On the family dynamics of the prohibition to talk in a borderline patient
Andreas von Wallenberg-Pachaly
In his paper, the author presents the silence, the central mode of communication of a borderline patient, as understandable from the specific family dynamics and examines their different influence on the ego and identity development of his patient and his autistic brother. On the basis of detailed anamnestic data, he gives an overview of the family dynamics of the language prohibition and discusses the importance of a partially available constructive object relationship for the development of a borderline structure in contrast to an autistic structure.
The combined individual and group therapy proved to be an effective therapeutic instrument to handle archaic fears therapeutically by splitting the therapeutic situation by offering the patient a setting that corresponds to his original situation.
The author examines the different qualities of silence and points out that the silence of this borderline patient, whose basic difficulty was to step out of a state of arrested symbiosis, results from a deprivation actually suffered by a sick primary group and not from an internalized conflict carried out between different instances.
To enable the patient to catch up in ego development, it was necessary to offer a wide range of therapeutic situations, including individual, group and milieu therapy.
In my paper I would like to present the silence, the central mode of communication of a borderline patient, as understandable from the specific family dynamics and examine their different influence on the development of ego and identity of my patient and his brother.
I had at my disposal information from a one-year psychoanalytic individual and group therapy with the patient, several anamnestic conversations with him, a questionnaire completed by the patient and a curriculum vitae written by him as well as psychiatric anamnesis, neurological and internal examinations of his autistic brother.
The 26 year old patient, Mr. S., sought therapy from me after his group therapy, which had already lasted three years, was abruptly interrupted by the therapist and the group “because it was too passive and silent”. as Mr. S. reported, had been dissolved. During these three years, Mr. S. sat in the group mostly in silence, and the superficial, friendly aggression-resisting group atmosphere – the therapist had educated all group members – had made him feel tolerated. He reacted very depressively to the literal exclusion from the therapy, his real anger about it he could only perceive and express much later.
He experienced the first session in his new therapy group so devouring and destructive that he ran out of the room in fear. I then decided to take him to an accompanying individual therapy because I had the feeling that the patient did not feel up to the group alone. During the next months the patient increasingly experienced me as a friendly support in the individual therapy, while he experienced the group and especially my co-therapist as hostile and very demanding.
In the group I always got the feeling that I had to protect him from the group as well as from my co-therapist. The patient himself behaved during the first months of the group increasingly autistic towards the group, refused to pay his fee, write minutes and almost never spoke. The patient experienced now his original primary situation again, in which he was at the mercy of a rigid, rejecting and at the same time very demanding mother, who could tolerate her children only as almost dead, which he experienced now in the group and particularly my co-therapist opposite. The group took over the honorarium payments and protocol writing for him on his behalf and accepted, although they were aware of the aggressive part of his behavior, his incapability. She behaved as reserved towards him in the countertransference as he had behaved towards his mother ;the group feared he could run away as Mr. S. had feared from his mother.
While Mr. S. had become increasingly autistic in the group and practiced active non-existence through his silence and his refusal to pay and write minutes, he increasingly thawed in his individual therapy. He split the group situation as a threateningly aggressive one away from the two-way situation in which he felt increasingly understood and accepted. His session usually began with a long silence that was on the threshold between provoked contact termination and feared contact loss.
In contrast to his predominantly provocative silence in the group, however, the anxious aspects predominated here; every word could hurt me, he thought to be an unreasonable patient for me, and seeks in his silence, not daring to look at me, to fearfully maintain contact with me. Only when I broke the spell and spoke to him could he talk about his inability to know whether his feelings were real or imagined, about his constant paranoid fears of being totally conformed or branded as totally antisocial, and about his great guilt for differentiating himself from his mother and partner. At that time the patient lived together with his partner who was anxiously clinging to him and at the same time mothering, he had already interrupted his studies for 5 years, and was briefly able to carry out casual work. Otherwise, he lived on his father’s financial support, dawdling and dreaming every day, believing that he could protect himself from the rapist demands of society.
The patient’s mother, his most important caregiver, was a steadily depressed woman who had no joy at all and divorced her husband when Mr. S. was eight years old. Their predominant feelings of life were embarrassment, anxiety and apathy. She was embarrassed, her son, Mr. S. to present a birthday present. Instead, she put it on a chest of drawers so that he had to casually ask her what it was. She never spoke of her feelings and her son never asked her about his . Two years passed until she once asked him about the course of his studies. In former times Mr. S. often experienced that when he confronted her with something, she ran out of the room. Mr. S., who until the age of 8 had slept on the bedridden between father and mother and until the age of 16 on a mattress next to his mother’s bed, spent most of his time with his mother in silence, often in front of the television. But while Mrs. S. experienced any direct emotional pronunciation by her son as an intolerable imposition, she reacted to his wish, when he was 22 years old, to look for his own room, deeply offended. “He didn’t like it with her anymore?” Mr. S. was so guilty of separating himself from her that he visited her daily for years to sit silently with her in front of the television.
The inability of Ms. S. to enter into a direct real relationship also expressed itself in relation to her husband, with whom she could never live together for a longer period of time.
Mr. S.’s father was hospitalized for a long time when the patient was four years old because of a paranoid schizophrenic reaction. His relationship with Mr. S. was marked both by mistrust – Mr. S. always had to present the bills after errands for the father in order to prove that he had not retained any money – and by idealization – he wanted his son to study medicine, which Mr. S. did without success for two years. Mr. S. himself was always afraid of his father to be persecuted and punished by him. He remembered hiding from him under the kitchen table. On the other hand, he felt abandoned by him because he was not understood but abused to fulfill his grandiose ideas. For several years Mr. S. could neither confess his therapy nor his unused studies, because he feared to be rejected and deprived of his financial support. With his antisocial behavior, which included his inability to study, work or pay fees, and his continued financial dependence, he also expressed his anger towards his father.
Although both parents superficially functioned in our society as typists or engineers, it would be expected that Mr. S. would have reacted either schizophrenically or autistically in such a climate of mistrust, depression and abandonment.
Another reference person was his grandmother on his father’s side, a warm, good-natured woman who accepted Mr. S. heartily. He lived with his mother until the age of 2 on the farm of this grandmother and spent the following time several months a year with her. The time there reminds Mr. S. as the most beautiful time of his life. He remembered this grandmother as a natural farmer’s wife who had time for him and on whose lap he was allowed to sit and ride. With her he felt himself escaped from the grey gloomy spell of his mother, the liveliness and kindness of this woman let him revive. When Mr. S. was 12 years old, his grandmother died. At that time he was very sad for a long time and had to repeat the school year. Today, Mr. S. yearns again and again for a relationship like the one he had with his grandmother. Someone who’s alive and warm and gives him life.
In contrast to him, his autistic brother had this life-saving relationship with his grandmother for only a few months. This only friendly relationship to a human being, experienced by the patient in his earliest childhood, enabled him to perceive me as supportive and to build up a beginning trust.
In the following I will briefly present the life story of the 3 years older autistic brother of Mr. S. . His brother could talk with 2 years dad, mom and some other words. With 4 years he spoke better, however clearly worse than age-appropriately would have been to be expected. When he was 6 years old, he stopped talking completely. An external cause was not reported. His lack of speech development was accompanied by stereotypical movements and a tendency to self-damage, such as hitting his head on the wall. He also laughed unmotivatedly, grimacing and giving psychiatric observers the impression of hallucinating. His hearing was normal. Neurologically and physically no findings were available despite intensive examination. The mother lived with Mr. S.’s brother only ½ year on the farm with her mother-in-law and then settled for 2 years over in another town where she lived together with her own mother. Only at the birth of Mr. S. she went again to her mother-in-law, in order to move then after 2 years with her two children to Munich. I see this in connection with the development of object relationships postulated by R.Spitz. In the period from the 6th to the 8th month of life he establishes the emergence of the child’s ability to distinguish between inanimate and animate environment and connects with it the emerging occupation of the libidinal object. Leaving the child through the libidinal object in this time makes it impossible for the child to further differentiate the object world and to create a self-presentation. I would also like to point out the supporting function of the mother-in-law for the mother.
When Mrs. S. had moved to Munich with her two children, where her husband had already worked for a long time, Mrs. S.’s mother also moved to Munich and lived with the family. Shortly after, Mr. S.’s brother stopped speaking, and a few months later his father reacted severely paranoid psychotic.
The mother’s relationship with her autistic son is evident from the following behaviour: she has a transistor radio, which she always brings with her when she visits him in the home. During the walks she turns it on and lets the music play. The brother of Mr. S. becomes very alive, rejoices enormously and dances also often. At the end of the visit, she takes the radio back with her and shuts down her child. She has never thought of leaving this radio to him, since he can’t operate it after all and would probably only break it. However, Mrs. S. only takes the radio with her if her non-autistic son, Mr. S., does not accompany her. Because if he comes along, with his rigid behavior he takes on the role of the cold, distance-creating person who allows her to enter into a symbiosis with his completely boundless autistic brother.
A role reversal takes place during the frequent visits of my patient to his mother, when both sit silently in front of the distance-creating television and he now as the autistic is allowed to enter the symbiosis with his mother.
In the following I will return once again to the manifestations of the silence of Mr. S. in the therapeutic process and present the communicative aspect of this acquired deficit in a differentiated way. What impressed me most was that Mr. S., through his silence, allowed both me and the whole group to take over the role of the toddler at the beginning of the therapy, who did not dare to address his mother, to approach her physically, since it had to fear that she would not endure it and run away and also not make any demands of her, in order not to totally overtax her. In this perverse restoration of the mother-child relationship within the psychoanalytic relationship, provoked by his injured silence where he was his mother, I experienced the need to treat him so gently and gently, as so helpless and weak, coupled with a claim on me to protect him and leave him alone. This was opposed by his aggressively refusing silence of incompetence as an expression of his consistently passive, antisocial attitude. In this negative identity, (Erikson , 1956 ; Winnicott , 1958 ) in which he defined himself by what he is not and does not do – like work, study and pay fees – he aroused strong aggressive feelings in me, although I must emphasize that Mr. S. could not be openly aggressive in any way at first. Besides these two aspects, however, his silence had a profound symbiotic character, whereby the boundary between him and me was abolished and a unity was established in which he on the one hand remained anxiously silent in order not to be hurt, in which he on the other hand felt comfortably secure.
After 7 months of therapy, Mr. S. hesitantly told me about his intense death wishes, which he had had when he was ten years old, for the first time in the first session after the Christmas holidays. I felt strong fear, which corresponded to the fear of my patient of self loss, which he longed for and feared at the same time. His desire to die expressed the longing for symbiotic oneness with his mother, which he had never experienced as a child and which he could only imagine in his death. Then he told me the following dream :
“He stands on the edge of a deep dark shaft into which all his group members have already jumped. I stand next to him and encourage him to jump too. There’s a rope in the shaft.” This dream clearly expresses the profound ambivalence of the patient. On the one hand I stand beside him and support him, on the other hand I encourage him to go into the rejecting devouring symbiosis with his mother in the deep, dark shaft. This ambivalence also shapes the patient’s relationship with his therapy group; on the one hand, he wants to be with it, on the other hand, he perceives it as hostile and devouring.
This dream, which Mr. S. interpreted as the decisive turning point of his therapy, at which he had to decide whether to confess his therapy or not, also reflected the prenatal deficiency he had experienced in a hostilely rejecting uterus, in which he was trapped with a torn umbilical cord. My fear for him gave way after he had told this dream, a feeling of confidence, because he gave me in his dream to understand that he could dare with my support to enter the prenatal symbiosis with the group, which he at that time still experienced as a rejecting uterus (Graber, 1975).
In the following months it was in the individual therapy also again and again about whether he could trust me or whether I would not put him one day also in front of the door and whether I am actually interested in him. To the extent that his confidence in me increased, he was able to express his fear and hostile feelings to the group and especially to my co-therapist.
Half a year later, after he had told me the dream, he brought a picture spontaneously painted with his fingers in the morning into his individual therapy. He had painted this picture after two days in which he had felt very sad, depressed and worthless because he had been rejected by a girl he had been interested in. In this picture, which he described as a universe in which he floated around space- and timelessly, he expressed his longing for a symbiosis, but a symbiosis that he could now imagine as friendly, in contrast to the dream described above. Behind my joy about this beautiful gift, which Mr. S. had made me with this picture, I felt however also the urge to keep it for me and to withhold it from the group and my co-therapist. Through the analysis of my counter-transference feelings I became aware, however, that he hoped from me the permission to be allowed to go into the lap of the mother group, which for him gradually protected and nourishing character got. Only if I allowed him, unlike his grandmother, to go back to the mother and feel there, in dual unity with the group, as a beloved child, would he be able to have an emotionally corrective and restorative experience. He experienced me as a resting, firm pole, according to the center of the picture center.
In the following weeks, the patient was able for the first time to speak openly to his mother and not only to distance himself aggressively from her, but also to distance himself from his girlfriend, with whom he had repeated the destructive symbiosis with his mother. The work in a three-week milieu-therapeutic group, which supported him through concrete joint work and the communication taking place mostly through a third object, also helped him to overcome his fear of being devoured and destroyed and to perceive it in the friendly reality of a group supporting him.
In my lecture I explained the genesis of my silent patient from the specific object relationships and their deficits in his primary group. I wanted to show that the silence of this borderline patient, whose basic difficulty is to step out of the state of non-existence of an arrested symbiosis, to overcome his almost all-encompassing fear of existence and to become identical with himself, results from a deprivation actually suffered by a sick primary group and not from an internalized conflict carried out between different psychological instances. The specific property of borderline structures to have certain ego functions at their disposal, such as intellectualization in order to establish partially stable object relations, and which is based on the fact that their primary reference persons within this sphere were able to communicate with them without conflict, is also found in Mr. S. . Modified, however, to the effect that he is a largely conflict-free, but completely split-off experienced object relationship – the one to his grandmother – so that the division of the ego experienced within an object relationship really occurred between different objects.
The combined individual and group therapy proved to be an effective therapeutic instrument to handle the archaic fears expressed in prenatal fantasies therapeutically by splitting the therapeutic situation by offering the patient a setting that corresponds to his original primary situation.
Ammon has shown that the therapeutic group can have protective uterine functions and is just the prerequisite for therapeutic work with archaic ego patients. “By allowing, as Ammon (1974) wrote, “through the protection it offers, the safe opening of the ego-boundaries and thus the access to the unconscious, she makes it possible to find again the continuity of the process of life interrupted by pathological aberrations and to redesign it in the course of therapeutic work”. The setting of the combined individual and group therapy enabled the therapeutic handling of the attempt to delimit a residual identity established by the patient at an early age.
In addition to the lack of relationship with the mother, who had never accepted him as a child, the patient had for a short time experienced the experience of friendly acceptance by his grandmother.
Using the example of his older, completely autistic brother, however, he had experienced the direct relationship with his mother combined with a total ban on identity. His brother has been vegetating for decades in complete speechlessness, fat and immobile in an institution.
The therapeutic examination of the patient, first with his experience of the group as a hostile uterus destroying him, in which I supported him and as a result of which he could imagine a warm and friendly group, to which he was still afraid to make contact, as well as the friendly mother group perceived in the following milieu therapy as a real life situation, made it possible for the patient to step out of his silence in the course of a catching up ego development and thus already a beginning of coping with his archaic fears of ego loss. To make this possible, it had been necessary to offer a wide range of therapeutic situations, including individual, group and milieu therapy.
Summary
On the Family Dynamics of the Interdiction of Language in a Borderline Patient
Andreas von Wallenberg-Pachaly
The author discusses silence, the central mode of communication of a borderline patient he had in therapy. He finds his silence intelligible on the base of the understanding of the patient’s specific family dynamics. The author also examines the different influence of the family dynamics on ego- and identity-development of the patient and his autistic elder brother . On the base of vaious anamnestic and therapy data he gives a detailed outline of the patient’s family dynamics .
The mother had warded off all liveliness of her children as an existentialk threat to her . She could enter into symbiosis with them only if they kept silent and were dead-like . Her extreme fear of aggressive feelings permitted no constructive carrying out of interpersonal conflicts . The patient’s father reacted several times with manifest paranoid schizophrenic reactions and was mostly suspicious towards him . Only because of the presence of the father’s mother , who warmly accepted him and his mother , and with whom he had lived together with his mother during his first couple of years the patient didn’t react autistically . To his autistic brother this supportive , accepting grandmother had not been available , and consequently he had not been able to develop the defence mechanism of splitting .
Combined individual and group psychotherapy proved to be an effective therapeutic instrument. For , by splitting the therapeutic situation the even in prenatal phantasies expressed archaic fears could be therapeutically handled , because the patient had been offered a setting corresponding to his original situation in his primary group .
In the reproduction of the language taboo during the therapeutic process three qualities of the patient’s silence became manifest . In the perversly reversed reproduction of the mother-child-relationship in the therapeutic relationship the patient was silent , injured and helpless , demanding from his therapist to protect him and to be left alone . Opposit to this was his aggressive , refusing silencs of not being able able , as an expression of his negative identity , which was defined by what he was not . Above this his silence still had a profound symbiotic quality , a silence that dilluded the demarcation between him and his therapist and created a union in which he anxiously persisted , so that he would not be harmed nor left alone , but where he also felt savely sheltered .
The author outlines that the silence of this patient , whose prime difficulty was to step out of an arrested symbiosis had resulted from a relly suffered deprivation through his disturbed primary group , and not from some internalized conflict between various psychic instances .
The therapeutic confrontation and working through of his way of experiencing the therapeutic group as a hostile destructive womb , where only his individual psychotherapist supported him , resulted in perception of a warm and friendly group , with which he could take up relations , but still was afraid of . The following milieu therapy , where he experienced a friendly mother-group as a real living situation , enabled the patient in the course of a reparative ego-development to step out of ego-loss . To make it possible for the patient to experience this ego-development , it had been necessary to offer the patient a broad scale of therapeutic situations , including individual , group and milieu therapy .