Mucus, saliva, urine, and menstrual blood: on patients who evacuate bodily fluids in psychotherapy

ABSTRACT

Drawing upon his work with psychotic and disabled patients, the author explores the often shocking and, at times, nauseating ways in which extremely traumatised individuals will communicate through the evacuation of bodily fluids such as mucus, spittle, urine, menstrual blood and, even, semen and faeces. Richly illustrated with several clinical vignettes, the author proposes a four-stage model, outlining the ways in which each psychotherapist must survive his or her countertransferential reaction of stupefaction and then navigate towards a state of toleration. Subsequently, each practitioner must develop the capacity to formulate an interpretation of the unconscious meaning of bodily communication, while, ultimately, working towards an eventual psychological resolution.

KEYWORDS:

• Bodily fluids
• compulsive spitting
• disability psychotherapy
• forensic psychotherapy
• primitive bodily communication
• psychosis

Acknowledgements

I first presented a very rudimentary version of the concept of communicating via primitive bodily fluids to the “One Year Intermediate Course on Psychodynamic Work in Mental Handicap” (D-6) in the Child and Family Department of the Tavistock Clinic in Belsize Park, London, many years ago, on 6 February 1995, and then again on 22 January 1996, and on 17 May 1996, and, also, to the Tavistock Clinic Mental Handicap Workshop at the Tavistock Clinic in London on 16 June 1995, and, once more, on 10 November 1997. I then delivered a somewhat expanded version to the Open Meetings Programme of the Division of Psychiatry of Disability in the Department of Mental Health Sciences at St. George’s Hospital Medical School in the University of London, London, on 1 March 1995, and, subsequently, to the monthly Clinical Forum at the Institute for Self Analysis Centre for Attachment-Based Psychoanalytic Psychotherapy in London, on 8 July 1995. I later discussed this topic in a keynote address to the Special Interest Group on Learning Disabilities of the Division of Clinical Psychology of the British Psychological Society, at a conference in Abergavenny, in Wales, on 24 April 1996.

In more recent years, I have expanded upon this material, especially on the psychodynamics of spitting (e.g., Kahr, 2017, 2020), a topic which I have discussed on numerous occasions. I owe a particular debt of gratitude to Professor Joan Raphael-Leff, who chaired a very robust discussion of this topic at a meeting of the Anna Freud Centre Academic Faculty for Psychoanalytic Research at the Anna Freud Centre in Swiss Cottage, London, linked to University College London, at the University of London, in London, on 3 October 2017. I have also published more extensively about the case of “Steven” and upon the dynamics of mucosal smearing (e.g., Kahr, 2012). I wish to thank my old disability psychotherapy colleagues at the Tavistock Clinic and at other institutions for their helpful remarks, most especially, Ms. Katy Dearnley, Dr. Susanne Griffin, Dr. Valerie Sinason, Mrs. Judy Townley, and Mrs. Judith Usiskin. Likewise, I owe a profound debt of thanks to my forensic psychotherapy colleagues, most particularly Dr. Carine Minne and Profesora Estela Welldon, and to all of the members of the International Association for Forensic Psychotherapy, who have encouraged me generously over the decades.

I extend my very grateful thanks to Professor Helen Payne and to Ms. Anna Fiona Keogh for their kind facilitation of the publication of this essay.

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No potential conflict of interest was reported by the author(s).

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Brett Kahr

Professor Brett Kahr is Senior Fellow at the Tavistock Institute of Medical Psychology in London and, also, Visiting Professor of Psychoanalysis and Mental Health at Regent’s University London. He is Honorary Director of Research at the Freud Museum London and the author of sixteen books, including, most recently, Freud’s Pandemics: Surviving Global War, Spanish Flu, and the Nazis. He works with individuals and couples in Central London and is Consultant Psychotherapist at The Balint Consultancy.