SAMIKSHA, Volume 13, Number 3, 1959

THE EVOLUTION AND RESOLUTION IN ANALYSIS OF A CASE OF PEPTIC ULCER

SAMUEL Z. ORGEL, M.D. New York, N.Y.

This account is based on the review of 730 psychoanalytic hours of a married.man of 40 yrs. old. The patient, a real estate broker, was specifically referred for psychoanalytic treatment because, of a gastric ulcer that had been recurrently present for fifteen years. This diagnosis had been definitely established clinically and radiologically. In 1933, four months before the beginning of analysis, he had his fifth attack of definitely diagnosed gastric ulcer and was advised to try psychoanalytic treatment before resorting to surgery. His attacks usually began with "indigestion" which was characterized by epigastric pain, especially at night, belching and heartburn. In the first interview it became evident that the patient's willingness to accept psychological treatment for his organic disease was but partly due to his high intellectual level, but mostly due to his neurosis. This was determined by his infantile strivings for painless, effortless relief and the wish to deny severe illness. His complaints, present through a great part of his adult life, had been increasingly severe since the financial disaster of 1929. Money seemed to cause excessive and unjustified anxiety about fluctuation in income and the expenditure of money. On this basis he experienced severe depressions and worried habitually. Although there was an apparent ease in attracting friends, he was unable to develop social relations with people. He was greatly concerned lest he be defeating himself in business. Though worried about money he played cards and seemed in an inexplicable neurotic way, to frequently lose large sums which he could ill afford. Besides his five attacks of gastric ulcer, the patient had and continued to have much trouble with his teeth. Sore throats occurred frequently having begun, in his fifth year and led to a tonsillectomy at the age of 12. He had an attack of Vincent's Angina that required treatment for a long time before it was finally cured. A severe food infection occurred at approximately 24, one

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year before being drafted for army service in 1918, during the First World War. In the initial interview the patient showed apparent eagerness for analytic help and a drive to get well. Allied with his enthusiasm was a certain uncritical naivete about the procedure. These were later better understood in connection with the powerful passive transference demands. A strong and obvious self-critical attitude, which one might describe as intellectual honesty, gave his neurosis deceptively benign impression. He was curiously vague of complaints, uncertain about details and dates, and even amnestic for certain important episodes of adolescence, early maturity and advanced childhood. This was repeatedly and tenaciously manifested in the analysis and only gradually lent themselves to dynamic understanding. Depression was not objectively manifest. Intelligence seemed adequate. The patient's personality as described by himself and as it appeared in early analytic sessions, seemed characterized by compulsive habit patterns and marked rigidity of both thinking and affect. He was tormented by the awareness of enormous demands on life and people and his utter inability to express these demands even on a social level, not to speak of securing their fulfilment. There was also an utter inability to give anything of himself to others and was associated with, violent self-reproaches. All lacks, whether within himself, or in the gratifications afforded by the world, he felt as a diffuse and intense envy of other people. Diagnostically the patient seemed best to fit into the psychiatric category of Obsessive-Compulsive Neurosis and into Freud's libidinal Erotic-Narcissistic type and the somatic disorder of gastric ulcer. The patient came from a West coast family of successful and smug business people. The family was American of Anglo-French extraction on both sides. The father was of limited intellectual scope, in the insurance business. He was tyrannical and during the patient's early childhood, had been violent towards his sons, and rigid with his wife in matters of money. He was extremely over-solicitous and over-protective to his daughter. He strongly suppressed initiative in his sons but extended paternalistic protection and patronage even in their advanced adult years. The patient's mother was an active woman of cheerful disposition. She was over indulgent towards her sons in all spheres, but

antagonistic towards her daughter. During the patient's prepubertal or early pubertal period, she had brief depressions, with bowel symptoms. Mother's cool, soft hand had provided an incentive to illness and malingering in childhood which frequently expressed itself in gastric symptoms. In early childhood, the patient had frequent nightmares of being attacked and eaten by large animals. These nightmares always brought his mother to his bedside. Until the patient was nine years old he and his brother came into his mother's bed. When his father was away on his frequent business trips, he fought with his brother for the pleasure of sleeping with mother. The patient felt that his intense love for his mother continued until the time he married. As he came under the domination of his wife, he became resentful and finally apathetic and forgetful towards mother. In early boyhood, he showed his desire to be a girl and identify with mother by experimenting with her cosmetics. At puberty, he used mother's powder to cover the rings under his eyes which he ascribed to masturbation, He commented that he often succeeded in getting a clown-like effect, a quality he suggested in the analysis by his repetitious and mournful but self-derisive complaints, The patient had always noted with pride the devious methods his mother used to extract money from his father. After marriage, his wife exposed his mother's cheating to him, which increased his disgust for mother. . The patient repeatedly emphasized the fact that he was the favorite child of both his mother and father. He had contempt for his brother John, one and a half years his senior ; this was associated with pity, guilt and irritation. The brother was described as a failure, utterly unsuccessful at everything he tried, including his work in his father's business where he received a small unearned salary. He had lived at home and was dependent on his parents financially, physically and emotionally. On one occasion he had suffered a mild attack of depression. The patient was ashamed of his brother and neither he nor his friends accepted him. Lacking the patient's facility in argument and lying in childhood, he had been the principal butt of his father's punishment. On one occasion during childhood, after a joint escapade, the father struck the brother so severely that his nose bled. The patient felt guilty and was terrified. The brother was also the patient's scapegoat, for on the

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slightest provocation, he would literally jump on his brother and beat him unmercifully. Once, after a severe episode in which the patient stated he "almost killed" him, his aunt made the pronouncement about his coming to "a bad end" ; this frightened him. The patient, until late in the analysis, refused to understand these attacks on his brother and believed that he was so greedy he did not want either his brother or his sister to have anything. The patient admitted that his brother did excel in a few minor personal talents and that he had prettier hair, which the patient often seized. The patient's sister Jessica, was born when he was five years old. He vividly remembered his discomfort Over his father's preference . for this girl child, and the special indulgences accorded her in the home. (He completely submerged beneath this, his conscious memory of his disappointment with his mother.) His envy and hate continued during the analysis, since the sister still received a regular monthly allowance from her father. The patient described her as an exacting ill-tempered child, who cried readily and was given to tantrums when frustrated. He was also ashamed of her socially because of her ineffectuality. The sister, a doting and indulgent mother, was a strikingly pretty small blonde woman. The patient managed to repress his incestuous attitude towards her and his homosexual attitudes towards his brother, which appeared only in dream material. Aside from his malingering, he was frequently ill as a child. He also suffered from pneumonia and mastoiditis before puberty. Sometime between the ages of 2 to 4 he had to have an operation on his penis, which ke spoke of as his second circumcision. There evidently was some degree of hypospeadias, which ventral orifice the patient thought was operatively induced. He clearly recalls the intense pain on urination, that he suffered, following this operation. He related a memory of a first circumcision which had occurred before the age of two, but expressed doubt of its validity. He envied his brother's normal penis as an unequivocal point of superiority. He suffered from nocturnal enuresis up to the age of 10. He recalls without sense of motivation, the perverse habit of crossing his legs in order to retain by violent effort, his urine and feces and thus avoid leaving his play to go to the toilet. His appetite was always ravenous, but especially so before the period of puberty ; yet

he never gained weight. As a child he was grasping, competitive and domineering, and a glib liar to the adults. He loved sweets and searched them out from hidden areas. He began very early, to steal pennies from his mother's purse and later larger sums from his father's trouser pockets. His mother apprehended him and punished him by forcing him to pace up and down the front porch of their home with a placard "I am a thief." Although the mother denied such an episode, he never forgave his mother for this severe punishment. The patient was a defiantly sloppy child, while as an adult he became as rigid and compulsive in his habits of neatness as his father. He described his early perverseness of rolling in the mud in his new white sailor suit, to spite his mother for refusing to take him with her to the store. He clearly recalled his earliest sexual play as a form of mutual exposure with a girl cousin. They would alternately pull up their nightgowns exposing their genital and buttocks to each other. On a later occasion, while in school, he exhibited and played with his penis before a woman teacher. He could not recall the consequences for his acts, except that she had "told him to stop." From the ages of 12 to 14 he submitted on numerous occasions to the squeezing of his testicles by homosexuals whom he met in a public toilet, He enjoyed the momentary pleasure followed by the pain, but in the last episode he became panicked and ran to his father who threatened to kill the man. At 16 he impulsively threw a girl down on the grass, jumped on her and ejaculated. At about this time the patient became aware of a young man's attention to his mother. He secretively listened to their conversation at the key-hole and over the extension telephone. One day he threatened his mother with exposure to the father if this unfair relationship did not cease immediately. At this time too he accidentally discovered masturbation, a habit against which he put up a terrific struggle. Each masturbatory episode was followed by severe guilt and self reproaches. He attempted to diminish its ill-effects by trying to suppress the ejaculation, thus diminishing or losing the pleasure of orgasm. Cold water baths were indulged in frequently in an effort to diminish his passion. At 18 he suffered from mumps and developed as a complication,

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an orchitis with some testicular atrophy. He denied these implications and later insisted it was due to masturbation as was his slightly smaller than average penis, about which he felt inferior. He was convinced that his masturbatory activities had prematurely exhausted his limited supply of sperm. Books and gossip about venereal disease were an added sexual threat of adolescence. He remained celebate until his marriage at 23. He fled from every prospect of sexual intercourse. He would however indulge in passionate necking with many girl friends. He characteristically took flight from these situations because to him respectable girls were taboo, while with loose girls there was a fear of disease. In back of this was a fear of being rebuffed because he might not meet up with the girls' expectations. The patient was graduated from a mid-western university. During his college career, he regularly became involved in triangular love relationships, which vividly repeated the essentials of both phases of the Oedipus situation. He would develop an intense sublimated, mutual attachment to the man and then in his friend's absence, carry on a passionate flirtation with his friend's sweetheart. He was more concerned with his rejection by the man, while the woman played only a secondary role. His university career was associated with a series of repetitive punishments for isolated and impulsive cribbing carried out in such a way that he was certain of discovery. These episodes caused a severe loss of self-esteem and a withdrawal of overt aggressiveness of any type. The patient, after a brief attempt at an independent business experience, went to work for his father, where he remained for 8 years. He was discontented with his subordinate position, but would not approach his father for fear of an open break- Instead he covertly supported the opinions of other malcontents in the firm. After this period he joined a large real-estate firm, where he remained. Originally he had intended to enter the same business as his father, and to compete with him. Although the patient always earned a living for his family, he was never free of a sense of inadequacy and insecurity in connection with it. He was continuously harassed by the feeling that he was living above his income for which he blamed, with intense resentment, his wife who was the dominant marital partner. He wished to get along by extreme economy, but

his wife always drove him to try to meet their needs by increasing his income. The patient married, at his wife's suggestion, at 23. His wife, Martha, came from a family similar to his own in general background. She was well educated, intelligent, capable, but harshly critical and exacting towards her intimates, especially her husband. His principal motive for marriage was to flee from masturbation which he thought would ruin him. Patient's sexual attempts in the first days of marriage were unsuccessful. He ascribed this failure to mutual clumsiness and ignorance of sexual technique. For a time periods of partially disturbed erectile potency occurred, as well as long periods of sexual apathy. He attempted to suppress his premature ejaculation by an effort of will. This heightened his righteous resentment against his wife for what he regarded as her inconsiderateness in intercourse. At 24 he was drafted into the army, towards which he showed marked ambivalence. He was glad to get away from his wife whom he felt he hated, and yet he feared the exposure of his small penis to the men in the army. He found military life exciting for awhile but he soon began to rebell at taking orders. He came under the direction of a dominating sergeant who tormented him with duties, distasteful assignments and unrelenting criticisms for minor infractions of rules. He became chronically angry with no opportunity to discharge his feelings. He began to suffer from blinding rages that seemed to well up from deep inside and burst forth in explosive tantrums and terminated in severe epigastric pain and vomiting. These symptoms continued for two months and were finally associated with bloody vomitus. He was immediately sent to the hospital where he was placed on a bland diet, with milk and alkalies. The medical examination and X-Ray showed a definite ulcer crater. After two weeks treatment at the army post hospital, he was given a medical discharge and transferred to a civilian hospital near his home town. Here, the diagnosis was confirmed and treatment continued. By the end of a month he had fully recovered and was discharged and returned home. The situation in the service closely resembled episodes in his earlier life, when submission and obedience became symbolically eqivalent to eating his own vomitus, The conflict included bis wish

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to please people, particularly older men, but he was also afraid of being duped or mistreated. All the men he ever trusted, he declared, had failed him. "People I depend upon do me dirt." Herein was the conflict-a wish to be loved and a dread of the hazards of obedience and coercion. On his return home he became extremely courteous towards other people and submissive in important matters. Towards his wife he was often offensive in terms of infantile bodily expression such as belching and passing flatus in her presence, especially in bed, with no apparent effort at restraint. Stretching and joint cracking as well as nose picking were allied problems. Since his return home he felt that his wife was too passive in intercourse, that she "let him do all the work." Later he felt that she was too much concerned with her own comfort and that she loathed to vary coital positions. In the belief that he had made a serious mistake in omitting premarital sexual experience, and in the strong conviction that variety would restore his flagging sexual powers, the patient yearned for a phanrasied extra-marital indulgence all the time. He could equate these phantasies with his masturbation. On two occasions he attempted to consummate brief flirtations with a married woman of his social circle, but it proved unsatisfactory and he immediately took flight. At about the same period, the patient told his wife that he was annoyed (as he had once told his mother) because she accepted with pleasure the admiration of a neighbor who frequently visited their house. At 32, seven years after his first attack of gastric ulcer, he had his second episode, this was precipitated by his wife's pregnancy. He began to drink excessively and now his sexual phantasies became a reality, for he sought out other women especially waitresses. The patient's extramarital phantasies during the analysis centered chiefly about a waitress. He acknowledged his dependence upon his wife and was furious with her for being willing to divide her interest with a child. His anger became so marked that he could not find an adequate expression for his rage. He began to suffer from nocturnal epigastric pains, nausea and vomiting which was diagnosed clinically and by X-Ray to be a recurrence of a gastric ulcer at the site of his old ulcer. His family physician hospitalized him and placed him on a bland diet, milk and alkalies and he responded an4

obtained relief.' He remarked that the attention received in the hospital enabled him to again accept his wife and her pregnancy. The child when born was a girl, and was shown every attention, by the mother. Mary grew to be warm, out-going attractive, and was specially attached to her mother. The patient too felt strongly attached to the child in spite of his jealousy because of the loss of some of his wife's attention to her. He often admitted that the girl was his favourite too and that he felt that she like him, occupied the central role of the best loved in the family, just as he was in his own childhood. The patient was always excessively concerned with the danger of "father fixation" and thus strained to avoid any sort of physical intimacy with the girl. In 1929 at 36, he suffered his third attack of gastric ulcer. This was associated with intense rage at a broker who had advised an investment shortly before the crash. He realized that he alone was to blame and not the broker, but phantasied that he was an omnipotent parent who had rejected him and deprived him of his money. His pent-up rage was increased by his wife's depreciation of him for his poor business ability. Being unable to adequately express his rage, he suffered from nocturnal epigastric pain and vomiting which developed into a recurrence of his old gastric ulcer and was so diagnosed clinically and by X-ray. Hospitalization, diet and alkalies brought about prompt improvement in his somatic ailment. He went to work for his father's firm but was discontented with his subordinate position, and because he could not or would not openly fight his father. His internalized and unexpressed rage resulted in another relapse in the Fall of 1930 which responded more slowly to medical treatment. After recovery he made a brief effort in another business venture but had to return to his father's firm for a short while. He then joined a large real estate firm where he remained and was employed when in 1933 his fifth gastric ulcer occurred and was associated with vomiting and hemorrhage and caused his referral for psychoanalysis before resorting to surgery. The patient's infant feeding history is not known. Food has been of major importance all the patient's life. He recalls his rumination over how terrible it must be to be uncertain of one's next meal. The patient felt that he was miserly with money and would only spend it freely on himself for excellent food? Food was

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always a concern of his parental family, they loved fancy cooking and were finicky in their tastes. The rich and highly flavored food his mother served in large quantities had always to be hot or he would refuse to eat it. Food was the preponderant interest of the patient's dream language and occupied an important place in bis daily life. His father presented the patient with a gift of several thousand dollars for not having indulged in smoking, up to his 21st year. Actually the patient had been smoking frequently, but only when not in danger of being seen and reported. The patient never smoked during the analytic hour and the analyst learned only several months after he began psychoanalysis, that-he smoked on the outside. The patient in relating the history of his last attack of gastric ulcer stated that it had begun with a sore throat seven months before beginning analysis, when he had been advised to cease smoking. During the period of abstinence he began to suffer from nocturnal epigastric pains and abdominal rumblings. He became so intolerable and irritable that his wife persuaded him to resume smoking. Although his irritability diminished, his pain persisted, and led to a thorough medical examination and the diagnosis of grstric ulcer. The patient resisted the advice of his physician and did not give up smoking until more than a year after he began analysis and then rather suddenly. Although cessation was followed by intense irritability and verbal aggressiveness, there was an unmistakable improvement in the symptoms connected with the ulcer pain. It seemed as if the painful feelings involved in his oral deprivation (castration) were importantly involved in the symptoms attendant on renewal of gratification. In the background of the transference was the patient's relationship with his personal physician, a surgeon, whom he looked upon as a sadistic father. He realized his own inclination to submit to him, as he had for a hemmorrhoidectomy and that he had escaped from him to the magic breast of psychoanalysis which he had hidden from him. The analysis began in rigidly compulsive manner in which free association and emotional expression rarely occurred. He was as careful of his speech as of his clothes, which besides his anal orderliness was bound up with the intense need for admiration and

love and his fear of risking those and his deep narcissism. During the early period of the analysis the patient showed a marked difficulty in understanding, or remembering his dreams ; the analyst's interpretative remarks important dates or events of his own life. All of these were attempts on the patient's part to frustrate the analyst and force him to activity or even forcefulness. This was part of his masochistic wish to provoke angry criticism and was based upon a strong identification with his brother who had constantly been exposed to it. This was due to guilt because of his treatment of his brother and because of his envy of the passive dependent relationship to the father and more deeply the brother's permanant relationship with the seducing mother. The patient failing to stimulate the abuse and criticism of the analyst, managed to get it from his harshly critical wife or in comtempt for himself for his infantilism, femininity, dependency, obstinacy or anything else he could find appropriate. The patient naively expressed and expected the fulfillment of his passive demands and was intensely disappointed when striking relief was not forth coming in the first few week. The predominant character was illuminated by early dreams of the patient's unconscious demands. In one dream, the Navy manned by women, revolted and seized two islands off the coast. The patient compared women's stupidity with males and especially the corporal with whom he had difficulty while in the army, when he had the onset of his first gastric ulcer attack. He associated to his wife's domination and his wish to revolt, as he did in the army. The effect of the war in producing malnutrition in people and his association of this weakened state, with himself. Beside the current marital animosities, this dream expressed his resentment to his own weaning, his aggressive cannibalistic and envious phantasy of his sister's and daughter's nursing experience were storngly indicated through the seizure of the two Islands, which represented the two breasts being taken by the two female infants. This was associated with his second ulcer attack at the time of his wife's pregnancy. The Navy also suggests the theme of enuresis. This dream was followed by a severe pain in his stomach. In another dream, the patient lies on the couch talking about a failure of his in business. As he talks he becomes upset with

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worries about repeated failures. The analyst leans over and kisses him gently on the mouth and some spital spray enters his mouth and he quiets down. He has been explaining how he travels a certain distance towards success, then loses interest and ability and begins to go downhill. This episode is preceded by a vague fragment about Hitler and the German police. His associations deal with mothers caring for babies, their chaste kiss and the spray as representing giving for growth. This he translates into his wish to be made to grow up by the analyst through affection and sympathy. The business failure recalled the advice he had received from the broker just before the crash and the development of his third attack of gastric ulcer. He also recalled his repressed aggression against his father and his inability to express it, which was associated with his fourth attack of gastric ulcer. There was expresssed the marked passive oral wish that was present as well as his evident regression from the genital level because of fear of castration, by Hitler, father, and his father's prohibitive role. Several months later the patient experienced an upset on the couch resembling his dream. This based on his reaction to severe epigastric pain, and the demand that the analyst do something. As forshadowed by this dream, food and drink began to appear frequently in dreams. In another dream, the patient is to assist at emergency appendectomy which is to be performed by a trained nurse on an unknown woman. A card table is being used as an operating table. The patient's husband, a phlegmatic man stands by watching. A large bowl of oyster stew stands on the floor as if to catch the drippings of the patient. His associations are directed to women, that they be kept in their proper place. The nurse is performing midwifery and not surgery. Ha resents his wife's domination and his feeling of being "cut up" at the bridge table by his wife. He recalls an emergency operation that was performed on his mother, in his early childhood. His love for oyster stew\ and his belief that it increased genital potency. His oral sadism and cannibalism were unmistakable and one could discern the Oedipus Complex. This combination of regressive and aggressive activity was associated with melancholia, based on disappointment. The ulcer pains, with the insistent associative demand for relief and cure began to play an increasingly important role in

analysis. This became the patient's means of evaluating his progress. Defiance about mild dietary restrictions were continually present. He frequently indulged in foods and drinks that were bad for his ulcer such as a cocktail, coffee or spicy food to tempt, and as a result suffer pain. If pain did not occur, he was delighted and would utilize it to support his rationalization that since the genesis of ulcer was "mental", dietary precautions were superfluous. All of this was in contrast to the enjoyment and tremendous relief he received from the very frequent feedings of milk and cream at the onset of the treatment. When he had pain, he regarded this as a demonstration that he "wanted to suffer" ignoring entirely the obvious aspect of his defiant insistence on pleasure. On many occasions the pain was found not connected with the patient's diet, for it could increase when business was bad or very good ; when he lost heavily or occasionally won at cards ; when he was antagonized and was impotent; when impatient, or delayed ; when he felt discriminated against, or unloved. At the peak of the analysis when a relationship was most apparent his ulcer pain was greatly diminished. The pain might begin shortly before the patient had to come for his hour and usually disappear during the hour. This seemed clearly dependent upon the increasing concentration of all the patient's major emotional demands and conflicts in the analytic relationship. The pain felt frequently worse in the evening and was occasionally associated with a depression before dinner. The unhappy relationship with his wife and daughter were the responsible factor for when this changed it disappeared, only to reappear when pleasure in returning became too intense. A fleeting dream was related by the patient as though it were an inane fragment, about a "dagger in his anus". When pressed for associations, he could recall only his hemorrhoid operation, which he claimed had been performed without a general anaesthetic, in contrast to his aunt who had received an anaesthetic. He was expressing a wish of submitting to an overpowering male by the anal route, but painlessly and without awareness. The desire to submit to a punishing sadistic father and be hurt was readily admitted, while the erotic aspect was denied.

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In another dream, the patient is with Dr> X. who is part of the government in a strange country, where the patient is visiting. A dictator invades the country and at first is abusive only towards Dr. X. but suddenly turns on the patient, grabs him by the ears, violently spins him around and then bands him over. H e realized the intense, submissive feminine elements in this dream blending with his longing for his mother. The bending over referred to the occurrence of lower abdominal pain with which he had gone complaining to a local doctor, thinking t h a t he might suggest an operation, his wife had an abdominal operation. The ears referred to his lack of attention to what the analyst said as well as to his early habits of listening on the telephone extension to his mother's conversation. These passive attitudes towards his father, recalled the patient's early overt competitive and highly contemptuous estimates of his father's ability and intelligence. H e had masked his deep competitive envy and hostility towards his father by submissive "good will", at times even naively expressing the patient's wish to fail in the sex act. The patient had married a phallic woman who quieted his castration anxiety and sense of guilt by fulfilling a parental role that induced chronic resentment beneath habitual submissiveness, in addition to her feminine and maternal functions. His wife, like his mother, bore children, ceased to nurse him, and accepted admiration from another man. As hostile rivalry and narcisstic pride were more freely expressed with some diminution of intensity, there was a growing awareness of an intense dependence on the analytic relationship itself, which lead to manifest anxiety and nocturnal insomnia. H e felt threatened by his wife's objections to the duration of the annalysis 5 in another instance, when he was feeling well and this became the subject of conversation he too suffered and felt threatened. These untoward reactions caused the patient to realize that he did not wish to get well lest he lose the analysis and the analyst. On a deeper layer the question of rivalry was associated with an apparent need to be able to carry out all functions himself-to be completely independent. This narcissistic attitude had a complicated and multiple genesis which primarily made it necessary for him to rival all other objects, including children and women (sister and

mother) and definitely included the function of maternal nursing. It is likely that the patient's nursing phantasy underlay the obvious fellatio and auto-fellatio phantasies that were incorporated in his masturbation. The following is a dream illustrating this; The patient is in a sail-boat fishing with G. S. He tells G. S. to pull his line in and out. While close to shore G. S. draws in his line and catches a huge fish. He grabs the fish close to the head and removes the hook. The patient pulls his own line up and down and catches a huge but strange fish. He is uncertain whether it is a dogfish or an "eating" fish. The patient awakes with an erection, and a feeling of sexual excitement, not present in the dream. The man in the dream is a son of rich parents, extremely selfish and not likable even to his own children, with an inexplicable aversion for sexual intercourse with his attractive wife. The patient described his companion's grip on the fish as similar to the grasp on an erect penis. The sail-boat suggests that for economy he must give up that sport for the summer while G. S. with his inheritances finds this unnecessary. This was felt as envy while dining at G.S.'s house the night before. The death of G.S.'s parents was discussed. He ate excessively in an almost conscious effort to allay his anxiety about buisness. After several more associations he thinks largely in terms of escaping into sleep. The patient began to express the conviction that a major purpose of the analysis was that he became able to analyse himself in the future, implying the need for treatment would never terminate. The patient began to develop drives that made it difficult and at times impossible to accept the analyst's help ; tried to rival the analyst, analytically ; he showed a deep sense of failure and a persistent sense of need, all expressed through a hostile oral urge for identification. After returning from a short vacation he related the following dream. He is trying to have intercourse with his daughter. His penis is at her vagina, but does not enter ; instead it pushes her up bodily towards the ceiling. He awakens with an erection and a slight ejaculation, which he has been trying to hold back. The patient has been lonesome for his daughter, who is away at camp. He expounded on her great charm and his desire to be loved by her as she loves her mother. . He recalls juggling her as a baby on his

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foot. He is frequently rigid and irritable towards his daughter because of her resemblances to himself when he was young, especially her charm, attractiveness and defiant sloppiness. He passes off his coital attempt by stating that he does not wish to huit his daughter. In his non-penetration and restraint of ejaculation, he recalls his early difficulty in coital, penetration and his early efforts to diminish the ill effects of his excessive mastrubation. He was reminded that in a previous dream his daughter had been equipped with a penis and had been sexually active towards him, as though he were mother and she were he. He had been aware of his strong, passive rivalry with his sister for his father's love, and. that the difficulty in penetration paralleled closely the position in which he placed the doctor by rejecting his interpretations. As the vacation neared, the patient expressed his disappointment and active resentment towards the analyst by manifesting emotion on several occasions. He had difficulty in controlling his violent rage and his urge to press his clients, to knock them down and wrest sustenance from them. In contradistinction to this was a frank dream of turning into a woman, with the desire to own a restaurant or be an inn-keeper, later a frank pleasure in cooking and doing housework and in jokes about how a man could have a baby if constructed properly. He equated the analysis with the soothing effect of his mother's massage in childhood, and the masseuse appeared several times in his dreams. Insomnia at this time was associated with compulsive rumination about his business. He had urgent wishes to quit the analysis which was associated with pains in his stomach. He had phantasies of of leisure and pleasure and dreams or phantasies of drinking, His manifest aggressive attitudes alternating with his passive feminine phantasies, or their combination, became intolerable and he desired to terminate the analysis, to be independent. On his return after a 6 week vacation he was depressed and had fleeting suicidal ruminations. Insomniaf was almost constant with depreciatory thoughts in the foreground. While the patient was in a deep depression his stomach pains were absent; they had also been absent both before and during the vacation. He expressed his sense of defeat and failure in phantasies relative to the occupational sphere in which the element of feminine identification was

strong. Active anger sunk into the background and his grievance, reproach and disappointment in the analysis was expressed by occasional assent to persistent interpretations of the deep hostility that was implied in the depression and directed towards the analyst and his siblings. At this time there was a severe struggle with symptomatic passivity, He preferred to stay in bed and just not work, and his obsessive rumination was active. He expressed a death wish against his parents so that he could have his full inheritance. Although urinary urges were frequent, there was an urge to drink water ; headaches or dizziness were frequent; these were soon replaced by the stomach-ache which became his predominant nocturnal problem. As his diffuse' death-wishing envy, hostility and grasping impulses, with inhibition and passivity towards his wife, parents, analyst and business associates were overtly expressed, we were able to do deep analytic working through of these attitudes. Sexual problem came in for detailed attention during a long period of extreme sexual apathy. He vividly recalled the second operation on his penis and the big bandage around it, while he sat on the pot and tried to urinate but feared the intense pain. He dreamed of being able to watch his penis through his wife's transparent abdominal wall, so as to reassure himself of its presence. Frank sexual comparison and rivalry with his father appeared in the dream material as did childhood memories of rivalry with his mother in other dreams. Of childhood or infantile masturbation he only recalled the school-room episode. During his review of adolescent masturbation he revived the memory of his brother's punishment in detail. The patient spoke of the killer instinct of the true male and illustrated it by a dream of wheeling two criminals strapped to a carriage, who were trying to get at him with their mouths. This was associated with the analytic situation. His impulse to assault women sexually was associated with his father's annoying request for confidence about women and his injunctions about controlling natural sexual brutality towards them. There emerged his manifest wish to tyrannize over his wife and daughter. At this time the patient's actual life situation improved, his wife resumed work, his business improved. He at this point confessed with great guilt, that his earnings were large and out of proportion 3

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with the small fee he was paying. He arranged for a moderate increase in fee and he showed marked improvement in his symptoms just as the summer vacation began. On his return after a six week vacation he complained of a severe gastric upset of several days duration, with belching, nausea, pain and vomitting. This was precipitated by a fight with his wife for her criticisms of their daughter. He could not eat at home, wondered whether he still loved his wife and expressed loathing for her verbal tirades. An X-ray at this time revealed a return of his old gastric ulcer and recent exacerbation of symptoms. He was more aggressive than he had been in the past, and insisted that his wife cease her verbal attacks and accept him as master of the house as well as accepting the changes in him due to psychoanalysis. He was aware of his violent attitude towards his wife and the role this played in his gastric symptoms. He resented further analytic work and sat up for several hours to express his attitude. He became actively critical of his parents, stressed his father's intellectual inferiority to him, his self-absorption, and his tendency to give and entertain solely for his own pleasure. His mother's interest in him he felt was of a prying morbid quality. It seemed true that both his father and mother had contributed to an incapacitating liberal materialism, which was repudiated by the patient intellectually, but added in depth to an anxiety which often led him to measure his security in the amount of money he had in his pocket, rather than in the bank or in securities. Dreams in this period were concerned with hunting birds which turned into a man and a beautiful woman, who dies in convulsions. These were seen to be the sexual relationship between his mother and father, as well as the analyst transference role. Primal scene memories were never actually elicited. The patient admitted his real need for the analyst was only present when he had stomachache. He refused to see his family physician claiming such treatment was only palliative. The patient's activity could readily be seen to be on one level a testing of a parent, a working through of an old fear of arbitrary rejection were present beneath the arrogant independence. He improved rapidly, maintained his agreement and established friendly relationships with his father, mother and siblings as well as his wife and child, and shortly discontinued his analysis

after his neurotic and gastric symptoms had been absent for about a year. I shall attempt to tentatively reconstruct the essential unconscious tendencies as observed through the transference phenomena and analytic material. There was a powerful passive receptive wish involving both libidinal and destructive elements, directed at the analyst and thus originally at the patents. Underlying these expressed demands was the original passive infantile wish for the parental breast and later the penis, ranging from the wish for immediate gratification to the total incorporation of the object. The motherbreast transference was primary but this was hidden by the submissive more obviously treacherous positive father transference and was motivated by guilt and need for punishment. He either sought a breast in the guise of the penis, with pain and humiliation, or the latter was desired because there was no hope of the former, which was now also hated. In attempting feebly to make the transition from passive to active libidinal gratification, the patient was apparently driven back into submission by intense castration fear. The unconscious memory of his own cannibalistic oral aggressions seemed to have contributed strongly, when pre-existing psychic constellations had to be shifted to new zones of biological emphasis. From the oral anxiety exhibited in the transference it was evident that threat to genital activity was important in leading to permanent and strong orality and general functional passivity, than the primary voracious, anxious, ultimately hostile oral fixation and its inhibitions. His strong feminine identification with passive homosexual wishes, was used as a compromise to numerous conflicting needs and fears, of the object and the bodily zone. Such a compromise brought up the need to be castrated and revived the old wish to castrate the object, with guilt and inhibition, with the narcissistic fear and rejection of the patient's own castration. The intense phantasy confusion between oral and genital activity readily permitted a displacement upward, so that prohibited food or drink became the penis and gastric symptoms the constant reminder of the threat of castration. The symptoms also represented the insistent original passive wish and need for the breast, with the complicated and severe reactions dependent on anxiety, deprivation, disappointment, and sibling rivalry. Influenced by a primary narcissism and anxiety driven

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identification with the parent, caused the same type of pathology to appear in masturbation, dream material and in enuresis. In the passive dependent wishes towards an object there was only a moderate and fluctuating degree of spontaneous Ego rejection of the wishes by this patient. Hostility, rivalry and fear towards the donor of the breast or penis seemed to be based most on repressed infantile (Id) factors, rather than on an adult form of repudiation of dependency. The barriers to the consummation of the patient's insistent passive wishes toward an external object were condensed in the patient's gastric symptoms, in terms of an object relationship based largely on verbal communication, it fused and epitomized the patient's pathological infantile relationship with both parents. His sharply etched nocturnal bouts seem to state clearly the coexistence and struggle between insistent receptive passivity and obsessively represented activity (male-female, parent-child) the diffusion of an uneasy alliance. His gradual capacity for a more genuine parental identification in the male role was the result of the analytical working through of the untenable aspects of pathological passive wishes and a better capacity to accept normal gratification of passive wishes, and finally the analysis of the residual exogenous castration fears. In the early part of this patient's long analysis, passivity was the pervasive attitude in his actual life and in the transference ; toward the end of the analysis it was steadily in the other direction. While one cannot assess conclusively, the factors entering into the profound passivity, anamnestic data, interpretive material and transference reactions point to the great importance of the need to inhibit violent aggressiveness. In the manual, oral, verbal and genital spheres the tendency is towards violent forbidden expressions, with recoil under severe penalty which probably originated from the cannibalistic oral hostilities of infancy. Markedly evident was the violent aggressive reaction against passive helplessness or as an effort to break through severe anxiety or inhibition, as part of a circular or alternating system of impulses. The character of the parents and the early history of seduction and surfeit in bioloical gratifications helped give rise to intense expectant dependency or its yiolent oral implementation when necessary. As a result capricious

punishment, threats or deprivation would engender violent hostility, complete inhibition as their alternation. Masochism was present and was manifested by the sudden relief of pain, experienced by the patient, after an outburst of verbal sadism or after manual sadism, as after throwing an orange. The absence of pain and depression were associated with the impulse to a precipitous flight into independence. His urinary urgency and water drinking with anxious nocturnal rumination suggests the significance of the childhood genito-urinary trauma and its sequelae (1) an earla genital castration threat of great severity. (2) Severe persistent pain associated with early bodily excretory experience. (3) A general prototype of bodily pain in essential gratification. Anal data touched on homosexuality, birth phantasies, narcissistic over-evaluation of faces, and resentment of enforced control. With increasing oral anxiety there was an intensification of constipatioa. On one occasion after anxious over eating the night before he reported a large, easy bowel movement and on a rare occasion, when he got drunk, he had a large bowel movement in bed, which enraged his wife. Insomnia developed on an established passive transference which was equivalent to the condition in infancy in which oral gratification is necessary to sleep. The separation or threatened separation from the oral objects as active wishes, including genital wishes began to appear, produced insomnia, since the only viable alternative was the identification with the object by introjection. With the patient fulfilling both roles, the required oral gratification at night met with the same complex barrier as existed in the analytic situation. Insomnia was also associated with guilt and self-punishment for hostile frustration of the analyst as represen-. tative of parent or parents or for erotic masturbatory phantasies expressed in sleep. It should be noted that the patient's acute expressions tended to displace his gastric symptoms during the course of analysis. This patient whose progress was slow and whose symptoms persisted almost up to the end of his analysis which took 4 years, of 730 hours of analytic treatment, show up and down line of progress which however showed slow but continuous evolution, Thj$

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continuous evolution from his low infantile level and associated depression gradually became less severe as evidenced in his marital life and sexual adjusment. The improvement in his work adjustment and interpersonal relationship were expressed in his increased earning capacity. In the follow-up interview which was had 19 years later he continued to manifest the evidence of his was progress, for he continued well and had no recurrence of his ulcer or ulcer symptoms which were checked by X-ray and showed the ulcer to be well healed. In the interim his family was increased by two healthy boys who are now 17 and 15 years old. His daughter who had been eight yeas old at the beginning of his analysis, had married 5 years ago and has given him two grandchildren. While all this shows the absence of an overt neurosis, beneath the surface one could sense the remnants of his old neurotic drives. These seem well under control for he has used the strong defenses established during the analysis to permit him to continue his friendly relationships with his parents and sibling?, his own wife and daughter and with the people at his work.

THE PLACE OF PREMONITION IN A CRISIS OF LIFE

NANDOR FODOR

To believe in an ability of foreseeing in any mental states events before they happen is not scientific. But that should not prevent premonitions from occurring. The unscientific was first. Science began by organising the observable. That which was observed but not yet organized wasper seunscientific but it still could have occurred. Science cannot prevent the impossible from happening. It can only sit down before it and study it in the hope of including it into accepted frames of understanding. ESP, or extra-sensory perception, is waiting for such organization. Much has been done by parapsychologists, as the researchers in this field are called, but a great deal remains to be done. As extra-sensory perception operates through the unconscious, psychoanalysts should be last to ignore it. It is for this reason that as a psychoanalystI feel compelled to tell the story of a dream I had on April 22nd, 1958 after a surgeon had inserted a probe into my salivary gland in searching for a salivary stone. The possibility that dream had a premonitory value received strong support a few days later when I found myself scheduled for a major operation. I wanted it to be on record, so on April 26th, 1958 I sent a letter to Martin Ebon, editor of Tomorrow Magazine and Director of Psychology Foundation (and a copy of the same to Marie Coleman, editor of Psychoanalysis) with the following content: "Tomorrow, Sunday I will be .entering Montefiori Hospital for a parotid tumor operation which is sceduled for Tuesday, April 29th. It is a major operation because of facial nerve complications, But the tumor is expected to be benign as such tumors are in the early stages. There is, therefore, every reason to think that about a week after I shall be out. "On Tuesday, Apill 22nd, the day after a probe was inserted into the salivery duct for exploration, I had a dream, this : "I saw Clement Staff (editor of Psychoanalysis* a friend who recently died) and asked him for a loan of $ 10.-for a pair of shoes* I think it was a second request. I bad asked for something before.

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I forget what that was. He did not give me the money but said he would. I had the feeling that I would have it in ten days. A little later, I was bothered for having asked him : after all, he had just come out of hospital (in the dream) and he must have spent all his money. Then I woke up." I added in commenting on the dream that Clem Staff looked exactly as when I last saw him two days before he had died at Mount Sinai, and that the first thought the dream suggested was that I am about to step into his shoes. This was supported by associating the f 10.with the wreath that I had sent to the funeral parlor where he was laid out. Stepping into his shoes, therefore, implied tnat I would die. This I refused to accept andas seen from the first paragraph of my lettertried anxiously to build up a favorable prognosis, ommitting to mention that the diagnosis spoke of a double tumor and that the dream impressed me as revealing somatic anxiety only but in view of the precognitive element it may contain (which can only be ruled out, or confirmed, by later events) I thought it worth while to place it on record. Obviously, the impression that the dream portended by impending death was wrong. Something within me must have known it, or I would have been more upset than I was and, possibly might have refused to undergo the subsequently proposed operation (which turned out to be unnecessary as it was performed on the basis of a diagnostic blunder). On the other hand, thr precognitive touch could have acted as a suggestion for accepting the operation as it shifted the emphasis from the necessity of undergoing it to the question of surviving it. In other words, it was a challenge the like of which I never hesitated to face in the past. All the while, I was vaguely aware of another possible interpretation. I was a member of the editorial committee of Psychoanalysis At a meeting called for purpose of discussing, succession, Marie Coleman sounded me on my aspirations. I said, emphatically, that I had none, that she was the right person to succeed Clement Staff in the editorial chair. Yet, unconsciously, I might have regretted the statement and, to cancel it out, I made Clem Staff live again the dream. That would explain the first request in the dream that I failed to remember, also why, -on my second request, I did not get the $ 10.-, only a promise that I would have it later, i.e. I may still

succeed him. If he did live, obviously neither Marie Coleman or I could step into his shoes. Some factors, however, militated against this simple analytic explanation, made two requests in the dream, and I was hospitalized, subsquent to it, twice. My stay in Montefiori Hospital lasted for nine days. Unknown to all, I was discharged with a deadly infection against which, at the time, no antibiotics prevailed. It was a typical hospital disease, and people were dying from it all over the country ; only, in my case, during the post-surgical treatment period, it was called erysipelas and later an erysipeloid condition. It was getting worse and worse. Massive penicilin injections kept away the fever but fed the disease. Not even on my entry in Mount Sinai (where Clement Staff had died) on June 16th for an immediate operation, was it properly diagnosed. It was called an abscess under the kidney. Two weeks after a successful operation I went under the knife again, and only during the critical 11 days while I was hovering between life and death was the dreaded germ identified. It was STAPH, short for staphilococcus,an abbreviation I never heard before and a complete vocal identification with Clement Staff. By this identification I did step into his shoes, so the dream was premonitory after all but in a different sense. It did not presage death (because he did come out of the hospital alive in the dream and I also survived) and only spoke of trouble ahead. I regretted my attempt to borrow $ 10.from him because he must have spent all his money in hospital period. That was also premonitory. My own hospitalization, with loss of income, reached the height of $ 10.000 for nine week period. Numbers in a dream are liable to a variety of interpretations. The figures of 10 and 2 seemed to have dominated the dream. I asked for $ 10.and was to get it in ten days. I made two requests and had been hospitalized twice. I spent 9 days at Montefiori and was on the critical list for 11 days at Mount Sinai; 9 and 11, adding up to 20 is another 2. All this, however, is just a play on numbers and cannot change the picture of resistance to the premonitory explanation. It runs counter to orthodox scientific experiences and most psychoanalysts will refuse to consider it. How could I on April 22nd, 1958 foresee two hospitalizations and a staphilococcus infection that had nearly

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carried me away ? By considering Staff and STAPH coincidental, the disturbing possibility of premonition can be eliminated. After all coincidences of the most unusual nature, do happen. Against this : is it right to escape from the difficulty of interpretation by invoking the bless of coincidence ? A dream is never fully explained until every part of it fits. Coincidence is not a fit. If the future is involved, only the passage of time can reveal the fit. If such a fit is revealed, coincidenceon retrospectlooks like evidence of intellectual cowardice. What is coincidence ? I have defined it once as the simultaneous occurrence of unrelated events with the suggestion of relatedness. The definition sounds good but it explains exactly nothing. The only important thing it points to is relatedness and that is exactly the problem of a dream and the future it seems to foretell. The first dream brought to an analytic session often proves to be a condensation of the whole story of the patient's neurosis. The reason of this condensation is, I assume, that the patient had reached a critical phase of his life on entering analysis. He sums up his whole life for the sake of orienting himself towards the future. Only, we cannot entangle the web for quite sometime to come as we have no prevision of future analytic developments. I was not presenting'to myself a first dream, but I was at a very critical stage. The retrospective element was slight, the prospective much stronger. May it not be that this prospective element (which Stekel had called an adumbration of the future) is always present in our dreams but is overwhelmed by the past ? If this were true, the first dreams of patients will have to be examined not only for what they may reveal regarding the past, but also for what their unconscious may disclose as a glimmering of the future ? I hold it also probable that any crisis in our life foreshadows the very future that plagues us with uncertainty. In which case, the real question is not whether premonition is a psychic factor in human life but the desperate need we have for it. Admitting that, can we set limit to the powers of the unconscious just because we cannot comprehend how such powers operate ? I leave the question open for discussion.

A NEW APPROACH TO THE OLD PROBLEM OF MASTURBATION

Why are most Neurotics Lifelong Masturbationists ?
EDMUND BERGLER, M.D. New York, N. Y. .. '

In my monograph, COUNTERFEIT-SEX * I have the following summary of the general analytic experience concerning the near universality of masturbation among adult neurotics : "There are male neurotics who avoid having any sexual contact whatsoever with a woman. Others marry as a sort of alibi, and even have intercourse occasionally without experiencing pleasure, while parallel with this 'official' sex life there runs another 'unofficial one, devoted to masturbation" (page 22). The same applies, of course, to female neurotics. It seems to be generally agreed in the analytic literature that adult masturbationists are unconsciously chained to their Oedipal fantasies. It is also acknowledged that adults whs prefer masturbation to'intercourse are neurotics. . Independently of each other, Jekels-Bergler and Nunberg arrived at the conclusion that the minus of satisfaction and surplus of guilt in adult masturbation has connection with insufficient discharge of aggression in the procedure. In "Transference and Love"**, Jekels-Bergler stated : "Why does normal man not stick to masturbation, which has been familiar to him since childhood ?...There is not enough possibility in the subject's own ego of discharge of so important aggressive elements, which in part from the substratum of these tendenceies, such as revenge, hostile feelings, etc., unless one chooses the masochistic and hence neurotic way out. It is practically the stigma of neurotics, with their insufficient and inhibited directing of aggression from
* COUNTERFEIT-SEX, A triple monograph on homosexuality, impotence, frigidity, 1951. Second, enlarged edition, Grune & Stratton, New York, 1958, ** Lecture delivered before the Vienna Psychoanalytic Society, November 8, 1933. Printed in Imago (Vienna), XX : 5-31, 1934, and The Psychoanalytic Quarterly (New York). XVIII: 325-350, 1949.

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their own egos upon objects, that they have to be contented with masturbation. The insufficient discharge of aggression in masturbation seems to us a circumstance of which the importance should not be under-rated. It is one which seems important to us for two reasons : first, it explains the inadequacy of satisfaction through masturbation ; second, it makes highly questionable the frequent allegation that masturbation in adults is harmlessindeed, it may contradict it." (pp. 349 ff., my italics). H. Nunberg, in ALLGEMEINE N-EUROSENLEHRE*, states that the reason for guilt feelings accompanying masturbation "is not quite clear." It cannot be the educational interdiction alone, because that guilt is visible even in cases in which that interdiction in childhood cannot be proven. The anoiher suspects that puberal masturbation revives infantile guilt connected with Oedipal fantasis. Moreever, "in the inhibition of satisfaction of sexual drives also the agressive drives cannot find cathexis outside, hence are turned inside and are changed into guilt. Never is there full satisfaction in. masturbation, at least not in the sexual sphere, since the real object is missing. The aggression, connected with libidinous tendencies, changes into need for punisment (p, 1/8)." That masturbation fantasies do not represent direct id-eruptions, but modified inner defenses, was first pointed out by myself in 1934. In my study, "Some Special Varieties of Ejaculatory Disturbance Not Hitherto Described.'' ** I adduced the case of a man who practised "coitus incognito," forcing the girl to describe in obscene words experiences with other men. This man's masturbation fantasy had the background of direct repetition of an observed intercourse of the parents. It was this masturbation fantasy which pushed him into analysis. The question arose : why had the patient retained in consciousness a fantasy otherwise repressed ? The answer was that he was hiding behind someone else (when he attempted intercourse "in his proper person" the erection collapsed immediately), and that the fantasy also served as unconscious camouflage for feminine identification. Specifically, the text states : "Other determinants of his peculiar wish were a tendency to masochistic abasement..." etc.
* Hans Huber, Berne, 1932.
** First published in Internationale Zeitschrifl fur Psychoanalyse, XX : 252-260, 1934 , translated in International Journal of Psycho-Analysis, X V I : 89-95.

The topic of defensive camouflage in masturbation fantasies was taken up, eleven years later, by L. Eidelberg in "A Contribution to the study of the Masturbation Fantasy," Int. Journal of Psycho-Ana-, lysis, XXVI, 1945, Parts 3 and 4. Summarizing the literature, one can state that adult masturbation is based on being chained to Oedipal fantasies, and the minus of satisfaction and plus of guilt (as compared with normal intercourse) is reducible to insufficient discharge of aggression outside. In the already-quoted extract from "Transference and Love" (which Jekels and I wrote in 1931) will be found the dictum : "...unless one chooses the masochistic and hence neurotic way out." In the intervening thirty years, recognition of that masochistic component has became more and more important clinically. I believe that the masochistic solution, based on oral regression, is the basic neurosis. All later stages are unconsciously used either as rescue stations from the oral danger, or as camouflages (expressing on a higher level in the language of these stations) of old, neverrelinquished oral-masochistic conflicts. Nobody denies the existence and reality of higher developmental levels in the libidinous-aggressive development of the child ; the question is solely whether or not these are subsumed and "reformulated" under the direction of the masochistic "solution.''* Not enough attention has been paid to the baby's many and powerful fears ; the more superficial phallic castration fear has been over-rated. The precursors of castration fears are decisive. In THE BASIC NEUROSIS I described the "septet of baby fears," comprising such fantastic (to the adult, that is) entities as fear of being starved, devoured, poisoned, choked, chopped to pieces, drained castrated. Every unprejudiced analytic observer who scrutinizes the contents of masturbation fantasies of adult male neurotics, will attest
* For elaboration, see the author's books, THE BASIC NEUROSIS (Grune & Stratton, New York, 1949) ; THE SUPEREGO (ibid, 1952) ; LAUGHTER AND THE SENSE OF HUMOR (ibid, 1956) ; PRINCIPLES OF SELF-DAMAGE (Philosonhical Library, New York, 1959) ; CURABLE AND INCURABLE NEUROTICS (in print).

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to the fact that seemingly sadistic features (or at least situations embarrassing to the woman) dominate ; these are covered by conquering heroic feats. One small exception can be noted : actual masochistic fantasies in which the masturbationist is either the direct victim or a spectator. In adult masturbating women, fantasies of "being forced," raped or victimzed are just as frequent as idyllic, covering love fantasies. Even the naive Kinsey claimed (on the basis of statements made by his neurotic volunteers, whom he mistakenly took to represent a cross-section of normality) that women are aroused by fantasies connected with reading romantic novels, seeing love movies, andby being bitten, That the first two parts of his triad could constitute an inner defense against the third did not occur to Kinsey.* To my surprise, it turned out thatregardless of the camouflageall adult masturbationists unconsciously live out masochistic fantasies. Those who half-admit to this substitute a more attenuated, "harmless," masochistic fantasy for a more deeply repressed, pangerous one, connected with one of th e participants from the "septet of baby fears." What does this mean f In my opinion, the allure of masturbation to the adult neurotic does not rest on Oedipal and/or pre-Oedipal fantasies. These are subsequently adduced (unconsciously, to be sure) as "admission of the lesser intrapsychic crime." The main unconscious attraction is that "something is done to me." Although the masturbationist seemingly plays an active rolehe produces the accompanying fantasy, handles his sex organ or moves it on the bed sheetthe underlying propelling fantasy is passive in scope. In this repressed fantasy, some partes constituentes of the "septet of baby fears" are invoked, with the masturbationist on the receiving end. As defense, pseudo-sadistic and narcissistic covering illusions are put in operation. In cases in which masochistic fantasies dominate outright, a strong attenuation is discernible. Beating fantasies are relatively harmless, compared with any of the partes constituentes of the ominous "septet of baby fears." There is also the known fact of
* KINSEY'S MYTH OF FEMALE SEXUALITY. By the author, in collaboration with W. S. Kroger. Grune & Stratton, New York, 1954.

double identification even in sadistic fantasies (Freud), where the official torturer also unconsciously identifies with the victim. One could add that "doing it oneself to oneselfwhich is what masturbation actually isreproduces in a watered-down and diluted form (with the addition of greater safeguards') what the child imagined as forcefully and with malicious intent dene to him by the Giantess of the Nursery, T hat transformation of an acute inner danger into a selfproduced game is the strongest allure of masturbation. Thus, masturbation ts a sanctuary of masochistic passivity, regardless of the "package wrapping" of superimposed, alibi-providing secondary defenses. The best the male neurotic can do in intercourse is to place passivityin a process that requires activityby unconsciously identifying with the allegedly passive woman. These attitudes have been connected with the negative Oedipus (feminine identification in the man), a conclusion which overlooks the fact that the negative ; Oedipus has an oral substructure.* In previous years, many authors stressed the fact that many men after a satisfactory intercourse, dream a homosexual dream. This was taken as positive proof of bisexuality. I believe that homosexuality is but a defense against oral-masochistic vicissitudes.** Hence, these dreams are, once more, a disguise of passivity. In short, homosexuality had been misunderstood. There is a connection with homosexuality, however. It is a well-known fact that homosexuals are constantly eager for new sexual experiences. Since masochistic passivity is the basis of homosexuality, the need for an alibi (of conquering "sex") must be constant as well. Masturbation is the faithful duenna of every adult neurotic for the following reasons : ' 1. Masturbation is the sanctuary of earliest, dangerous masochistic passivity, now converted into a "harmless" game ; instead
* Elaboration in THE BASIC NEUROSIS, I.e. ** ONE THOUSAND HOMOSEXUALS (Pageant Books, Inc., Paterson, N. J. 1959) ; HOMOSEXUALITY : DISEASE OR WAY OF LIFE ? (Hill & Wang, N.Y., 1956).

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EDMUND BERGLER

[SAMIKSA

of being cruelly manipulated by the pre-Oedipal mother image, the masturbationist handles himself in a "repetition in reverse" (active repetition of passively endured or fantasied passive experiences). 2. In men, masturbation as depository of the "septet of baby fears" is defensively covered by narcissistic-conquering, womanembarrassing fantasies. In women, the original supposed cruelties of the mother image are diluted and attenuated into more superficial fantasies of being raped, mishandled or forced, or into superficial, secondarily defensive romantic fantasies of unending love. 3. An added inner allure in masturbation is provided by elements of the forbidden and uncanny, with their promise of dangerous self-damage. These are faint reverberations of the original dangerous masochism. 4. Guilt because of masturbation pertains to the masochistic substructure, and is secondarily shifted to the pseudo-aggression in the act itself or the fantasy (Oedipal, pre-Oedipal). 5. Normal intercourse is no substitute for masochistically tinged masturbation.; the normal satisfaction accruing from placing normal aggression in the sex act does not allure the masochistic neurotic ; his major problem is the inability to place a superabundance of masochistic passivity. 6. Oedipal and pre-Oedipal repressed fantasies are not the motor power of neurotic masturbation, but the half-admitted (though also unconscious) 'lesser intrapsychic crime." These fantasies cover the "crime of inner crimes"psychic baby-masochism. * The conclusion from the thesismasturbation in adults covers exclusively a masochistic substratumis inescapable : analyzing the sexual-aggressive cover fantasies alone cannot destroy the masochistic basis. The opposite technique is necessary : these fantasies have to be discarded as camouflage and the hidden oral-masochistic basis analytically attacked.