Ms. R. functioned capably as a mother, homemaker, community leader,
and nurse until the death of one of her children. She became depressed and
was hospitalized. In the hospital, the physician became interested in her case
and provided daily psychotherapy sessions during which her history of severe
sexual abuse by an incestuous father and uncle, not forgotten but sup(p. 179)
pressed until now, was elicited. The patient was encouraged to relive her
painful experiences and soon experienced dissociated states in which she
had different names. At the same time, Ms. R. deteriorated into a state of
implacable self-destructiveness and developed the conviction that she was
intrinsically evil. "These terrible things would not have happened to me,"
she said, "if I had not been an evil child." Intensive encouragement to reveal
the humiliating and rage-infused details of her childhood experience
constituted a retraumatization that overwhelmed her previously effective,
if fragile, defenses.
à ce qu'il semble, il y a une faute ici: on saurait attendre une approche semblable à celle dont on trait une détérioration de l'état subjectif en effet de la transformation of the psychopathical transference to the paranoid transference, that is, as something positive (a stage in the normal way of the theraphy), but, then, of course, there was a need to switch to the treatment of DID. But this school doesn't recognize such things...
Cross-generational incest prevents the integration of parental prohibitions
and punishments and rewards into a reliable system of moral and ethical
values, leaving the child to be guided by superego structures that are
both cruel and lax: the child experiences the world as morally chaotic and (p. 182)
unpredictable, and herself as intrinsically bad. These views are often reinforced
explicitly by the traumatizing adult. Unable to make accurate judgments
regarding the parent's behavior, the child cannot work through the
sexually traumatic experience toward a coherent sense of self and a firm assignment
of responsibility to the exploitive adult. Instead, these patients
rigidly maintain mutually contradictor}' internalized object relations in the
service of conserving whatever "good" aspects of the incestuous object can
be retained, while holding off the traumatic aspects: splitting and identity
diffusion protect against the intolerable anxiety of living in a state of hatred,
danger, and chaos.
Eating disorders are common among patients who were sexually abused in
childhood. Patterns of intense overeating in an attempt at self-soothing
may alternate with induced vomiting and purging in response to feelings of
self-loathing. Obesity as a form of destruction of sexual attractiveness is
very common among victims of incest; weight reduction stirs intense anxi(p.184)ety in these patients. Symptoms of choking or of revulsion toward food or
liquids are often reflections of early oral sexual assaults or of punishments
involving force-feeding or starvation in childhood.
The extent to which sexuality has been welcomed and enjoyed may have
important prognostic and diagnostic implications. Borderline patients who
have a capacity for sexual pleasure tend to respond more favorably to psychotherapy.
In cases of sexual anesthesia or discomfort, it is important to
differentiate dissociation or extreme repression from other possible causes.
Patients who completely lack the capacity for sexual enjoyment, whose
lives are devoid of any sexual activity, fantasies, or wishes, may well be
those most impaired and most difficult to treat. Severe sexual disturbances
can contribute to binge eating as a means of obtaining pleasure while also
fending off potential sexual partners by maintaining obesity.