Adolescence and Developmental Breakdown

A Psychoanalytic View

M.Egle Laufer, Moses Laufer

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429910616
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this book, Moses and Egle Laufer contend that severely disturbed adolescents can be assessed and treated psychoanalytically, and that their illness differs from comparable in older patients, and that the psychopathology has its source in conflicts over the sexually mature body. Extensive case histories support their argument.

I
ADOLESCENT DEVELOPMENT, PATHOLOGY, AND BREAKDOWN

1
Adolescence and the Final Sexual Organization

In trying to be more precise about the contribution the period of adolescence makes to normal psychological development, we realized that we had to be precise not only about our definition of the structure of the psychopathologies in adolescence but also about how this structure differs from that of the neuroses, perversions, and psychoses of adulthood. Freud’s belief that perversion, for example, could not be defined as such until the person’s sexual orientation was fixed (1905, 162–72; 1919) made a great deal of sense to us when we applied this view initially to the organization of psychopathology during adolescence and later to the developmental function of adolescence. Although Freud chose perversion as his example, he had in mind the development of the person’s sexual orientation and the idea that the main means of gratification normally has a fixed and predictable pattern only by the end of adolescence. But he also considered it essential to show that the disorders in sexual life which are present before the main means of gratification has been established must be viewed and understood differently from those that exist afterward.

In our work with adolescents, our clinical observations repeatedly seemed to confirm this assumption about the timing and course of a pathological outcome in sexual development and orientation. If the main means of gratification normally become fixed only by the end of adolescence, we thought it likely that psychopathology too is fixed at that time. But something specific needed to be added to our existing knowledge of the contribution of puberty and its relation to the developmental function of adolescence to bring us nearer to a precise definition of the characteristics of the pathologies of adolescence—characteristics that would enable us to differentiate these pathologies from those of childhood or adulthood. To be able to do this would have extremely important implications for assessment and treatment in adolescence and would, in addition, be especially relevant to the issues of the prevention and reversibility of severe disorders in adolescence and adulthood.

In “Three Essays on the Theory of Sexuality” Freud (1905) begins his essay on “The Transformations of Puberty” as follows: “With the arrival of puberty, changes set in which are destined to give infantile sexual life its final, normal shape.” When describing some of the changes that should take place in puberty—and here he was referring to the subordination of component instincts to the primacy of the genitals—Freud stated: “Just as on any other occasion on which the organism should by rights make new combinations and adjustments leading to complicated mechanisms, here too there are possibilities of pathological disorders if these new arrangements are not carried out. Every pathological disorder of sexual life is rightly to be regarded as an inhibition in development” (pp. 207–8). After summarizing his views about infantile sexual life and the pregenital organization of the child, Freud then refers to the period up to puberty as “an important precursor of the subsequent final sexual organization” (p. 234).

Regarding Freud’s reference to the changes that occur with the arrival of puberty, we add the following: Puberty—that is, physical sexual maturity and the accompanying physical ability to procreate—activates a process that continues throughout adolescence. It is a process of experiencing, reorganizing, and integrating one’s past psychological development within a new context of physical sexual maturity. The prepubertal wishes and fantasies were safe and acceptable before physical sexual maturity, but these same wishes and fantasies will from puberty onward carry a new incestuous meaning. Past normality or pathology will now be experienced and reacted to as signs of sexual normality or pathology. The body, which until puberty was experienced as a passive carrier of needs and wishes, now becomes the active force in sexual and aggressive fantasy and behavior.

Stated in somewhat general terms, our thesis is this: Although the resolution of the oedipal conflict means that the main sexual identifications become fixed and the core of the body image established, it is only during adolescence that the content of the sexual wishes and the oedipal identifications become integrated into an irreversible sexual identity. During adolescence, oedipal wishes are tested within the context of the person’s having physically mature genitals, and a compromise solution is found between what is wished for and what can be allowed. This compromise solution, within the variations of normality, defines the person’s sexual identity.

We therefore see the main developmental function of adolescence as the establishment of the final sexual organization—an organization which, from the point of view of the body representation, must now include the physically mature genitals. The various developmental tasks of adolescence—change in relationship to the oedipal objects, change in relationship to one’s contemporaries, and change in attitude toward one’s own body—should be subsumed under this main developmental function rather than viewed as separate tasks. The manner in which the adolescent deals with these developmental tasks enables us to know whether there is a continued progressive move to adulthood or whether therapeutic intervention is necessary. Once this final sexual organization is established, there no longer is a choice for any kind of internal compromise, such as may have existed earlier in adolescence. What we then see in young adults, at least in their pathological disorders, is the result of a breakdown in the developmental process that took place in adolescence.

Later in this chapter we shall present clinical material from the analyses of a late adolescent and a young adult to clarify the nature of these new arrangements in adolescence and of the pathological disorders in young adulthood that reflect the breakdown of the developmental process during adolescence. We show how these new arrangements are tied to the manner in which the content of the central masturbation fantasy is integrated into the person’s final sexual organization by the end of adolescence and how this reflects the way in which the adolescent has, by the end of this developmental period, integrated the physically mature genitals as part of the representation of the body.

THE CENTRAL MASTURBATION FANTASY

We assume that, as part of normal development from infancy, a person finds means of gratifying instinctual demands by using either his own body or an object (Freud 1905; Mahler 1974; Schilder 1935). The preoedipal child may have available a whole range of autoerotic activities, games, and fantasies that help to recreate and relive the relationship to the gratifying mother. After the resolution of the oedipus complex and the internalization of the superego, however, we can no longer refer in the same way to the child’s means of gratifying his instinctual wishes and demands in relation to his first love object, the mother. With the resolution of the oedipus complex, all regressive satisfactions will be judged by the superego as being either acceptable or not. Moreover, in terms of the future sexual orientation and the final sexual organization of the person, the resolution of the oedipus complex fixes the central masturbation fantasy—the fantasy that contains the various regressive satisfactions and the main sexual identifications. The fate of this fantasy is of special significance in understanding normal and psychopathological development in adolescence, and the way this fantasy forms part of or interferes with development during adolescence can be seen later in the person’s adult life.

This central masturbation fantasy is, we believe, a universal phenomenon and itself has nothing to do with pathology. During childhood and latency its content remains unconscious but is expressed in a disguised form via daydreams, or fantasies that accompany masturbation, or games or make-believe activities and relationships (A. Freud 1965). Although the reactions of the latency child and the preadolescent to this fantasy and to various forms of autoerotic activity are determined mainly by the reaction of the superego, with the physical maturation of the genitals the content of the fantasy takes on new meaning and makes demands on the ego that differ qualitatively from the earlier ones. Although the content of the central masturbation fantasy does not normally alter during adolescence, the fact that it is experienced within the context of having physically mature genitals means that the defensive organization is under much stress.

We have found that, after puberty, a compelling quality may be added to this fantasy, with the need for it to be lived out in object relationships and in one’s sexual life and with the feeling that the only gratification that really matters is the one that also represents unconsciously the living out of that fantasy. The compelling quality is frightening to the adolescent because of the power and destructiveness that may then be added to the fantasy and because of the ease with which reality may be denied at the time the fantasy is being lived out. This fantasy becomes an integral part of the patient’s experience of the transference and is often secretly the basis of the gratifications obtained from treatment. It is our impression that much of the acting-out behavior that we associate with adolescence and often accept as part of normal development reflects the adolescent’s efforts to find new ways of integrating the central masturbation fantasy. Similarly, some of the breakdowns or temporary psychotic episodes that manifest themselves in adolescence represent the only solution available to the ego (even though it is a pathological solution) in the effort to find new ways of integrating the content of the central masturbation fantasy within the context of genitality. The clinical material illustrates some of these points.

We want to avoid the impression either that these core fantasies are readily available to consciousness or that the analyst’s main function is to put together the core fantasies while disregarding the rest of the person’s functioning. Of course this is not so. It will undoubtedly take a long time to construct in one’s own mind a patient’s central masturbation fantasy, but the clues are there in the clinical material, in the whole range of derivatives from the unconscious—such as repeated daydreams, object relationships that take on meaning for the patient, the fantasies that accompany the patient’s masturbation or other sexual activities, and repetitive forms of behavior that may be understood partially as an undoing of the repression. In our work with the ill adolescent, these entries into the unconscious enable us, over a period of time, to put together the fantasy, which then permits us to understand the motivation, the power of certain kinds of gratifications, and ultimately the pathology. These fantasies will not themselves tell us about the history of their development, nor will piecing them together assure anything but an insight into the unconscious and a meaning of the pathology. The history of the development of these fantasies can only be gained through understanding them within the context of the transference. But to establish what is the core fantasy is a necessary part of the treatment and of the undoing of the illness.

The presence or the significance of the central masturbation fantasy is in no way dependent on whether the person masturbates or not. Instead, it is important to keep the link, at least in our understanding of the patient’s pathology, between his present sexual life and object relationships and his infantile sexuality—which means his autoerotism, his early relationship to the gratifying object, his preoedipal fantasies and relation to reality, and the changing relationship to his own body as a source of gratification. In our experience, it is not at all uncommon for the adolescent patient (or the adult) to have found ways of completely repressing any memory of early autoerotic activity and to present himself as someone who has few, if any, fantasies and who may even have given up the conscious wish for any sexually gratifying relationships in his present life. But such an outcome is part of the patient’s pathology and in no way diminishes the presence or the power or the status of this fantasy; it only means that it may be a much more delicate task to unearth the fantasies and to establish their meaning in the life of the patient.

LATE ADOLESCENCE AND YOUNG ADULTHOOD

Through trial action, the adolescent will seek a compromise answer that, optimally, enables him to satisfy the wishes contained in his central masturbation fantasy, while at the same time obtaining superego approval by satisfying the demands of conscience and the expectations of his ego ideal. This means that, normally, the adolescent must have available some age-appropriate ways of finding gratification and new objects. Having physically mature genitals means that regressive wishes can no longer be allowed the same freedom as before because now those wishes may threaten the defense organization and bring about superego condemnation.

The problem can be considered a developmental one when genitality remains the main means of gratification. As is often the case in pathological development, however, we see severe interference in the adolescent’s ability to use masturbation and the accompanying fantasies as trial action if the pregenital wishes override genitality. This is especially so in late adolescence, from about the age of sixteen. Instead, the sexually mature body is experienced as the source of these regressive wishes, resulting in the need to repudiate it as the means through which gratification can be obtained (Blos 1972; Ritvo 1971). Because of the wishes contained in the central masturbation fantasy, the adolescent may feel in constant danger of giving in to what he both wants and must not allow. In the face of these demands, he feels passive or, perhaps more correctly, helpless. As a result, he may renounce his ability to control his body or the sensations coming from it.

The process is different in normal development during this period. However much the adolescent feels in danger of giving in to regressive wishes, he still has the unconscious awareness that a choice exists. If we examine the direction of the libido and the relationships to objects as expressed in the fantasies and especially in the masturbation fantasies, we find that the libido is object-directed, even though the gratification is of a narcissistic or autoerotic nature. At the same time, the masturbation fantasies of adolescents who are developing normally, especially older adolescents, include the active seeking of a sexual love object. Normal progressive development and the “trial action” solutions during adolescence have an active quality—that is, the adolescent feels that he is at least partially in charge and in control—whether he imagines himself the active or the passive one in the fantasy. The important factor from a developmental point of view is the feeling that he still has the choice to be active or passive within the sexual role. This factor defines the nature of progressive development in adolescence and conveys that the final sexual organization is in the process of being established. It implies that genital as well as pregenital wishes contained in the central masturbation fantasy can still be used actively in the attempt to find an answer. While this may be a compromise answer, nevertheless, genitality is the final victor.

Something different happens in the adolescents whose defense organization is incapable of warding off the regressive pull of pregenital wishes (Deutsch 1932; Harley 1961) and who experience the living out of the central masturbation fantasy mainly as being repetitively overwhelmed. They then experience their sexual body as the source as well as the representative of their abnormality. For these adolescents, the predominant wishes remain pregenital, thus precluding the use of masturbation as a trial action; instead, sexual gratification from their bodies acts as a constant proof that they have surrendered. In these adolescents, the final sexual organization may be established prematurely—either because the choices are nonexistent or because they view choice as an additional threat to an already precarious defense against further regression.¹ What we see then, especially in older adolescents and young adults, is the pathological answer to the conflict that existed during adolescence; it is as if they have accepted that genitality, with regard to both object relationships and gratification, either cannot or must not be attained. They have accepted the fact that there no longer is a choice.

CLINICAL MATERIAL

The clinical material is taken from the analyses of two male patients, an adolescent and a young adult. Although this material may seem to represent the extreme of what we meet in analytic work, it highlights the main points of this chapter: the part played by the central masturbation fantasy in the establishment of a final sexual organization by the end of adolescence, and the difference in development and functioning between the adolescent and the young adult.

The Adolescent Patient: Mark

Mark was in analytic treatment for four and a half years, from the age of sixteen and a half to twenty-one. Although he first sought help for migraine, depression, and poor attendance at school, it was really his behavior during masturbation that worried him, conveying to him that he was either mad or perverted. Most often he masturbated in the nude. He liked to have his anus exposed and his buttocks very tensed. Sometimes he hit himself on his back. At other times he crawled about on the floor growling, with the pleasurable idea that somebody might enter his anus; or he masturbated in the living room while his mother was ostensibly asleep in one of the armchairs, placing himself either behind or beside her.

Except for the sudden tragic death of his father when Mark was twelve years old, his history before adolescence sounded uneventful and not unusual. But it soon became obvious that some of his relationships during latency, especially his relationship to the church, foreshadowed the pathological development that became obvious during adolescence. When he was alone in the church, he would walk around it with a huge load of books on his back until he was utterly exhausted—a behavior in which he lived out part of his central masturbation fantasy. The savior theme and its relation to his masochism and his need to be humiliated played a very important part in his adolescence.

After Mark had been in treatment for nearly two years, his previously casual drug taking developed into an addiction to methedrine; soon thereafter he stopped coming to treatment. During this time, he was near death. Although we will not discuss some of the technical problems encountered, it was an error by the analyst to allow Mark to give in to the fantasy of being castrated, helpless, a girl. It was obvious throughout his treatment that his castration wish was much greater than his castration fear; the treatment, and later the drug addiction, meant for Mark giving in to his feminine wish and perpetuating the central fantasy of being loved, humiliated, and saved.

We have come across this wish in the treatment of other male adolescents, but the fear of castration and t...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• I. Adolescent Development, Pathology, and Breakdown
• II.Breakdown and the Treatment Process
• III. Clinical Issues
• IV. Assessment
• References
• Index