of adolescence developmentally, and is linked i ita ‘ed to the establishment of a final sexual organization by the end of Clinically, there are certain problems which are specific to the adolescent patient. Core fantasies in adolescence tell us the direction of the person's psychosexual development and the potential of abnormality. In the transference neurosis of the adolescent patient, the developmental breakdown has to be re-experienced and re-enacted with the analyst, but itis the core fantasies which contain the clue to the nature of the pathology and to the direction of the abnormality in terms of sexual functioning and of object relationships. i When reference is made to psychopathology in adolescence, we often are referring to manifest or descriptive signs of pathological development which are commonly associated with this period—anorexia, attempted suicide, drug addiction, acute psychosis, or the more quiet pathologies such as depression, academic failure, perverse sexual development, work inhibitions, and so on. The adolescent himself may feel that there is rothing wrong, or he may be troubled by a feeling of purposelessness, by an inability to maintain relationships. tya feeling that he has no future, or by a feeling that he may be mad in some way. If psychopathology seems to te present, the diagnostic and prognostic questions which must be answered are—what is wrong?; is it* Which form of intervention, if any, would 1 will not discuss the mam x siemens cher ges ibe ane hho msde the position 1 ae and to the assumptions me 5 ee Soe Instead, I will address myself primarily to ology as being a b Per that psion, Un eases peat Te is acne epee on watreakinn dato ae adolescents whose clinical materi coat eetk4¥n Simpy been a teary val disguisat view. woud tend now ta eae SEE someting ee ese oe there has to be an extension of this «:SOrize psychopathological sates 9 adolescence under the following broad categories: (1) those which point to an acute breakdown having taken place at th f puberty; (2) those ier brash te ao¥m having taken place lane Ales oven engl ioe ee vulnerability to breakdown from puberty We dn) and (3) those which imply that the dsterbane transitory eine a Nh sits that progressive develgnng) still aking place. 1am here avoiding the use of discuss, As regards severity of pathology, I would view the acute breakdown at puberty as being potentially the more serious and the more dangerous to development. I say thie because the breakdown at puberty is, from my perience of the analyses of adolescents, always related tothe direct incestuous wishes of the adolescent, and points ta 2 disruption in the defensive organization which is such tha ne function of reality testing is seriously damaged, either temporarily or permanently. (The clinical materia’ which I will present later will show this.) Ofte, in assessment, iis very difficult to establish tha sucha breakdaaes has taken place, partly because of the quiciness ofthe breakdown, but more often because it is not until later in adolescence or in adulthood that the ferson may seek help and, by that time, the person may have found a range of pathological answers which give ihe false picture of progressive development as still taking place. These breakoowas Puberty may manifest themselves ina range of ways—withdrawal from contemporaries, seeret compulaive masturbation with have ata ng Sadistic oF perverse actions, sudden atacks on the oedipal paren, school phobia which seems to have @ start at puberty, denial of pubertal changes and near-conscious efforts to change the pubertal body toa Prepubertal one, injury or damage to one's own body. conscious efforts to die or to kill onevelf do not wish to give the impression that the acute breakdowns which take place later in (MS. received November 1979) Copyright © M. Laurer : rience that the breakdown which manifests itself later as well. But itis my experience that the break: iolescence are not very serious as we! yreanization has successfully, even if only temporarily, enabled the in adolescence implies that the defensive organization has s lly. ly temporarily, enabled 1 answers to his direct incestuous wishes, with a somewhat lesser likelihood of ee ere arte pspeap aerate attempted suicide, anorexia, See e depression, sudden academic failure) are more a sign of serious drug taking or addiction, homosexuality, severe depression, * i body ater an eifort has been made at some kind of integration ofthe physically narace Caen ae dv cepresemation, The projections of these adolescents nay be very dieaiee Eells as part ofthe oo ear ooiryalTet ther ability to differentiate realty fom fantasy, but the damage eee ee ee a at length. These imply a temporary disturbance in functioning ith an ail me ge an acveeatinshp tones Own sexual bod Wishes, and an ongoing ability OF ADOLESCENCE AND THE NATURE OF ADOLESCENT THE FUNCTION N PATHOLOGY AND BREAKDOW! for the personal use of the owner ef te re caraate coe i conyih othe WARNING! This text is primed oF Os? aia con a at 2 Jotimat in shhinh it originally —_E © maprevious Paper (1978), diseu, tholo, Ae Sed the developm, adolescent pathology, and 1 wil» Hmental function of adolescence as ' right. Itis during adolescence thar the persor asexual identity by the eng of. adolescence imeversible—irreversible, that is, without th nn Decomes the guardian of his sexually mature body. He establishes peso lidated picture ofhimseltas a semen being, which is erapeutic intervention Following this, 1 would define ado psy mature body image noe tobey way eeakdoun inthe process of integrating the f i dia stot OF oneself. Whatever may be the eontibe, patter i ne the etitkdown in the developmental Process whose primary or perhaps specific function is Coevelop ne Ant Person's sexual identiy, Whee may asa nay be the specific disorder, the primary interference inthe developmental process (which ean be devin d ng which wd 25 8dolescent pathology) isin the adolecrents dine nes and relationship to his body. something which ig “poressed via the hatred or shame of, the fury with, the sexual body. The presence of pathology in adolescence ifvvays means that there isa disturbance in relation to the person's sexual lif or. to paraphrase a view held by Frag (1923), illness in adolescence means that there must be some abnormality in sexual development and functioning CLUES TO BREAKDOWN IN ADOLESCENCE What may be the clues that a breakdown has occurred at Puberty or later in adolescence? Although these are most obvious during treatment rather than during the assesemere Period itself, there are nevertheless many Nas Of Piecing together some ofthe adolescent’ intemal life now and inthe past without having to attack the defensive structure. In my own work, I rely a great deal on information herg the adolescent about this funetion on a day-to-day basis at home, a school, at work, and with contemporaries. And fom these, wil ty to piece together what is happening to the adolescents relationship to hime as a sexed! being, TRANSFERENCE NEUROSIS AND CORE FANTASIES IN ADOLESCENT ANALYSIS specificity is tied to i ecific to the adolescent patient. and this ain clinical problems which are spe ene or adolescent oo With the adolescent patient, the kind of transference which develops not sagem 5h thology in historical terms, but now also contains the pathological solution whieh being a eri a to try to resolve a developmental conflict. This developmental conflict seems to be more used unconsciously to try than the repetition of an earlier conflict a, conflict is integral to the function enleetey pate is 200 : The pathology is contained in the breakdove ofthe proces imeeraing aaa of the representation of oneself. It seems that, when a breakdown takes place sy pagar sinie siciow has a cumulative effect throughout adolescence. The breakdown a puberty Eee eee but it may be recognized by the ditect incestuous nature ofthe wishes hich are now not able to be kept rep) a ‘0 do with pathology the physically ighout adolescence The idea that the developmental breakdown has a cumulative effect throughout adolescence WARNING! This text is printed for the personal use of the owner of the PEP. Archive CD and is copyright to thein clarifying what one of the cen (Panel, 1972). Itis based on the has an integrative function, with person's future sexual organizatio tasies during puberty and thei ing that time is directly relevant to what I wish to say about core fantasies during adolescence ar ta tase as well as tothe relationship between analytical intervention adolescence and prevention of organized pathology after adolescence. I place importance on this statement of Freud's because of the implication that certain fantasies in adolescence can become integrated into a pathologieal sexual organization, and that this integration is then much less reversible after adolescence. It also implies that analytical reatment can have a preventive function, femnch as it may sable the adolescent to fel that there isan active choice ether integrating or rejecting these Tenasies as Part of his sexual organization, rather than passively oy in fo their iteome, 8 Passively giving ino their power and ou Zhe Core fantasies (central masturbation fantasy) in adolesce tell us the direction of the person's Bsychosexual development and the potential of abnormality, ene diagnostic and prognostic significance of these fantasies. The resolution of the Oedipus complex fixes the for aa ‘content of this central masturbation fantasythe fantasy whose content contains the various regressive satisfactions and the main sexual identification (Laufer, 1976). This fantasy is, 1 think, a universal Phenomenon, and itself has nothing to do with pathology. But, itis only in adolescence that it finaly becomes inesrated inte the, sexual body image, carrying with it also the direction ofthe person's sexual relationships and gratiieatione In the transference neurosis ofthe adolescent patient, | the developmental breakdown has tobe ‘reexperienced and re-enacted withthe analyst. This means thatthe content as well a the nsmoch Ihave described adolescent pathology a consiuing a beeak down inthe developmental proces. rather than asa he en em Kansfrence neurosis may not be sry applicable But in wing tns erm. am deseo he peas tee eeaentspatkology becomes conenaed tally win the analss an inthe eaten totic nahn ree ha (Loewald. 1971). defensive manoeuvres employed to deal with the sexual body andthe dret sexual wishes become totally, even if only temporariy, focused on the relationship to the analyst, Unles this happens in tweatment the desc aene force of the developmental breakdown doesnot diminish throughout adolesceneqThe Cre fantasies, omence, tive us the clue tothe historical meaning ofthe breakdown and tots dynamic understanding, In ther wenac the transference and the transference neurosis in adolescence must be understood in two ways historically and dynamically as shown by the content ofthe core fantasies; and developmentally as shown inthe adolesoorgc resent relationship to his sexual body. that is tothe way in which the sexual body is used or experiensct now in Ty ul eS be pa pe oo yom aN LE patients, it seems that a critical feature | pathology—by getting the analyst to take charge of the adolescents action and fantasies. by demanding tha pe analyst should seduce the adolescent sexually, or by presentin himself as sexually and socially useless a vation seems to come fom the adolescent patent ned to destroy his oun sexta body Fare EC Een] soap ae MT erpetuaing a relationship othe presoedipa! moe andar ame ine ingots te eatin uh these oreo heer ‘mother and at the sane time tryin Tr mi im fen encountered in the treatment ofthe ill adolesc nical problems which are o = ce Soe es tthe avoidance, ether by the patient or by the analyst, of recognizing or ay, to some extent, represent tur is developmental breakdown, es way in which we may miss the understanding af Understanding the nature of this developr historical terms, as | think may kdown is to understand the clini ly Pre-oedipal experiences, Instead. { have found it more useful to see iliness during adolescence as representing e-oedipal experi L : ‘ofthe owner ofthe PEP Archive CD and is copyright oth f is printed for the personal use E Ineo te cs SFR WBS IGT apebarcatt egal copy dead Greer ae a in any form whatsoever. imal in which itt ‘nstruct the met implying that treatment of the adolescent means that 4 ine the eeanins ofthe breakdown which took place either at (6 ee owes] Of the breakdown in historical terms, In this '8 ofthe pathological relationship to his sexual body. CLINICAL MATERIAL The clinical material which fe is athology, rather than to discuss lows is intended to illustrate breakdown and the beginning undoing of the Pp a ies of | ‘ique of work. It may seem from the material which follows that the various sisi OF ry Patient, especially his masturbation fantasies, were easily obtained and were readily understood. OF course, this is not so. The caution in obtaining such material cannot be over-emphasized: nevertheless, we know that it is possible to Put together the content of these fantasies from the patient's ; associations and behaviour, as well as from the whole range of derivatives rom the unconseioe John first came to see me at the age of 16, he and his parents feeling certain that he was mad or would become mad as he grew older. Psychiatrists had previously considered him to be near-psychotic, but he never had any treatment other than what he described as talks’. His parents were quite frantic whetp! first saw John. with telephone calls from them.pleading with me to treat him. ? ‘The family were not only vely worfed about Kim th&s wore aso terrorized for some years by his behaviour Itwas a quiet kind or terrorizing which took place (his friendlessness and the accompanying accusation of his parents that it was their fault, especially his mother’s; his sudden verbal and physical attacks on his mother and his younger sister; his episodes of depression and crying; his refusal often to leave the house), and by the time he came to treatment the family’s feeling was one of ‘last chance’. Although he remembered his latency as a lonely and sad time, he dates the belief that he was mad or was going mad from the time he was aged 13. There occurred at this time a devastating coincidence —that of puberty and a decision by the school that he should move to a lower class. It was at this time that he left a note stating that he wanted to kill himself, In fact, he has never attempted suicide. even though there were many occasions during his early adolescence when he felt deadened by his depression and by his feelings of worthlessness. During these times he would spend days away from school refusing to leave the 5 threatening to kill his mother, of just sitting about being cared for by his mother. +inging him food, bathing him. and pleading with him to talk about what was behaviour is obvious. the more important factor from the point of Tent to which these events or emotions had already been woven house, sleeping, masturbating The caring took the form of bri worrying him. Although the sadism in his view of understanding his pathology was the extent into what he and | could establish later as his core fantasy. Many ofthe sessions during the first few months of treatment were taken up with details of his daily tite, The theme of suffering was included in almost every description ofhis life. His mother was described asa sly snanipulator: his father, a man highly regarded in his profession, was mainly idealized and dismissed as being near to perfection: and his younger sister was considered to be somewhat stupid and harmless - with his good fortune in being treated by me, with some cautious fer were to do mainly with his £00 Seen eae a from the start that I considered him mad and that it was for this reason only that! had aeaee ieee amtendance, He reminded me regulary that | was making his suffering worse, but with the insisted on his daily attendan: 2 asa erin wos. bu aaa ie aa eacihe did not mind because he was sure it was good for him, a Belief which was correct in : rant part ofthe content of his core fantasy wc wana than one Because the suffering person was a mp0 9 more way’ than one because the vat he was a very disturbed young man, but | did tell him early on nothide my concern for him and my bell young ballad : id not consi ‘ded to do this because of the quality aio aug al consider i mad. 1 deci jn-addition, his night Jeprand basal solaton during the firs, —— a was essential with certain kinds of patients, th Pat analysis helped me decide to do wha Freud said was essen a at is. 10 ew that this way of Wor hold them with one hand while doing surgery with the other. I knew thot (hi i temporarily the PEP Archive CD and is copyright to the WARNING! This text is printed for the personal use of the owner of the PEP APUST TA’ © Copyright todisturb the development ofthe ty rans . body tome, but elt that had w one 24 Miah easy pa gg mad way and that only then wo, le him to begi madness, The early clues of the inn of the impingement on hy cription of is reality desertion is tig and relief when large mumtens 0" ean fantasy content came inially fom his flowing mastubstion tines tans POSE 10 ing Tenge ee eeean Bete hin kas only : nized w ring to hi 7S became clear that some of his mrastrbation fans eee eee bead been before masa Namie terce he Ud not be sure whether he was the sae personas compete touch nh : ified to talk tome about this bee ¢ would lose I the outside world. The identification an’ the dimaged asitena at ey behaviour. he would feel out of control and frightened of what he might do to me. His present fantasies, as well 35 the gratification he was now getting from seeing himself asthe isolated and suffering boy, continued ve interfere seriously in his ability to use day-to-day experiences asa kind of trial action. His relationships to contemporaries were severely affected—he could not continue any friendships for more than a few weeks, he Spent hours alone in his room in the hostel where he lived; he visited sports arenas and spent many hours watching girls staining themselves. It was through the ability to begin to talk about his masturbation that he began to realize that his need to look at women's or girls’ faces had existed consciously since the age of 7, and that the face in the fantasy had to have a pained expression. This fantasy remained a secret, but it was only ay Puberty that the compelling quality was added. The breakdown at puberty manifested itself by sudden brutal attacks on his mother (a number of times tothe point that he hurt her quite seriously) and, atthe same time, by the need to avoid girls for fear that he might want to attack them or kill them. This breakthrough at puberty of the oedipal wish to attack and sexually assault his mother was very worrying to me diagnostically because rt sounded very much like an acute psychotic breakthrough, but | fel thatthe assault also contained the defence against the more direct sexual wish and might therefore be somewhat less ominous. was during this time soon after puberty that he sometimes believed that he had ae Te Feroe fllovting en iless of minc—he could not stop king of what he had done to See eae ee ang accom ee Oe og ea cea et Tae and hurt eae ee ntact with him during this period enabled him to feel convinced that | me: the fact that I maintained telephone contact s was well and that he had not harmed me. Ts 1 of the fantasy and my belief, of which I told him, thatthe fantasy and the compelling behaviout had a me gave him hope that something could be done about his illness Even etoteseis mate be able to concentrate miore on his academic work. He also was able to give up the diminished, and he began oe ane ve him a new hope that he might afterall not be mad. Although it was not Possible yet for the fa chive CD and is copyright to the ‘onal use of the owner of the PEP Archive Cl a for the pay ilegal to copy. distribute or circulate it a any form whatsoever. eae eee inaly appeared 1set ina Way Which enabled hi ised hs life for years, and Which marr th We Were together uying to make sense of| something which had cys that he should be killed, “The wacreated the feeling before weatment ha fe should es akon wee a wien We could add this meaning sro wtich Me bad eft at 13 saying he wots glo ek ee ey ad fhm, mean thar ee eNain withthe vette eee y wis vo could attack and pratty him ar the same ees Ne ditected alo at his father who was for John the person acknowl , plein fet importance ofthe fantasy in his compelling behaviour, but he otis need 10 submit 10 me, to want te geass ier isolation ‘The concentration in he interpretations his mother had done), to want me to see jon his body to me so that I could do with it what I liked (as he felt helped 1 make it possible for he crack hit and for him to want tobe the girl whose facets contorted. penever ite, he began to shou eet vou to become more and more confined to his sessions, AuthouLh Sear e and accuse me of influencing his thoughts. This was his way of being voaing close to him, His sev onset is Masturbation fantasy. By shouting at me he felt he could keep me from Be See nth Povaiag ns, asia crv be eed ead song spn ics: old ae rather thon hae fit Prognostially, this ability for him to confine his crazy behaviour to his sesions rather than it encompassing all of hs life, was an encouragement to me because erabled eva be tore certain that is psychotictype functioning was nota sign that hs reality testing had been damned i on as aa ce ie also enabled me to speculate with some greater certainty that the damage developmentally 10 is mencal tru was very probably oedipally organized and therefore more readily reversible. rather than it having existed from infancy or very early childhood with the resultant distortion in development and structuralizatior and with the lesser likelihood of reversibility through treatment. He described how he now felt he had a need to masturbate before coming to his sessions. It was clear from the shame he felt now tha: he imagined me as the one masturbating him, but it was still some tirne before we could establish that this also contained his wish to give me his sexual feelings and his excitement or, more correctly, to make me responsible for them, ‘The ability to contain or confine much of his pathology now within the transference also had the effect of his feeling somewhat freer to have closer friendships at coliege. and he began to demand that I take his mad thoughts away so that he could be like others which, for him, mieant that he could ‘el calm when being with a gir ety of ways, and here U think that itis the spzvitic The understanding of this material could be taken in a v: node! of menta! functioning with which the analyst identifies und uses, which adds one kind of meaning or naterial and to the interpretations which we choose to make. Although | understood this another to the cl material within the transference initially as representing the wish for a homosexual contact with me, feelin. forced to submit to me, and wishing to identify in the thouch with the wownen or girls with pai.ed tacial expressions, these interpretations were intended only as the preparation for what | think is nul: mere central to the understanding and the undoing of psychopathology of the adalescent patient. To have stopped with the reconstruction either of the fear or the wish for the hoitiosexual contact or longing would have een insufficient (even though correct in its own way) because it would have by itself missed the essential hi at was certainly representative. So, by adding and ngredi Jolescent pathology, of which John’s pathology was cert 9 adding zn Satan his point the understanding through interpretation of his wish to offer me = tra to the analysis att Faecal tek ad make me responsible fr that pa of is bod and mind nh was the producer ang cater of his mad sexual thoughts and feeling, and thereky makine me responsible for his setthared and tods-hatred, changed the focus ofthe treatment, enabled vs inscad to ance on hi haiszd and on the responsibility for it which he tried to hand over to me. This brought bac smeore ofthe Ission noi ried Fons hog mother whic he felt he could not contol, partly because ofthe gratification he got. He recalled .d or bathed until he was 14 and how, following the bathing, he would nif insisted on being was i Pow he had mse oe psn penetrated Sexually By his mother’ penis, ually through the anus Interpretation and re masturbate with the thou: By this time in the analysis. he had begun to have ith her. He iiad by now been in analysis for three years a oitlfriend, and he was able to risk having intercourse He described how he had t0 100k into her vagina EP Archive CD and is copyright to Eceriava .al use of the owner of the P! WARNING! This text is printed for the person:ra fiat Pave net Because he was too frightened that he might have contact with another penis, aera Penis her pained facial expression would make him lose contol and he would then ae tious gece fightened that he had to stop seeing he te nearly a month, that is, until he cal ering heres Teatment that he would not go mad, He mecdime tenet an girlfriend, this being his ro reer me and Of siving up his own sexual body. Then iad a nee sition this watching ae rt lets sais when he was aged about 3 seving her pained expression, and feeling convinced ea hs dreare eat is show she looked when hs father 'atoekea he, Denne tis period ofthe analysis, his dreams consisted mainly of monsters coming out of holes, of people falling out of aircraft and being killed, or of people dying. Once when he Greamed of me hitting him and he pleading for me to stop, he told me 66 ee bol il hos tin om paiteg id sp wth Ste The deen et te feeling that his date rpccting (ten that he was having intercourse with his girtiend only bossene I wee inetng on aes ea tena " ofhim. This stil remains a danger, inasmuch asthe intercoune is experienced also 0 submission to me, But wat has begun to make sense is that his actions and his behaviour both in the weatment and outside also cary the wish to attack mie and destroy my potency. His envy and ideslization of me camry the defence against ish te destroy sae as a man and asthe person who might give him the Potency which for most of his life he did not have and partly did not want. Developmentally, the idealization of me is an area of danger because it carries the passive submission to me. with only some hint of there being an active process of taking me in. CONCLUSIONS John's breakdown was ushered in with puberty, and for some time it was not possible to know whether this breakdown was such that his reality testing had been or became seriously damaged. But it was the experience in the transference of his wish for me to take charge of his sexual body, together withthe experience of blaming me for his pathology, which enabled him to add some affective meaning to this acute breakdown. By blaming me, as he had perpetually blamed his mother, he did not kave to be responsible himself for his pathology or, more specifically. for the direction of his sexual life. In addition, our establishing the presence of the core fantasy and beginning to understand its place in his life was more shan a useful guide to his pathology. tt was a nevessary Patt of putting him into touch with the direction of his sexual fife and with the meaning of the need to be tied to these regressive satisfactions. When I say that John wanted me to take charge of his sexual body, lam refering to an important ingredient inthe analysis of the adolescent. Itis the working through inthe transference of the meaning of this, withig the context of the specific core fantasy, which adds the possibility of e different kind of integration of the sexual body image. i enables tie adolescent to fee that, instead of being tied by his pathology or by the breakdown at puberty or during adolescence, there may now be greater possibilty of ataning a sexual identity which is of hg choice and which is more in accord with the expectations of the superego. The presentation and discussion ofthe transference and the core fantasies had also a subsidiary purpose, \which was to show that analytical work withthe adolescent is inevitably an active intervention rather then there being no special focus of work. The description of axalysis as active is contrary tothe view we may hold of wat we door should do, but Iam implying tha there is no such thing as passive work inasmuch a8 every interpretation or reconstruction is experienced by the patient as fs ae inerveion with the direction of that imervention being determined by the analyst's understanding oft aia material. From my experience, it Seems that analytical treatment is essential for those adolescents : ho st Non Sons of einen either at Puberty ot later in adolescence, and that a central focus of this treatment u titely mut be ii understanding, via the core fantasies and their being experienced within the transference, othe meaning ofthe breakdown in terms of chip to his own sexual body, tothe nature of his present object relationships, tore historical meaning, the adolescent's relat se nature and meaning of his present gratifications, as well as ia terms of th REFERENCES . F the owner of the PEP Archive CD and ! This text is printed for the personal use of i {s copyright to the pa aa Ra it rianally appeared. It is illegal to copy, dis:ribute or circulate it in anv farm wie