BOQ O4 0D X199 CLS3024500: Psychoanalytic study of the child WR: BF721 .P97 (ISSN 0079-7308 / Yale University Press [etc.] /) Requested: 2017-03-20 13:48 Not needed after: Pickup at: GW George Washington - Gelman WDD: Web Delivery Citation: Issue: v.49() 1994; Article: Sexual abuse, or a delusional structure From adolescent to young adult. / Laufer, Moses; Pages: 208-221 * WRLC Shared Collections Facility BF721 .P97 - 3053004223681 - - Charged(2002-06-24) * WRLC Shared Collections Facility BF721 .P97 - 30530004222998 - - Charged(2002-06-24) * WRLC Shared Collections Facility BF721 .P97 - 30530004223236 - - Charged(2002-06-24)Sexual Abuse, or a Delusional Structure? From Adolescent to Young Adult MOSES LAUFER, PH.D. The treatment of an adolescent patient who recalled having been sexwally abused in childhood by her father is described. In the course of treatment, various doubts were raised in the analysts mind about the truth of this memory. As the analysis progressed, the analyst felt thatthe patient's responses (o interpretations were signs of the presence of a delusional structure, When the patient felt that the analyst doubted her memory, or was not on her side, she angrily and vengefully broke off her treatment, She remains avery vulnerable young woman, The delusional structure contained the patients sexual need to destroy ‘the male's potency as a defense against her longing for the oedipal mother who, in reality, had left the patient for a new husband, WE KNOW FROM THE TREATMENT OF SERIOUSLY DISTURBED ADOLESCENTS and adults—those who live a perverse life, or who show features of a break with was entered by patients of frightened, convinced th; or Vagina Such 1g alone, ashamed, al Sexual Abuse, or Delusional Structure? 209 life, and not uncommonly feeling that the only and ultimate solution is, to kill themselves. In recent years, sexual abuse in childhood has been in the forefront of the news, which has highlighted how destructive the experience has been in the emotional lives of many people—or so it seems. What I will try to do is to show how and when it may be possible during the treat mentof an adolescent who is convinced that he or she has be abused to hear and understand the patient's communica signal of a break with the world. The adolescent patient who “remembers” having been sexually abused at some time during childhood lives with the belief (usually not conscious) that his body does not belong to him. [tis constant watched or observed; there is nothing that can be private beca “abuser” has taken over the privacy of the body, and the adolescent, in his private masturbation or in a sexual relationship with another pe son, feels convinced that the persecuting seducer is always there, watching or sharing in the sexual gratification (Shengold, 1989). A characteristic of the adolescent who remembers unequivocally having been sexually abused ‘uth of the memory. Even if this “memory” turns out to bea creation of he mind, the adolescent is not ying but expressing a false memory, one that has a specific function in his life and especially in the way he relates to his sexual body issues addressed here are by no meat ly in his writings Freud doubted the validity of his “sedi ory” and instead began to focus on the meaning of seduction, or the famtasy of sed hold on to painful experiences, on the one hand, and to create and guard painful creations of the mind, on the other (Freud, 1918) Twant to describe briefly my way ng about adolescence and psychopathology di the clinical material will be seen within a specifi sexual maturity—that is, the beginning of the period of adolescence— ‘means not only a fundamental change in the person’s relationship to his body but also the availability of the sexually mature body for the expression of psychopathology. The development of one’s sexi iod of adolescence has an integrating func -gration is normal or takes a pathological direction tence of a ph from puberty on means, in phys terms, that one to grow a child in one’s body. But this process of becoming a sexual male or a sexu; female, and then enabling oneself to experience the reality of father-210 Moses Laufer hood or motherhood, depends on the ability to alter the image of one’s body during adolescence to include the functioning genitals. This in turn depends on the ability to gratify the oedipal incestuous wishes in ways that are removed psychically from the oedipal parents—that is, from the incestuous objects. Without this ability, sexuality during ado- lescence becomes a psychically frightening and anxiety-ridden area of experience that participates or results in the psychic destruction of the person as a functioning male or a functioning female (Laufer and Laufer, 1984), Some of the adolescents we have treated analytically at our centre have grown up with a shameful secret—the memory of an experience, usually a sexual seduction, that was overwhelming (Laufer and Laufer, 1989), Such patients remember nothing about these “events” for years and then are startled during their treatment by the emergence of mem- ries that they then use as confirm: sively to a person or people (Segal, 1972). The adolescent patient child in the memory—remembers that the person responsible for this seduction (and for the secret) was an incestuous object—a parent, a a relative of the parents—and that during the experience/secret the body of the child was entered in some way (by the ' penis, tongue, finger) via the child's vagina or anus or mout That is, the interference was not limited to touching or caressing the surface of the child’s body. The adolescent patient recalls these events as having taken place when he or she was aged between two and five (Hartmann, 1953). When these children are seen as patients in adolescence, they are very ready to run away from help, to forget it all, to ask to be admitted to a hospital because they are mad or going mad, to feel there is no answer but to be dead, and to be absolutely convinced that their memo- ries are authentic. The patient believes that the events recalled have shaped his or her life, but in the course of treatment, some doubt at least is raised in the mind of the analyst regarding the truth of the ‘memory. I believe that this may be critical in saving the mental life of the patient. That is, the analysts doubt of the authenticity of this mem- ory, conveyed to the patient through interpretation, begins a process that separates delusion from fact and enables the adolescent patient to put meaning to the “memory,” which until now has moved the person in the direction of at least a partial break with the world, Once the patient remembers these “events,” he feels consumed by 1¢ memory and the details of the experience, and he believes with certainty that he has found the clue to his dreadful past and his long- standing wish to be dead or at least to destroy his body—which means Sexual Abuse, or Delusional Structure? an for him the physically, sexuall body: His present psychopath- ology is, he believes, the direct result of these past events. A critical characteristic of these events, or the memories attached t© them, is that the patient does not doubt the truth of what he remem bers; the doubt, if any, that arises about these memories is located singularly in the analyst who feels unable to put together what is being remembered by the patient and what isbeing experienced in the trans- ference. The confusions experienced by the analyst may be explained by the fact that heis in the presence of anadolescent who u sly may be remembering or reviving the history of the development of a delusional structure or who is in the throes of an internal battle about submitting to a delusion (by breaking with the real world) he currently is experiencing in the relation to his own sexually demanding body. ne adolescent may know unconsciously that this kind of submission destroy his chances of emotional survival, but he may neverthe- only the destruction of the sexual body but a regressive and sel destructive gratification that the adolescent feels helpless to fig! against. Mics urgent for the analyst to detect the formation of this dang ly pathological delusional structure or the clues to the presence of such a structure because allowing free rein to this break with the real world (which is focused primarily on the physical sexual body) in ado- lescence means that the person's whole affective world will be de- stroyed (Ritvo, 1984). The adolescent will experience his body—or, ‘more correctly, his sexually mature body—as housing and reliving t fantasied trauma of having been forced into submission. Each sexual gratification during adolescence and beyond then brings the patient closer to the behavior of the seducer or destroyer, with the result that identification with the oedipal parent becomes the destruction of him- self and of that parent. Bre body is the only way open for any emotion: CLINIGAL MATERIAL Molly was in analysis for four years and then suddenly and unpredicta- bly ended her treatment. ne to our Centre when she was aged eighteen. She compl 1 think, that she felt at ‘e murdering people, that she herself would like to die, and that research study at Inston House, “Mentalaig Moses Laufer she had no wish to be female. She also thought she was mad or going mad. Some of the staff expressed the view that there were signs of ming and the danger that Molly would not be able to to be admitted to a psychiatric hospi lly I did not agree with this view, but within jer analysis I changed my mind and felt that those a psychotic break might be imminent were right. Molly described herself as of “mixed race.” from Mexico, and her mother’s from Europe. Molly shares some fea- tures with her Mexican father—her hair is black and her lips are thick. Her brother, one year younger, has similar features, but sees himself as white rather than as of mixed race. The parents separated when Molly ‘was aged two, which meant that her father moved out of the house but visited fairly regularly for a meal or, according to Molly, for intercourse with her mother, after which he would leave without indicating when he would next appear. This arrangement did not last long: according to Molly, her father began relationships with many young girls (she says bitterly that his present girlfriend is her own age) and soor in the mother, Molly, and her brother. For some years, Molly lived with her mother and brother, with the mother having passing relationships with some men. When Molly was aged about sixteen, a man with whom her mother was having a relationship moved into the house. ‘Three years later they married and moved to another country to start a new life. Molly and her brother stayed in London, living separately from one another but maintaining contact by telephone or by meeting. When Molly's brother wanted help for himself, she told him of our Centre; the brother had help for three years, which was ended by agreement between him and his therapist. T now come to the analytic treatment. Some of the cli terial ‘may throw light on how Molly has had to falsify memories and help the reader to understand her break with reality and organization of a delusional structure, as reflected in her adolescent life and specit in her present psychopathology (Hartmann, 19 Katan, 1969). I first met a terrified, silent, tearful girl who cou passed as a boy; she was dressed in trousers and shirt, with short hair, somewhat disheveled. She at first sat in a chair facing me, and I did not bring up the question of the use of the couch for some months. When I did, she said she would not lie down; it frightened her, and in she had to be able to look at me. After several months she camé said she was lying down that day, as she did. Up to then, I was aware from some exchanges in the treatment that it would have been possible for me to use interpretations or comments to get her to passively give in Sexual Abuse, or Delusional Structure? 213 to what she believed I wanted her to do, but important not to interpret anything until I understood more of who she was and what she mightbe frightened about. By the time she chose to use the couch, I had learned that she was failing at college, had almost no friend: found it difficult to use the bus because she was convinced that people ‘were looking at her, missed classes a great deal, and had tossit in the last row in class and by the door. She stayed in her room for days at a time, sleeping or watching television, and masturbated often with litle or n fantasy, though at times with the fantasy of being next 10 one of her female classmates or teachers. For the first weeks after she began to use the couch, I could barely follow what she said. She talked very quietly or at such speed that her words became a jumble. But I did learn that she was miserable at lege, that she felt sexually attracted to some of the female teachers, dge champion but had given up playing bridge because she had been deteated in a ‘onship game, and that although she had done wi up to the time of her O-levels, she had failed miserably a time for boys, even though her brother for having girl- analysis for about seven months, and after remembering how her was about nine, badly bruising her ey she wept and screamed and then suddenly sat up, moved to the end of the couch, and said she had. done wrong here and did not know why I wanted to hit her, (This was the first time she could let me in on the terror with which she lived.) I acknowledged that I had moved in my chair and added that thought she might feel that I should be hitting her. At this she was able to lie down again but wept and did not speak. Some days later she told me she had recalled having allowed a boy to put his tongue into her vagina and having sucked his penis; this had happened before treat- ment began, but she could not be sure exactly when. (With hindsight, I think this was the first critical clue to the break in her relationship to her body.) This was a crucial addition to what was now being enacted in the transference, and it made it more possible for me to refer some weeks later to what was happening between her and me and to her fantasy of arousing me sexually. There followed a series of descriptions of events, fantasies, and fears which shared the quality of being shameful, frightening, secretive, and requiring that they be distorted in some way—namely, that the truth must not be told about them. For examp not only that she had weird dreams of being eaten or entered in some214 Moses Laufer way or being attacked by men who would get into her room or that she agined cunnilingus with other girls but also the shameful she had to sleep with the light on in her room and the television set turned nd was a jumble, she felt rotally confused, how she might kill herself. In fact, she found it impossible to sit for her exams and was very ted when she and the college agreed that she would have to hdraw from her studies. T nobody and doing nothing except co alytic sessions. She could not walk past the college for fear that people would see her. She felt ashamed and was convinced that people were laughing at her, knew what sh ing her insulting names (such a ing sucker”). Butt was only as a result of this failure at col she could allow me to say that she was unable to study or ime I mentioned this she cried, and this was often yy accusations that 1, her parents, and sometimes her brother were getting pleasure from her failure. She was convinced that her present state was the fault of her or father—somet claimed that she herself was responsible for her parents’ disastrous relationship because her mother was pregnant with her when they married; if Molly had died not have been any problem. Her mother had never held or comforted her, she said, and in fact was, not really able to love anybody. But maybe it was her father who was t0 blame—she suddenly ind_was convinced that he had masturbated her when she wasaged about four or five, and that he may even have put his penis in her- led, cried, and was convinced that I planned to do the same; otherwise, why would I treat half-caste, and why would our Centre offer a person like her psycho- ment without cost? This was followed by an apology nk T have to go into the hospital?” she inquired, saying that ki herself might be the easiest answer. It would remove everything, in- cluding the secret of what her father had done to her, and she would 1ot have to lie in bed for hours thinking terrible things, masturbating, and wanting me near But with all this turmoil and inner violence, I felt that a different process was going on—a process that was new to Molly and one that she had never before been able to allow for fear of what she described as “ or as “showing how much I hate.” The many weeks she her room feeling that she just could not do anything were for Sexual Abuse, or Delusional Structure? 215 hera defeat and a shameful outcome. But I focused on the destructive- ness contained in this experience, on her feeling that she was the un wanted baby who had the capacity to destroy her parents and who now wanted to destroy me because I was not making her into my baby. I that the hatred she had inside her wasin her vagina, waiting to destroy men, but that ultimately she hoped she could destroy herself as ‘woman. She wept and wept in sessions, barely able to speak, but she could say that, in response to a question from her a couple of years back, her father had admitted that he had longed for his first child to have been a boy rather than a girl (Freud, 1924; Abrams, 1984), ‘One day Molly mentioned that she had applied for a job. She had decided, she said, that she was not going to die, so she had to work. During this same period, she mentioned that she had met a man who seemed to like her. He was her own age, also Mexican, and trying to study, and she was very pleased that he was somebody she could be proud of —he was intelligent, and he wanted to do something with his life. Although his parents were living together, his father had other women, His mother had spent a period of time in a mental hospital. late attendances, and thoughts of wanting to di 1 they had started to “sleep” with each other, @ description that referred to their practice of cu ‘out genital intercourse. She talked of her great deli ‘wanted her, but she could not let him enter her with not mind this because having his tongue in her vagina and his penis in her mouth was “perfect. Meanwhile her job, although boring and uncreative, gave her many opportunities to meet people. But I soon learned that she was at the same time spending many hours at work telephoning people—her father, her brother, former friends from college—to such an extent that the organization she worked for complained that the cost of tele- phone service had increased substantially as a result. But Molly could feel close to the people she telephoned only if she could not see their faces (as also had to be the case during sex). The important silent excitement was her ability to cheat people (something I had already been prepared for in the transference by her description of her sexu life and her “secret” excitement in the sessions). In this case, it was her ‘employer that was cheated. She became extremely anxious and angry when I called her attention to her need to do this. But she herself could begin to make the link between this form of cheating and the cheating. she felt existed in the fellatio/cunnilingus that was “secretly” taking place, which contained her secret of her father and her having done ng, a secret hidden in her vagina.216 Moses Laufer This analytic work enabled her to risk having intercourse or, more correctly, allowing her vagina to be investigated by the penis without destroying either herself or her boyfriend. It also led to acting-out behavior, which could have been extremely dangerous. She became pregnant by her boyfriend in spite of her conviction that she had taken all precautions possible, and this awakened the fantasy that it was really her father who had left the seed inside her vagina and that her preg- nancy was an elaboration of what her father had done to her (Green acre, 1949), She felt that she must not allow her life tobe destroyed nov, especially after her fantasy that having my baby would mean thatshe had been pronounced innocent by me and had been forgiven for believing she had destroyed her mothers the oedipal savior. Nobody other than her boyfriend and I were to know of her quickly arranged abortion. ancy and the abortion, she had contin: ‘who took part in the plan. She felt that should have been aborted and that having been offered psychoanalytic treatment through our Gentre meant that she was suc- cessfully seducing me and that my penis really belonged only to her. She experienced great remorse for some weeks after her abortion, feeling that she had killed her own baby and that she herself had no right to go on living. holiday break, I felt that her tre: igh I was prepared for a very ugh the dest Femoved. She is now a nce (o allowing her hatred and des transference. But un having put his revenge and destru ‘On my return from my holiday, a shore note was waiting for me which Molly had sent by post. In it she said that she would not de returning because she felt that the treatment was not giving her what she needed, that some of her friends at work had told her not to goon wasting her time by coming every day for treatment, and that she had Sexual Abuse, or Delusional Structure? 27 decided to work with people who may have had things done to them by normally. replied to her some days later saying that I would keep her times free for her, that I thought we should meet and talk because I believed that hei ‘not to continue with her treatment was @ mistake. I got an Since that time, I have heard some alarming things about Molly from her brother's therapist. She has left her job and given up her boyfr She is doing some work with an organization that helps people who are in trouble with the law, having difficulty finding work, or are being or hhave been sexually abused. She claims that I, through the analytic treatment, brainwashed her and harmed rather than helped her. She relies on the writings of a psychiatrist who asserts that people who have been sexually abused have a right to feel destroyed by the parents and that what people need is to be cared for and supported so as to protect themselves from nonunderstanding or destructive parents and thera- pists. I also heard that Molly is considering bringing a lawsuit against at time she tried to convince (0 give up treatment and has made accusations to him about mistaken perceptions of what I said, and about our Centre asa harmful organization. Discussion’ on that Molly showed features of tect the precariousness of her hold he left treatment suddenly aware from ear psychou joning, I did no ‘on reality until it was too late—that after having attended for four years. How might itbe possible to under- stand a process that ultimately removes the patient, an adolescent, from the world around her and that goes on silently or at least un- wertheless with great impact? And what may have race that kept me from seeing this as the How much of the failure of the treatment d how much was a quality integral to the development of a mal structure in some adolescent pa Although Iw. Itis clear that during the period of treatment I did not take seriously enough Molly's power and uncompromising need to create a memory in which she had to believe. The gratification she derived from living based on the fact that it enabled Molly to iced and impregnated by the smory wa he fantasy of having beena8 Moses Laufer Mexican oedipal father while at the same time being able to destroy the white mother—whom, I believe, she really wanted as her sexual part (Freud, 1907; Hartmann, 1955; Solnit, 1959). Her leaving treat left her with the belief that she had «d me so that I could be destroyed and left impotent. But in attack was ultimately on herself, and it destroyed her ability to give up the delusional belief and to putin its place an identification with a mother who once loved her but then chose to leave her. With hindsight, itis clear that Molly never responded to her sex: body as one that belonged to her. She lived with the delusional bel that her father’s penis was inside her and that he, or more correctly penis, could destroy ied to make her into a sexual How could [ be sure that her memory of being sexually abused was a creation rather than a fact? Her need not to see her lover's face during intercourse and her ability to have a climax are two important clues to the answer. During intercourse, she could imagine her sexual partner experience climax during intercourse because interc abused patients means a violent rape and a near-destruc oedipal parent. Her pat ing and prote: perverse gratific nships. Housing the Mexican oedipal father in jeant that he was always there as part of her intercourse and also was safe from total destruction Finally, how might it be possible to est ‘ment, that the adolescer delusional stru ference so that the patient can be protected and treated (or, as Freud said, held with one hand while the analyst does surgery with the other)? ‘To treat such an adolescent is a precarious undertaking, but itis clear the break with the world, with the constant risk of suicide or a psychotic withdrawal If the developmental breakdown—that i from self lable the possibility of torelive wable to protect himsel destruction. A first requires admitting the patient to hi Sexual Abuse, or Delusional Structure? 219 tinuing the analysis while the patient sin the hospital. My mistake with Molly was that I did not detect early enough what I was dealing with; 1 dealt with the various crises that arose featment by interpreta~ tion and by making an effort to enable her t ive her usual life (of attending college or going to work, house), In looking back at the analytic data, it is clear to me that Molly was repeatedly asking me indirectly to do something about her mental creations. I heard this much too late. By the time I could begin to make better sense of her behavior and some of her enactments, she had established ways of gratifying her fantasy, which contained her delu- sion of housing her father’s penis in her vagina while enabling her own body and her father’s penis to destroy her boyfriend’s potency (Freud, 1924). At the same time, cach intercourse was for her a revengeful and destructive attack on her mother. It may have been a mistake for Molly to have a male rather than a female analyst. I believe now that patien like Molly, with severe pathology revolving around the fantasy of their parents’ sexual lives, should have an analyst of the same sex. I say this because such disturbed and damaged adolescent patients will, at some point in the transference, need to have active sexual fantasies about the analyst. With an analyst of the same sex, homosexual fantasies and panicmay result, but thisis quite different from having sexual fantasies about a person who represents the fantasied seducer ‘The mistake I made in my interpretations with Molly—and it was one that [ think contributed very much to her need to run away from ‘me—was of her need to destroy me through her declared love for and dependence on me. These kinds of interpretations were exciting and dangerous for Molly, and ultimately she had co find ways of keeping me ‘out of her fantasies during masturbation, My interpretations may have been correct in content, but they were not correct in timing. By the time she broke off her treatment, she had begun to experience me as similar to the fantasied father housed in her vagina, as if I was, in the transference, the person who was exciting and abusing her at the same time. Tam not sure how I could have avoided such an outcome, but it might have helped Molly to understand what was going on in the transference if had made more use of her relationships with contemporaries to put ‘meaning to her sexual fantasies and activities and included myself less in sexual content. For example, my interpretation that she wanted me sexually and wanted to destroy me by tricking me into giving her my penis could be heard by her only asa threat and an accusation, while at the same time it was exciting for her. It would have been more eff220 ‘Moses Laufer tive, safer, and much less dangerous to focus interpretations around other adults in her world, Such patients hear many interpret accusations and feel secretly excited by interpretations that i!am not, able to understand this destructive process well enough to have prevented it or reversed it. BIBLIOGRAPHY ‘Ankaws, S. (1984), Fantasy and reality in the oedipal phase. Psychoanal, Study Child, 39:83-100, The epigenesis of the adult neurosis. Psychoanal. Study Child, ). Delusions and dreams in Jensenss gravida. S.F. 18). From the history of an infantile neurosis. S. oss of realty in neurosis and psychosis. S. ing of the ego in the process of defense, S.E. 17:3-122, 19:183-187. 8 1953). Contribution to the metapsychology of schizophrenia. Study Cf 177-198, theory of sublimation. Psychoanal, Study Child, fotes on the reality principle. Psychoanal. 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