Fear and Shame in an Israeli Psychoanalyst and His Patient: Lessons Learned in Times of War

Abstract

Living in the midst of a war presents unique challenges to ongoing psychotherapeutic treatment. This paper focuses on the ever-present threat of fracture to the analytic frame and the limited ability of the therapist to create a safe, insulated environment— a reliable container—in which to work, while coping with a violent external reality. Using an intrapsychic lens, as well as an interpersonal one, the dynamics of both the analyst's and the patient's fear and shame are brought into focus. This delicate balance is illustrated through two cases: one occurring during the First Gulf War (1991) and the second taking place during the Second Lebanon War (2006). In both cases, fear and shame cause a stalemate in the psychotherapeutic process. The analyst recalls his active duty as a soldier during the Yom Kippur War (1973). These memories and their attendant acknowledgement of fear and shame by the analyst, as well as his analysand's “supervisory” comments, gradually dissolve the knot and repair the rupture in the analytic process. The ability to fully experience fear, shame, and helplessness is at the core of psychic health, a health once destroyed by dissociation and denial of these feelings. This ability to experience fear and shame is the psyche's antidote to mental breakdown. Following discussion of the two case studies, this paper seeks to illustrate how the very structure of a society, in this case Israel, can codify societal defense mechanisms against emotions like fear and shame, exacerbating the very problems it seeks to assuage.

Notes

This paper began as a short note, written during the second Israeli war in Lebanon (July 12–August 14, 2006).We are grateful to Owen Renik and Stephen Seligman, Psychoanalytic Dialogues' editors, for inviting us to develop this short note into an article, as well as for their insightful comments and suggestions. We also wish to express our gratitude to Philip Bromberg, Patrick Casement, Dodi Goldman, James Grostein, Danielle Knafo, Joyce Slochower, and Nina Thomas, for reading earlier versions of this paper and offering their valuable comments.

¹This is the first, but definitely not the last, time that we touch upon the feeling of shame in this article, and we are reminded here of Nietzsche's (1966) deep wisdom: “I did that,” says my memory. “I could not have done that,” says my pride, and remains inexorable. Eventually—the memory yields” (Beyond Good and Evil, Aphorism 68). Out of therapeutic experience, and using the writings of Ferenczi, Fairbairn, Sullivan, Balint, Winnicott, and Kohut, psychoanalysis was able to recognize the importance of the external reality and the impact of external traumas on development. There are vital psychic events that cannot be fully explained and conceptualized as results of intrapsychic complexes and conflicts. In recent years, we have learned from the Relational School and the Self Psychology School that the sharp distinction between the internal and external realities is a false dichotomy: the two are integrated and co-constructed, creating one combined fabric.

²Because of Michael's very personal experience, the two case studies are presented in the first person. One of my patients at that time was a middle-aged woman named Shirley, who had been in therapy with me for 2 years. Shirley, a difficult- to-reach patient, was not interested in talking about the war, as if it were not really happening. She was very preoccupied with telling me about a conflict she had had with some of her friends at work, relating a quarrel she had had with her mother, and complaining about her doctor (GP) who was not attentive enough to her complaints about her sore throat. She said that she was practically mute and that he did not help her. I remember thinking that this doctor who did not listen to her was, in the transference, probably me. I should have tried to help her find her “voice” since she was “mute,” but my ability to fulfill this role as her therapist was compromised because of how the war was affecting me.

³For the opposite position, see Melanie Klein's (1961) Narrative of a Child Analysis, where she talks about her analysis of a young child during World War II where she analyzed the patient when bombs were dropping not too far from where she lived. Klein leaves the reader with the impression that itwas business as usual as far as her psychotherapy with the child was concerned, as though external reality did not exist.

⁴See Sullivan (1953).

⁵See Bromberg (2006), especially chapter 9

⁶ Bass (2007).

⁷ Aron (2006); Benjamin (2004).

⁸“… the wish to wipe out the unbearable sense of mortification and nameless shame imposed by the ultimate recognition of a failure of all-encompassing magnitude” (Kohut, 1977, p. 241).

⁹Aristotle in the Nicomachean Ethics says, “Shame is the mental picture of disgrace in which we shrink from the disgrace itself and both from its consequences.”

¹⁰When I shared this paper with Ron, he wrote a few comments, and some of them were surprising to me. I thought I would pass some of them on to the reader—Regarding the issue at hand: Ron wrote, “My mother recalls from the first day of the LebanonWar, when we were living in the North, I was six and my brother was four, I woke up from the sounds of the bombing, took my brother out, and we roamed the streets alone during the early hours of the morning. I have no recollection on this.” Interestingly enough, this was never brought up in our sessions, and Ron has never told me this story.

¹¹Because of Michael's very personal experience, the two case studies are presented in the first person.

¹²For further elaboration, see Shoshani (2010).

¹³Ron was rejected and boycotted aggressively by all of his classmates, and by all of the other schoolchildren, because he urinated in his pants and would pick his nose and eat the “boogers,” along with other disgusting habits.

¹⁴Ron's second comment on this paper was the following: “I think you should include the metaphor that you used in that specific session when we discussed the issue at hand. I remember that you said that I should try to compare a solid, unbendable road to a road made of steel, but capable of bending. I remember it very vividly because it hit home for me back then, and it still does.”

¹⁵Another comment in Ron's letter to me: ‘“The more Ron could experience his imperfection …’ I think that is wrong. I think the more I could experience your humanity and imperfections, the better I could take a look at my own.”

¹⁶I am grateful to Benjamin Kilborne, Ph.D., for introducing me to this moving quotation in his article “The Importance of Shame in Clinical Work” (Kilborne, 2007).

¹⁷We, the authors, made the decision that as long as we were “in” the clinical examples that were taken from Michael's practice that we would refer to Michael in the first person. We are now changing the perspective to the third person since we are no longer “in the sessions” but discussing them and these discussions represent the opinions of all three authors.

¹⁸Here are some of Grotstein's illuminating remarks on the earlier version of this paper during the war itself. The remarks have to do with fear and defenses against feeling fear: “Bion talks about those who cannot suffer pain must endure it (namelessly as beta-elements) I think that is what you are talking about. Your patient was in a state of negative K (-K). You were absolutely right in asserting that we must be able to accept experience and acknowledge our weaknesses in order for our strengths to be effectively summoned. The two men you talked about in your platoon which was ambushed, are prime examples of what Klein calls the ‘manic defense.’ A triumph, an imaginary, omnipotent fantasy in which they show triumph contempt and control over the objects they depend on, and also over the depended infant who depends on this object. I think you‘re right about the concept of ‘unfelt experienced’…From one standpoint, psychoanalysis has as it's main purpose to complete those experiences we‘ve had that were left uncompleted because we didn't feel strong enough or our objects didn't feel strong enough to contain us. Bion first came up with concept of container/contained—then alpha function—and then dreaming. We suffer from unsuccessful dreaming. Every event must be dreamed in order to become normally unconscious or to be able to become conscious as well. If we cannot dream the event becomes a beta-element that nags at us from a psychic retreat or pathological organization” (J. Grotstein, personal communication, 2006).

¹⁹We are grateful to Moshe Halevi Spero for introducing me to this beautiful and illuminating story.

²⁰Grotstein (personal communication, 2007) commented that this story a marvelous exemplification of Bion's concept of Transformation in O.

²¹See Fonagy&Target's (2007) A Theory of External Reality Rooted in Intersubjectivity.

²² Symington (2006) and Alvarez (1992) expressed similar ideas in their writing.

²³We thank our editor, Stephen Seligman, for his insightful comments which pointed us in this direction.

²⁴In the context, see Vanik Volkan's illuminating discussion of his concept of chosen trauma (Volkan, 2009).

²⁵In the last decade, although gradual, a significant change has started to occur. The Israeli society has started to enable and legitimize the working through of the mourning of the survivors of the Holocaust.