Stuttering and destructive impulses in an Autistic patient

A man in his late forties, who lives in a supervised setting because he carries the label of Developmentally Disabled, suffers from crippling stuttering. He rarely completes a sentence of any length without such severe stuttering that the listener quickly loses interest in relating with him.
In a therapy session, after the Thanksgiving holiday, noticing that he was stuttering more than usual, I paid closer attention to his chopped speech. And what I heard took me by surprise. He was hurling violent abuses against his mother, to whose house he had gone for the big dinner.
They ran - with stuttering obscuring one's ability to understand them clearly - something like this: "I will blow my mother with a pistol. I will knock her to the ground....bash her teeth."
Curious - for they were Tourettian in their intensity and explosiveness - I inquired what his mother did that has him so enraged. All he could say was that she was a bitch throughout the dinner. Then he went into a tirade about how she was cruel to him when he was growing up, would not let him speak his mind, and would hit him with the back of her hand right on his mouth for the slightest mistake, when he was so little.
"I want to tell her suck my you-know-what," and this piece was delivered without any stutter. And then, as if horrified at his own boldness, he immediately retreated into an apologetic mode. "It will hurt her feelings. So I cannot say that to her, you know that Dr. Kelwala. You know that Dr. Kelwala. I should get a pistol and blow myself."
After expressing remorse in which he thought the most deserving punishment for expressing defiance towards his mother would be to blow his head off or be jailed for life, he returned to the previous hostile mood, as if the aggressive impulse had to go back and forth against his mother and himself.
"I want to call her, "You fat broad. You bitch. And other bad names. But it will hurt her feelings, you know that Dr. Kelwala. You know that. So I cannot do that."
Then returning to the remorse mode he said that he should be punished because he is not thankful for all he got in his life. "There are people who are homeless. There are people who have nothing to eat. They are much worse than me."
Now I constructed in my mind that his stuttering has to do with sadistic sexual impulses and [premature and excessively strong] counter measures that got displaced on to his speech centers.
What was the ground for such a construction?
The fact that he made the statement:
"I want to tell her suck my you-know-what," followed by immediate guilt and wishing to be locked up in jail and blowing off his brain with a pistol. So here was a sadistic incestuous thought and guilt and countermeasures and punishment for it. Theoretically, the sadistic sexual impulse must have arose in the Oedipal period and the fear associated with such an incestuous thought had brought on the inhibition. Then the struggle over that impulse had got displaced on to expressing such a thought through speech and countermeasures to prevent the expression had resulted in stuttering.
But in the normal Oedipal Complex the anger would have targeted the father more than the mother. So I asked him did he have any such angry thoughts towards his father.
To my astonishment he said, "Yes, I always wanted to hit my father on the jaw. Or give him a bloody nose. Get a gun and shoot him in the stomach."
And he claimed that his father was as mean as his mother, and worse, for though he did not hit him directly, he never intervened and stopped his mother from hitting.
So the aggression from the Oedipal period had found outlet towards father as well. However, because of the fear of retaliation he had redirected it mostly upon his own self. The sexual current had regressed from the genital phase to sado-masochistic phase perhaps because the mother was too hostile for him to approach her without contemplating first knocking her down to the ground, bashing her teeth or outright shooting her, so she would not castrate him for his attempt.
His sexuality had mostly withdrawn on to himself and only a very small portion of it flowed to others, and here too through the center of speech with the impediment of stuttering blocking its passage.
Now could we place all of the blame for his stuttering on his paretn's cruelty towards him.
Well, something prevents us from doing so. And this something was confirmed in that very session.
I got a phone call from my son to which I had to attend to for a few minutes.
My autistic patient threw a fit at my focus shifting from him to the phone. Within 30 seconds he started ranting, "You are ignoring me. I am being ignored." He started sighing and muttered "shit" and threw up his hands in despair.
So behind the stuttering, more than his mother's hitting him on the mouth, was his inability to postpone gratification. The man wanted attention, right now and could share the person from whom he wanted attention with nobody. In fact his acute discomfort was so excessive and motor movements accompanying it so wild, almost bordering on violent, and the speech associated with the protest so aggressive that one had to wonder whether the primary pathology lay in this inborn aggression and the parents were provoked to mete out harsher punishments to contain the explosive behavior.
One also had to consider whether his autism itself was not a withdrawal from the world to prevent acting out upon others such an inordinate response to frustration.

Body odors: A psychosomatic method of discharging aggression?

An Indian man in his mid-fifties reported that when stressed he gets allergic reaction that manifests as excessive mucous secretions from his sinuses and tracheo-bronchial passage. His face turns red, he has to repeatedly blow his nose, he can hardly talk because the constant dabbing of nose and mouth with facial tissues interferes with it, and he is unable to focus or listen to others.

A little exploration revealed that the last such attack occurred when his boss was being mean to him. The boss had exaggerated the significance of the mistake he had made, and this had triggered a strong reaction in him to resign, or to tell the boss some home truths about him too. But he could do neither.

So his "allergic reaction" had set in. But to me it appeared like an extension of crying. Now that he was a grown up man, the secretory response had shifted from mucosa of the eye to those of surrounding regions. It was crying in displacement.  It was discharge of tension and rage, caused by the insult, through a secretory response.

But there was something else to this displaced crying. Along with the paranasal sinus discharge and post-nasal drip, when stressed he also emits a strong odor. Which also, he attributes to allergic reaction. But why should an allergic reaction give rise to foul smell?

Is it possible that his odor was a form of aggression designed to tell others to get lost when he could not do it by words or physical action?

He claimed that his foul smell has nothing to do with anger because he does not believe in getting angry. Responding with negative emotions never resolves a conflict per his philosophy.

Now this gentleman, a sterling fellow, who I know well, is very religious, devotee of a Hindu Goddess, whose bhajjans (hymns) he listens to as he drives his car, and he genuinely strives to be saintly. Every insult hurled at him is handled with turning the other cheek and equanimity.

He countered my theory of undischarged rage by claiming that the odor is due to secretion of nitric oxide. And there is nothing more to it.

But can we accept his explanation? Or is it just a rationalization to hide from himself that he does get angry? A rationalization so strong that he does not feel the affect of anger which seeks expression through halitosis aimed to tell others to get off from his space.

Over the years I have observed that anger/destructive urges often find expression through foul odors. When something disturbs one, there is an immediate motor response to destroy the source of the disturbance. However, this is not always possible. The source of disturbance is often stronger than one's self or out of one's reach. In such cases I have found the motor response may occur through involuntary muscles. I have found that if I am driving and someone cuts in front of me, or honks at me, or even if someone else makes a traffic violation which has nothing to do with me, I react with a tinge of fear and then immediately get unpleasant sensations in my chest, and sometimes, a few minutes later,  get a gut reaction. The gut reaction is sensing of slight tension or pressure in the abdomen, an awareness of increased motility in the intestines, and sometimes discharge of the tension through flatulence.

Is the mechanism of Irritable Bowel Syndrome and various other colitis similar to this pathophysiological process that I see in myself?

Many of my patients who show a tendency to act out their conflicts through their intestines have reported to me that when something disturbs them, or if they hear their parents fighting, or a sibling makes them angry, they get "the gut reaction" and have to run to the toilet. The greater the stress the more thunderous is the reaction of the bowel.

They also report that greater the stress more foul is the smell that accompanies the gas and feces. Now in the man whose breath becomes foul under stress, he insists that it is due to allergic reaction.

Now allergic reaction itself is a method to expel and destroy foreign objects. There appears to be a cascading relationship between rage, motor response [mediated by cholinergic neurotransmission], generation of nitric oxide, histamine over-activity, allergic reaction, GI tract excessive secretions and foul odor.

Are all these different methods of getting rid of something alien or unwanted?

Psychology of feeling depressed in winter and gloomy weather in a young man

A 26 year old man reported that with approaching winter his mood is going down. Till Spring comes, he wants to just stay inside the house. He finds it difficult to tolerate the dark and gloomy weather. Outside feels cold. The overcast skies and lack of sun makes him feel listless. He claimed without the sun he has a bad attitude. He attributed his problems to suffering from "the winter blues" and wondered if he should get "serotonin light therapy". He claimed that there are lamps which emit light that raises your serotonin, the lack of which is behind depression. He also wondered if he should take 5HTP pills, along with St. John's wort. He talked about going to the chiropractor to boost up his morale. He wanted my opinion if high doses of Vitamin D would be a possible antidote to his "SAD" - Seasonal Affective Disorder.
He also attributed his addiction to narcotics -Vicodin - which goes out of control during winter as an attempt to create warmth inside him. When I go out in winter I can feel the chill penetrating right into my marrow. The Vicodins wipe out that feeling. I feel warm and confident and ready to face the world.

The patient suffers from remarkable inhibitions in all areas of life despite having superior intelligence. He attributes it to heredity and declares that his father and his aunts have the same problems. "We are all shy and inhibited. We lack confidence."
He claimed he is so inhibited that he cannot even go to the toilet freely if he is in uncomfortable surroundings, including his parents home, where he still lives and never feels at home. When I conjectured that he is uncomfortable there because he has disturbed relationship with his father, he outright rejected that construction, claiming that he has great relationship with his father, only to proceed on to indirectly confirm the accuracy of my construction by saying that he does have disturbed relationship with his siblings, one of whom broke his nose. The ambivalence towards his father had long ago gotten displaced to his brothers.
He stated that he has to take laxatives to goad his inhibited bowels. But remarkably the lax bowels resume their normal tone when he is staying at his girlfriend's house. So, he declared, there is something psychological rather than physical that keeps his bowels inhibited.
When the construction was made that his lack of confidence was because he feels he lacks the psychological support of his father - symbolized by the sun - and he feels completely not up to par to face the world without his father/sun with him, he was stunned. He said that he had always felt that, and had arrived by his own independent thinking that his feeling of inadequacy in cold and gloomy weather has to do with not feeling man enough, but he had never expressed it to anybody because of the fear of appearing crazy. It was easier to rationalize his problems as "Seasonal Affective Disorder."
The patient agreed that his searching for Vitamin D, 5-HTP, chiropractitioners, different therapists, and other esoteric objects also was an attempt to get "phallic potency", which he felt he had not received enough from his father. Bright shining sun nullified best this feeling of inadequacy, hence he felt good in summers.
That his inhibitions had to do with excessive sensitivity to pain, which had made him shy in interacting with other men to avoid getting hurt, and this lack of robust relationship with men in general, was behind his feelings of phallic inadequacy, and when he took Vicodin the fear of pain disappeared, enabling him to face the world and other men, was conjectured but not explored with the patient.

An agoraphobic's dream

A patient who suffers from severe agoraphobia and cannot step out of her apartment, without being accompanied by someone familiar, brought the following dream to the session:

My husband is taking me out to dinner. It is not a fancy place. May be a drive-thru fast food restaurant. I look through the menu to decide what to eat. But I can barely see the items. Then I find that my husband is not interested in the menu. He has not even come there to eat but to meet someone. I get angry, and throw the menu across. The scene shifts to inside of the restaurant. It is really dark and uncanny. It is a stark white building. I notice there is nothing inside; no people at all. There is just one dim light. There is a whole stack of plastic menus. My husband responds to my anger, and my sending the menu sailing through the air, with even greater anger. So I start running. He begins to throw rocks at me. They hurt. I get pelted by big and small rocks as I run down the street to my house. But I can barely get past the rock throwing. Even when I reach the house I cannot get inside as I cannot get the key in to the lock because so many dirt clods and rocks are falling on me.

The patient is divorced from her husband, but they still live together for financial reasons. First thing she expressed about the dream was her surprise that her husband is throwing stones. It is so unlike him. He is not a violent person at all. It makes no sense. Also it makes no sense that she has gone to eat at a restaurant because her agoraphobia precludes that. She cannot eat in public. So the dream, according to the patient, was senseless.
She brought scanty associations to the other elements of the dream which - following the technical rules of dream interpretation - allowed me to proceed with the analysis primarily on the basis of typical symbols and typical scenarios that dreamwork utilizes to couch our ordinary thoughts in the language of dreams.
Now the patient did associate here and there to the constructions I made, and which served as guideposts that the analysis was proceeding in the right direction.
First construction which was made was that in the dream she is free of her illness and eating at the restaurant, something she can only dream about in real life. Further construction was made that eating in public in her case could mean meeting strangers on the street and having liaison with them. For underneath the agoraphobic's fear of streets lies the fear of getting too bold in demanding sexual satisfaction and becoming a brazen hussy who does not hesitate to solicit sex from total strangers - prostitution fantasy.
The patient responded with "That is so weird. So strange. I would have never thought of that."All the typical phrases which patients use - as if they have jointly conspired - to confirm the correctness of an interpretation. Then she went on to say that she had read somewhere that behind agoraphobia lies the fear of soliciting sex on the street. But she always thought that that explanation applied to low life agoraphobics not her.

I look through the menu to decide what to eat. But I can barely see the items.

This expressed two contrary impulses. Finding a dish on the meny was finding something satisfactory to eat - sexual satisfaction - while the inability to read expressed the emergence of repression and blocking of the wish which was unacceptable to her conscience.

Then I find that my husband is not interested in the menu. He has not even come there to eat but to meet someone.

This was a projection of her impulse to meet someone upon her husband out of moral sense. She is avoiding the guilt of having the impulse to solicit sex with a stranger by projecting the tendency, and hence the blame, from herself to her husband. There is of course the element of wish fulfillment, vicariously, through her husband. The unconscious hypocritical reasoning which the dreamwork uses must have gone something like this: "I have come here just to eat food and I am looking so innocently at the menu, and it is my husband who is interested in getting illicit sex, and has come here to meet someone."

I get angry and throw the menu across

This anger is actually the superego anger directed towards her unacceptable conduct - wanting sex with a stranger. Her father was very strict disciplinarian, quick to anger and take up the belt to punish children for the slightest infraction. Her superego [conscience] had become the representative of her father, and she was identifying with her father to give expression to the condemnation, with her husband taking on the role of her lascivious self and becoming the object of the fury. The throwing away of the menu gave expression to her rejection of the impulse to take interest in women - the flat menu and the food items in it represented women. In the sexual encounter that she was hoping that would happen to her, in the dream she was identifying with the male role.

Then the scene shifts to inside the restaurant. It is really dark and uncanny.

Lack of success in finding the fulfillment of the wish - inability to read the menu, and its getting thrown away - leads to the complex getting reenacted on a different venue. And the wish tries to find an outlet at a much deeper [regressed] level. Being inside a structure like a restaurant or a house or a Mall, especially which is dark and uncanny, is fulfillment of the wish to return to the womb. So it is the familiar 'womb fantasy'. The patient frightened of soliciting sex on the street, shown here as looking for food at a drive-thru restaurant, and hoping to see its fulfillment through her husband, to whom she is attempting to present the women [the menu items] while simultaneously opposing it, out of jealousy - throwing the menu across - now shifts the stage for the acting out of the two contrary impulses on to her mother's womb.

It is a stark white building.

This is an allusion to death. Fantasy of returning to womb - the fantasy of rebirth - is regularly accompanied by fear of death. Birth of our children, heralds our own death. White is often used as an allusion to death. So she wants to die and reemerge as a new avatar.
Now we know from countless other dreams that the womb fantasy is always undertaken to fulfill the wish of the dreamer to go back to the womb and reemerge as a better fortified avatar. And this fortification is invariably connected with the deepest wish of women - to be born again, and this time with a penis, so as to do a better job of her life in her masculine reincarnation.

I notice as to how no one is in the restaurant. No people at all.

The association to this was how Kroger -the supermarket - is so full of people and how even the thought of facing them triggers a panic attack. So the fear/panic of crowded places - the core of her agoraphobia - is a defense strategy the mind of the agoraphobic uses to suppress the impulse to have illicit liaisons with strangers. In the dream, however, she has managed to conquer this fear. And she has done this making all the people who would stare and disapprove of her disappear. With no disapproving people around, she can indulge in her fantasy.

There is just one dim light. There is a whole stack of plastic menus.

The whole stack of menus alludes to a row or pile of women. The patient's relationship with men had been severely disturbed in childhood primarily because of her father's harshness and ruthlessness. She felt more comfortable with women, and in the unconscious her sexuality sought satisfaction from women. In the dream the desired women were being portrayed by flat menus. The dim light was allusion to clitoris, and the inferiority of female organ, and thus an allusion to her rejection of finding sexual satisfaction with women. Patient's taking special pains to mention that the menus were of plastic was expression that I may desire women, but real intercourse with them would be artificial and non-satisfactory.

My husband responds to my anger, and my sending the menu sailing through the air, with even greater anger.

Wish fulfilment had blocked the restraining influence of public by showing no people at all in the restaurant. But the moral sense was making a comeback finding expression through showing her husband getting angry [at her brazenness]. Sailing of the menu through the air was an allusion to sexual satisfaction as well. In fact this was the core of the dream. It was the most vivid element of the dream. And she did emphasize as to how dramatic was her sending of the menu across the room. The dream was woven around this wish. It alluded to her going back to the womb, stealing the penis from there from the father, while parental intercourse was taking place, and then flying away with it. The familiar feeling of being at the top of the world after satisfactory sexual act. It is best captured by the song "Oh what a feeling, dancing on the ceiling."The fear that it will arouse the ire of her father - who in the dream was being represented by her husband - whose penis she was stealing, brought an end to that section of the dream.

So I start running. He begins to throw rocks at me. They hurt. I get pelted by big and small rocks as I run down the street to my house.

Now the wish is on the retreat and the punishment for it takes the upper hand. She could make the public and the public opinion disappear for a moment at the restaurant, but the moral sense was returning with a vengeance. The association to the rock throwing at her was to the Biblical woman who was about to be stoned by the crowd for adultery. She is running back to the house - womb - away from the trysts of life which will invite dirt and rocks to be thrown at her.

Even when I reach the house I cannot get inside as I cannot get the key in to the lock because so many dirt clods and rocks are falling on me.

This was the last to replay the two opposing impulses. Entering the house by opening the lock with the key would have been symbolic depiction of intercourse. But the hail of abuse, represented by the rocks and mud clods, and the fact that she does not know how to use the key -penis - holds her back.

The dream ended with her waking up in fright.

Aggressive impulse at the root of easy distractability and multi-tasking

A 29 year old girl who came for Suboxone treatment reported that the reason she was addicted to Vicodin, and now kind of addicted to Suboxone, is because they attenuate her distractability. She claimed she can rarely keep her focus on a task long enough to complete it unless she is taking Vicodin or Suboxone. Every task undertaken, after sometime, is interfered by a creeping anxiety and premonition of disaster happening somewhere else, and her mind begins to search for some other project that she was supposed to do, and forgot, and which, if not immediately attended to, will cause problems and she abandons whatever she is doing to take up the new task. The cycle repeats itself with the new project, leading her to pick up yet another project, till there are so many open projects that she feels overwhelmed and gives up on all of them.
If she can't find something to do that has the potential to distract her in the outside world than she searches for pimples on her face and bursts them lest they grow too big and offensive and make her object of ridicule. When asked as to why others would they find the pimples offensive she said because they are ugly and it will invite them to attack her.
Now we know that Attention Deficit Disorder and Obsessional Neurosis are two sides of the same coin. The aggressive/destructive impulse, which these people are plagued with more than others, has to be suppressed and an impulse opposite in its intent [constructive in nature] has to be put in its place to keep the hostile impulse from getting hold of the motor apparatus. The hyperactivity of the ADHD child is a compromise formation between these two motor trends, to wit, destructive and constructive.
The easy distractability of ADHD patients is also a play between these two opposing impulses. The person is beseeched with an impulse to cause harm. This he suppresses with doing something constructive that will not only occupy his motor apparatus so the harmful impulse cannot take hold of motor movements, but also because by doing something constructive he hopes to please the person/s towards towards whom the destructive impulse was aimed at.
In this girl, the destructive impulses were directed towards her mother. In her conscious mind, she was completely unaware that she harbored extensive rage towards her mother.
Her mother was abused as a child, and had numerous mental problems herself, and she was mean towards her children. However, mother had also been in therapy all her life, and had taken the kids to her therapist to undo the damage her erratic and mean behavior was possibly doing to them. In these therapy sessions, the children had learnt not to hate their mother for her meanness on the rationalization that she was mentally ill. So the girl had learnt to not consciously feel angry towards her mother and also to believe that she harbored no resentment because she understood the roots of her mother's behavior. Nevertheless in her unconscious the desire to give tit for tat for her mother's meanness had persisted.
It was these revenge impulses, laced with furious rage, that sought motor actions and had to be kept at bay by doing some constructive project [that would please her mother].
Now in mild cases of obsessional neurosis, or where obsessional neurosis is sublimated towards useful goal, and this includes majority of mankind, for our world's do-gooders are no more than those who have harnessed their destructiveness to fuel the opposite impulse of constructiveness in such a fashion that the latter almost always manages to triumph over the former, the pathology is only apparent in that the person obsessively wants to do good - herein lies the psychology of hyperfocusing in ADHD.
But where the destructiveness is too powerful, as was the case in this girl, the constructive activity fails to keep the former in check for too long. The person gets a premonition that her good intention is going to be trumped by the evil one, which will result in some disaster happening [anticipation of punishment for the evil designs], and the conscious mind perceives it as a rising anxiety. And to take care of this anxiety she looks around for some project that was supposed to be done but which has not been done and which she deems as a potential candidate for causing trouble and she leaves whatever she was doing to take care of this new project. Herein lies the psychology of distractability. The destructive and constructive impulses are equally matched and the projects undertaken get interminably procrastinated.
The phenomena of multi-tasking arises from the same complex as well. Here projects are not abandoned but pursued simultaneously. When the anxiety arises about destructive impulse messing up the task at hand, the person, instead of putting additional energy in the constructive efforts, or abandoning the project and moving on to something else as the ADHD distractable person does, does not abandon the first project but takes on another, and then yet another, and juggles between all of them, and if he does it successfully then he is looked upon with admiration and if he messes it up he is viewed as a bumbling fool.
Now to her preoccupation with pimples. They symbolized siblings. She was trying to hurt her mother by identifying herself with her mother and destroying the mother's potential children. As if the desire to harm her mother had been displaced on to harming her mother's children. The penance for such fratricidal behavior was also expressed from the same act. The pimples stood for her children too, which she was destroying as a retribution for doing the same to her mother's children. It is interesting that despite her being at the peak of her femininity she had no interest in settling down and having children. As if all her interest in life had been consumed in managing this interplay between aggression and love impulses which strove to fight with each other in every aspect of her life.

Childhood sexual abuse, Kleptomania and Castration Complex

There is little doubt that nothing causes greater disturbance of mental stability than prepubertal sexual abuse. Earlier the age of abuse, greater is the disturbance. With genital sexual apparatus not yet ready for sexual activity/sexual arousal, and thus incapable of discharging genital sexual stimulation, the reaction is abnormal, excessive, pre-genital, and condemns the child to perverted and inordinate sexual preoccupations for the rest of her life. Fibromyalgia - which use to be called Beard's Disease and then neurasthenia at Freud's time - is almost always present in these individuals and there is never-ending restlessness that does not leave the patient in peace even when she is asleep.
The memory traces of the abuse obsessively emerge during daytime, and the thoughts and affects associated with these memories return in disguise in dreams. Since the affects are exceedingly strong, and more negative than positive, the dreams are usually nightmares. The dreams quite often are a faithful reproduction of the abuse, but over time the usual wish-fulfilling dream mechanisms are utilized to lessen the pain/dysphoria associated with the humiliation and the perpetrator/s may appear in the guise of strangers or wild animals who are chasing the dreamer. The sexual act itself is portrayed as getting knifed, gored or killed. The sexuality becomes predominantly sadomasochistic with the affect of fear masking all other emotions. The daytime reveries and nighttime dreams are accompanied by revenge fantasies. And this preoccupation with the childhood sexual abuse pervades the person's life so extensively that one marvels as to how childhood sexual trauma, sometimes limited to just one incident, can disturb someone to such a remarkable extent.
For sometime I have been noticing an interesting pathological behavior in these victims of childhood sexual abuse. They show kleptomania. Since the unconscious complexes that underlie this kleptomania is of theoretical interest, I will discuss a case in detail and then discuss its psychology.

The patient was 39 years old when I interviewed her. She had been sentenced to jail for a year for incorrigible kleptomania. She stated that she "stole for the rush of it". It was small items that she stole, and emphasized that the thefts were undertaken not because there was no money in her purse, but because the excitement of getting something for free was too overpowering. She placed the blame for this irresistible impulse to childhood sexual abuse. "When I was sexually abused I got nothing, in fact it was more humiliating and painful than pleasurable, so now I am entitled to all these [alluring] objects in the store without paying for them. I am so "mad" all the time. I need something to calm me down. I want somebody to love me. I have never been loved. No one ever showed love to me. They just wanted to fuck me. I never got love from my mother or father. So I feel a right for these things which others got but I did not."
At the age of 5, she was repeatedly subjected to anal intercourse by an uncle. It came to an end when her sister, who was 16 years older than her, discovered the abuse and threatened to cut the uncle's penis with a butcher knife if she ever caught him doing this to her sister. That put a stop to the abuse but not without leaving her permanently addicted to victimization.
Now it is well known that once a victim always a victim- as if to undo the trauma the person keeps seeking identical situations. She faced another round of abuse at the age of 12 by a cousin. And when she was incarcerated for habitual shoplifting, in the prison too, she was raped by a female prisoner. She had been married twice and both her husbands had abused her. Her second husband called her crazy and stupid.
Now as if abuse and victimization by real people was not enough she also developed pain in her lower back, hips, and legs, which she labelled as arthritis but which were more hysterical conversion of the memory of the rape than physical diseases. The hysteria was overlaid upon underlying real physical problems. Victimization persisted in the dreams as well, where she would relive the trauma, and see herself getting raped by the uncle and cousin.
There were strong reactions to this passivity/victimization at the same time. She would go in to spells of anorexia - rejection of oral sexuality- and would hardly eat. In fact, when she came to see me, she had lost 100 pounds. She normally was overweight, but in her current episode of anorexia she had made herself pathologically thin. She was consumed with the fantasy of taking a knife, finding her uncle and cutting his penis off. She would hear voices telling her to do so or at least to go and stab him. And while walking on the streets she often looked back over her shoulder to make sure that the police were not following her to arrest her for stabbing strangers on the road - strangers on the streets had become, in her unconscious - substitutes for her uncle. She had attempted suicide at least couple of times as a punishment for her promiscuity. She had become hypercritical of herself and people around her. But the biggest reaction formation was her pathological obsession with the Bible. She was constantly drawn towards older men, and she resisted the impulse to try to seduce them by keeping the Bible with her all the time and reading uplifting passages from it.
But it is not these symptoms of victimization that are the main objective of this post. It is the analysis of her impulse to steal. And that the analysis showed to be a demand for compensation. "If I was subjected to such horrible pain and humiliation at such an early age, and way ahead of all other children, then I am very special and I am entitled to all those shiny stuff in these stores and without paying anything, because I have already paid a huge price."
This attitude of entitlement at bottom was nothing more than pathological exaggeration of the central complex of women - a demand for penis. The logic behind it ran something like this: "I have been unnaturally subjected to these sexual activities at such an early age, certainly before other children, so I am way ahead of them all, boys included, and I am entitled to a penis. Especially with this experience under my belt I am no less than any boy that I know." It is the same impulse that in normal development, without hobbled by seduction or other disturbances from the environment like excessive parental fighting - would have metamorphosed from a wish for a penis into the wish for a baby. Wish for a penis is an earlier version of the wish for a child. In victims of childhood sexual abuse a fixation occurs at the stage of crude wish for a penis. The victimized child is unable to get past this stage. Or more correctly the later versions of this developmental line are feeble in comparison to this earlier wish.
And the disturbances from such an arrested development are protean. There is a great overvaluation of the role of sexuality in human affairs. The girl starts seeing her primary role in society as a sex object. The main purpose of life for her becomes being sexually attractive and pleasing to men, especially men she can put in class of fathers. The main game of her life becomes "to act seductive" and get victimized by men. There is of course reaction formation to this role of being just a sex kitten, and the girl occasionally lurches towards taking the responsible role of the mother which will cure her of this obsession with being an innocent/unsuspecting sex victim - for mothers are responsible beings, so engrossed with taking care of their children that they have no time for sex. But unfortunately this often results in teenage pregnancies.
And now to the kleptomania which is the subject of this discussion.
Why does this happen? Because when the child is sexually stimulated at that early age there is less sexual excitement in her than in the man who is abusing her. In her the predominant affect is that of anxiety and fear. Also the furtive behavior of the man, who is looking over the shoulder lest someone shows up, who is constantly threatening her that if she tells this to anybody he will kill her and her family, or extracting promises from her that this is our own little secret that should never be told to anyone else, all the while groping areas which are generally thought to be unclean, they all feel to her as something connected with excretory activity fun than genital. But the child can still rightly deduce that while in her the activity is more in pregenital zones, in man the nexus of the pleasure is in his penis and he is getting far more excitement and discharge of tensions through his penis than she is getting from the stimulation of her anal and oral zones. The penis then becomes the coveted organ.
And there are further pathological consequences. With the vaginal passage still not mature to become subject of excitement, the pregenital oral and anal passages become disproportionately more erotogenic. And this has serious consequences for the future fate of sexuality. After puberty the sexual discharge instead of maturing into the genital zone, remains fixated in oral and anal zone. The struggle against excessive pressure of oral sexuality often manifests as alternating bulimia and anorexia and in anally disposed person as Irritable Bowel Syndrome and other types of colitis. Also, sexual stimulation of genital area when it is not yet ready for reproductive activity, since it does not bring discharge and relief from tension, leads to an endless sexual preoccupation. This explains why the victims of prepubertal sexual abuse act seductive, but refuse genital sex when approached and get blamed for being a "tease". Their loud, histrionic and ostentatious display of hypersexuality are a facade and underneath lies sexual frigidity. And even when they give into genital sex, since it gives them little relief, they keep repeating the behavior and garner the epithet of "nymphomaniac."
The solution to all their problems they see in having their own penis. There are number of converging reasons for it. The child sees that because the man has a penis he can subjugate her to abuse. If only she had a penis she would not be subjected to this passivity. The penis also inflicts upon her pain and humiliation. The child also feels that since she has been subjected to this pain now she should be compensated with the reward of having her own penis which she can use upon others to get even. Also as the abuse causes a permanent irritation in her without possibility of complete discharge she is all the time seeking the repetition of the abuse. But the repetition implies repetition of the same pain and humiliation, which she detests. [In fact as the victimized girl gets older she often gives up all sexual activities with men, despite constant sexual tension]. To escape this dilemma she often turns to homosexuality along with wishing for a penis of her own that she could use at will without subjection to humiliation in hands of men. There is also, of course, another powerful motive added to all the above complexes - the revenge fantasy of castrating the man and it is done in displacement.
The whole process of castrating a man is now transferred to symbolic stealing - kleptomania. The fine objects in the store are symbols of the male genitals that are coveted and stolen.
But is kleptomania always a result of childhood abuse?
Of course not. But let us examine a few cases where there was no sexual abuse and see what they have to teach us.
An extremely pretty Caucasian girl of 26, who had married an African-American man way below her socially and academically, suffered from kleptomania. She had all the symptoms generally associated with childhood sexual abuse like fibromyalgia, migraine headaches, hysterical vomiting, colitis and victimization in hands of men. Yet, she had no history of sexual abuse as a child.
But careful history revealed that while she had no personal history of sexual abuse, her motheras a child was abused by her step-grandfather, her sister had been raped, and she strongly identified with both of them. Her mother had all the stigmata of childhood sexual abuse and she had identified herself with her mother. She herself had great passivity of character and vulnerability in her demeanor and been many times had had near-rape intimidation by men, and one time had been subjected to a prolonged stalking by an Arab-American ex-boyfriend. Her nightmares were full of extreme anxiety. They were based upon a TV show she regularly watched which showed in graphic details the sexual victimization of young children by sexual predators and serial killers. In her nightmares she would identify with these children and see herself subjected to similar sexual abuse.
Another lady, a doctor, turned to kleptomania after she found her husband was cheating on her. This was the reason she gave for acting kleptomaniac. But analysis showed that the act had greater connection with the death of her father which had occured when she was around 12, leaving her feeling cheated and an attitude of revenge towards society, and when marriage did not compensate her enough for the unfair loss of her father she turned to kleptomania.
Another woman an Arab-American was severely bullied by her classmates for her darker complexion, being overweight and her Arab features, and she always harbored revenge fantasies against the world, and compensated herself through kleptomania. There was an additional factor. She was the only child and spoilt rotten by her father to whom she was very tenderly attached and when he died she compensated for his disappearance from her life through stealing.
A master kleptomaniac, who boasted of having amassed a fortune through stealing costly vintage wine bottles and who was expert in forging checks and embezzling, and who had come to me not for cure from his illness but just because he was court ordered, gave the history of having been subjected to a brutal beating as a child by his father for a single incident of stealing, and in the teenage years had turned into a thief to get even with his father with whom, to begin with, he had intense feelings of rivalry from the Oedipal period.

Forgetting as an expression of Death Wish

In Psychopathology of Everyday life Freud discusses how ordinary forgetting, mislaying of objects, slips of tongue, errors in execution of goal directed motor movements, for example making a wrong turn while driving or accidentally pressing upon the accelerator instead of the brakes, they all indicate hidden [repressed] motives. They cannot be dismissed as purely chance errors. They indicate the existence of some repressed complex which, when opportunity had presented itself, had seized upon the consciously directed behavior - to which it was connected in some way - and had interfered with it. The links between the repressed complex and the goal-directed conscious behavior occur in the unconscious and through Primary Process logic. In conscious mind we just perceive the silly error and cannot account as to why it happened or more likely give false explanations like it happened due to fatigue or distraction.
Freud's book goes into details of how forgetting of a name often indicates some negative association with that name, and in order to not allow the unpleasant affect attached to the negative memory to emerge in the consciousness, the person, along with the affect, blocks out [forgets] the name as well.
I once had devil of a time trying to recall the name of a teacher of mine from my medical school, of whom I had pleasant memories. So why would I block the name of a person whose memory did not provoke any unpleasant affect? For he was a nice man and kind to me, and his physiognomy and complexion, and the way he carried himself, reminded me of of an uncle of mine. He was a teacher in the department of Pathology. It made no sense. You do not block the name of a person of whom you are fond of. Unless of course something else is attached to the memory of that name which is unpleasant or which you rather not deal with. The analysis of the forgetting of his name affirmed this general rule.
Let us see why I forgot his name.
One morning, during a time when I was under lot of stress trying to get a Residency Training Program going that I had nurtured from scratch, and also was having devil of a time with insomnia due to my inability to get my personal and professional life in a trajectory which would be commensurate with what I believed I deserved, I woke up and found myself thinking of this teacher. His face popped up in my mind's eye as clear as day, but for the world I could not recall his name. I racked my brain for weeks. And weeks turned to months. Then my mind must have put the issue on a backburner for I ceased trying to think of dozens of other names in order to arrive at the right one. Though every now and then I would get preoccupied with the puzzle and would wonder as to why the name had become a closed book to me. Only when I went back to the medical college for a Class Reunion, where his name was mentioned by someone did I recall it perfectly and could not be more amazed as to why such an easy and familiar name had disappeared from my consciousness. The name was Anand Daate.
And I at once knew too as to why I had forgotten his name. He had always reminded me of one of my uncles, whose name too was Anand. And I had blocked out the name common to both, because they had many other features in common besides the name.
But why was I trying to block the memory of my uncle?
It was only one particular aspect of my uncle that I was trying to banish from my memory. My uncle was a child prodigy, who had won numerous prizes in school and colleges and every one was expecting him to be a trailblazer on reaching maturity. Yet once his education was over, he could find no other job in his speciality of Chemistry, but the job of a school teacher. In a few years of trying to exhort his students to do extraordinary things, which landed one of them to try to swim across a lake and drowning in the attempt, his job became a dead end for his extraordinary abilities. He became increasingly mentally disturbed over this cruel turn of fate, withdrew from the world, resigned as a teacher and turned into a monk. So his life trajectory had not turned out to be commensurate with what he deserved. Now that was exactly what I was dreading was happening to my career and life trajectory. As a Veterans Hospital psychiatrist I was doing not much in way of treating patients other than medicating them. Yes, I was doing a large scale study on lithium's usefulness in schizophrenia, and had over half a million dollar grant for it, but I knew at heart that the study was worthless. The residency program was somewhat satisfying, but I did not think I was cut out for that kind of bureaucratic career.
So what I was trying to block out from fully realizing and submitting to the fact that I was becoming more and more like my loser uncle. And along with blocking out the realization of this commonness between my uncle and myself, I was also blocking out his name.
But that does not explain as to why suddenly waking up one morning, completely out of the blue, I would recall the face but not the name of the teacher who had been nice to me. If anything I should have neither recalled his face nor his name. That would be more in keeping with how our mind works - block out all associations that would provoke the unwanted emotions.
Now the reason why his face emerged without any rhyme or reason was to counterbalance the dreaded possibility that I was turning into my uncle. The pathology professor looked, carried himself, and even had the name common with my uncle, but he did not look unhappy with his life as a teacher unlike my uncle. So it was his [hopeful] face that my mind had conjured up as a counterbalance to the depressing memory of my uncle. And so the mind did two activities that were diametrically opposite to each other. It blocked out the memory of the fate of my uncle and its residue the [common] name from my consciousness, while it brought out the memory of my pathology teacher [with the same name] with extra emphasis.
And why did I not recall his last name Daate?
One was because if I had recalled his last name I would have recalled the first name as well. They always called him with both his name. But there was another unpleasant memory associated with the last name. There was a military officer Captain Datta, who I had befriended in a military regiment in Kashmir, when I was 16. I had gone in summer vacation to another uncle of mine - brother of the uncle who turned into a monk - who was a medical officer there, and Captain Datta was stationed at the same regiment. He boasted himself as the youngest captain in whole of India. And he was just 21 years old. I identified with him, and had looked up to him, till in a social get together he had tried appearing funny at my expense, which left a bitter taste of him in my memory. Since he was also in the category of Uncles in my mind, I had put him and Anand Daate together and by using the phonetic similarity had used the unpleasantness associated with the captain in blocking out the last name of the pathology professor.
And now to the title of the essay which is that we forget and distort names as an attempt to show our distaste for the other person or something distasteful connected with the other person, and which often implies wishing them to disappear/die . I don't recall Freud specifically going into any discussion into how forgetting of name has very often at its root a wish for the person to be dead, at least for immediate expediency and not as a permanent solution, and hence the justification for writing this.
We often forget the name of a person who we wish was not there at that particular moment. This wishing for the other person not to be there is in some sense equivalent [in the unconscious] to that person being dead .
In obsessional neurotics who are constantly plagued with death wishes, this impulse to have the other person dead takes an interesting twist. Instead of not remembering the other person's name and other facts about him, the obsessive hyper-remembers not just the name but trivial facts about the other person. It is as if he is overcompensating for his thought/desire for death by making sure that he remembers every single thing and holds the person in such high regard that he takes pain not to wipe out [cause death] even insignificant facts about him.
In one obsessive lady this wish for death of others emerged in wanting to forget their birthdays. By not remembering the birthday of the other person she was declaring in a very roundabout fashion that you are as good as not ever being born as far as I am concerned. This wish for death of hated people had primarily arisen from death wishes towards her younger brother - 2 years her junior and her hated rival in childhood in getting their father's attention - but had now generalized to great number of people. He favorite abuse towards others was saying in contempt,"I don't know from where people like you get born."
Curiously she had a phenomenal memory for remembering the birthdays of all her relatives, and not just siblings and immediate family members, but up to most of her second cousins. She did not fail to call and wish them happy birthday. It was a Reaction Formation to her wish - which was quite strong when she was a child - for them to disappear and for her to be all alone with her father. Now she remembered everyone's birthday religiously as if to tell them that far from harboring any wish for them to have never been born, she values their birth so much that she can never forget such a precious day.