The author would like to express his appreciation to Joyce Catlett, M.A., associate and collaborator, for her major contribution to the organization and writing of this book. I am also grateful to Tamsen Firestone and Barry Langberg for their continuing critique and evaluation of the manuscript; to Cecilia Hunt for her initial editing and suggestions; and to Anne Baker and Eileen Tobe for their help in completing the final draft.
I would like to extend my special thanks to Dr. Stuart Boyd for his commentary on the psychotherapeutic community and the concepts that evolved from that setting, and to Dr. Richard Seiden for his interest and criticism of the manuscript. I would also like to express my admiration and appreciation to R. D. Laing for his moral courage in exposing the essential destructiveness in the conventional family unit and perceiving the validity of human suffering and resulting psychopathology emanating from that source.
The names, places, and other identifying facts contained herein have been fictionalized and no similarity to any persons, living or dead, is intended.
A Developmental Overview
Psychological defenses that protected people from suffering emotional pain and anxiety when they were children later play destructive limiting roles in their adult lives. An individual’s defense system acts to keep him or her insulated, mechanical, and removed from the deepest personal experiences.
Our defenses can malfunction in a manner that is analogous to the body’s physical reaction in the case of pneumonia. In this disease, the body’s defensive reaction is more destructive than the original assault. The presence of organisms in the lungs evokes cellular and humoral responses that meet the invasion, yet the magnitude of the defensive reaction leads to congestion that is potentially dangerous to the organism.
In a like manner, defenses that were erected by the vulnerable child to protect him or herself against a toxic environment may become more detrimental than the original trauma. In this sense, one’s psychological defenses become the core of one’s neurosis.
Our defensive solution acts as a general resistance to change or progress, cuts off our feeling for ourselves, and presents the fundamental problem in any psychotherapy. In our investigation of resistance, we have been confounded by what for us is the single most remarkable fact of human behavior: the perversity with which most people avoid or minimize experiences that are warm or constructive. Most of us reject or manipulate our environments to avoid any emotional interaction that would contradict our early conception of reality, and this fact of human nature may be the single most delimiting factor for all psychotherapies.
The author conceives of neurosis as an inward, protective style of living that leads the individual to seek satisfaction more in fantasy than in the real world. It is the result of the frustration of infantile urges and the primal hunger caused by emotional deprivation in one’s childhood. It is the process of reliving rather than living, choosing bondage over freedom, the old over the new, the past over the now. It is the attempt to recreate a parent or parents in other persons or institutions, or even, if all else fails, in oneself. It is the abrogation of real power in exchange for childish manipulations. It is the avoidance of genuine friendship, free choice, and love in favor of familiarity and false safety. In other words, one clings to the emotional deadness of the family and to illusions of safety and security by repeating early patterns with new objects.
In one sense, neurosis is a response to a realistic fear—the terror and anxiety that surround our awareness of death. As a child matures and becomes conscious of his or her own end, the young person uses defenses to protect the self. However, it is a maladaptive procedure because it involves a progessive giving up of our real lives in an attempt to alleviate death anxiety. Indeed, most people prefer to exist in a nonfeeling, defended state because to feel for themselves or for another person would make them more aware of their vulnerability and limitation in time.
The basic tenet of my theoretical approach is the concept of a fantasy bond (Firestone, 1984). The “primary fantasy bond” is an illusion of connection, originally an imaginary fusion or joining with the mother’s body, most particularly the breast. It is a core defense and is protected by other patterns of thoughts and behaviors (secondary fantasies). The term “fantasy bond” describes both the original imaginary connection formed during childhood and the transference of this internal image of oneness to significant figures in the adult’s intimate associations. The process of forming a fantasy bond leads to a subsequent deterioration in the adult’s personal relationships. The function of resistance is to protect the individual from the anxiety that arises whenever this fantasy bond is threatened.
It is important to differentiate this specific use of the word “bond” from its other uses in psychological and popular literature. It is not “bond” as in “bonding” (maternal-infant attachment) in a positive sense nor does it refer to a relationship that includes loyalty, devotion, and genuine love. Our concept of the fantasy bond uses bond rather in the sense of bondage or limitation of freedom.
For the infant, this fantasized connection alleviates pain and anxiety by providing partial gratification of its emotional or physical hunger. In other words, the fantasy bond is a substitute for the love and care that may be missing in the infant’s environment. The more deprivation in the infant’s immediate surroundings, the more dependency the infant will have on this fantasy of fusion. The fantasy bond is created to deal with the intolerable pain and anxiety that arise when the infant is faced with excessive frustration. This type of anxiety can be far more devastating to the infant than the frustration itself. Winnicott (1958) has described this reaction:
Maternal failures produce phases of reaction to impingement and these reactions interrupt the ‘going on being’ of the infant. An excess of this reacting produces not frustration but a threat of annihilation. This … is a very real primitive anxiety, (p. 303)
At the preverbal stage, the state of anxiety is intolerable to the infant and creates a dread not only of separation and starvation, but perhaps even of death. Observing these phenomena in early research, the author concluded that the mother needs adequate emotional resources and an ability to express affection if she is to provide her infant with proper emotional sustenance. She must be able to feed and care for her infant without arousing severe anxiety in the child, and she should be sensitive to the child’s needs. In this way, she will enable it to develop into a social being. I have called the product of this ability on the part of the mother “love-food,” which implies both the capability and the desire to provide for the need-gratification of the infant. In terms of this theory, love-food is necessary for survival in both the physical and psychological sense (Firestone, 1957).
When deprived of love-food, an infant experiences considerable anxiety and pain and attempts to compensate by sucking its thumb and by providing self-nourishment in various ways. At this point in its development, a baby is able to create the illusion of the breast. An infant who feels empty and starved emotionally relies increasingly on this fantasy for gratification. And, indeed, this process provides partial relief. In working with regressed schizophrenic patients, my colleagues and I observed that some had visions and dreams of white hazes, snow, and the like, sometimes representing the wish for milk and nourishment. One patient described to me a white breast that he saw, and when I asked what came out of it, he said, “Pictures.” Thus, fantasy may eventually become “more real” to the seriously disturbed person than does experience in the “real” environment.
In explaining the survival function of schizophrenia, Rosen (1953) has written:
When a wish for something is so important that it involves a matter of life and death, then, and only then, does the unconscious part of the psychic apparatus spring into action and provide the necessary gratification with an imagination. (p. 107-108)
Rosen goes on to report the story of a soldier, lost in the African desert, who imagined that the sand was water and scooped up handfuls of it, which he said “were wet and cool to his touch and refreshing to taste.” Such is the power of imagination when one is faced with a situation perceived to be one of life-threatening deprivation.
In the early stages of an infant’s development, intolerable feelings of dread, anxiety, and isolation are at times conveyed through the physical interaction between the mother and child. It is impossible for an anxious mother to hide her fears and anxieties from her infant. Her true emotional state is transmitted on a deep level to the child.
In observing rejected infants, the author has noted an important characteristic in their mothers that appeared to damage them. This was the mother’s (unconscious) refusal to let herself be affected or moved by the emotional experience of feeding or caring for the child. Other observers have noted that this type of mother seems to avoid her baby’s loving looks at the point when the baby first begins to recognize her. This avoidance is usually detrimental to the baby’s subsequent emotional development.
The symptoms in such an infant are a general dissatisfaction, often consisting of whining, an inability to relax against the mother’s body (or, on the other hand, a desperate clinging to the mother), excessive crying, and a “spaced-out” or pitiful, pinched look on the face. Later, the child appears to avoid love and affection and may have a tendency toward behavior that provokes anger or hostility in others. Sensitive adults may even sense within themselves hostility and feelings of loathing toward an unloved child.
A particularly destructive type of mother is one whose physical contact with her infant is expressed in an automatic, unfeeling manner or touch. The more contact there is with a well-defended, emotionally cutoff mother, the more damage will be done to the infant. Though inadequate mothers vary in their characteristics, certain qualities stand out as detrimental. Some mothers give their children exaggerated praise and flattery for their physical appearance and abilities. Other mothers tend to talk a great deal about their love for their children, but their actions often contradict their words. They may be overly solicitous in one situation, and cold and distant in another. Also fairly common is over-identification with the child, with its accompanying stylized language and use of the pronoun “we”—“now we’re going to have our bath.”
The “good” or adequate mother, in contrast, has the capacity to tolerate real closeness followed by separation, to a greater degree than the mother described above. She has the ability to give sensitive care to her child and to relieve its anxiety without being overprotective.
The “good” mother does not regularly try to put her infant to sleep after a feeding, but is interested in maintaining the contact through play and communication. As the child grows older, the mother offers appropriately varied responses, alternating spontaneous contact with letting-go of her offspring. This mother also copes with acting-out behaviors—whining, excessive crying, tantrums—before these negative patterns become integrated into the child’s personality. A “good” mother has little need to reassure her child of a connection because she is better able to tolerate her own separateness as a person. Typically, she also enjoys a close, intimate, and sexually satisfying relationship with her husband.
In terms of the mother-child interaction, it is my hypothesis that the most damaging factor is the presence of habitual physical contact in the absence of genuine emotionality; that is, the mother has withdrawn her affect and her desire for contact with the child, but still offers adequate, or even excessive, automatic physical care or affection.
Other researchers have noticed this particular form of withdrawal in psychotic patients:
Bateson and Jackson assume that the schizophrenogenic mother is a mother who becomes anxious and withdraws if the child responds to her as a loving mother; that is, her anxiety and hostility are aroused when she is in danger of intimate contact with the child. (Grotjahn, 1960, p. 82)
The mother-child dynamics formulated here are the variables that the author believes to be conducive to the formation of the primary fantasy bond, with varying degrees of subsequent damage, ranging from mildly neurotic behavior to, in some cases, schizophrenic regression.
The primary fantasy of connection leads to a posture of pseudo-independence in the developing child—“I don’t need anyone, I can take care of myself”—yet the irony is that the more the person relies on fantasy, the more helpless he or she becomes in the real world and the more he or she demands to be taken care of.
Many children feel this false sense of self-sufficiency—or omnipotence—because they have introjected the image of the “good and powerful mother” into themselves. Unfortunately, they generally incorporate her covert rejecting attitudes as well. The more pain and suffering a child experiences, the more that child will need to incorporate the mother or the self-mothering process. Erikson (1963), describing the process of introjection, states that: “In introjection we feel and act as if an outer goodness had become an inner certainty” (p. 248-249). He emphasizes that the early defenses of introjection and projection are the strongest (and most persistent) of all the defenses the child may later develop.
The incorporated parental attitudes form the basis of the self-concept. Through introjection, the child has the feeling of being a combination of the good, strong parent and the bad, weak child. The child now feels that he or she needs nothing from the outside world, but is a complete, self-sufficient system. The more pseudo-independent the developing young person feels, the more dependent such an individual becomes. This is best exemplified in psychotic patients who, at the same time, have omnipotent delusions and are barely able to take care of themselves, requiring full-time care from others.
The primary fantasy bond can relieve fear and allay the anxiety of feeling separate and alone. It can stave off painful feelings of emotional starvation and emptiness. It creates numerous distortions, however. For example, in this process the child has a tendency to idealize the parent at the child’s own expense. The child must conceptualize him or herself as bad or unlovable in order to defend against the realization that the parents are inadequate. Recognition of real faults in the parent would destroy the bond, or the imagined connection, and the feeling of imagined self-sufficiency.
The child, and later the adult, defend against the awareness of separateness. For the adult, the primary fantasy also protects one from the terror that accompanies a realization of one’s inevitable personal death. Many imaginary connections are used to give this illusion of immortality: the fantasy bond between husband and wife, the bond with one’s children, a bond with one’s original family, religion, country, or a geographical place.
Bettelheim (1943/1980) observed that a strong fantasized connection formed among the inmates of a compound in a German concentration camp. Facing almost certain death, the prisoners imagined that they would somehow survive as a group, if not individually. On one occasion, the group was forced to stand all night in subfreezing temperatures because two prisoners had tried to escape. More than 80 perished; but the survivors reported that during the event they felt “free from fear and … actually happier than at most other times during their camp experiences” (p. 65). When, after the ordeal was over, they were returned to their barracks, they felt relieved but no longer happy or free from fear. “Each prisoner as an individual was now comparatively safer [in reality], but he had lost the [imagined] safety orginating in being a member of a unified group” (p. 66).
Kaiser (1955) has described a “delusion of fusion” that the child develops when threatened by feelings of isolation and separateness. This concept is directly analogous to the concept of a fantasy bond. Kaiser reported that this delusion not only is common in childhood but occurs in many adult situations. He believes that transference in the therapy setting is another attempt on the part of the patient to fuse with a parental figure in order to avoid being a separate individual. To escape from an interaction where he would be an equal (an adult) with the therapist, the patient often retreats to a childish, dependent, submissive posture in a desperate effort to make this primitive connection with another person. The author agrees with Kaiser’s perception that the patient wants to form a fantasy bond with the therapist, and the role of therapist often supports the patient’s desire. Resistance in therapy derives from this bond, that is, the patient struggles against the therapist as a parental figure whom he or she imagines wants the patient to change.
In summary, the primary fantasy originates in early childhood or infancy to fill a gap where there is environmental deprivation; it “nourishes” the self; and it becomes the motivating force behind self-destructive, neurotic behavior. It is a maladaptive solution that occurs not only in the seriously ill psychotic but also, to a lesser degree, in the neurotic person. No child has an ideal environment, thus all people depend to varying degrees on internal gratification from the primary fantasy.
The fantasy process can become functionally autonomous; that is, it can persist for long periods after the deprivation has ceased, and it predisposes behavioral responses. Concomitant to the process of substituting fantasy for real gratification, there is a powerful resistance to accepting anything from the real world. Once the primary fantasy is formed, people often choose to protect it at all costs. Their principal goal then is to maintain the safety and security of this imagined connection. They come to prefer fantasy gratification to real satisfaction and love from others. They tend to develop a cynical view of life and blame others for their failure to achieve their desired goals.
Anything that arouses an individual’s awareness of separateness or nonbonded existence provokes anxiety and often leads to hostility, even toward the very people and circumstances that would give the individual the greatest satisfaction. Viewed as attempts to defend the primary fantasy, many irrational, self-limiting, neurotic responses begin to make sense.
Paradoxically, a satisfying sexual experience can be a major disruption to the bond or the fantasy of being connected. The sex act is a real, but temporary, physical connection followed by a sharp separation. Similarly, physical intimacy is a close, affectionate contact with a subsequent separation, and real communication is a sharing of thoughts and feelings followed by a distinct awareness of boundaries. Resentment may be inherent in these separations, which inevitably follow real closeness, though the anger and hostility can be unconscious.
In a bond, these situations are avoided. Moving in and out of closeness is intolerable to those people who have become dependent upon repetitive, habitual contact without much feeling. For example, a woman will often withhold her full sexual response—real satisfaction—to avoid this rejoining and subsequent separation. People avoid real communication because expressing their views implies that they are a discrete entity, that they count, that “they have a vote.” This stimulates the fear of separateness and aloneness.
It is the author’s conclusion that most people avoid real sexuality, physical intimacy, and honest communication because they don’t want to face the fact that each of these transactions has an ending and necessitates a letting go. Each small ending can remind them that everything eventually ends—in death. Genuine love and intimacy challenge the primary fantasy of connection and arouse an acute awareness of mortality. Separateness is intolerable because it fosters an awareness of death. Establishing an imaginary connection with another person can become a major defense against this unbearable anxiety.
Anxious parents attempt to reassure their children and themselves that there are no endings. Most parents attempt to maintain an imagined link to safety, security, and immortality for two reasons: first, to relieve and avoid their own anxiety about separation; and secondly, because on a deep level they feel guilty for bringing another human being into a world where the ultimate end is death.
Threats to the primary fantasy also create anxiety because they rearouse the painful feelings that were operating at the time the original defense was formed. Most adults don’t want to be vulnerable again. Because they fear positive experiences that make them feel deeply about their lives, they avoid them and tend to remain passive, somewhat childish, and may even provoke rejection or bring about disappointment. Because their actions seem to them so perverse and unacceptable, they often speak with duplicity and mixed messages and are generally misleading in their communications. To the degree that they are defended, people no longer really want or pursue what they say they want.
As adults, many people keep intact an idealized image of their parents in the hope that some day their parents will love them or at least approve of them. As a result, their behavior is more conforming, compromising, and conventional, rather than self-directed or independent. Self-hatred and a lack of self-esteeem stem from an idealization of the parents and the introjection of their covertly rejecting attitudes.
Several years ago; a patient of mine, Joanne, recognized that she had reached a point in her therapy where the idealization of her family and her subsequent self-hatred were beginning to be challenged. Writing a letter to friends in her therapy group, she spoke of avoiding contact with them and not wanting to admit the reasons. This highly intelligent woman was extremely sensitive to her defenses and had an unusual understanding of her resistance to abandoning them and taking another chance on people. In her letter, Joanne wrote:
Not until recently did I let myself see my avoidance as a rejection of real people, as rejecting you. When I’ve consciously made the choice not to linger and talk after the group, to not talk about myself during the group … I never let myself see it as a rejection of people I care about … I feel like nothing, no person, no experience is worth giving up my defenses for. I hate seeing that, I hate even more for you to know it, to put it in writing, but it’s true. That’s how I act, that’s how I live my life.
It’s really just one basic defense—self-hatred. It was the first “made-up,” pretend emotion I created. It seems hard to believe, but I know I was an infant when I seized on hating myself as a way to keep on living…. It’s a cold, numb feeling where self-loathing was so intense, everything and everyone else is blocked out. Without that feeling, I know I really would have died … the only other alternative to self-hatred would be to directly experience rejection, real rejection.
In some twisted way, I structured my whole personality, my behavior, my feeling of “validity” as a person on that made-up emotion. And self-loathing has become so firmly entrenched in my being, it feels like the very core of me—in some crazy way, self-hatred feels like my “life-force.”
In all the months and years of therapy, I never saw it so clearly. I eventually saw that feeding my face was a substitute to feeding my vagina, that keeping myself asexual and isolated was keeping a pact with my parents … but I never really saw until now how all of that—the fat, the asexual isolation—was keeping my “life-force,” my self-hatred intact.
I can’t hang on to self-hatred around you any more—even with briefest contact of groups and weekly sessions. No matter how I “insure” the feeling by acts of self-destructiveness during the week—the eating, picking at myself, calling up my mother’s voice to ridicule and denounce myself—you just have to see me, I mean really see and address the person that’s real in me, to strip away the self-hate, even for just a second or two. It’s like the world falls in on me, I feel like screaming down the hall and doing anything—banging my head against the wall—to get back my “life-force” of self-hatred.
When I make jokes at the end of a session, it feels like a desperate attempt to get that self-hatred in force again; it feels like falling off a building and grabbing for ledges to save myself.
In my case, self-hatred was formed very early, to protect myself from the certain total insanity that rejection would have led me into. From there, keeping a layer of fat surrounding me, twisting my face into ugly expressions, kept that basic or primal defense alive in me. (I just remembered that I began being fat at the age of five when a friend of the family began showing an interest in me. It was also a time during which I first acted out self-destructiveness, inflicting a concussion on myself, sitting on a live battery and burning my legs. He was the first to threaten that primary defense … by being nice to me.)
Later on, I dealt with the threat of people being nice to me by surrounding myself with not-nice, phony people. And, even then, if they began to respond to anything outside my primary defense, I threw up a barrage of cruel jokes about myself and, worse, about them. I added other superficial defenses, as well, to send up a “smoke screen” to mask the more basic defense. I became an “intellectual,” using phony words; I became tough and aggressive to keep people confused and self-protective around me … all still in defense of their threatening to strip away my self-hatred.
The “realer” I became (through therapy) and the “realer” all of you have become, the more threatened my “life-force” defense has become…. I guess what I’m doing now is exposing the primary defense. I guess I’m ready to risk living for longer and longer periods without that core of self-hatred.
This letter was written over 8 years ago, as some of my later concepts were being developed. This patient, who described herself so honestly, showed a remarkable understanding of herself that was partially ahead of my knowledge at that time. For example, she writes of “calling up her mother’s voice” to criticize her during the week. She was referring to the concept of an “inner voice” (Chapter 4), remnants of the incorporated rejecting parental attitudes. Joanne’s insight was remarkably perceptive, as I was to discover when I began to experiment more with formulating the self-destructive thought processes of this “inner voice.” This was accomplished by having patients verbalize negative thoughts about themselves thereby externalizing their inner dialogue in a dramatic and feelingful release.
The tragedy is that this woman, who was so viciously intolerant of nice treatment as a child that she deliberately burned her legs when someone took an interest in her, could not bring herself to give up her basic defense and eventually left therapy and her friends. Today she is living the isolated life of which she so poignantly wrote.
Joanne’s conception of a strong self-hatred being her primary defense was only partly correct theoretically. More precisely, it was the fantasy bond or imagined connection with her family that sustained in her the belief that she could survive alone and take care of herself without ever risking taking anything from the outside world. Her self-hatred was formed as a result of her idealization of her mother, probably before conscious memory. It functioned to maintain her primary fantasy of connection. However, in one sense, Joanne’s self-hatred was a major defense. By hating herself, she never had to risk rejection or hatred from others; she rejected herself and them first. It was, in fact, a force in her life that ultimately protected her from the dreaded possibility of being hurt again.
Human beings desire freedom and individuality, but paradoxically they fight stubbornly against change and progress. Ernest Becker (1964), in writing about the problem of resistance, attempts an explanation;
It is barely imaginable that one should struggle so hard, except against the relinquishment of real basic inner drives, of irrevocable natural urges [instincts]…. But this is to fail to understand human action: the patient is not struggling against himself, against forces deep within his animal nature. He is struggling rather against the loss of his world, of the whole range of action and objects that he so laboriously and painfully fashioned during his early training, (p. 170)
I believe that the concept of the fantasy bond—the illusion of connection to the mother—and all the subsequent actions and thought processes, are a dynamic formulation of the primitive defensive inner world that Becker writes about.
Anxiety arises whenever this inner world is intruded upon, and especially when the fantasy bond, the imaginary connection, and one’s pseudo-independence is threatened. Anxiety is aroused, too, whenever there is an awareness of one’s separateness and mortality. The author sees resistance as the holding on to an imaginary connection to others, due to the dread of re-experiencing one’s sense of aloneness and helplessness. Ultimately, resistance functions in order to protect the individual from experiencing anxiety states that arise from the threats to the neurotic resolution of the basic conflict—the conflict between dependency on inner fantasy for gratification versus a desire for real gratification in the interpersonal environment.
As humans, we are torn between pursuing an assertive goal-directed life, and depending on passive-dependent machinations that assure us of a fantasy bond. How we resolve this basic conflict determines whether we have a free-flowing, changing existence or a static, rigid, defensive posture. The primary fantasy bond is the core defense underlying our resistance to change. It is the major barrier to a full, rich existence.
Self-nourishing habits fulfill the function of parenting oneself and thereby establish a pseudo-independence. They also serve the purpose of cutting off painful feelings. In denying oneself fulfillment and satisfaction from objects in the outside world, a person comes to rely more on self-nourishing behaviors as substitutes. In order to ease their suffering, people learn to block out painful episodes and emotions. Unfortunately, they simultaneously limit feelings of joy and exhilaration as well. Psychological methods and means used to dull pain generally become addictive. Like drugs, they reduce anxiety and lead to feeling better temporarily. However, because these habits are closely tied to the destructive process of self-denial, people who rely on painkilling habits become increasingly crippled in their ability to function and find satisfaction in personal relationships. They tend to limit their pursuit of actual goals and become progressively more involved in an inward life style of fantasy and substance dependency.
Self-nourishing habits include a wide range of behaviors beginning with thumb-sucking, then progressing to masturbation, excessive television viewing, compulsive eating, drinking, drug use, addiction to routines, and mechanical, impersonal sex. These habits temporarily satisfy emotional hunger and primitive longings left over from infancy or early childhood, giving the individual some measure of control over the internal state. They function to support the illusion of self-sufficiency, the fantasy that one can take care of oneself without the need for others. A self-nourishing life style emerges that shuts off personal feelings and is primarily defensive and self-protective (Firestone & Catlett, 1981).
Breaking a compulsive habit pattern or an addiction can be the most difficult task that a patient undertakes in therapy. Anxiety and other painful symptoms generally accompany this withdrawal. The patient’s dependence obviously involves more than would a simple physiological addiction.
In psychoanalytic terms, self-nourishing habits are categorized as “ego-syntonic,” that is, they arouse little conflict with normal ego functioning. Evidently, until their use becomes obviously self-destructive or potentially dangerous, they are “in consonance with the person’s ego” (Freud, 1916-17/1961). These habits tend to be acceptable to the self and do not cause deep inner conflicts until they become quite serious.
Eventually, well-established self-nourishing habits usually become self-destructive because they progressively limit the person’s capacity to cope with everyday experiences. They tend to foster an inward, isolated life style. When these habits do become associated with a more generalized retreat from the real world, they no longer feel acceptable to the self and cause the person considerable guilt.
The more a person has been emotionally deprived and frustrated in early life, the more he or she tends to rely on self-feeding defenses that give the illusion of self-sufficiency and ease the pain. As in all other aspects of the defensive process, the “voice” plays an important role in supporting addictive tendencies: first, by seducing the person into indulging the “habit,” then by punishing him or her. For example, first it encourages the person who drinks excessively to “take one more drink—what’s the harm?” then it accuses the drinker of “having no will power” or of “being a hopeless alcoholic.” These self-accusations in turn lead to more self-hatred. In attempting to alleviate these secondary reactions of guilt and pain, a person invariably resorts to more “painkillers,” and the vicious cycle continues. In some cases of long-standing addictions to harmful physical substances, these self-nourishing habits lead to ultimate self-destruction.
Self-nourishing or self-mothering habits come into play early as infants expand their repertoire of behaviors. Some of these habits develop out of natural predispositions, such as the sucking reflex. Healthy infants exhibit a certain amount of sucking beyond what they engage in while taking the bottle or nursing. For this reason, it is difficult to determine exactly when sucking begins to function more as a substitute for parental love. Nevertheless, thumb-sucking and the use of the pacifier can become prolonged and habitual, and beyond the age of approximately two years, these patterns may be symptomatic of emotional deprivation.
These primitive self-nourishing behaviors become associated in the infant’s mind with the fantasized image of the mother (the fantasy bond), and they act to reduce the baby’s tension and partially satisfy its hunger. Later, in times of emotional stress, the child retreats into an inner world of fantasy and utilizes these same techniques to soothe and comfort itself. As children become older, these behaviors proliferate, and they develop new habits and techniques with which to parent or symbolically feed themselves. Nail biting, smoking, excessive drinking, masturbation, or drug use are some of the activities that come to be relied upon for pleasant sensations and relief of tension.
There are three general categories of painkillers that can become associated with a self-nourishing life style: (1) addiction to physical substances; (2) addiction to ritualistic behavior and routines; and (3) the use of private, isolated time to fantasize and maintain one’s self-hatred.
Food as an Addictive Substance
Many children eventually learn to substitute eating for the love and companionship that is missing in the family situation. Food then becomes their major focus and overeating may become a well-established habit. Later, as an adult, a person’s attempt to cope with obesity can become as destructive as the original eating disorder. A cycle of overeating, then dieting, compulsively acted out during the course of a lifetime, affects not only one’s physical health, but it can also become extremely detrimental to one’s emotional well-being. When they become part of a self-gratifying, inward process, both concern with dieting and overeating are functionally maladaptive.
Some years ago, a physician referred a patient to me whose problem with overweight was complicated by a long-standing dependency on prescription diet pills. When Mrs. R., thirty-one, finally sought professional help, she had been struggling for many years to break her addiction to several types of diet-related drugs, an addiction that started when she was twelve years old.
Although Mrs. R. was a well-respected instructor at a local college and a woman of exceptional intelligence, she was rarely able to go through a full day of teaching without a large number of amphetamines. Terrified by a close call with death after ingesting a combination of amphetamines and alcohol, the patient decided to seek professional help and was eventually referred for psychotherapy.
Mrs. R.’s history revealed a lifelong focus on dieting. Commencing at three years old when her mother placed her on a strict diet to qualify her as a model for a baby commercial, through puberty when a doctor prescribed diuretics in response to her mother’s concern about her “unusual” metabolism, the young woman became dependent on diet drugs and developed an image of herself as different from other girls her age. The nightmare continued in college and graduate school where Mrs. R., still striving for perfection and some sign of approval from her parents, was forced to live furtively, obtaining pills where she could.
Mrs. R.’s therapy included elimination of all diet drugs, identification and separation from the attacks of her destructive “voice,” and use of a dieting method that broke into her inward, self-nourishing style.
In her sessions, the patient focused on her deceptively seductive “voice” that urged her to eat her favorite foods and then savagely attacked her after the indulgence. Her insights into the myriad self-attacks with which she tormented herself dispelled some of her hopelessness and motivated her to lose weight in a sensible manner. During the therapy, as Mrs. R. approached her ideal weight, this “voice” became even more active. In one session she enumerated her attacks on herself and discovered that each one could be traced to a distorted image she had of herself as a woman. She found herself thinking, “You may be losing weight, but nobody notices, especially men.” “You’re still unattractive; your clothes just hang on you.” “You’re ugly anyway, so why bother to lose weight.”
The end result of this series of attacks was an almost overpowering urge to cheat on her diet. Mrs. R.’s voice effectively supported her self-nourishing habits as well as her negative self-image. Traditional methods of controlling her food intake had not worked for her because of her inward style of self-parenting. Her stubborn habit patterns originally developed because of severe emotional deprivation during early childhood. These defense patterns were preserved and administered by her destructive voice.
To combat this inward, self-nourishing style of dieting, I suggested to Mrs. R. that she utilize a technique that appears to interfere with long-standing eating disorders by breaking into the patient’s illusion of being self-sufficient. This technique, described in the literature as The Love Diet (Jansen & Catlett, 1978), involves the dieter including a friend in her diet. The friend plans the entire menu for the dieter, the dieter eating only what is given by the friend. In this way, inward secretive methods are interrupted and contact with another person replaces preoccupation with food and dieting. A real friendship is substituted for internal self-feeding.
At the other extreme in the category of eating disorders, anorexia nervosa is also associated with self-feeding. The patient (generally a female) may alternate between self-starvation and bulimia (gorging and self-induced vomiting). In this situation, the patient exercises total control over her food intake. Often, the process of not eating has become the sole focus of the anorexic patient’s struggle to find some sense of identity. These patients often have little sense of what they feel, physically or emotionally; and they lack a clear awareness of the sensation of hunger.
Dr. Hilde Bruch (1973), writing about the anorexic patient in Eating Disorders, states that:
If … a mother’s reaction [in feeding the infant] is continuously inappropriate, be it neglectful, oversolicitous, inhibiting, or indiscriminately permissive, the outcome for the child will be a perplexing confusion. When he is older he will not be able to discriminate between being hungry or sated, or between nutritional need and some other discomfort or tension. (p. 56)
Very early, children raised by mothers with the characteristics described above realize, on some level, that they cannot trust their mother adequately to feed or nourish them. They attempt to take control of this basic process and “nourish themselves.” However, their disturbed perception of their internal state makes even this primitive adjustment tenuous. The anorexic patient’s methods of taking care of herself are desperate attempts to ward off extreme anxiety and panic or to escape emotional involvement with a controlling, intrusive mother. These maneuvers may lead to bizarre eating behavior and destructive fasting. The patient usually reports feeling terrified of “taking the first bite of food, for fear that I’ll never be able to stop eating.”
Anorexia nervosa and obesity are conditions that reflect the use of food for purposes other than sustenance; these disorders indicate that food has taken on a separate, specialized meaning. The anorexic patient refuses food in order to have some semblance of control over her life. It can also represent a defiant oppositional gesture toward the parent who wants her to eat.
The most significant factor is that both habits, overeating and self-starvation, preserve the patients’ illusion that they can take care of themselves, because they temporarily alleviate anxiety. Indeed, the strict regulation that the anorexic patient exerts over food intake serves in some cases to avert further regression into a psychotic state. In summary, as is so often the case in other self-nourishing habits, the dynamics revolve around the central issue of control and self-parenting.
Dependence on Alcohol
A compulsive need for self-nourishment and control is also characteristic of an individual’s addiction to alcohol, cigarettes, and drugs of various kinds. Anxiety that is allayed by these substances will come to the foreground when the “drug” is given up by the patient. The perceived loss of control that accompanies withdrawal leaves the person in a disoriented state, feeling helpless and at the mercy of outside forces. Regression to childish behaviors and angry outbursts of temper are common.
The compulsive eater, the drug-user, the alcoholic, all deny their dependency on other persons and have pseudo-independent attitudes—“I can feed myself, I have my own bottle.”
One patient, an alcoholic man, a professor at a nearby university, was very meek and self-depreciating in manner. Yet in relation to stopping his drinking, he was extremely defiant and hostile, saying to his therapist, “Don’t tell me what to do.” In his dependency on alcohol, he had succeeded in denying his need for real people. His stubborn refusal to break his addiction to this self-nourishing habit caused him to terminate therapy after a few months, precluding any progress he might have made in other areas of his life.
The determinants of substance addiction—alcoholism, drug abuse, and eating disorders—are varied, yet each behavior or habit is an attempt on the part of the patient to numb primal pain from the past as well as suffering due to present-day frustration and stress. In every case, the patients’ addiction supports the fantasy that they can somehow “feed” and care for themselves. However, in repeatedly turning to these habits for relief and for a sense of control over their pain, the person progressively blocks out important emotional reactions. In this manner, they become more incapacitated in their ability to work productively or to function adequately in social situations. They come to exist in a dazed, cut-off state for long periods of time and damage their personal relationships. Friends and family experience considerable suffering and become increasingly alienated as this process spirals downward.
Almost any repetitive behavior or ritual may be used to dull one’s sensitivity to painful feelings and can be said to have addictive qualities. A person who suffers from a high degree of emotional stress in life may easily fall prey to habits that are tension reducing. Once these patterns are formed, any behavior seems preferable to the anxiety that the person would experience if these routines were to be interrupted.
Early childhood compulsions illustrate the compelling nature of ritualistic behaviors. Everyone remembers certain favorite phrases they repeated over and over as children. “Step on a crack, break your grandmother’s back,” and other magical slogans are traditionally chanted over and over by children. Youngsters will repeatedly count up to a certain number or sing a favorite song over and over again. Some adults make elaborate lists, over-planning every detail of their day. Many people insist on having their ritual morning cup of coffee before they can function adequately. Some people who live alone go through nightly rituals of looking under their beds, inside their closets, and compulsively checking the locks on the doors many times before retiring. Family observations of holidays, birthdays, and reunions are often ritualistic in nature, and are characterized by much formality and role-playing. Religious rituals are observed to ease pain and grief. They provide needed structure to relieve the anxiety inherent in the issues of life and death.
Ritualistic activities take an enormous importance in severely disturbed children. A colleague who worked at a residential children’s treatment center told of her young patients’ insistence that things always be kept the same—the daily routines as well as each piece of furniture in the room. In an attempt systematically to desensitize these autistic and schizophrenic children to gradual changes in their environment, it was decided that the tables, chairs, easels, and desks would be rearranged each morning in the children’s classroom. Additional teachers and therapists were on hand to handle the ensuing panic and anxiety in the children, which were immediately aroused when they entered the room.
The children were “contained” physically, held and reassured, and gradually their panic abated. Each day their anxiety eased somewhat and gradual changes were also made each day in the furnishings of the day-room in the cottage where the children lived. This program had the incidental effect of intruding into these patients’ fantasy world and, to some degree, decreased their autistic self-stimulatory behaviors. The significant feature in this experiment was the amount of anxiety and panic that was aroused in the children during the first few days. This phenomenon was evidence of the fact that rigidity and routines served the purpose of keeping the children’s anxiety and panic from becoming conscious or out of control. Similarly, neurotic patients often unknowingly adhere to strict schedules and daily routines in order to avoid anxiety. Routines offer a false sense of permanence and a feeling of certainty, yet their negative side effect is to deaden the individual as a feeling person.