性和身体虐待(otto Kernberg)
lechi01 作者: lechi01 / 2918次阅读 时间: 2016年8月13日

Incest as trauma has received much recent attention, and psychoanalytic study of its victims indeed illustrates the basic dynamic of internalization of an object relation dominated by hatred. In exploring these psychodynamics we have to keep in mind that the sadomasochistic component of sexual excitement permits the recruitment of aggression in the service of love. But this is a response that, when a sexual response is overwhelmed by rage and hatred, may be transformed into sexual sadomasochism in which love is recruited in the service of aggression. That is, sexual intercourse may become a symbolic gratification of sadomasochistic tendencies, replicating in the sexual area the interactions I have described in relationships dominated by hatred.


Not all sexual abuse is experienced as aggressive; unconscious infantile sexuality, the excitement, gratification, and triumph resulting from breaking oedipal barriers, and the guilt such triumph produces, complicate the psychological effects of sexual abuse. Nevertheless, the distortion of superego structures brought about when cross-generational (in particular, parent-child) incest occurs destroys the potential for integrating sadistic parental images into the superego. The conflict between sexual excitement and guilt is thus transformed into one between frail idealization and overwhelming aggression, creating a truly traumatic situation in which libidinal and aggressive strivings can no longer be differentiated. The unconscious identification with the victimizer and the victim may become confused. The repetition compulsion of incest victims who transform their later sexual life into a chain of traumatophilic experiences often makes it difficult to determine whether the patient was the victim or the victimizer.


In the clinical situation, such incest victims reactivate the identification wit the victim-victimizer dyad and unconsciously attempt to reproduce the traumati situation in order to undo it and to recover the ideal object behind th persecutor. In addition, the repetition compulsion expresses the desire for revenge the rationalization of hatred of the seducer, and the potential sexualizatio of the hatred in the form of efforts to seduce the seducer. The psychoanalytic treatment of incest victims who have had sexual experiences with forme therapists sometimes repeats these experiences with uncanny clarity. Unconsciou envy of the current therapist, not involved in the chaotic mixture of hatred and sexuality in which the patient experiences himself as hopelessly mired, is another source of negative therapeutic reactions.


Recent research by Paris (1994b) confirms the importance of a history of sexual abuse in patients with borderline personality disorder as well as their tendency toward dissociative reactions. Paris also points out that a predisposition to dissociative reactions does not seem to be secondary to sexual trauma. In clinical practice, both types of problems are seen together with some frequency. Some borderline patients present dissociative reactions in the form of amnesias, depersonalization states, and even multiple personalities, of which the patients are cognitively aware but which are affectively split.


What is often striking in such dissociative states is the patient’s remarkable indifference to what seems to be a dramatic psychopathological phenomenon: Indeed, some patients present an almost defiant affirmation of the “autonomy” of their split-off personalities while refusing to consider any personal responsibility for these phenomena. Often, the mutual dissociation of alternate personality states raises the question of why some apparently not incongruous personality states appear to be split from each other.


In my experience, when the clinician asks how the patient’s central personality, her sense of awareness, concern, and responsibility, relates to these split-off personality states, this immediately triggers a new development in the transference. Many patients develop a paranoid reaction to such inquiry; this evolves into a specific transference disposition in which the therapist appears as a persecutory figure in contrast to other persons in the patient’s life, including other therapists, who are idealized as helpful, tolerant, nonquestioning, admiring, and supportive. The patient’s alternate personality states take on more specific meanings in relation to such split object representations, permitting a clarification of the function of such split states in the transference. In short, approaching the patient from the position of an assumed observing, central, “categorical” self illuminates hidden splits in the transference and permits exploration of the unconscious dynamics involved in the split personality state that are obscured by the usual, apparently untroubled enactment of such states.


The patient now may be tempted to angrily accuse the therapist of not believing in the existence of his multiple personalities. The therapist’s concerned and neutral stand—being interested in the patient’s experience, not questioning its authenticity, but at the same time evaluating the implications for the patient’s central self-experience—gradually permits the patient to increase his self-observing function in contrast to the previous defensive denial of concern and what might be called blind enactment of dissociative states.


In severe personality disorders, the approach I have just outlined transforms what appears to be a dreamlike, often apparently affectless dramatization into a concrete object relation in which intense rage and hatred emerge, split off from other idealized object relations. Once the emergence of mutually split-off peak affect states in the context of split-off primitive object relations becomes evident in the transference, the intepretive integration of these developments may proceed.


This approach contrasts with a tendency on the part of some therapists to explore each dissociated personality state while respecting its split-off condition, bypassing the defensive denial of concern about this condition. I believe that such an approach tends to prolong the dissociative condition itself unnecessarily and may aggravate it.


When such dissociative reactions occur in the context of real or fantasied past incest or sexual abuse, a similar defensive denial of concern for the nature of the dissociative process may often be observed. Such a development contrasts markedly with cases in which, under psychoanalytic exploration, repressed memories of past sexual abuse, including incest, are uncovered, leading to a traumatic emotional reaction that colors the psychotherapeutic relationship for perhaps several months and is gradually worked through. In this latter case, characteristics of a post-traumatic stress syndrome may emerge in the psychotherapeutic relationship; the patient shows great concern for himself, intense ambivalence in relation to the abuser, and ambivalence regarding his own past and present sexuality. The elaboration of such a traumatic recovery of memory contrasts sharply with the long-term repetitive evocation of past traumatic sexual experiences in the context of a present-day expression of hatred, disgust, and revulsion linked to the patient’s sexual life in general or to all persons of the gender of the traumatizing agent.


In such cases, particularly when traumatic sexual memories appear repeatedly in the context of dissociative ego states, a characteristic lack of concern, denial, or dramatic indifference toward the dissociative process may also be present. The patient may insist on engaging the therapist as a “witness” or support figure in the struggle against a hated and feared sexual object. In the transference, the therapist may be identified with either the abusing object or a conspiratorial helper (for example, the “innocent bystander” mother, who, in subtle or not-so-subtle ways, protected an incestuous father).


Here again, the world seems to be split between those who side with the traumatizing object and those who support the patient’s wishes for a vengeful campaign against that object. Because of the current cultural concerns about sexual abuse, the patient’s split world of object relations may be rationalized in a conventional ideology that confirms and maintains his condition as a victim.


I have found it very helpful to ask the patient what keeps the hatred alive in his life and what its functions are in his current conflicts. When the fact of past sexual abuse is unclear, even in the patient’s mind, the patient may insistently demand the therapist’s confirmation of his suspicions. The therapist’s stance— that the patient’s experiences are real in their present quality and that the patient himself will eventually be able to clarify and gain understanding of and control over the internal past—often raises the same intensity of suspicion and rage in the transference as do attempts to clarify the relation between the patient’s central self-experience and a dissociative state. In other words, the patient may not be able to tolerate the therapist’s concerned but neutral position, which runs counter to the overriding need to divide the world into allies and enemies. The therapist’s consistent interpretation of the patient’s need to maintain such split relations will eventually, under optimal conditions, permit more specific focus on the enactment of the relationship between victimizer and victim, with frequent role reversals, in the transference. This permits analysis of the patient’s unconscious identification with the victimizer as well as with the victim role as the major dynamic that maintains the characterologically anchored hatred.


A positive consequence of such a therapeutic approach is the gradual liberation of the patient’s sexual life from its infiltration by unrecognized, unmetabolized hatred. The revulsion against sexuality in victims of early sexual abuse has many roots: The invasion of their psychic and physical boundaries is experienced as a violent attack; the transformation of a person in a parental function into a sexual abuser is experienced as sadistic treason, in addition to disorganizing the early buildup of an integrated if primitive superego. The reprojection of early persecutory superego precursors in the form of paranoid tendencies intensifies yet more the aggressive implications of a sexual attack and weakens the capacity for any trusting relationship.


Unconscious guilt arising from the activation of the patient’s own sexual impulses in the context of sexual seduction and abuse increases this revulsion against all sexuality and the temptation to reproject such guilt feelings, thus reinforcing the patient’s paranoid approach to sexual objects and repression of sexual wishes, fantasies, and experiences. If traumatized victims of concentration camps or torture have to reencounter awareness of their own sadistic tendencies as they discover their unconscious identification with both victim and victimizer, the victims of sexual abuse have to reencounter an awareness of their own sexuality in unconscious identification with both the self and the object of the traumatic experience. The treatment cannot be completed if such a reencounter has not been achieved. Stoller’s (1985) understanding of the nature of erotic excitement as an early fusion of sensuous experience and unconscious identification with an aggressive object—in other words, the erotic roots of polymorphous perverse sadomasochism—is relevant in this connection. At some point, a toned-down, tolerable sadomasochistic tendency should become available for retranslation into a language of erotic fantasies, opening up the polymorphous perverse component of adult genital sexuality.



——(摘自KERNBERGHatred as a Core Affect of Aggression》 朱一峰译)


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