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Cronos and his Children

 Envy and Reparation

 Mary Ashwin

[ Contents |Introduction |Chapter: 1 | 2 | 3 | 4 | Conclusion | References ]

Chapter 4: Envy in Psychotherapy Sessions

Much has been written about the difficulties encountered in the treatment of the envious patient. It seems reasonable to expect that those seeking psychotherapeutic help are experiencing some emotional problems at the very least. It is not usual for someone to enter into the arduous and painful process without good reason. I assume that most people who come to us will have had disrupting and dislocating early experiences, though the impulse that brings them through the door may have been their difficulty with coming to terms with a recent occurrence. Theologians, philosophers, sociologists and psychotherapists agree that envy is part and parcel of being human, and psychological investigation leads us to understand that, as a result of infantile experiences, envy can become not just an apparently distasteful but useful attribute, but also a force that is corrosive, destructive and vindictive in its attack on the self and others. Therefore, it seems to me, problematic envy will be lurking somewhere in the psyche of practically all of our patients. I am aware that when one is immersed in a subject there is the tendency to see it everywhere; that can be due to an acute sensitivity to its presence however disguised, or it can be plain slanted vision.

 

Envy between Patient and Therapist

The relationship between patient and therapist is based on the agreed assumption that the patient has problems and needs to understand themselves more fully, and the therapist is there to help in that process. Diverse orientations and models will have differences in the language, inter-relationships, expectations of length of treatment, even the expected or hoped-for outcome. Nevertheless, from Rogerian counselling to the most austere psychoanalysis, the expectation is that there will be change for the better and the therapist will have been instrumental in that process. So the patient, however successful in some areas, is acknowledging there is an need, a deficit, a sore place, an obstruction in a part of their life and they cannot 'fix' it on their own.

   What I am labouring to say is that the reason patients come into therapy is because of a disturbed  relationship somewhere in their lives, and they come into a relationship that is  bound to reflect those disturbances. If my assumption that envy is smouldering at the base of the disturbances is correct, the patient is, ipso facto, going to be envious of the therapist, because the patient is the patient and the therapist is the therapist which will emerge in the transference. Of course there will be enormous variations in the depth of envy.

   Not only does the patient have to admit a need  for help, which can be enormously hard for those with a narcissistic dread of dependence, but the help is, necessarily, coming from someone who will be viewed by the patient as sane and healthy, integrated and successful; they have the very attributes the patient lacks and hopes to gain. Or perhaps they lack consciously but are in the shadow and are projected onto the therapist.  Of course perceiving the therapist in this light is a basis for emulation and admiration but in the steamy swamps of exploration into the deeper areas of one's understanding of oneself I think the relationship will be suffused with envy.1 Etchegoyen (1991) does not appear to allow for this existential envy. He suggests that envy only appears if the analyst is precise in his interpretations.  'It is worth pointing out as a self-evident truth that if an analyst does not work with sufficient accuracy envy does not appear and has no reason to appear!'(p.744)

   Jung writes about a patient's envy of him in a 1910 paper, 'The Significance of Number in Dreams' where he uncovered an apparently unconscious envy in his patient by working on the number symbolism in his dreams.2 Jung's wife had recently given birth to another child which meant he outdid his patient in the procreation stakes by two to four. The patient then included the time his wife had been pregnant with three still births and two miscarriages.  Jung's interest in the number game seems to have blinded him to the tragic implications in this; the patient 'wins', but it is the victory of death over life.  Sometimes the need of patients to score a victory over their therapists leads to a refusal to allow the therapist a success  - the patient's health and happiness - a somewhat pyrrhic victory.

   Williams (1972) and Ulanov (1983) write of the resistance to improving health, the determination not to 'put a feather in the analyst's professional cap' (Ulanov,1983:31), as a manifestation of the patient's envy of the analyst. Boris (1994) suggests that as the envious attempt to abort or  obliterate any relationship, the truly envious do not seek psychoanalysis but will try self-help measures. If they do  turn to others they will find 'practitioners, who out of their own envy, do not take human complexities seriously - so cannot take themselves seriously' (p. xvii). He writes of the unwilling envy and admiration elicited from the analyst for the patient who, with reckless disregard for their own chance of a fuller life, attacks the understanding the analyst offers and spitefully attempts to destroy the whole process.

   The traffic, however, is not one way; the therapist can envy the patient, though few admit it. Searles (1979) describes his work with a schizophrenic man over nine years. He says that progress only occurred when he brought in to consciousness his own intense envy of the patient's inherited millions and the indulgent life that afforded him.  He also cites a desperately ill woman who, helped through his labours,  began to improve; then she assumed a huge stature in his mind. He was  envious of her expansion and the superior social position she had and saw himself as insignificant and puny, not having contributed anything to her blossoming health (pp,490, 496).

   In the paper 'On Envy and How to Interpret It' Etchegoyen et al. describe the case of a frigid woman who, thanks to her analysis, formed a relationship and got married.  However, she then complained in sessions of the minutiae of life and its problems which 'everyone faces' and the analyst was tempted to  react with reproachful interpretations.  Now their understanding of this was that envy was 'projected into the analyst himself' and 'if not aware of what is going on, the analyst may act out the conflict  provoked in him by projective identification' (1987:53).  

   Mitrani (1993), in an illuminating paper,  notes that the argument about impasse either in the development of the patient or the analytic process is usually attributed to the patient's shortcomings and innate predispositions, among which is primary envy. She adds a new dimension to the usual debate on 'what is  the patient doing - or not doing' by asking whether it is not analysts ourselves who are suffering a form  of deficiency.  We suffer from insufficient experience and need our patients' material to act as food for thought about the patient. She says,

            Are not those experiences that the patient grants us, in the transference-countertransference interaction, a sine qua non of our creative interpretive interventions?  It seems to me that without the patient's experiences we cannot survive professionally.  We are dependent upon the patient, not only to practise our chosen occupation but also so that we may expand upon our theories and thus grow as a discipline (p. 690).

She goes on to  suggest that the analyst's envious feeling towards the patient as sole owner of the experiences we need in order to do our work, can be such that we project our ignorance onto the patient so  as to get rid of the unbearable state of 'not knowing'. In this way we may render the patient lacking in experience while re-establishing ourselves as those 'who have it all' and therefore 'have it all to give'; thus we construct ourselves as the primary source of knowledge. She posits that in sustaining this position we then rely too heavily on theories and superimpose them on the patient  rather than allowing a truth about the patient and ourselves emerge. 

   This state  of unknowing and allowing is difficult and anxiety provoking. It feels so much safer to think 'Aha, that's it, now I know' and label the material and the patient neatly if only for a while.  Bion's injunction to enter each session 'without memory or  desire' is so well  known as to be almost cliched; except, of course, that although it sounds so simple, it is frightening, difficult and challenging to attempt.  He writes that by excluding memory and desire, and he recognises how anxiety inducing this is, the therapist's  interpretations '... should gain in force and conviction - both for himself and his patient  - because they derive from emotional experiences with a unique individual and not from generalized theories imperfectly "remembered"'(Bion,1967:19).

   Treating the patient who is deeply envious is notoriously fraught. Envy is complex, with many strata and often heavily defended.  The advice on how help the individual how to reach an understanding of their inner machinations is  as varied as the emotion is multi-faceted.

 

 

Introjection

The infant wants to own the breast, that it is not his and not his to control gives rise to extremely painful feelings which manifest in the sadistic attack on the breast (Klein 1957). In the adult the envy can either be projected outwards into the analyst as source of goodness or turned inwards onto the subject's own good parts - progressive and creative abilities, or both. When the therapist is the target all that the s/he offers is perceived as noxious, not because the therapist is making mistakes but because the s/he is accurate and this ability is envied.  Envy produces confusion because it cannot allow a distinction between the good object and the bad (Klein 1957).  For a change, a modulation in their ways of thinking and being the patient must allow the therapist's words to penetrate.  Envy can lead to blocking of the introjective processes; as the infant cannot allow itself to feed so the adult can block food, words, ideas.3 Anything that is nurturing will be viewed with the suspicion that it is bad. In early session Mrs.W. spat out every interpretation I made; she could not and would not take in anything. Inevitably she complained bitterly that she could not tolerate the time that intervened between sessions. In this way, and with the aid of projective identification the therapist is made to feel utterly helpless and hopeless.

   Not only does envy, as Segal states, pose problems for the healthy development of the infant, but also in the therapeutic relationship which can mirror the earliest relationship. An interpretation which is accurate will initially be taken in, but later will be rejected and criticised.  The introjection of the good object in the form of the therapist is resisted and the work of the therapy undermined. Until there is some ability in the patient to introject the therapist as a good object it is hard to make progress that is sustained. Mrs W. who had a fleeting experience of mother finds it hard to trust that any good relationship or experience will not be wiped out any minute. Rather than wait for that to happen she would rather execute it herself.

            Envy aims at being as good as the object, but, when this is felt as impossible, it aims at spoiling the goodness of the object, to remove the source of envious feelings. It is this spoiling aspect of envy that is so destructive to development, since the very source of goodness that the infant depends on is turned bad. and good introjections, therefore, cannot be achieved (Segal, 1964;40).

   The infant is dependent on the breast and feels it contains everything which he desires and that it is an unlimited source of milk and love which sometimes is shared with him but often is withheld and kept for itself (Klein, 1957).  The sense of grievance that the infant feels is also apparent in patients who feel there is a way of 'doing' psychotherapy which everyone else knows about but the therapist refuses to tell them; that there is the interpretation, the  'eureka' factor, which if given to them would mean that everything would fall into place and they would be fine. The therapist, either out of malice or incompetence, keeps it from them.

 

Interpretation

Interpretation is an invaluable tool; whether it is seen as the most effective modulating instrument or one of many rather depends on the orientation of the therapist. Etchegoyen gives a succinct definition of an interpretation, he says it 'always refers to something that belongs to the patient but of which he has no knowledge'(1991:321). He says he uses the word  knowledge rather than consciousness as existential psychologists do not differ between conscious, preconscious and unconscious but will accept knowledge as a term meaning, being aware of oneself, being  responsible for oneself, knowing about oneself.

   In 1936 Riviere sternly enjoined, 'Nothing will lead more surely to a negative therapeutic reaction in the patient than failure to recognize anything but the aggression in his material'(Riviere 1936:311). However Klein thought it vital to get to the deeper layers of the unconscious and was confrontational in her interpretations of envy. She says (1957) it is necessary to interpret the anxieties and defences bound up with envy and destructive impulses 'over and over again' for integration. She recognizes that 'the anxieties  aroused by hate and envy towards the primal object, and the feeling of persecution towards the analyst whose work stirs up these emotions, are more painful than any other material we interpret'(232). She declares that analysis fails because the patient is unable or unwilling to bear the pain involved in attaining the truth, and their desire to be helped is outweighed by the anxieties that are induced. Patients  with 'strong paranoid anxieties and schizoid mechanisms' are unable to balance  the 'persecutory anxieties stirred up by the interpretations' (ibid) with trust in the analyst and are not likely to achieve success in their analysis. One could speculate whether the failures were due to the patients inability to cope with analysis or the analyst's determination that her strategies were right and efficacious for all.

   Etchegoyen allows there are risks inherent in the heavy reliance on interpretation, that the technique is, at times, brusque and inconsiderate, but he believes that the inevitable side-effects of the action are outweighed by its value. He says the virtue of Kleinian interpretations lies in,

            ... interpreting with no other commitment or goal than that of making conscious the unconscious, without allowing oneself ever to be led by complacency and weakness, without fearing the consequences of saying what the analyst considers is happening in the mind of the analysand, and which he ought to express. (Etchegoyen,1991;416)

Etchegoyen et al. (1987) confidently affirm that 'envy must be  interpreted always and without delay, as soon as it appears and without erroneously giving way to considerations of tact or timing' (p.59). They and Boris (1994) point out that to sidestep envy only serves to underline the patient's belief in their omnipotent destructiveness.

   I have to confess I have difficulty with the 'interpret come what may' school. The case material that is presented to illustrate this argument in 'On Envy and How to Interpret It' is of a competent doctor who works in a specialised and demanding field. That strategy is therapeutic, helpful and enlightening for her but I wonder about a patient who is in a more fragile state. I have in mind a man from a middle eastern background. I will call him Omar.  As a child his father beat him frequently and brutally; his mother was a well known clairvoyant and psychic. He felt she  could enter his mind at will and know all that was happening in his inner world.

            The orifices of the body as well as the sensitivity of the skin always have powerful feelings attached to them and in early zonal confusion, are experienced as interchangeable. Their unwanted penetration in infancy or childhood by force-feeding, sex, invasive emotions or actual beating is an assault on the body-ego which is forming and damages the  sense of integrity' (Yariv 1993:155).

The feeling of being permeable; of being unable to keep out intrusive forces is very frightening.

   This man is highly intelligent and he pursues esoteric studies. He routinely sees people who are not visible to others and hears a voice. These occurrences he accepts partly as his mother's psychic legacy and in part finds frightening. He has had various psychological interventions from childhood, the most recent before seeing me, a psychoanalyst. He found her intolerably intrusive. I find that any intervention that indicates that I might have an inkling as to what is going on in his mind if he is not aware of it, feels unbearable. He talks about his feelings in a  metaphorical way which he wants me to understand, but does not want me to reflect back to him. It seems to me that I could insist on telling him what I think is going on in his mind and he would leave, either literally or he would escape into madness.  When I do say something that  goes beyond his ability to tolerate he flies into a panic and takes refuge in talking about the most arcane of his interests or theorizing why I could possibly have said such a thing.

   Recently he was musing on envy and admiration and using me as the theoretical object of either feeling. When, after a while, I wondered if was envy or admiration he  felt for me, he was incredulous that I had applied his theoretical musing to me personally and anyway how could possibly he envy me? I am, after all, a woman; this expressed in the friendliest tones. I think, for the time being, he needs a safe transitional place where he  will not be invaded either physically  or mentally but can explore thoughts, emotions, memories with an 'other' who can hold for him such understanding that grows from that interaction. In time he  will, I hope, be able to bear the idea that someone has understood more about himself than he is able to at that time.

    I think this is what Young is expressing when he says what an analyst does is,'...take things in, ruminate and detoxify them, and if seemly, let them out again in good time and good measure so they can be of some constructive use in facilitating thought, feeling and constructive  relating (my italics, 1994:34).  

   Freud (1937) made the analogy between archaeology and psychoanalysis which is wonderfully apt. As with archaeology if we attempt to hurry the slow uncovering of material, seek to reach layers that are not yet near the surface, are clumsy or over-enthusiastic in interpreting to the patient what is so far from consciousness they are unable to own it, we run the risk of damaging perhaps beyond repair the whole edifice.

I suggest that when a person is at their most envious they are in the paranoid-schizoid position.

            It is now generally accepted that it is not useful to interpret envy directly to patients who are locked into the psychopathology of the paranoid-schizoid position... and have very little insight or interest in understanding their motives. The analyst may think the patient is envious; the patient has no such idea (Spillius, 1993:1202).

   However, even when nearer the depressive position, at times, the envious patient will experience nearly every intervention as a criticism.  That constellates all their own self-critical forces, which then wreak havoc on everything they have and are, and is annihilating.  It feels like a deliberately sadistic attack.

 

The Negative Therapeutic Reaction

It would seem that any exploration of envy and its manifestation in psychotherapy will have to look at negative therapeutic reaction. It has been written about extensively (Klein,1957; Joseph,1982; Rosenfeld,1987; Hinshelwood,1989; Etchegoyen,1991; Sandler,1992). This is by no means a comprehensive list. Usually the term is used to mean the reaction which sets in when an accurate interpretation has  brought relief to the patient but is then attacked for being too long, for not  being comprehensive, for being late, 'why have you not told me this until now?, and even more angry 'why have you withheld this from me till now?' The accurate interpretation can be attacked when its worth is recognized for two reasons; because it induces envy of the therapist, and because it is good and helpful and for that  very reason invites attack. Baranger, quoted in The  Patient and the Analyst, expresses the essence of negative therapeutic reaction,

            ... for it is precisely at  this point when the analyst feels sure that he understands the analysand and when the latter shares this assurance, that the problem of the negative therapeutic reaction actually emerges; through it the analysand frustrates the analyst's success and triumphs over him. It is a last resource on the part of the analysand; after all, he is still capable of making the analyst fail, even at the cost of his own failure (Baranger 1974 in Sandler 1992: 130).

   Segal (1973) uses the term somewhat differently; she applies it to a man who had had many failed treatments and, because she represented a powerful and hated father for him, attacked her potency as an analyst. I have found with Mrs.W. the reaction emerges not so much after an interpretation, but after a session when we both feel light has been shed, some understanding has occurred on both sides; it seems it is the good shared experience that is insufferable and has to be attacked. There can be a similar reaction when the therapist uses interpretations defensively, and is, therefore, off target.  It goes without saying it is important to differentiate between the two reaction which appear similar but stem from entirely different roots. It is sometimes easier to blame the patient's pathology than look at our own.

 

Thanatos

Freud, writing in 1937, describes the deep seated resistances to progress in psychoanalysis and attributes this to a powerful expression of the death  instinct. 'No stronger impression arises from the resistances during the work of analysis than of there being a force which is defending itself by every possible means against recovery, and which is absolutely resolved to hold on to illness and suffering' (p.243).

   It seems to me the death instinct manifests in different ways. There is the 'half in love with easeful Death' (Keats)4 stance in which the patient romanticises death and sees it as a release from the problems of life. There is the  sense of a struggle not to be sucked back into oblivion and there is the  angry excited destructive aspect as described by Rosenfeld (1971 and Joseph 1982). It is the last two manifestations which are, I think, most bound up with envy, though I have observed the first in envious patients as well. There is, in envy, a recognition of what is good and necessary for life, but because the death instinct is strong, there is the impulse to attack and destroy the good.  This mechanism is also a defence against experiencing envy by obliterating  the good object.

  The first type is, I think, to do with being held in bondage by the introject of an envious, destructive, chthonic negative Mother archetype. The actual mother may or may not have been envious of her child. If she was not, then, I believe, there was some fracture of the infant mother relationship which stimulated the infant's envy; this was then projected into the mother and not subsequently withdrawn. One patient on the verge of a successful conclusion of a taxing project and having made some important shifts in her attitude to herself and her abilities, talked of feeling as though tentacles were dragging her back into the depths.  Mrs. W., also nearing  completion of her course, speaks of being at the bottom of a deep hole and fearing the water will  close over her head and that I will lose my grip on her. The fear of the envious mother is a powerful deterrent to attaining success beyond what is perceived as the mother's expectation. The struggle is against being drawn back into the  rapacious womb.

   The death instinct is apparent in the second type when the patient almost gleefully, systematically seeks to destroy everything in their sights, most particularly any progress in their therapy. It seems they desire a witness to their mayhem to achieve full gratification.  Though, as described by Joseph in her masterly paper 'Addiction to Near Death', there are many internal dialogues in which attacks are made on their good objects as well.  Although I have emphasised the gratification derived from these processes, it must be remembered they are also terribly painful for the patient.

   In my experience one of the more taxing times for the therapist is staying with the envious patient in the wasteland they have created for themselves, scattered with shattered and ravaged good objects. It is, I think, important to recognize the full horror and fascination it holds for the patient without also being held powerless in its thrall.  It is at these times when the temptation to assume the role of benign superego is strong. 5  For one's own relief as much as the patient's it feels necessary to point out achievements, positive attributes, good relationships, anything in order not to get drowned in the obliterating forgetfulness.  For the patient this feels as though the therapist is unable to bear their experience and is profoundly distancing.  Moreover, it can feel frightening as the patient has forgotten or hidden those attributes to keep them safe from their own envious attack. On the other hand the therapist cannot sit and watch as the whole process and all the progress that has been made is systematically shredded. It is important to point out what they are doing and why, though as each route is blocked, so to speak, the patient moves effortlessly from one target to the next and the therapist's interventions sound stale and repetitive in their own ears.

   'It is very hard for our patients to find it possible to abandon such terrible delights [the sado-masochistic addictive gratification] for the uncertain pleasures of real relationship' (Joseph, 1982:138).

 

 

 

Narcissism and Dependence

The infant is entirely dependent on a caring adult, without that support it would surely die.  This very real vulnerability is intolerable so the infant defends against the knowledge of its being separate from the mother by what Rosenfeld (1987) calls narcissistic omnipotent object relations.  For some adults the fear of dependence and the resultant acknowledgement of dependence is such that the boundaries between who is self and who is object are blurred. Omar is an example of this.  He reiterates fiercely that he will not become dependent on me.  He says he could look into my mind but will not as it would spoil the therapy.

   Dependence is acutely uncomfortable for the  envious.  There is a narcissistic need for self-sufficiency the phantasy that one can provide all that is necessary for life is an expression of narcissistic omnipotence. Recognition of separateness is hazardous as the patient is caught between becoming dependent and/or then feeling envious.

   Rosenfeld (1971) feels the dependence is the sanest part of the patient.  Dependency means an appreciation of need and an ability to accept. 'Attacks on dependency equal attacks on the breast. They inevitably feature a contemptuous dismissal and triumphal overtaking of the functions of the envied objects of desire' (Berke,1989;88).

   Envy is closely linked with the death instinct and negative narcissism.  In narcissistic states there is

            .          ... the projective and introjective identification of self and object, which act as a defence against any recognition of separateness between the self and objects.  Awareness of separation immediately leads to feelings of dependence on an object and therefore to inevitable frustrations. However, dependence also stimulates envy, when the goodness of the object is recognized. Aggressiveness towards objects therefore seems inevitable  in giving up the narcissistic position and it appears that the strength and persistence of omnipotent narcissistic object relations is closely related to the strength of the envious destructive  impulses (Rosenfeld, 1971;172).

  In that 1971 paper Rosenfeld writes graphically of the organisation of the narcissistic omnipotent structure and likens it to a Mafia gang in its reach into all parts of the patient's internal world and determination not to  allow progress to be made. It attacks not only others but also the self, attacking and destroying any good experiences which are taken in.  This makes it difficult to  build up the necessary internalised good objects which help to create and maintain a strong ego.

   Klein (1957) writes feelingly about the difficulties encountered in the analysis of deeply envious patients and the pain and depressive anxiety experienced by the patient as anxieties and defences are analyzed endlessly.  However it is possible that the analyst and primal objects are built as good objects and introjected.  Happiness, being able to tolerate ones shortcomings and being able to use ones talents more freely are possible as the personality becomes more integrated.  'I have found that creativeness grows in proportion to being able to establish the good object more securely, which in successful cases is the result of the analysis of envy and destructiveness' (p 233).

   Envy becomes excessive when the early relation with the breast has, for whatever reasons, become disturbed. It is, as Klein (1957), points out, gratitude and love that mitigate the force of the envy and its attendant  baleful emotions. The object of psychotherapy, it could be argued, is the integration of the personality, this requires an inner good object which 'loves and protects the self and is loved and protected by the self. This is the basis for trust in one's own goodness'(p.188). When this has been established in therapy, when the lost original objects are  regained, there is a foundation for gratitude and inner wealth and the ability to share with the more friendly outer world.

            He then dwells on memories of incidents and feelings, speaks with deep and genuine concern about them, works out what a certain episode must have meant to his  mother or father, how he misunderstood them or they misunderstood him at the time, whilst he now realises that he falsely attributed to them motives of indifference or hostility. In these thoughts and feelings there is sadness, remorse, and quiet love, not paranoid hatred or self-pity. The experience is immensely meaningful and important to the patient; it is truly an experience with his original objects, they are alive to him and present, they are felt as an essential part of himself and his present life even thought in fact they may be dead (Heimann,1956:309).

   The envious person is on a treadmill.  Each and every success is not enough. Although they may experience life as forever moving the goal posts, this is also what they do to themselves. No sooner is one project brought to fruition than it is  seen to be worthless, and another even more taxing goal is set. Colman (1991) provides an insightful account of his work with a young woman who set and reset ever more difficult goals for herself. If our patients were able to appreciate en route their successes, however small,  all would be well.  The need to set new goals could be seen as a healthy need for stretching oneself. The urge to spur oneself on is one of the positive attributes of envy, but until some shift has been made in the patients' relation to themselves and their attributes, as soon as the next goal is achieved it is attacked for not being good enough.  As the previous ones have suffered the same fate it is felt that their lives are littered with failures. This compulsive cycle is in  some ways a constant search to find lost good objects. This search and its relation to creativity will be discussed in the next chapter.



 

 

1. I would have thought this must be so, particularly, in training analyses, but I have not seen any literature  on this topic.

2. The only other time Jung appears to have written about envy is in the  foreword to the I Ching.  He had asked about how the English translation of the ancient Chinese text would be received. He cast No. 50 'The Cauldron'. The cauldron contains food. The comrades are envious. Jung understands this in terms of those who are envious of the I Ching and its possession of nourishment. They want to rob it of its great possession and  seek to rob it of its meaning or destroy its meaning.

3.  The problems with taking, food coupled with narcissistic omnipotence can lead to eating disorders. See Lost for Words; The Psychoanalysis of Anorexia and Bulimia by Em Farrell for an excellent account of the treatment of these disorders.

 


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