The Abandonment Neurosis

Germaine Guex, Peter-David Douglas

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367327422
• eBook ISBN: 9780429919985
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

First published in 1950, La nevrose d'abandon was and still is a ground-breaking work. The author's research turns on two clinical observations: the frequent occurrence of analysands whose neurotic symptoms are unrecognizable when measured against any of the Freudian diagnostic models, and the relatively large number of these patients who sought help from her, having already undergone thorough classically Freudian treatments with analysts whose abilities were never in question, but whose efforts did nothing to relieve patient suffering. What all these subjects had in common, the author observed, were extme and debilitating feelings of abandonment, insecurity and lack of self-worth, originally ignited by severe pre-oedipal trauma. Having described the neurosis of abandonment, The author goes on to outline every diagnostic tool and treatment methodology, developed over many years, which can be deployed in the successful and lasting eradication of this pervasive neurosis.

Chapter One
Clinical description of symptomatology

Generalities

At the outset of treatment, if the therapist is not sure what to look for, the abandonment neurotic—whom, for convenience sake, we shall refer to from here on in as the abandonic¹— presents nothing specific that might enable the analyst to make such a diagnosis. This is an important point that needs to be emphasised. First, because it explains why, until now, so many abandonics have been erroneously pigeonholed into classical neurotic disorders; and second, in an attempt to dispel the fearful fascination and subsequent abusive employ that greeted and has grown around the term abandonment neurosis. I am referring here to the fashionable popularity that abandonment theory seems to enjoy among newer analysts, which appears to stem from a number who, themselves analysed according to classical Freudian method, none the less remain fixed on that orthodox path, even when confronted with patients who demonstrate unresolved ego problems attached precisely to the anxiety of abandonment.

Abandonment neurosis is equally prevalent among men and women. We see adults aged, say, thirty to forty, as well as children and adolescents, coming to treatment. However, it seems the abandonic’s disturbance—unlike in the other neuroses—has not appeared suddenly with an acute onset of symptoms. Rather, it presents as a chronic debilitation dating back to infancy, which, ever since, has noticeably disrupted character and behaviour and can quickly escalate to levels difficult or intolerable to bear through reignition of the original trauma from an external source and circumstance.

Initial contact and first impressions

The first contact between psychotherapist and abandonic is particularly delicate, for two reasons: first, because of a profound affective reverence the patient assumes towards the analyst, and second, through the diverse range of expression the patient employs to communicate the depth of these emotions. An initial objection here would be that the same can be said of all the neuroses. However, my experience has consistently been that an abandonic will, on initial entry into the analytic setting, demonstrate a more acute reaction, and furthermore, that an accurate assessment of this reaction is sufficient for us to avoid certain diagnostic errors.

The very fact of the abandonic’s severe sense of insecurity and manic state, conscious or not, will place greater hope and expectation on the analyst than in the case of other neuroses. This hope and expectation—characteristic of the neurosis—is the expression of all primary need, made with the full imperative of the age to which it is attached. Our ultimate quest is to analyse this interior life, and the precise demands peculiar to the abandonic. Of interest in this regard is that the abandonic, from the very first session, casts the analyst in the role of crucial new object, able to crystallise all rapacity, as well as being a unique interpretative source, feeding the passive and aggressive affective states that necessarily arise.

One observation, both interesting and useful here, follows from the experiences of a number of analysts who note that the abandonic will usually play simultaneously on both passive and aggressive fronts, but whether there is a predominance of one or the other, it seems, is due, in part at least, to the analyst’s gender. Generally, a female analyst, being less impersonal and technically driven than most male counterparts, comes to embody the original source of conflict: the mother, in which case the analysand tends towards the passive, the aggressive element having been repressed, not because of the intervention of a superego formed by an Oedipus complex, but from fear of it causing the link to be severed with the analyst-mother. A male analyst, on the other hand, more often tends to expose the patient’s aggression. This is because the therapeutic setting can be less emo tional—colder. The reason seems to be that a male presence has represented in the abandonic’s life an ongoing source of consternation, although not, it should be emphasised, as a rival object. Interpretations of sadistic or masochistic transference in accordance with the analyst’s gender are not hard and fast rules, but, rather, of greatest assistance when regarded as a general trend in the diagnosis and treatment of abandonment neurosis. By contrast, for the most part, the analyst’s gender plays a far less dominant role in the treatment of post-oedipal neuroses.

So, proceeding in the face of hungry expectation from an anxiety-wrought abandonic, who also exhibits a full range of mechanisms that pull in the opposite direction, we resolve to dissipate the patient’s anguish by analysing its structure and formation, not only to bring provisional calm but, moreover, to create from the very beginning—one human being to another—milestones of trust through the delicate, subtle role and weighty responsibility that the analyst must bear.

As mentioned, the second factor that significantly increases the problematic nature of our task is that the sheer diversity of primary data collected from the patient can be so vast. However, beneath this scope of diagnostic difficulty we can, it seems, roughly speaking, classify these patients into one of two main groups, depending on the degree of conscious awareness they possess of their own condition.

Patients more or less conscious of their affective condition

From the outset these patients recount with ease the frustrations, deceptions, and disappointments they were subjected to. They know their need for love goes unsatisfied because self-confidence is lacking. Characteristic also is the ongoing state of emotional insecurity and fluctuating levels of anxiety, all of which conspire to create a life beset with difficulty and ongoing struggle.

These analysands can be further separated into another two possible categories, but, before settling on one or the other, the analyst must make a thorough, unhurried examination of the patient’s history, previous behaviour, and current difficulties. Only then will we be best able to determine whether the patient is either a genuine abandonment neurotic fixed at a pre-oedipal stage of development, or a more conventional post-oedipal neurotic, where the superego plays a role we recognise, but is combined with certain elements of abandonment that are secondary to the central neurosis.

Patients not conscious of their affective condition

These patients become preoccupied with peripheral problems in an attempt to steer the analyst’s attention off course, which is an unconscious defence against analytic investigation and, above all, the dread of revealing a profound infantilism that is all but completely hidden from the self. It is worth noting that the abandonic gifted with greater intelligence, reasonably enough, has more chance of detecting flaws in an analyst’s perspicacity. Often revealing vast gaps between certain elements of the ego and unconscious affectivity, these patients quickly reveal the truth regarding their actual degree of emotional development. An outwardly strong sense of security and self-value in certain fields tends towards illusion, masking a depreciation of these achievements as being of only partial and compensatory worth.

Furthermore, knowing themselves as adaptable and capable of success in certain domains, as well as being—by virtue of their neurosis—dedicated to, for example, moral, intellectual, and sometimes religious pursuits with absolute rigour, it is painfully difficult for patients of this type to acknowledge their shortcomings and failures and, as a consequence, come to accept that the love they so desperately crave is an infantile anachronism. It is from this vantage point that their ingenuity is employed to sabotage any meaningful analytic investigation.²

In short, whether a patient sets out to guide the analyst towards a diagnosis of abandonment neurosis or, conversely, away from it, we must exercise the greatest prudence before arriving at a definitive conclusion. So, care must be taken to avoid diagnosing the neurosis purely on the basis of identifying an abandonment and insecurity complex, for example, because there is every chance it could be connected to another disorder entirely: moral neurosis, notably. On the other hand, we need to be equally vigilant not to fall into the trap of allowing a patient to lead us away from an accurate diagnosis by missing, for instance, the core abandonment anxiety that is at the heart of this neurosis.

To summarise: upon initial consultation, nothing in particular seems to distinguish an abandonic from the other neurotic types. However, upon closer examination, we note that the patient’s psychic structure is revealed to be fundamentally different in the case of abandonment neurosis. To avoid technical mistakes and diagnostic errors during the initial contact with patients, therefore, it is essential to clarify these structural differences, which alone can isolate the symptoms of abandonment neurosis, in an analytic setting that otherwise provides poor and often contradictory differentiation, and can potentially lead the analyst down a path of misinterpretation.

The problem of symptom classification

To my knowledge, no study exists that provides for us a thorough clinical description or precise definition of the psychic structures that formulate abandonment neurosis. With no illusions as to the difficulty of the task, I shall endeavour in the pages that follow to provide such a description, with particular regard to the ego, instinctual attitude, and what I call the bio-affective system of regulation, which is a necessary accompaniment. Any attempt here to align these elements with Freud’s own description and definition of the ego, id, and superego, as has been emphasised, is erroneous, so, in the unique case of abandonment neurosis, we must first desist from classifying its symptoms around the dynamics of these three psychic structures as we would do routinely otherwise. Having tested numerous methods of classification, all of which were problematic, I shall confine myself here to an enumeration of the symptoms of the neurosis that is as clear and logically ordered as is possible. This is a procedure that may seem overly fastidious, but enjoys the advantage of eliminating the arbitrary.

Abandonment neurosis manifests as a series of varied emotional reactions that mark the character and behaviour of the subject from an early age, and that assert themselves with particular violence whenever a circumstance arises that provokes feelings of frustration and abandonment. Although these levels of intensity differ from one abandonic to another, all share two characteristics: anxiety and aggression, which is a regression to initial experience, characterised by an ego that lacks any feeling of value. So, we can say that the spectre of abandonment creates anxiety, which, in turn, spawns aggression and the non-valued self. This is the tripod upon which rests the entire symptomatology of this neurosis.

Anxiety

Every abandonment neurotic suffers anxiety, the intensity of which, depending on each individual case, varies greatly, ranging from a slight interior malaise to pure unabated anguish.³ The condition is more or less chronic, aroused most often by the affective threats of frustration and separation, etc., which become reactivations of infantile trauma, sparking the crisis where love is absent and solitude looms.

This is to say that the abandonic will betray anxiety in connection with the role that other individuals of importance play in his or her personal life, so, when treatment commences, analytic scrutiny results in the patient being confronted with a renewed crystallisation of uncertainty and fear, as well as, simultaneously, a fulfilment of need and hope.

Example 1: Mrs X, married, a mother, who lives in terror of losing her family and finding herself alone. A friend of hers lost both parents just a few days apart. Mrs X, in the grip of a dark and intense anxiety, found slight relief by requiring her mother, father, and husband to be by her side day and night.

Example 2: Miss N, throughout childhood, felt her mother’s rejection; she was a woman of little time and sentiment who greeted all expressions of affection with sarcasm. As a child, Miss N once brought a friend home, and, while witnessing her mother treat the little girl similarly, felt her own throat tighten, until she could not swallow. She began to tremble, broke into a cold sweat, and, finally, without explanation, stormed off in an affective eruption she could not control.

Example 3: Mr Z was materially pampered throughout childhood but totally neglected psychologically. He presented with intense anxiety and an apparent abandonment neurosis. His parents, staunch altruists, lavished attention on associates and strangers at the expense of their children. Now married, Mr Z cannot bear his wife meeting friends. Agreeing to attend a dinner party with her, on the evening in question, invariably an ill-tempered Mr Z, complaining of feeling unwell, returned home suffering insurmountable fatigue and anxiety. On good days he can cope until evening, but after dinner will ask to be excused and retire to bed, but when the anxiety is too intense, no words from his wife can induce him to remain: his pain having returned, he retires to bed, sulking like a child, clutching her to his side for extended periods.

Example 4: Mrs V, who usually speaks with ease, arrived at one session in the grip of an anxiety so fierce she was unable to utter a word; her anguished silence continued until finally Mrs V managed to say, “I heard you laugh.” She then burst into tears and continued to sob inconsolably. Little by little, I learnt she had arrived early that day, and heard the session preceding hers conclude with laughter, which immediately revived memories from her past: “My mother would laugh with my older brothers and sisters, they were all much smarter than me and my mother preferred them. I was the littlest, a nuisance, and only good for telling off. So here it’s the same, I bore you, I’m stupid … etc.” Hence, feelings of inferiority and fear of being cast out, heightening despair and anxiety.

As every analyst knows, such cases are encountered so frequently further examples need not be cited. However, what concerns us most here, as I have said, is that they are subject to such a diverse range of interpretations, as listed below.

Example 1:	some will detect in this patient the presence of an unconscious death wish, projected outward in her constant fear of losing close relatives.
Example 2:	a tendency towards excessive identification.
Example 3:	Mr Z experienced two and a half years of conventional treatment with a very good analyst, who concluded that the anxiety attacks I have described, as with other symptoms, were cathected in passive dependence to an older sister. This initial interpretation broke the attachment, liberating Mr Z, much to his relief, but it left untouched the crippling abandonment anxiety that continues to permeate every aspect of his life, relationships, and, in particular, his marriage.
Example 4:	Mrs V's reaction went well beyond an expression of simple inferiority.

It is precisely the problem of interpreting the symptoms of abandonment neurosis that is the fragile focus of this work. We shall leave anxiety for the moment, but return to it in Chapter Four for a more detailed study in the context of therapy. The phenomenon of anxiety-related emotional insecurity and fear of abandonment has already been the subject of an extensive study by Odier (1956). So, in the pages to come, I shall continue to concentrate on the description of other abandonment neurosis symptoms.

Aggression

As with anxiety, abandonic forms of aggression are diverse and of wide-ranging intensity. Apparent or hidden, immediate or delayed, with levels expressed or restrained (for fear of rupturing the bond, per haps), aggression is an essential component of the abandonment syndrome.

Here, we speak of a reactive aggression sparked by the privation of love in infancy, which may diminish, then disappear altogether, over the course of treatment. The distinction between reactive aggression and primitive constitutional aggression is, we know, signified by nothing definitive, it being sometimes very difficult to separate one from the other. Yet, this has been the key issue to resolve regarding the application of analytic treatment, which has been rendered inoperable in cases where such constitutional aggression dominates.

Because they are so broad in number and diversity, it is difficult to describe and enumerate all the different forms of aggression manifest in abandonment neurosis. It is, however, identifiable as being attached to most acts, thoughts, and feelings, except in circumstances where the abandonic has the complete affirmation of love. However, this truce brokered wit...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• ACKNOWLEDGEMENTS
• Dedication
• ABOUT THE AUTHOR
• ABOUT THE TRANSLATOR
• TRANSLATOR’S PREFACE
• SERIES EDITOR’S FOREWORD
• INTRODUCTION
• CHAPTER ONE Clinical description of symptomatology
• CHAPTER TWO Structures
• CHAPTER THREE Aetiology
• CHAPTER FOUR Therapy
• NOTES
• REFERENCES
• INDEX