Reference: Walker, S.C. (2006). Trauma in South Africa. Psychoanal. Q., 75:657-684

Many of the papers in Psycho-Analytic Psychotherapy in South Africa, the primary journal in South Africa that publishes articles on psychoanalysis, consciously explore the complex relationships between societal events in the external world and the development of the individual psyche. Apartheid, and South Africa’s need to metabolize its effects, clearly shapes the context and much of the content of a number of the articles published in this journal over the last five years. As an African American recently graduated from an American psychoanalytic institute, I am particularly appreciative of attempts to illuminate the ways in which societal trauma shapes individual development across generations. In my experience, such formative dynamics are not often a focus of psychoanalytic education in the U.S., despite the historical realities of slavery, Jim Crow, and the immigration of many people displaced to America by war and social atrocities in many parts of the world. Therefore, I have chosen to abstract papers that elaborate on these themes that emerge in my clinical work with patients.1
Volume IX, Number 1 2001
Memories, Healing, Reconciliation, and Forgiveness. Leonia Kurgan, pp. 1-10.
This paper is written from the personal perspective of the author, who describes herself as “a child Holocaust survivor, a refugee,
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1 Editor’s Note: Readers may wish to refer to The Psychoanalytic Quarterly’s January 2006 Special Issue on “Race, Culture, and Ethnicity in the Consulting Room.”

and a forced emigrant compelled to leave Poland because I was Jewish and would have been murdered if I had stayed.” As an undergraduate, she studied at the University of Cape Town. She now practices psychoanalysis in California. Her paper explores societal attempts to achieve reconciliation between groups that have been subjected to socially sanctioned violation and perpetrators of such acts of violation. To develop her ideas, she draws from South Africa’s Truth and Reconciliation Commission, American slavery, and a 1999 Vienna conference promoting dialogue between children of Holocaust survivors and children of Nazis.
Kurgan sees social and individual healing as contingent upon the memory and integration of unbearable truth. Both society and the analytic situation have potential to function as an emotional container in which memory and integration can occur. South Africa’s Truth Commission heard testimony from 20,000 black victims of apartheid atrocities and 8,000 white perpetrators who sought amnesty for committing politically motivated atrocities between 1960 and 1994. Previously untold stories were voiced; unbearable memories were retrieved. Although apology and forgiveness were not achieved in every case, the Commission laid claim to keeping South Africa’s apartheid history in memory and to a beginning of collective responsibility for what occurred.
American slavery, now generations old as a legally sanctioned fact, did not have the benefit of a national, socially sanctioned Truth Commission. Kurgan draws on the story of an individual African American journalist, seeking to contain the shame inherent in her ancestry as a descendant of both black slave and white master, to illustrate the enduring, intrapsychic impacts of America’s “peculiar institution.”
The Vienna Conference, entitled “The Presence of the Absence,” provided the basis for Kurgan’s observations about the developmental impact of those atrocities that could not be spoken of on children of both Nazis and Jews. A study of twenty-eight Jewish Israeli and non-Jewish German families was presented at the conference. Children born to Nazi perpetrators before World War II had to struggle with the paranoid feelings engendered by the inconsistency between their own memories of crimes they witnessed and their parents’ denial that such events occurred. Children born after the war became depressed by their parents’ defensive assertions that they would have committed the same acts had they been alive during wartime.
Children of Jewish victims and survivors struggled to make sense of fragments of stories about the past, and of the silence about events fraught with shame and humiliation that had censored the telling of the whole historical truth. Kurgan illustrates this idea with a vignette from her own history in which her mother spoke of her wartime experiences only in brief, flat, stereotypic sentences, unable fully to recall the experience of starvation. Thus, she withheld food from her children, who were anxious and uninterested in eating during flight from Poland to Romania, repeating what she was unable to remember. The study, described by Gabriele Rosen-thai in The Holocaust in Three Generations (1998), postulates that the desire to face the truth about the past grows stronger over succeeding generations.
A Clinical Explication of Andre Green’s Conceptualisation of “Absence” in Borderline Psychic Structure. Jacqueline Watts, pp. 33-45.
Jacqueline Watts, a clinical psychologist at the University of Witwatersrand, presents the case of a 30-year-old university student as illustrative of both Green’s concept of absence as characteristic of borderline states and of its implications for therapeutic intervention. In preface, she locates Green’s ideas in relation to other psychoanalytic ideas about the reality of the self.
Watts proposes that, for Freud, the reality principle dictated that an object either is or is not present, and a sense of “me” or “not me” is clear. Winnicott later introduced the concept of transitional experience in which an object can simultaneously be present and not be present. Winnicott located the origins of this transitional experience in the “good enough” psychological/physical holding of the infant by the mother. When the maternal hold is not “good enough,” a “false self,” adapting its desire to perceptions of the other, can develop.
Watts explains Green’s proposal that, in borderline states, the self is neither present nor absent. He calls this self-experience the negative refusal choice. Here, one is not present as an autonomous person able to share the presence, but separateness, of another; rather, one experiences a sense of presence when merged with another. Yet, this merger is also felt as an absence of self. The other becomes a threat to self-existence. Whereas for Winnicott, the false self preserves the self, for Green, the merged false self kills the true self. Reality is experienced as a tension between an absence of self and the death of self as merged with an object. For Green, and for Watts as illustrated in the case she presents, this tension is present in the struggles with closeness and withdrawal experienced in the treatment of borderline patients.
Watts’s paper, like several others published in Psycho-Analytic Psychotherapy in South Africa, does not attempt to understand the psychic experience of groups that are socially excluded. However, I found myself wondering if Green’s concept might help to illuminate—without implication for diagnostic categorization—the internal struggle against a sense of invisibility that some from socially marginalized groups may experience. I have in mind, as a potential example, the sense of invisibility of the black man in a historically white-dominated society that yet seems to appropriate black creativity as emblematic of its own vitality.
Volume IX, Number 2 2001
This issue and the first issue of 2002 include papers presented at a conference entitled “Widening Horizons,” which addressed aspects of psychoanalytic work in South Africa. The conference took place in Johannesburg in 2001, and followed a conference on “Change: Psychoanalytic Perspectives” that took place in 1999 in Cape Town, under sponsorship of the International Psychoanalytical Association.
Abuse and Handicap: South Africa’s Dangerous Legacy. Valerie Sinason, pp. 1-12.
Sinason, a London psychoanalyst and honorary consultant to the Cape Town Child Guidance Clinic, presented the conference plenary paper. She began by remarking on an observation made by Lilian Cingo that two-thirds of South Africans are mentally handicapped. Cingo is the director of South Africa’s Phelophepa Health Train, which delivers health and mental health services from railroad cars traveling through the country. According to Sinason, Cingo was referring to the impact of trauma, political violence, and civic unrest, leading to high rates of illiteracy and shame. These in turn may shade into organic handicap. Violence, danger, unspeakable experience, and the emotional pain that comes from being “different” can increase the likelihood of mental and emotional handicap. Subsequently, the disability itself also becomes a family and personal trauma. People with handicaps may live with the unexpressed sense that others wish them dead. Intolerable experience can render a person stupefied.
Sinason cites the observation of South Africa’s Goldstone Commission that in some of South Africa’s townships, the majority of children have been witness to rape or murder, and many have themselves been abused. Therapists working with clients thus psychically injured can find the work stressful. She finds helpful the conceptualizations of Bettelheim regarding the destructive impacts of simultaneous internal and external trauma on children. Additionally, Klein’s theories of projective identification and Bion’s ideas about attacks on linking have proved helpful in understanding otherwise overwhelming client experiences. When therapists cannot bear empathic engagement with the actual external experience of the client, they risk invalidation of the client’s experience and may trivialize the dissociative strategies that these individuals need to protect the psyche.
Sinason provides case material illustrating the interaction of intellectual disability, trauma, and abandonment in her work with a 40-year-old man and in a few other vignettes that illustrate for her the ways in which her visits to South Africa have helped enhance her ability to understand clients who might be thought resistant or untreatable. She has found that clients attempt psychic repair of trauma through reenactments in the therapeutic situation, in which gender, race, authority, and power have meaning.
On the Transgenerational Transmission of Trauma and Violence. Suzanne Maiello, pp. 13-31.
Suzanne Maiello, a psychoanalyst from Rome who has been an annual visitor to South African, begins her paper with the statement that all South Africans, regardless of race, and whether patient or therapist, have been affected by apartheid. Psychoanalysts and providers of mental health care in South Africa have to confront issues raised by present and past violence and trauma under apartheid. Such violence cannot be metabolized and rendered meaningful unless the therapist recognizes that they arise outside the intrapsychic field. Such recognition and acknowledgment of its adverse effect on the mind of the individual is the first step toward a deeper understanding of the impact of state-sanctioned violence. State violence cuts into and distorts the intrapsychic field that is the traditional concern of transference. When state violence is directed against a particular race, the victim has no escape. Therapist and patient share the same cultural context of violence.
In South African apartheid, paranoid-schizoid defenses of splitting along racial lines were apparent. Whites were able to preserve a sense of a “good object” group by projecting destructive fantasies into “bad object” groups of blacks and coloureds. Denial resulted in a long-standing fantasy of living in a “perfectly normal system,” in which a vicious circle of fantasized and enacted persecution contributed to anxiety on the part of the perpetrators who defended against it by denigration of their victims. “How is it possible that everything felt so right at the time?” is a poignant question raised by one representative of the apartheid establishment during testimony before the Truth and Reconciliation Commission.
Maiello explains that experiences of relationships are internalized from birth. Freud identified the internalization of sadomasochistic fantasies in his paper, “A Child is Being Beaten.” Maiello cites Schwartz and Sinason in observing that in state-supported violence, legalized persecution leads to “internalized colonialism” in both perpetrator and victim. Such internalizations reverberate within these groups. As an example, Maiello cites South African clinician Maseko’s observation that the segregation of apartheid is reflected in conflicts between the AmaZulu and AmaXhosa ethnic groups and in the high rates of child abuse within these communities.
Maiello also references the situation in Germany after the fall of the Berlin wall in 1989: “Pulling down the external wall did not have an immediate effect on the internal world of individuals, whose mental functioning in relation to the former enemy is still widely based on splitting and projection at the collective level.” In a case vignette, she further illustrates the concept of internalization of trans-subjective dimensions of reality.
Freud described how traumatic experience can penetrate a child’s sense of safety, inhibit the development of basic trust, and leave the individual ego helpless, both during the traumatic event and thereafter. Further, overwhelming horror is expelled from thought, and emotion that links history and meaning is numbed. Maeillo cites the work of Israeli psychoanalyst Yblanda Gampel and American Robert Pynoos to elaborate on how traumatic experience can fragment a sense of personal narrative and restrict psychological flexibility. Unconsciously, repetition of trauma is expected and can induce its reproduction, sometimes with roles of perpetrator and victim reversed.
Referring to Fraiberg’s idea of “ghosts in the nursery,” in which split-off and denied trauma from the parent’s past is projected into the child, Maiello describes a mechanism of transgenerational transmission of trauma. She illustrates this idea with further clinical material from her work with a white woman whose mother had immigrated to South Africa from Eastern Europe in order to escape the Nazi pogroms. Her patient was the recipient of complex internalized perpetrator/victim relationships in a persecuted Jewish family that had become a respected part of the white apartheid establishment.
Additionally, Maiello notes that children develop unconscious identifications with their parents early on. If the parental generation is silent about its traumatic experience to protect itself and future generations from the pain of recalled atrocity, the trauma becomes unreal and cannot be transformed. Aspects of the trauma may, however, be enacted in ways of being or in symptoms. Gampel describes such transmissions as “radioactive identification.”
Maeillo continues this paper with additional clinical material from the long analysis of a second-generation, Italian immigrant Jewish girl.
Volume X, Number 1 2002
Seven Intrapsychic Dimensions of Violence. Duncan Cartwright, pp. 25-58.
Violence, when addressed at all in my psychoanalytic education, was more vividly encountered in my clinical work with “widening scope” patients with sadomasochistic psychological organization. Rarely was violence, per se, a topic of didactic consideration. Thus, I found Cartwright’s exploration of theoretical considerations of actual acts of violence from a psychoanalytic perspective of particular interest.
Only recently have intrapsychic factors associated with violent behavior been systematically addressed in psychoanalytic literature. Psychoanalytic authors have begun to explore definitions of and distinctions among different forms of violence, such as self-preservative, sadomasochistic, affective, or those that fuel predatory acts. Cartwright observes that a fuller understanding of the nature of violence must also include other factors, such as the experience of trauma, external factors, defensive organization, and the capacity for mental representation. Violent acts, for Cartwright, depend on the coincidence of these factors in a particular way at a given time. This article reviews the psychoanalytic literature on actual physical violence, defined as “the physical show, or actualization, of aggression, leading to the destruction or damage of an external object.”
Cartwright identifies the following seven intrapsychic dimensions of violence: (1) the nature and quality of the object world, (2) representational capacity and the body, (3) brutalization of the self: trauma and loss, (4) sexuality, (5) the role of phantasy/fantasy, (6) defensive organization, and (7) interaction with the external situation.
Briefly, in considering the object world of perpetrators of violence, Cartwright cites authors such as Meloy and Hering, who suggest that primitive object relations may be a factor even in objectless acts of violence, such as rage reactions. Citing Biven and Bollas, he notes that perversions of object relations are apparent in sadistic violence in which the object is dehumanized and/ or the suffering of the victim is experienced as enlivening the perpetrator. Biven also points out that trauma may disrupt the development of a sense of mastery of the object world, leading to a diversion away from human contact and to aggressiveness toward de-animated objects as a form of stimulation.
For some perpetrators, violence may represent an attempt to overcome a pathological, symbiotic attachment with a primal object, such as a mother. Cartwright sites the work of a number of writers (e.g., Perelberg, Meloy, Fonagy and Glasser) to illuminate the impact of narcissistic, overprotective yet overgratifying mothering on the development of the child’s self and object representations. In these situations, the child must choose between withdrawal from or aggression toward an obliterating maternal object. These dynamics are reflected in Shengold’s idea of soul murder. Attachment theorists since Bowlby have also addressed the importance of disorders of extreme attachment and difficulty in psychological separation from the mother as important to the understanding of defensive violence.
The role of the father in creating the internal capacity for symbolization and superego development is also elaborated. The paternal object can break a pathological symbiosis between child and mother. Perelberg and others have observed the absence of a coherent introjection of the father in persons who have committed violent acts. Fonagy and Target have argued that aggression and envy of the father, who is a witness to the mother’s pathological attachment to the child, may also be a precipitant of violence. In addition to these preoedipal considerations, violence may stem from oedipal motivations such as rivalry, revenge, or jealousy. The superego, derived from internalization of parental values, may be variable in violent individuals—absent in psychopaths or overly restrictive in perpetrators of explosive acts of violence.
Cartwright notes that several psychoanalytic writers have related the capacity for violence to an inability to mentalize. When there is no coherent internal representation of the object world, there is confusion between the mental and the physical. Freud recognized the relationship between touch and the internal experience linking object and drives. Subsequently, other psychoanalytic theorists, including Bion and Fonagy, have elaborated on the interaction between physical interaction with people in the object world and the ability to reflect on one’s own internal state and that of another. In the absence of this reflective capacity, physical action may replace mentation, making inhibition of aggressive acts very difficult. Additionally, when parents lack this reflective capacity, the child may be destructively aggressive.
In violent individuals, the incapacity to mentalize may not pervade the entire personality. Rather, parts of the personality may remain unsymbolized, or the capacity for mentalization may be overwhelmed in a particular circumstance. In premeditated violence, however, the capacity for symbolization and mentalization may become obsessive, with the mentalization itself providing primitive, meaningless, excitement.
Acute or cumulative trauma and loss may contribute to a tendency toward violence. The victim may act in identification with the aggressor. The identification may be defensive or may become an enduring, characteristic affirmation of identity.
For Kernberg, Cartwright explains, an early traumatic experience with a bad maternal object can lead to violence aimed at destroying the bad object and restoring a good mother. However, the perpetrator may become trapped in identifications with both the damaged self and the persecutory mother.
Shengold, says Cartwright, observes that some violent people have experienced not trauma but overindulgence and overstimulation, however. This overstimulation creates an appetite for intense (but meaningless) affective states that can be transformed into narcissistic rage.
Cartwright draws on the thinking of writers such as Joseph in distinguishing between mature sexuality and sexualization as a determinant of violence. Sexualization—the erotization of parts of the mind or body—can be a defense against thinking and against painful experience. For the sadist, painful experience is sexualized. Some perpetrators of violence may, however, engage in violent acts in order to ward off sexual excitement that they experience as dangerous. Social and cultural, as well as internal, values around masculinity may support violence in defense of phallic power.
In discussing the role of phantasy/fantasy in violent behavior, Cartwright cites theorists who assert that violence is associated with conscious or unconscious narratives. Hyatt-Williams makes a distinction between unconscious phantasy and conscious fantasy. Cartwright sees conscious, perverse fantasy at work in sadistic violence; but the conscious fantasy may subsume a destructive unconscious phantasy.
Writers following soon after Freud emphasized unconscious oedipal phantasies, e.g., of castration or mutilation directed at parents, or phantasies of sexual inadequacy in connection with acts of violence. More recently, writers have extended these ideas by including phantasies relating to preserving the self from the engulfing or attacking preoedipal mother. Per Cartwright, Glasser emphasizes a core complex of phantasies involving longing for fusion with the object, while simultaneously fearing the resulting annihilation of self. Violence may occur when psychological defenses collapse and the ego is left with unmanageable affect. Menninger et al. developed this idea as episodic dyscontrol. However, defenses may themselves lead to violent behavior. While repression may keep forbidden impulses under control, action defenses of splitting and projective identification may employ violence in an attempt to ward off attacking objects or to rid the psyche of painful affect. Klein’s concept of systems of defense and object relations as working together to ward off intolerable affect is helpful in understanding the interplay of these factors.
Borderline and narcissistic psychic organization are often found in perpetrators of violence. The presence of paranoid or psychotic splitting and some impairment in reality testing can render the personality subject to violent overreaction to benign stimuli. Finally, the internal world of the perpetrator cannot be considered in isolation from the external world. This reality is often ignored in psychoanalytic discourse. Howells and Hollin have noted that most violent acts have external precipitants. The external world may cause an alteration in the individual’s internal world, or the individual may manipulate elements in the external world to serve an internal purpose. In some pathological states, the perpetrator may experience the external world as representing elements of the internal phantasy. Understanding the external precipitants of violence can help to identify the relationship between the victim and the perpetrator in the perpetrator’s mind. The role of the victim in precipitating an attack also needs to be considered; psychic boundaries between the perpetrator and the victim can become confused.
These seven dimensions of violence as articulated by Cart-wright have significant clinical and forensic implications for the treatment of violent individuals.
When Objects Attack in Reality: Psychodynamic Contributions to Formulations of the Impact and Treatment of Traumatic Stress Incidences: Part I. Gillian Eagle and Jackie Watts, pp. 1-24.
Eagle and Watts are clinical psychologists in private practice and are affiliated with the University of Witwatersrand. Eagle also has extensive experience in many nongovernmental organizations.
As an African American of middle age working with patients who have experienced American racism, as a psychoanalyst working with patients deeply affected by violence, and as a psychiatrist working in community settings with patients whose addictions oftentimes represent an attempt to dissociate from the emotional impacts of violence and loss, I read these papers with particular interest.
This paper and its second part, published in the subsequent issue of Psycho-Analytic Psychotherapy in South Africa (see the following entry in these abstracts), explore the contributions of psycho-dynamic perspectives to the treatment of cases of acute and chronic traumatic stress as they present in a South African context. The authors also seek to integrate classical Freudian concepts (drive theory, preoccupation with survival, the structural model of the personality, and the role of the ego in coping with anxiety) with concepts drawn from object relations theory (developmental history, the internal world, and the processes of introjection and projection in engaging the external world) in understanding the effects of both acute and chronic trauma. They do this in the context of a contemporary society in which exposure to actual violence is widespread.
The first paper puts exposure to violence in the South African context and addresses ways that psychodynamic formulations can inform therapeutic interventions. The authors reference 1996 data highlighting the seriousness of South Africa’s crime problem: “an average of 52 murders a day, a rape committed on average every 30 minutes, a car stolen every 9 minutes and an armed robbery committed every 11 minutes.” Black South Africans make up a significant portion of persons needing therapeutic help after experiencing direct violence. The authors review some of the literature on the pathogenic role of trauma, beginning with Freud’s emphasis on the nature and intensity of the stimulus, strength of the ego, the role of prior and subsequent life experiences, and efficacy of the stimulus barrier. They point to debates regarding the relative importance of the nature of the stressor, as opposed to the characteristics of the recipient of violence. The authors take the position that, in treating persons who have experienced trauma, clinicians need to be open both to considerations of the nature of the trauma, and to the ways in which individuals construct its meaning. Theoretical overemphasis on the victim’s unconscious motives with respect to the experience of violence may overpathologize the victim. Yet, it is also naive to dismiss the impact of unconscious factors in understanding the responses of victims to the violence perpetrated upon them.
Human-inflicted trauma, particularly trauma that employs gratuitous and degrading violence, is more likely than trauma from natural disasters to cause post-traumatic stress disorders, according to the American Psychiatric Association’s DSM-IV and other sources cited in this article. In Africa, however, natural disasters maybe seen in androcentric terms, such as the withdrawal of protection of ancestral spirits, understandable from an object relational perspective.
In South Africa, most therapeutic interventions with traumatized persons are brief and are provided in the context of nongovernmental organizations. The authors believe that psychodynamic formulations are important enrichments to these trauma-related services. They offer examples from both Freudian and object relational perspectives.
Freud addressed the disturbances seen in people suffering actual violent attacks in Beyond the Pleasure Principle (1920). He recognized that in some people, the experience of unexpected, overwhelming violence seemed to derail the ego’s capacity for maintaining homeostasis in the face of aversive stimuli. Garland, in Understanding Trauma: A Psychoanalytic Approach (1999), notes that victims of violence may lose the ability to distinguish between a potential threat and an actual threat. Signal anxiety becomes automatic anxiety such that, for example, the body odor of a colleague can trigger a panic attack in the survivor of a rape during which the odor of the attacker was overpowering.
The authors draw on the work of Horowitz and Rangel, among others, in elaborating extensions of ego psychological thinking about the impacts of trauma on the minds of the victim. They describe the traumatic state as one characterized by helplessness that can be brief, transitory, or complete and long lasting. In the traumatic state, victims may vacillate between feelings of traumatic intrusion and psychic numbing. Therapy can assist in what Horowitz terms optimal dosing of intrusive recall and defensive numbing, aimed at helping the traumatized person manage anxiety.
The ego may at times have trouble distinguishing between past and present. Where Freud saw the psychic repetition and reliving of trauma as an attempt at passive to active defense, Garland extends the idea of the repetition compulsion as “an unconscious attempt to get the original event into conscious life.” Lifton recon-ceptualizes the idea of repetition compulsion as a kind of attempt at retrospective mastery of the traumatic situation through enactment.
The authors see in Freud’s “Mourning and Melancholia” (1917) and the Ego and the Id (1923) an awareness of the internalization of object relations that paves the way for later considerations of the role of object relatedness in trauma. For the trauma victim, the external world may be experienced as filled with attacking objects, objects that fail to protect, and objects that abandon. Eagle and Watts believe that all psychoanalytic theories hold the internalization of stable and dependable object relations as important. Also important is the preservation of the representation of the good object.
Winnicott developed the idea of the transitional space in which a child can develop internal and external representations of object stability. Eagle and Watts see Nazi and apartheid ideologies as symbolic frameworks that attack psychic integrity and threaten the internalized good object representations. Elaborating on Bion’s ideas about symbolization (alpha function) and experience (beta function), the authors hypothesize that corrupt symbolic frameworks can interfere with the transformation of bizarre experience (trauma) into symbolization (thought). Traumatic experience is thus concretely expulsed through dissociation, flashbacks, acting out, or aggression.
The authors summarize their principles for the treatment of trauma in reality in nine points as follows:
• Optimal dosing of traumatic stimuli
• Restoration and reinforcement of healthy ego boundaries
• Recognition of repetitions-elated symptoms as attempts at retrospective mastery
• Sensitivity to failed enactments
• Awareness of cognitive constriction
• Restoration of the capacity to think
• Restoration of the good object
• Psychological accompanying of survivors through traumatic accounts of their experience
• Provision of an actively experienced containing relationship
Both Winnicott and Bion addressed the idea of containment (providing a sense of safety and psychological space) as important to the development of the capacity for thought, symbolization, and the ability to bear intolerable affect. The capacity of the therapist to provide containment in the form of a safe setting open to the account of traumatic experience, of reflection on that experience and of verbal naming of the experience, facilitates the trauma victim’s ability to metabolize the trauma and restore his capacity for good object representation. The therapist may need to be more active than is customary in classical psychoanalytic settings and may need to tolerate what self psychologists have called an idealizing transference.
The authors conclude the paper by discussing the reality of multiple traumatization and of secondary victimization by the criminal justice system. Therapists working in South Africa encounter—as do therapists working with certain populations in America—victims of multiple traumas. Therapy in such cases may be complex, longer term, and require exploration of each incident.
Victims of violence, the authors hypothesize, can be additionally traumatized by failures of the criminal justice system to act as a safe, reliable container. In sensitivity, inaction, failure to collect evidence, and valuing a law officer’s safety over the victim’s can all function as breaches in the social framework that supports good object representations. Angry transferences to the criminal justice system—and to treatment centers and therapists— can ensue. These transferences may exert strong pressures on therapists to take action by intervening in the victim’s behalf outside the treatment setting.
Volume X, Number 2 2002
When Objects Attack in Reality: Psychodynamic Contributions to Formulations of the Impact and Treatment of Traumatic Stress Incidences: Part n. Gillian Eagle and Jackie Watts, pp. 1-10.
This paper both extends and repeats material presented in the first of this two-part article (see preceding entry in these abstracts). Eagle and Watts begin the second in this pair of papers by observing that contemporary mass communications bring violence vicariously into our lives every day. This awareness of violence shapes the social matrix in which we develop psychologically. They consider trauma broadly: as a consequence of discrete acts of violence, prolonged or repetitive acts of violence, or of entrenched, institutionalized violence and discrimination against a target group. All forms of violence, they assert, impinge on the internal object relations of both perpetrator and victim. Through acts of violence, the psyches of attacker and victim interact to form new self and other representations.
A violent attack is both an external and an intrapsychic event. Projections, projective identifications, and forced introjections of violence occur between and among the participants and contribute to a new area of experience involving threats of destruction or loss of good object representations.
The authors describe Kirshner’s ideas about the interaction of social violence and intrapsychic functioning. Violation of symbolic social laws can lead to confusion about symbolic categories. For example, incest may result in confusion about distinctions between parent and child. The negation of the status of an individual can lead to depersonalization. Massive trauma or catastrophic loss can be destructive to an individual’s capacity to assimilate and articulate the experience. Attacks against community leaders can disrupt the sense of community stability. For Kirshner, the authors note, the psychic disruptions caused by violence lead to new object representations and meanings: “Aggression is love, I am an object, life is without meaning, racism is good.”
Violence can also lead to a regression in defensive function to more archaic modes, such as splitting, projective identification, or fusion, thus weakening the capacity of the ego. It can also activate manic defenses as a means of protecting good object representations. In the clinical situation, what Grinberg has called counter projective identification can occur. Here psychological boundaries between the clinician and the patient become blurred, and awareness of distinctions between the reactions of the one and of the other are lost. This resembles the “psychic spillage” that may occur between perpetrator and victim in the moment of attack, as the psychic content of the experience becomes too violent or too destructive to contain. For the attacker, a violent act releases dread and urgency that is worked out in the exchange with the victim. The victim experiences the attacker’s feelings of helplessness and anxiety. The attacker is thus unburdened, and the victim becomes the psychic container for the attacker’s projections. Eagle and Watts assert that this exchange forces both to adopt new pathological object representations.
Citing Bollas, the authors discuss the concept of object stealing, suggesting that the attacker’s envy of the good parts of the victim motivates the violent extraction of the victim’s self representation, which leaves the victim empty of thought. Eagle and Watts suggest that the validity of this concept needs more testing. A clinical vignette illustrative of this concept concludes the paper.
Volume XII, Number 2 2004
Critiques of Projective Identification: A Critical Evaluation. Gavin Ivey, pp. 1-20.
Gavin Ivey, a member of the psychology faculty at the University of Witwatersrand, has written this paper to address both the importance of Klein’s concept of projective identification and objections to it. He also proposes a more precise definition of the concept and considers several alternative explanations for the clinical phenomena that the concept addresses.
Ivey explains that Klein considered projective identification to be both a primitive defense mechanism and a form of aggressive object relating. The idea has gained popularity because it does not involve a metatheory based on instinct, and it has lent itself to reformulation as a theory of unconscious communication. The concept has changed the way psychoanalysts think about the unconscious.
Grotstein has suggested that projective identification “demonstrates the existence of the unconscious as an ‘alter ego’ in a way that Freud had inadequately or incompletely envisioned.” Further, according to Steiner, the self is no longer seen as a unitary structure, but rather is achieved “through the regaining and integration of lost and dispersed elements.” Thus, the idea of projective identification shifts the aim of psychoanalytic treatment from making the unconscious conscious to helping the patient regain and integrate split-off or projected parts of the self. It also suggests that the unconscious is recognized not just in what people think about each other, but also in what they do to one another.
Critics of the concept of projective identification, such as Knapp, Ogden, and Meissner, have suggested that it is too vague and introduces more confusion than clarity into psychoanalytic theory. Others, such as Harris, have described it as “metaphysical magic” with “thought projectiles flying through interpersonal space, psychic structures jumping between minds and bodies.” Grotstein, says Ivey, counters this objection by noting that it confuses “a mental process in psychic reality with a mechanical process in physical reality.” Sandier further clarified that the “parts of the self put into the object are put into the phantasy object, the ‘internal’ object, not the external object.” Bion observed that projective identification is experienced in the psychoanalytic situation when the analyst “feels he is being manipulated into playing a part in the patient’s phantasy.” This results in the analyst’s experiencing feeling states that don’t seem to belong to him, a quality that distinguishes projective identification from projection.
How this occurs is not adequately addressed in the literature, says Ivey. He discusses the mechanism of projective identification in the context of clinical material presented in the paper. He then reformulates a definition of projective identification as follows:
Projective identification is a dual intra- and inter-subjective phenomenon whereby, for various unconscious motives, some aspects of one’s person/ self, based on early interactions with primary caretakers, is split off in phantasy and located inside some internal figure/representation, thereby identifying the figure with the disowned aspect of the self. Because the projector relates transferentially to other people as though they are internal figures, the projector behaves towards these others in a manner that puts interpersonal pressure on them to respond in a manner consistent with the projected self-aspect.
Projective identification has been criticized for giving the impression that the therapist’s countertransference is the patient’s creation and for allowing the defensive analyst to blame the patient for his own uncomfortable feelings. Ivey proposes that projective identification is an “amalgam … of what the patient unconsciously wishes to put into the analyst and what the analyst unconsciously discovers is already there.” Ogden, says Ivey, carries this notion into his concept of the “subjugating third.” When “the projected aspects of the patient’s subjective life encounter the therapist’s receptive subjectivity, a third intersubjective reality is created.”
Other critics of projective identification have asserted that it does not differ from projection. Ivey reviews the literature with respect to distinctions between these two concepts. While he sees them as having some validity, he does not believe that they justify abandonment of the concept of projective identification. He finds more compelling the arguments of critics who offer alternative explanations for phenomena explained by projective identification. One such alternative explanation is Sandler’s concept of role responsiveness, in which the patient unconsciously provokes the therapist into unconscious enactment of a role deriving from the patient’s childhood experience. Ivey believes that his revised definition of projective identification captures the nature of the interaction Sandier has identified, however.
Another alternative explanation is Porder’s model, in which the patient induces strong emotions in the analyst (as opposed to projecting these emotions into the analyst). Ivey calls this the interpersonal induction model, and sees it as identical to Sandler’s idea of role responsiveness. For Ivey, neither of these models accounts for the patient’s phantasies of “locating mental and body contents in the person of the therapist,” nor do they account for the patient’s sense of emptiness and internal impoverishment. The interpersonal induction model does not imply a theory of cure, whereas projective identification implies, says Ivey, that the therapist’s reception and processing of the patient’s projections of aspects of himself is an essential therapeutic element.
A final alternative explanation addressed by Ivey is Weiss’s idea of passive-into-active testing. For Weiss, “The patient who turns passive into active reproduces in his relationship with the analyst parental behaviour that he had experienced as traumatic: that is, he identifies with a parent and does to the analyst those traumatizing things a parent had previously done to him.” In doing this, the patient unconsciously demonstrates the traumatic experience and tests the therapist’s tolerance of these experiences. This interaction is a reenactment of trauma for the purpose of cure. Ivey sees Weiss’s idea as more limited than projective identification and incapable of accounting for phenomena not already explained by the projective identification concept.
Ivey concludes with the observation that projective identification is an essential concept for the analysis of unconscious inter-subjective and interactional fields.
Volume XIII, Number 1 2005
The Relationship Between Deficit and Defence: An Exploration of the Ideas of Anne Alvarez. Arlene Joffe, pp. 1-18.
This paper is one of two in this issue that address the question of whether a symptom represents a defense or expresses a patient’s need. The author is a psychoanalytic psychotherapist practicing in Pretoria.
Joffe states that Alvarez has introduced the idea that some defenses may represent the internalization of objects that are defective in their psychological containment function. Joffe believes that this idea can be extended to include the notion of interaction between deficit and defense. Psychological deficits may give rise to defenses that in turn aggravate the deficit.
Bion considered the mother as the container of her child’s anxieties. In order to internalize this containment function, the child must first experience the satisfaction of her need and the accompanying sense of recognition of her own existence. Develop-mentally, this must occur before the child can tolerate recognition of the separate reality of the mother and bear her absence.
For Alvarez, says Joffe, paranoid-schizoid defenses can be seen as part of a developmental phase in which the good object representation is split off and protected when the environment fails to meet the child’s needs. This relieves the child’s anxiety. Idealization also serves the function of preserving a good object long enough for its internalization to be accomplished. Severely disturbed children may not have developed the ego integration necessary for the deployment of pathological defenses.
Additionally, as primitive defenses develop, further development may be inhibited. For example, if an individual attacks the links between thoughts that give them meaning, he becomes incapable of reflective and symbolic thought. Similarly, if a person has not experienced, and thus has not been able to internalize, the mother’s ability to link thoughts and affects, the person’s capacity for thought is defective.
The infant whose mother cannot contain the infant’s anxieties becomes a child who cannot contain his painful feelings. Such a child, as Winnicott believed, can use disintegration of thought as a defense against a sense of un-integration. In so doing, such a child can further alienate himself from available objects. Alvarez has suggested that deficits and defenses are invariably mixed. Joffe illustrates these ideas with clinical material from her work with a boy with severe impairment in his capacity to symbolize.
Joffe also discusses the defenses that Fraiberg observed in severely abused and neglected babies. These included avoidance and complete immobilization (“freezing”). These defenses prevented the babies from getting the contact they needed from their mothers; however, they were often able to make contact with a father or a clinician. Joffe proposes that, in the absence of an alternative object, the defensive behaviors employed by these babies with regard to their mothers might harden into more generalized defense mechanisms and create a developmental deficit. Joffe cites Reid and Tustin in suggesting that autism is related to this kind of deficit. (This, from my perspective, does not give adequate regard to biological deficits identified in persons with autism.)
Alvarez draws heavily on the concepts of projective identification, containment, and reclamation in developing an understanding of severely withdrawn, depressed, or disturbed children. Such children may have to experience feelings in an object before they can locate feelings inside themselves. When her mother is very depressed or unresponsive, the child cannot project aspects of herself to be contained and modified in the mother’s mind. In the most ill children, there may be no sense of self until the child is able to find or reclaim a sense of aliveness in someone else. Joffe illustrates this idea through clinical material from her work with an autistic-seeming three-year-old girl.
She also uses this case material to illustrate adhesive identification. Meltzer and Bick introduced the concept of this defense.
Lacking a sense of self, the child clings to the mother to avoid the anxiety of a sense of separation. The child feels that she exists when she is stuck to, and the same as, the mother. Joffe sees this as a developmental step toward a sense of self. Her small patient’s adhesive identification to a depressed mother contributed to the child’s developmental deficit that could only be overcome by providing a responsive object in the person of the therapist. For Joffe, Alvarez has opened the door to thinking respectfully about the patient’s need to find an object in any way that he can, and about how the patient’s use of the object may prevent further development.
A separate article in this issue explores the use of erotic transference not as a defense against feelings of need, but as a bridge toward a meaningful self-object relationship with the therapist.
Volume XIII, Number 2 2005
And What about the Nanny? An Introductory Review of the Psychoanalytic Literature. Sarron Goldman, pp. 78-105.
This paper arose from recognition that in South Africa, the presence of the black nanny is frequently felt in case material. However, the literature on the role of the nanny in the psychological development of the child is sparse. Although the nanny may be the child’s psychological parent, the temporary nature of her role may contribute to a lack of interest in her influence. With so many middle-class children around the world receiving care from nannies, this omission needs to be corrected.
Goldman cites Bowlby’s observation that Freud came to recognize the significance of the infant-mother relationship late in his career. Bowlby attributes this to the fact that many of Freud’s patients, like Freud himself, were raised by nannies. Goldman finds Freud’s relative silence on the significance of the nanny curious, given the role of his nanny in his own life. She sees a blind spot in Freud’s reflective thinking when it came to Monica Zajic, although he described her, and her appearance in his dreams during his self-analysis, in his letters to Fleiss. Zajic was Freud’s nanny until he was two and a half years old. Freud’s mother, he wrote, had described Zajic thus:
She was always taking you to church. When you came home, you used to preach and tell us all how God conducted His affairs. At the time, I was in bed when Anna was being born …. She turned out to be a thief, and all the shiny Kreuzers and Zehners and toys that had been given you were found among her things. Your brother Philipp went himself to fetch the policeman and she got ten months!
Freud did acknowledge the influence of his nanny in a recurring screen memory in which he was crying because he could not find his mother. His brother Philipp opened a cupboard, but his mother was not there. He cried until she came through the cupboard, looking “slim and beautiful.” Freud concluded that the memory related to his mother’s absence during the birth of his sister. Goldman cites subsequent authors, such as Hardin, who see a conflation of the nanny and the mother in this memory, in which the affect of sadness over the loss of the nanny, whom he had described as having provided him with the “means for living and surviving,” was obscured. Other authors, including Gedo and Blum, however, see Freud’s attachment to the nanny as a displacement of his feelings for his mother.
Goldman sees other influences of Freud’s experience with his nanny, a Catholic domestic worker who instructed him in “sexual matters,” as well as in the religion of Rome. Goldman speculates that this is unconsciously manifest in Freud’s hysterical anxiety about entering the city of Rome. She cites other authors who see in Freud’s development of the theory of the Oedipus complex an attempt to disavow both his wishes with regard to the mother surrogate, and his awareness of the “intrusion of desire for servants in the lives of the servant-keeping classes.”
Not until World War II did psychoanalytic thought focus on the role of substitute mothers. In England, wartime events provided theorists at the Tavistock (Melanie Klein) and the Hampstead (Anna Freud) Clinics with many opportunities to observe the effects of substitute parents. Many children were separated from their parents during the war and cared for in nurseries. Anna Freud and Dorothy Burlingham organized some of these nurseries, where children seemed to spontaneously identify a specific mother substitute among the young girls who served as nannies. According to Goldman, in writings based on observation of children in these nurseries, Anna Freud did not add much to the theoretical understanding of the impact of nannies.
Giessman, says Goldman, observed that Anna Freud’s own nanny, Josephine, had an impact on Anna’s sense of herself as special in Josephine’s eyes. Anna’s own experience with her nanny may have influenced her interest in the idea of the “psychological parent.”
Hellman, a psychoanalyst who worked in the Hampstead Clinic, developed ideas about the triangulation that can occur between a child, his nanny, and his mother. Mothers frequently hold ambivalent feelings toward the nanny and may relate differently toward the child, depending on whether or not the nanny is present. The nanny and the child may keep secrets from the mother. The child may exploit the mother’s ambivalence and play the mother and nanny against each other. The nanny inevitably abandons the child and may thus bear the brunt of the child’s hatred for both her and the mother.
Bowlby’s work in attachment theory had its origins in observation of World War II orphans. Attachment, according to Bowlby occurs between an infant and a single primary caretaker, and persists throughout the life cycle. The influence of other caretakers is, in Bowlby’s view, marginal. Deprived of a primary psychological caregiver, usually a mother, a child can experience psychological damage. Bowlby’s work has been cited both to support the role of the mother as the best provider of care for the child and to advance the professionalism of child-care. Bowlby did not oppose the idea of live-in nannies, and recognized that they could become the child’s true mother figure, supplanting the parents.
Since the 1970s, more empirical research on nonparental care has emerged. This research, says Goldman, does not support the idea that a child must have only one primary caregiver in order to thrive. A meta-analysis of fifty-nine studies of maternal versus non-maternal care showed no real developmental differences between children receiving care from their mothers and those receiving nonmaternal care.
Today, in first-world countries, nonmaternal care is commonplace. Hardin, a Canadian psychoanalyst, observed that, over a five-year period, one-third of his new patients had nonmaternal primary caretakers. Goldman believes that this percentage is higher among white South Africans.
The nanny or female servant appears in several of Freud’s case histories: Little Hans, the Rat Man, the Wolf Man, and Leonardo. Helene Deutsch has written about her own error in replacing her two-year-old son’s nanny with a stranger. While Fenichel, Marmor, Winnicott, and Bollas wrote about cases in which the patient’s relationship with a nanny had significance, they did not do so from a theoretical perspective. Sachs, writing in The Psychoanalytic Quarterly in 1971, may have been the first to give systematic consideration to the role of the maid in the child’s development.
However, Hardin—perhaps more than any other analytic writer—has given detailed accounts of his patients’ experiences with their nannies. Patients with early “primary surrogate mothering” often have screen memories in which the nanny is hidden in the image of the mother. What he calls “surrogate mother transferences” appear in the course of analysis and illustrate the “primordial importance” of the nanny. The fact that the presence of the nanny is often screened in memories, dreams, and the transference is due, according to Hardin, to several factors. The nanny is often lost early in the child’s life; she is frequently replaced by the mother who was previously absent; and what may emerge in the transference is a longing to regain the closeness to the early primary caregiver and to expunge the profound experience of her loss. The loss of the nanny may be layered on top of the even earlier experience of the loss of the mother, leading to substitution by the nanny.
The child’s experience of the loss of the nanny can be catastrophic and can lead to a fear of closeness with others, Hardin continues. The loss of the nanny is one of the most frequently occurring experiences of loss in childhood. Children may be unable to mourn this loss, and parents may be unaware of or deny the significance of the loss to the child.
In South Africa, domestic employment is the single largest source of work for black women. Hardin notes that, given this reality, the impact of their presence on the development of the South African children in their charge should be further explored.