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CLINICAL MANIFESTATIONS OF
AMBIVALENCE

BY MORRIS W. BRODY, M.D. (PHILADELPHIA)

The term ambivalence was introduced by Bleuler, to designate

contradictory feelings of love and hate directed simultaneously
toward the same person. Most psychoanalysts would consider an
object relationship to be ambivalent whenever impulses to de-
stroy and to preserve the object coexist. Bergler, however, has
pointed out that the term has been used to describe practically
all contradictory feelings including conflicts between love and
hate, submission and aggression, masculine and feminine, good
and bad, dirty and meticulous (5). Some analysts apply the term
in all its consequences to the contrasting introjected images of
the 'good' and 'bad' mother, some to quick shifting between
introjection and projection, others to the conflict of indecision,
and to the struggle between the life and death instincts. Bleuler
also considers synchronous laughing and crying to be a mani-
festation of schizophrenic ambivalence (6). Ambivalent feelings,
Bleuler says, are the exception among normal persons who make
a decision between contradictory values. But the abnormal per-
son often cannot conciliate these opposing values; hate and love
are felt simultaneously without either of the affects influencing
the other. According to Alexander the antithesis self-love and
object love explains why all love objects are enemies to narcis-
sism and may under certain conditions become objects of hate
(4). Rambert finds ambivalence to be rooted in the fact that
parents are visualized sometimes as benevolent and at other
times as malevolent; thus ambivalence is a result of projection
(I2). Bornstein believes that in early latency the conflicts be-
tween superego and instinctual drives in the struggle against
masturbation result in heightened ambivalence (7). Eidelberg
considers ambivalence to be a defense mechanism (9).

From the Department of Psychiatry, Temple University Medical School, Phila-

delphia, Pa.
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MORRIS W. BRODY
506
Freud considered ambivalence inherent in the nature of
infantile sexuality both from the child's unlimited demands for
love and the impossibility of fulfilling its sexual wishes. He said
one might believe even that this first relation of the child is
doomed to extinction by the very reason of its being the first.
With the child's intense love there is always present a strong
aggression; and the more passionately the child loves, the more
sensitive it will be to disappointments and frustrations coming
from that object. In the end, love capitulates to the accumu-
lated hostility (I I). Elsewhere this statement is reaffirmed by
Freud who said that we cannot go so far as to assert that the
ambivalence of emotional cathexis is a universally valid psy-
chological law; i.e., that it is quite impossible to feel great love
for a person without the accompaniment of hatred perhaps as
great, and vice versa. Mature adults do, undoubtedly, succeed
in separating these two attitudes and do not find themselves com-
pelled to hate their love objects or to love as well as hate their
enemies. This attitude seems to be the result of adult develop-
ment, but in childhood, ambivalence is evidently the rule.
Many adults retain this archaic trait throughout life. It is char-
acteristic of obsessional neurotic personalities that in their
object relations love and hate counterbalance each other (IO).
Abraham considered the early oral period as preambivalent
(2). In a later period of orality, the infant becomes prepon-
derantly ambivalent toward its object. This ambivalence is in-
tensified by bowel training. In the genital period the individual
overcomes his ambivalent attitude.
The sense of omnipotence of some infants is traumatically
disrupted by their distorted perception of suckling as a maternal
aggression, as being passively pierced; bowel training is also
sometimes experienced as passive victimization. Ambivalence is
the outward manifestation of a desperate unconscious struggle
between the wish to be penetrated, orally and anally, and an
anxious denial of this dangerous wish by an aggressive pretense
that autarchy is preserved (5).
This concept has been confirmed clinically (8). It is further
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CLINICAL MANIFESTATIONS OF AMBIVALENCE 507

illustrated by an instance reported by a colleague. He had can-

celed an appointment with his patient, a dental surgeon, who
appeared for the next hour but because of external circum-
stances the therapist could not meet with him. In the following
hour the patient weakly protested against this treatment and
reported the following dream.
I walked into a room that reminded me of this office. There was
a child who had wires in its mouth, stretching the mouth forci-
bly open. The wires extended around the back of the neck,
around the body, pinning its arms to the side, and both ends of
the wire were forcibly jammed up the anus.

The dream depicts treatment as an oral and an anal attack

in which the patient is unable to do anything in his own behalf.
It is also a disguised wish for passive anal and oral gratification.

It is generally agreed that so long as there is no conception

of objects we cannot talk of ambivalence. The nascence of
ambivalence is in that stage of development in which the infant
begins to relinquish its passive narcissistic oral and anal libidinal
attitudes for more active object libidinal ones. Ambivalence
seems to become exaggerated in those infants who are pre-
vented from expressing their angry protest against oral and
anal frustrations. The resulting sadism is isolated and displaced
from the object toward whom it might reasonably have been
directed to an attribute of the object. The infant also reacts as
if the parental aggression was not directed toward it but was
aimed at its behavior, i.e., its oral and anal sadistic impulses,
and the isolation of the sadistic impulses is re-enforced.
The isolation of sadistic impulses causes the individual to feel
a sense of helplessness and it is this sense of helplessness that
creates the clinical manifestations of ambivalence. The am-
bivalent person vainly struggles to free himself from this feeling
of helplessness. Since he feels helpless to do anything in his own
behalf, he believes himself to be the victim of a hostile en-
vironment. He reacts to the environment with a pseudo aggres-
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MORRIS W. BRODY

sian which is his way of achieving love. Typically, this reaction

is engendered in a child by an unloving parent or nurse who
provokes the child to excesses of rage and then forces it into
passive obedience.
As a result of isolating his sadistic impulses, the ambivalent
person is not capable of experiencing strong affects, either love
or hate. Without an adequate inner sense of security, he lacks
a frame of reference for realistic evaluation of external percep-
tions. Defined as the presence of two contradictory psychic
strivings, the term, ambivalence, is an oversimplification which
is not helpful clinically because it refers to various facets of a
complex psychic state of affairs. It is helpful only to describe
ambivalence precisely in terms of object relationships.
When the child first becomes aware that there is a world
around it which it cannot control, its narcissistic state of magi-
cal omnipotence is shaken. It becomes painfully aware that its
gratifications are not determined by its wishes. Essentially he-
donistic and concerned only with the gratification of its primi-
tive sensual cravings, it is not likely that the concept of a parent
being outside itself is yet formed in the infant's mind. The in-
fant's concern is what is being done to and for it rather than
who is doing it; it is not so much the parent as the fulfilment
of the infant's creature comforts. The transition from the pas-
sive oral-receptive phase into the active one of chewing and
biting is a difficult step for a child who has been forced into
passivity by an anxious or hostile mother. 'In a child who has
been disappointed or overindulged in the sucking period, the
pleasure of biting, the most primitive form of sadism, will be
emphasized. Thus the formation of character in such a child
begins under the influence of an abnormally pronounced am-
bivalence of feeling' (J). In such a child, the commencement of
toilet training, passive sexual feelings, and the active sadistic
feelings are associated. Painfully aware of its dependence on out-
side forces for its comfort and increasingly cognizant of its own
helplessness, such a child would like to destroy the forces out-
side itself which frustrate it but it dares not because its very ex-
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CLINICAL MANIFESTATIONS OF AMBIVALENCE 509

istence is dependent on them. Unable to find a compromise, the

child isolates its sadistic impulses in an attempt to regain mas-
tery. It is as though it remains fixed in a state of being ready to
bite and yet not daring to do so.
This state of surrender, literally a fixation in bitter helpless-
ness, corresponds clinically to the state of ambivalence which
manifests itself in insoluble contradictory strivings. These con-
tradictory strivings are more apparent than real. They stem
essentially from the feeling of hopelessness against which the
individual defends himself with helplessness.

The following incident typifies the ambivalent conflict. A

woman with a severe obsessive-compulsive neurosis constantly
demanded relief from her difficulties. Toward the therapist she
remained quite impersonal. During one of many analytic ses-
sions in which she tearfully described her husband as unreason-
able, inconsiderate, cruel, and having no kind regard for her,
the therapist said, 'You must be quite angry with your husband'.
The patient was shocked, denied vehemently that she felt angry
with her husband, said she loved him very much, but admitted
she was possibly hurt by his behavior toward her and often
wished he would treat her with more kindness. She truthfully
felt no real hostility toward the husband. She loved him very
much and did everything in her power to make him happy. In
reality her reaction was one of helplessness. She hoped her hus-
band would treat her more kindly, and believed that her hurt
feeling could in some magic way produce the desired kindness
of which she had long ago been deprived. When she was asked
why she did not tell her husband that she was displeased with
his behavior, she replied that she would not dare for fear that it
would make him angry. Actually it was her passive demand
that the husband supply her frustrated need for love that caused
him to be angry with her. Her conditioned resort to helpless-
ness as a solution to her need provoked the problem.
In an ambivalent relationship there is no sound object-libidi-
nal involvement. In an adult relationship libido flows as a
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51 0 MORRIS W. BRODY

continuum between the two persons involved. In an ambivalent

relationship libido flows only in one direction. It is entirely
utilitarian and only one individual is favored or neglected. The
relationship is always partial and the affective reactions toward
the object are displaced to certain attributes of the object.
There can be no reconciliation between these reactions that
remain isolated one from the other. Problems of ambivalence
are the basis of many marital difficulties. A female patient talked
for hours describing the intolerable behavior of her husband,
implying that if the husband would change, everything would
be well with her. When we suggested that she could best spend
her time in treatment talking about herself and her problem,
she replied that she was talking of her problem: her husband.
She would have no problem if, by magic, we could change her
husband. Since the ambivalent person isolates his affective re-
actions, he evaluates a sensory perception in terms of the values
he believes inherent in the object perceived. Such an evaluation
cannot be reliable. A realistic appraisal of a situation can only
be arrived at by utilization of all the cognitive faculties.
A patient one day came into the office for an analytic hour
saying, 'You are angry with me today, aren't you?' The patient
reported that as he walked into the room he had noticed that
the therapist had raised an eyebrow. In response to questioning,
the patient said he was feeling friendly toward the therapist.
When asked how he thought the therapist was feeling toward
the patient, the patient replied, 'O.K. You were very friendly;
you greeted me with a big smile and seemed pleased to see me.'
In this instance the patient apparently felt friendly toward the
analyst, believed that the therapist felt similarly, yet did not
trust either of these postulates, preferring to accept what to him
seemed more reliable evidence. Either he had seen or imagined
he had seen the therapist's raised eyebrow to which gesture the
patient had arbitrarily assigned the significance of the thera-
pist's anger toward him. As a result of his life experiences, this
man was an angry, hostile person. Completely intimidated by
an overwhelming, ambitious mother and a successful father who
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CLINICAL MANIFESTATIONS OF AMBIVALENCE 511

was dissatisfied with his son's accomplishment, the patient had

not dared allow himself to become aware of his hostility. Re-
pressing this emotion, he was conditioned to seek cryptic evi-
dence of counterhostility.
A similar displacement from a patient's affective attitude to-
ward the therapist and his reaction toward certain attributes of
the therapist is revealed in the following incident. Free associa-
tions during an analytic session led the patient to think of a
bird, a bird's neck, wringing the bird's neck, and the therapist.
The patient said, 'It sounds as though I am feeling angry with
you today, but it can't be so because I feel quite friendly toward
you'. Further investigation proved that in fact the patient felt
friendly, but that he also felt envious because he believed the
therapist had achieved greater success in life than had the
patient himself. It was his feeling of frustration that evoked his
latent anger.
The following dream clearly illustrates the ambivalent con-
flict of a male patient with a severe obsessive-compulsive
neurosis.
I was captured by cannibals. They placed me in a huge stewing
pot and I seemed to melt to a massive pile of rice. The pile of
rice seemed to become larger and larger.

The dream expresses the patient's feeling of helplessness in his

orally aggressive world. The pile of rice that continues to grow
and grow expresses the patient's unconscious thought that he
can overpower the world by his passive helplessness; i.e., gorge
the cannibals with rice until they choke. Helplessness became
his method of retaliation, of orally aggressive retribution.
Whenever the ambivalent person feels threatened or abused,
he regresses to a state of helplessness which seems his only
weapon for defending himself. Using this defense, he errone-
ously either perceives himself as being a hostile-aggressive per-
son instead of the helpless one he actually is, or, to conceal from
himself his helplessness, he believes himself overwhelmed by
gigantic forces impossible of being coped with by any human
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51 2 MORRIS W. BRODY

being. The ambivalent person attempts to solve this problem

by externalizing it, as though to say, '1 am not helpless; 1 am in
the hands of Fate'. This characteristic of ambivalent thinking
is illustrated in the following remark of a woman patient.
'When 1 was pregnant, 1 took innumerable vitamin pills so this
would make my baby healthy.' This woman who placed all her
faith in vitamin pills would not allow herself to show any love
toward her child because her doing so might in some way harm
it. Although she could place hope in vitamins, book learning,
and doctors' instructions, she judged that any expression of
love or any other emotion was not trustworthy and therefore
potentially detrimental to her child. The repression of her own
emotional responses had caused this patient to become a chaoti-
cally disorganized personality, and yet she was rearing her child
in the same atmosphere of emotional deprivation she herself
had experienced.
Believing himself treated badly, the ambivalent person hates
(even though he may love) the malefactor; believing himself
well treated, he loves (even though he may hate) the benefactor;
nor is the ambivalent person concerned with the object's libidi-
nal ties with him. He is not particularly interested in whether
he is being loved or hated. His sole concern is whether he is
made comfortable or uncomfortable.
The question must be raised as to why the ambivalent person
is so ready to place his fate in someone else's hands or in forces
outside of himself. This maneuver enables him to imagine his
autarchy, and thereby control the external object. Should the
object then withdraw love, the ambivalent person can retaliate
by also withdrawing love, thus forcing the object to bestow love.
The ambivalent person behaves as though he neither loves
nor hates, and although he may appear hostile, he is not in so
far as his reaction is appropriate to the situation. He feels he
was treated badly and this to him means he was hated; there-
fore he responds with hate. Whenever the ambivalent person
appears friendly, he is not really feeling so since his reaction is
appropriate only to the immediate situation. Because he is well
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CLINICAL MANIFESTATIONS OF AMBIVALENCE 513

treated, this to him means he is loved; therefore he responds

with love.
SUMMARY
Ambivalence describes a disturbance of libidinal development,
but the term tends to lose significance when applied to the
protean clinical manifestations of all psychopathological bipo-
larities. Ambivalence is described as a dynamic concept, al-
though in the literature it is often referred to in a structural
sense and as such it is employed with varying meanings. Ambiva-
lence is a psychic striving and is essentially narcissistically
hedonistic in nature. It is most intense in the infant who has
been subjected to gross oral and anal deprivations and is there-
fore retarded in differentiating between itself and the outside
world. Such an infant imperfectly distinguishes the parent, as a
person, from the traumatic behavior of the parent toward it.
Ambivalence manifests itself clinically as a partial object rela-
tionship. There is an isolation of the libidinal affective reaction
toward the object in favor of an affective reaction toward an
attribute of the object. Since the ambivalent person is so pain-
fully aware of his dependence on the outside world, he does not
fully feel nor express his hostility to frustration. Whenever he
is challenged, he feels helpless to do anything in his own behalf.
Unable to find a reasonable, adaptive compromise, he defends
his helpless state with further helplessness in the service of
achieving a magical autarchy; thus he externalizes the problem
and temporarily relieves himself of feeling helpless. He sees
himself as a victim of overwhelming outside forces and justifies
his reaction of passivity as appropriate to the situation. Help-
lessness, often masked by pseudo aggression, is then employed
in the service of magical omnipotence allowing the ambivalent
person to consider these overwhelming outside forces as poten-
tially under his control. The ambivalent person, feeling wholly
helpless, behaves as though his affective reactions do not origi-
nate within himself but rather are reactions to outside stimula-
tions. He lacks, therefore, a frame of reference for realistic
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MORRIS W. BRODY

appraisal of his sensory perceptions. It is as though he neither

loves nor hates. Whenever he believes himself to be hated, he
withdraws love as though this were a magical maneuver which
will compel the object to bestow love. .

REFERENCES

1. ABRAHAM, KARL: The Narcissistic Evaluation of Excretory Processes in Dreams

and Neurosis (1920). In: Selected Papers on Psychoanalysis. New York:
Basic Books, Inc., 1953.
2. - - - : The Influence of Oral Erotism on Character Formation (1924). Se-
lected Papers on Psychoanalysis. Ibid.
3. - - : Ibid.
4. ALEXANDER, FRANZ: Fundamentals of Psychoanalysis. New York: W. W. Norton
& Co., Inc., 1948.
5. BERGLER, EDMUND: Three Tributaries to the Development of Ambivalence.
This QUARTERLY, XVII, 1948, p. 173.
6. BLEULER, EUGEN: Textbook of Psychiatry. New York: The Macmillan Co.,
1924·
7. BORNSTEIN, BERTA: On Latency. In: The Psychoanalytic Study of the Child,
Vol. VI. New York: International Universities Press, Inc., 1945.
8. BUNKER, HENRY ALDEN: Note on an 'Ambivalent' Dream. This QUARTERLY,
XVII, 1948, p. 389.
9. ElDELBERG, LUDWIG: An Outline of a Comparative Pathology of the Neuroses.
New York: International Universities Press, Inc., 1954.
10. FREUD: The Interpretation of Dreams. In: The Basic Writings of Sigmund
Freud. New York: Modern Library, 1938.
11. - - - : A General Introduction to Psychoanalysis. New York: Boni and Live-
right, 1920.
12. RAMBERT, MADELEINE: La pensee infantile et la psychanalyse. Revue Francaise
de Psychanalyse, XV, 1951, pp. 577-597. Reviewed by John Frosch in An-
nual Survey of Psychoanalysis, Vol. II. New York: International Universities
Press, Inc., 1951.
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