The Scent of The Other (Encopresis)

The Scent of the Other
BERNADETTE S. KOVACH, Ph.D.
While there are many exchanges that take place during our early development, some have a more profound impact on our developmental trajectory
than others. In the milieu of a disturbed mother-child dyad, what becomes
of self and other object representations? How do the derivatives of trauma,
neglect, and overstimulation become expressed and used during important life transitions? In this paper, convergent themes in the analysis of
an eleven-year-old boy and a forty-year-old man illustrate how the evocative nature of smell was used as a means of holding on to early object ties
and fantasies of a blissful union. I am proposing that by conceptualizing
encopresis and the use of body odors as an expression of the individuals
early trauma and object representations, we can advance our understanding of the tenacity of these symptoms and further develop appropriate and effective technical approaches. A select review of the literature is
used to establish the relationship between earlier developmental phases
and an internalization of early object relations relevant to this paper.
Introduction
during my work with eleven-year-old steven, we came to
understand his symptom of encopresis as a means of holding on to his
relationship with his mother. Stevens comfort with the smell of his feces
and the repulsion it provoked in others led to a counterreaction and
Bernadette Kovach, Ph.D., is an adult analyst and an Advanced Child Analytic Candidate
at the Michigan Psychoanalytic Institute. I am grateful to Nancy Kulish, Marvin Margolis,
Michael Singer, and my fellow candidates at MPI for their contributions to my development.
It is with sincere gratefulness that I would like to acknowledge Dr. Ivan Shericks consultation both during Stevens analysis and throughout the writing of this paper. I would
also like to acknowledge Kerry Kelly Novick and Dr. Channing Lipsons careful editing and
comments throughout the development of this paper.
The Psychoanalytic Study of the Child 66, ed. Robert A. King, Samuel Abrams, A. Scott
Dowling, Paul M. Brinich, and Claudia Lament (Yale University Press, copyright 2012 by
Robert A King, Samuel Abrams, A. Scott Dowling, Paul M. Brinich, and Claudia Lament).
60
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understanding of how his feces came to represent an internalization

of a part-object tie to his mother in the form of a fecal mass. Stevens
use of his body products, and their smell, alerted me to the presence
of similar dynamics in my work with Michael, a middle-aged man. The
scent of Michaels sexual escapades with women clung to his clothes
just as he clung to fantasies of a perfect union. Keeping the scent of
the other with him was Michaels way of conveying his feelings about
his childhood experiences and his reason for making messes of his relationships and in his life. Steven and Michael held similar fantasies of
uniting with an object that would transform earlier painful relationships
into pure narcissistic gratication. Losing their smell meant losing the
essence of their re-union fantasy. Loss of this centrally held fantasy was
akin to facing death for both Steven and Michael.
Literature Review
How and with whom we begin our life helps organize who we are within
ourselves and with others. It is within the context of our early relationships with others that our experiences, affects, and fantasies become
a part of our self-understanding and our later interactions. The tenet
that early experiences play a signicant role in normal and pathologic
developmental has a long history in psychoanalytic theory and practice.
One of the rst clinical references alluding to the importance of early
stages of development on pathological solutions and symptoms was that
of Little Hans (S. Freud, 1909). Freuds conceptualization of Hanss
phobia and disruptive behaviors was a valuable contribution to our
understanding of displacement and childhood fantasies, even though
it was strongly inuenced by his need to validate infantile sexuality
and positive oedipal conict as the most important determinant of the
childs psychopathology (Blum, 2007a, p. 756). However, Freuds interpretation of Hanss fear of horses as related to his oedipal strivings and
castration anxiety did not incorporate the mothers ministrations and
inuence on the childs defensive entrance into the oedipal phase. After the release of previously restricted letters, it became clear that there
were multiple reasons why the importance of the early mother-child
relationship was not part of Freuds initial interpretations of Hanss
symptoms.1 However, in modern reconsiderations of the case of Little
Hans, the signicance of the early mother-child relationship to Hanss
1. A full review of Little Hans is presented in the 2007 Journal of the American Psychoanalytic Association 55, no. 3. Also see Freud, S. (1909). Analysis of a phobia in a ve-year-old
boy. The Standard Edition of the Complete Psychological Works of Sigmund Freud 10:5147.
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Bernadette S. Kovach
symptom formation and the intensity of his conict have become apparent (Blum, 2007a, 2007b; Chused, 2007; Ross, 2007). Ross (2007,
pp. 78794) purports that by reconsidering Little Hanss symptom formation as a means of conveying the trauma of the family constellation, as well as Frau Grafs abusive behaviors toward her children, we
are afforded the opportunity to reect on how these early experiences
became woven into later developmental stages and fantasies. Although
the major focus was on Hanss fear of horses and phobic behavior,
there were many other symptoms present, including Hanss rage when
expected to use the chamber pot (Blum, 2007a, p. 757).
According to Anna Freud (1963, p. 253), feces are offered as gifts,
which are surrendered to the mother as a sign of love. The childs
productions and the process surrounding their productions becomes
representative of the movement toward self-mastery and mutual reciprocity. In other words, in each instance of self-mastery, including toilet
mastery, early mother-child interactions are represented in the childs
experience of self and other. Therefore, mother-child dyadic experiences become woven into the separate actions of the child. In the
presence of a good enough mother, separation and mastery become
part of a reciprocal exchange of pleasure in self and other. However,
this was not the case with Little Hans. Even though Hanss mother was
overly solicitous toward him, preferring him over his father and his sister (as reported by Blum, 2007a, p. 755), he did not wish to give gladly
of his bodily productions, as other toddlers are apt to do. His feces
would not be easily surrendered and therefore could not be enjoyed
as a production separating him from his mother. Instead of a mutually
pleasing developmental transition, Hans kept himself painfully tied to
his mother, and she to him. His feces became an expression of his
wish for omnipotent control and the attendant masochistic surrender
that had likely been part of his relationship with his mother from infancy. His difculty relinquishing his feces was complicated and could
easily represent rage at his parents, just as it could represent a partial
internalization of his mothers treatment of him as her widdler (see
Ross, 2007, p. 788). Frau Grafs abuse of baby Hanna, overstimulation
of Hans, and loss of her own productive capacity as a musician set
the stage for Hanss particular expression of reciprocity through bodily
productions. Through an understanding of his identication with his
mother, Hanss reference to his feces as a baby can also be understood
as a reference to the way his mother treated his sister Hanna as the fecal
baby, unwanted and disposable.
There is sufcient agreement in the literature that derivatives from
earlier stages of development inuence later stages. How do the deriva-
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tives of trauma, neglect, and overstimulation become expressed and

used during important life transitions? What happens when a child
who has not completely differentiated moves from the symbiotic or
dependant stage of development into the anal phase? Shabad (2000,
p. 695) suggested that children who remain unrecognized by their parents feel incomplete, inadequate, and spiteful because the humiliation of
their expulsion pursues them unrelentingly. . . . Disposed of like human refuse,
expelled individuals lack the condence to move directly toward the freedom of
the autonomy for which they yearn (italics added). Shabads description
of Marty, a young man who as a child used encopresis to humiliate his
parents, demonstrates the concreteness with which the derivatives of
preverbal trauma can be expressed. Similarly, when the data regarding
Frau Grafs sadism toward her children is taken into consideration,
Hanss episodes of encopresis can easily be understood to represent the
objects in his life. His transitions into later developmental stages are
tinged with the pain and warmth of a partially internalized relationship
with his mother. His fecal baby then becomes the rival to his mother
and her new baby, as well as the reason for his punishment. By delivering a stinky baby, just as his mother delivered her stinky baby, Hans
communicated the dilemma of being the product of someones body
rather than a longed-for gift of love.
Through the use of literary references and poignant clinical examples, Kerry Kelly Novick (1987, 1990) demonstrated how the threads
or residues of early experiences of self and other are carried through
the childs later developmental phases into adult associations as undifferentiated experiences of discomfort or an attachment to pain.
Similarly, Greenacre (1969, p. 155) conceptualized body memory as
residuals of actual events that are incorporated into later memories,
fantasies, and bodily reactions. These residuals become recognizable
through the patients wish for merger, their neediness and desire to
be given to, reluctance to give, and corporal reactions to the transference (Greenacre, 1969, p. 155; A. Freud, 1962, p. 241). In his thesis
on anal narcissism Shengold (1985, p. 52) draws our attention to the
relationship between a lack of differentiation of self and other and an
individuals need to physically hold on to and let go of objects through
hostile provocation. He states that the beginning of object representation occurs during the anal phase with the establishment of a sense of
self, separate from other. Shengold (p. 53) notes that during the anal
period, separation is accomplished (under conditions of at least adequate
parenting and parental letting go) by the continuing and now differentiated
psychic registration of what are outside the body and the mindrst the parents
and then the rest of the external environment. The worlds outside and inside
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the body have become mental representations. . . . The establishment of reliable

mental representations that constitute the basis for object relationships (reliable
meaning possessing object constancy) is made possible by yet another kind of
transformation that bursts into ower during the period of anality: the transformation of body feeling into thought (italics added).
Fast (1992, p. 394) highlights the development of a sense of self, embodied in our relationships with others, where original representations
of both self and objects are conceived as initially part selves and partobjects merged in undifferentiated self-other units. Fast contends that
in infancy, self and object are part of an undifferentiated interactional
scheme. These early schemes are body bound and become a template for
our representations of self and other, and become integrated into our
later interactions. Through differentiation and integration, self and object no longer stand for one another and the blissful union of infancy
is relinquished for the competences achieved in our separateness from
others. Maturation during the later part of the anal phase brings about
the ability to distinguish self and other as well as action from thought.
During the process of differentiation the childs ability to verbalize
and hold on to mental representations of self and other plays a crucial
role in making mental memories as well as in how the memory of self
and other is maintained. Bach (2001) identied the importance of a
mutual memory system where the mother and the infant rst hold on
to each other in memories originally formed through recognition of
the others scent, sound, and feel. The ability of the mother to build
memories for the child to hold on to helps the child develop a mental
representation of self and other. This mental representation of the self
holds the child while the mother and child mourn the loss of the physical experience of self and other as one. What happens to the process of
loss and mourning when early relationships are steeped in emotional
neglect, rejection, and overstimulation? The following clinical examples
demonstrate how bodily smells served as a defense against depression,
anxiety, and as a means to deal with maturational failure by holding on
to part-objects. In the following examples, smell and body products are
merged with fantasies so that the world inside and the world outside
are only partially differentiated.
Case Examples
case 1: steven
Dr. S summarized his understanding of eleven-year-old Stevens encopresis and the reason for his referral for analysis by saying,
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I think you should know that this is a miserable child. He is hostile and
foul. He has been to several doctors and there is no reason for him to
continue to lose control of his bowels. I believe it is his choice. I expect
because of his background, and the way he has behaved with me, he is
lled with rage. The profound neglect and poverty this child has endured is as repulsive as what he does.
As Dr. S listed the medical interventions Steven endured since he

was ve, including dietary changes, laxatives, suppositories, enemas,
and sigmoidoscopies, I considered the complex nature of Stevens encopresis in relation to these interventions and to his caretakers. Each
intervention seemed laden with anal stimulation and sadomasochistic
elements that could easily affect Stevens willingness to relinquish his
symptom. In addition to extensive medical evaluations, Steven had been
in several cognitive and behavioral treatments, yet his encopresis continued. Just prior to being referred for analysis, Steven was placed on
an antidepressant medication that made him feel like a zombie and
increased his suicidal ideations. Medication was withdrawn, and Stevens
father sought out analysis as a last resort. Stevens father, Rob, reported
that he and Stevens stepmother, Sheila, tried everything to stop Steven
from crapping in his pants and all over our lives.
Stevens early history was riddled with neglect, multiple caretakers,
and harsh treatment bordering on abuse since birth. Rob was expressionless as he spoke about Stevens mother, Kay, and Stevens life as
an infant. He recalled coming home from work to nd his infant son
lying in soiled diapers next to Kay, as she slept off an alcohol binge.
Sometimes he heard Steven crying as he approached the apartment,
but more often than not, Steven lay quiet in his soiled diaper and dirty
clothes. The apartment was lled with the smell of feces. Consciously
disgusted and fearing his anger, Rob ed, leaving Steven alone with
his mother until Steven was approximately fourteen months old. Rob
readily admitted that his decision to return, and later petition for custody, was more out of a sense of guilt and responsibility than affection
for his son.
Robs hardened expression broke as he tearfully remembered Kay
taking three-year-old Stevens favorite teddy from him, saying the teddy
was to stay with her. Although Steven sobbed and pleaded for his stuffed
animal, he was told he could have his teddy again when he came to see
his mother. She promised to give the teddy bear back to him each time
he came to visit. However, this was a promise Kay was unable to keep,
as she lost the teddy bear in a move soon after taking it from him. Rob
recalled Stevens tearful rage at having his teddy taken from him, and
the subsequent symptom of encopresis. Rob believed Stevens initial
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episode of encopresis was invoked by the trauma Steven experienced

during this departure from his mothers house. Since this beginning
episode, Stevens encopresis would remit between visits with his mother,
only to return after a phone call or a visit with her. This pattern was
evident during our analytic sessions and eventually became part of Stevens response to my absences as well. Together we came to appreciate
Stevens ability to express his feelings of rejection and abandonment in
a very pungent way.
At his fathers home, Steven treated his feces as if they were precious
belongings. He wrapped his feces in his underwear and hid them in his
room on shelves, in the closet, and stuffed them in a hole in his mattress. Steven became enraged when his precious packages were found.
He argued when he was told his clothes and bedding needed to be
laundered. Although this description might sound as if Steven were
psychotic or oppositional at best, he showed no signs of psychosis over
the course of a two-year analysis. In addition, his oppositional tendencies seemed to arise only in relation to his symptom. In fact, given his
history of trauma, I found Steven to be surprisingly engaging, humorous, and at times rather introspective for a child his age.
In our initial sessions, Steven was very well behaved. He helped pick
up the toys we used without being asked and entered every session
eagerly. When I inquired about his amenable behavior, he openly admitted that he had been around therapists and knew how to behave
around them. He knew that if he told them everything was okay, acted
well mannered, and went along with whatever they prescribed, he would
be able to get out of therapy quickly. Stevens compliance was a masochistic compromise in which he surrendered his need to express his
feelings in order to adapt behaviors he was told signaled his progress.
His masochistic solution was also aimed at maintaining his denial about
the reasons he was in analysis. I addressed Stevens denial directly by
telling him that his parents brought him to see me because, among
other things, he was having some trouble with his bowel movements.
Appearing earnestly confused, Steven replied, I dont have a problem
with my bowel movements. None . . . at . . . all. At rst, I thought of
his remark as denial, or anxiety about admitting to his symptom for fear
of punishment. In time I understood that he was not at all troubled by
his encopresis and as such was not denying his symptom. I also came
to appreciate that Stevens encopresis was not being defended against,
but defended.
Although verbally adept and often verbose, Steven spoke in a littleboy voice when making requests. On one such occasion, he shyly asked
if we could make a town with the dollhouses and toy buildings he found
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in my ofce. Using the toy buildings and other toy construction materials, Steven promptly formed a circle. He was the hub and I was on the
outside of the womblike structure. Steven repeated this scene each day
for several months, only allowing me to participate from outside of the
circle as a witness and narrator. The toy structure had become a physical boundary allowing Steven to feel held within my ofce yet separated
from me while he told the story of his life. Toy dolls were brought
into the circular city. These toy characters came to be known as the
people and the babies. The babies were usually bad and unwanted.
The people changed rapidly from hostile to neglectful, depending on
the story that needed to be told. Themes of longing, disappointment,
overstimulation, and inhuman living conditions were exemplied in the
actions of the babies and the people. The babies were thrown away, left
in the cold to die, anally pierced with long rods by doctors, fed poisonous elixirs, and left alone to fend for themselves for hours.
Eventually, Steven invited me to play along using the doctor and
grandmother dolls. My dolls could occasionally enter the circle, but I
was to remain outside the circle. During this time, Stevens anger toward
me and other doctors was expressed in displaced violence toward the
doctor and grandma dolls. The doctor doll was thrown off the roof of a
building, run over, hit, beaten, and tortured. As the fervor of his attacks
on the doctor doll increased, I wondered aloud if he was worried that
I would be like the other doctors and try to put him on medication or
make him do homework or worse. Steven responded with surprise and
relief: Yes! They were all stupid. They didnt help me. I know what I
need to do but I cant do it.
Steven continued to express his rage and sadism in displacement
over the next several months. Although Steven continued to help pick
up at the end of a session, messes within the play town were made and
not cleaned. Toy bathtubs were lled with imaginary shit and the doll
people were routinely urinated or defecated on to Stevens delight. The
people walked around with their heads on backward, butts rst, because
That is the most important part of them! Steven exclaimed.
Over the next several months of analysis, a crazy woman appeared.
She was crazy because she hated her baby and so she threw him off the
top of the buildings. She abandoned him in the streets, where he was
thrown in the garbage like trash. If the doctor doll tried to intervene
and help the baby, Steven would stop playing. In those moments, I silently wondered if he felt thwarted in his efforts to express his sadistic
feelings and have them accepted by me. When I did not intervene,
Steven would initially respond with delight, but eventually he became
silent and angry. His reactions led me to believe that when the doctor
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doll did nothing to help the baby, Steven experienced me as just like
others who had abandoned him and done nothing to stop his earlier
traumas. I was frustrated and confused. Eventually Steven announced
his reason for withdrawing from play when the doctor doll tried to
intervene: Doctors are not to be trusted! He sobbed. All they want
to do is take away what is mine. They want to punish me for keeping
what is mine.
Steven began to make demands for more people, more men, and
gifts from me. He wanted me to make people with him. The oedipal
strivings implied in his request were indicative of the progress Steven
was making in the analysis. At the same time, I also considered if his
need to create people was linked with his need to create something
with his stool, and as such, I introduced pungent smelling modeling
clay into our work. At rst, we made colorful adults to help the other
people in the city and to take care of the children. Then we began to
make babies, not just any babies; we made chocolate babies by mixing
the colors together. However, chocolate babies were not the only addition to our sessions. Stevens symptom of encopresis also began to be
expressed in session more frequently. As Stevens in-session encopresis
escalated, his cooperation at home also increased, as did his at-home
interest in self-care and toilet mastery. In order to support our sessions
and Stevens mastery of self-care, his stepmother prepared a backpack
with a change of clothes, cleaning supplies, and a plastic bag for his
soiled underwear. The backpack became known as Stevens clean kit
and was brought to session each day in case he needed to clean himself before the ride home. Over the next several months, we enjoyed
a complete but temporary remission in Stevens encopresis. During his
remission, Steven gave me a gift of words. He brought in the book The
Golden Compass (Pullman, 1995) to help me understand how he felt
about losing what was his.
After Steven returned from a two-week vacation at his mothers house,
his play in session changed. We stopped creating people, and the babies were once again mischievous and hid from the adults. The babies
were repeatedly taken out and put back into their hiding places. Steven
giggled and squealed as the babies moved in and out of hiding. His
expressions of pleasure took on a frantic quality as the babies naughty
behaviors turned to stealing and eventually killing the adult characters. I was again barred from directly playing with the toys or Steven.
I asked Steven if he wanted me to feel excluded the way he had felt
separate and excluded from me and others. Stevens answer came in a
pronouncement that he wasnt clean now or while he was at his moms.
His mother worked long hours and rarely spoke with him while he was
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with her, except to point out how difcult her life was. His symptom of
encopresis had returned along with his rage at being abandoned and
not being able to be held or to hold on to his mother.
Steven continued to reject me during our sessions by inviting me to
play then abruptly stopping me from any interactions with him or the
toy people. During these nonplay times, I reexively began to make
things. I made paper ornaments, rugs out of scraps of cloth, and anything I could think of. I produced something to keep me occupied
while I sat alone outside the toy barrier. Eventually Steven began to
take my productions from me. As I sat, left with nothing, I wondered
silently how I could make something out of the loneliness I was feeling.
I craved stimulation of any kind. Steven withdrew further into himself,
barely acknowledging my presence. As my feeling of isolation increased,
I decided to tell Steven I believed he wanted me to feel lonely and unable to talk about my feelings because he felt unable to talk about his
painful, lonely feelings. Stevens response came in the form of a story
about a toy he had received for Christmas. He said he would take the
toy into his room and talk with it until he fell asleep. Sobbing bitterly,
he added, It was taken from me, like everything else I really want to
keep. His story was reminiscent of the teddy bear that had been taken
from him and later lost by his mother. Both memories were emblematic
of the tenuous connection between Steven and his mother, and her
unavailability to him physically and emotionally.
Several weeks later Steven brought a surprise for me on his return
from a long weekend with his mother. When I opened the door to my
waiting room, Steven was lying on the oor looking through a magazine, excited to see me. He smiled, but the smell in the waiting room
was overpowering, leaving me unable to greet him in kind. Picking up
his clean kit, he eagerly walked down the hall to my ofce, seemingly
oblivious to the odor. Sitting on the oor, Steven opened his clean kit,
revealing its contents. He had stuffed his backpack with soiled underwear and pants. I stood motionless as thoughts raced through my mind
about cleanliness, germs, and illness. I pictured the types of organisms
that grow and multiply in fecal material. I remembered a story I had
read as a child about a little girl that died from diphtheria, a devastating illness, from drinking water contaminated with feces. I thought
about my child and my other patients. What resounded in my mind
was I cannot do this.
Closing the door to my ofce, I asked Steven what he was planning.
He smiled and said, I thought we could play. As he started to reach
into his clean kit, I stopped him abruptly saying, No Steven. I am sorry,
but I cant appreciate this the way you do. I cant do this. I am not able
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to play with your poop the way you do. I know it is exciting for you. I
am too old, and so are you now. We can pretend to play with poop, but
not for real. I was completely repulsed at the sight of the fecal-stained
clothing and stench. As my disgust and fear escalated, I felt propelled
to send Steven home to use our time to clean his clothes and his body.
Stevens smell, his fatal gift,2 and his murderous rage evoked a countertransference enactment of terror and rejection. Together we acted
out the rejection Steven so often experienced in his past and current
relationships with others.
Another aspect of Stevens symptom became clear to us in subsequent
sessions. Steven wanted to play with the toy people again. The babies
took other people prisoner and placed them in a big dumpster. The
captured people could not hear or see, but they could smell everything.
Of utmost importance, the captured people could never leave the babies and never go away or make him go away the way his mother and I
had. It was during these sessions that we were able to begin recognizing
and discussing Stevens enjoyment in the anal stimulation of pooping
and his fantasies of holding on to the people in his life. We were able
to understand how he used his symptom of encopresis as a means of
maintaining a hostile dependent relationship with others as both captor
and captured in fantasy and in reality.
Although Steven spoke more frequently about his anger and frustration with others, particularly his mother, he continued to foul the air
and make messes in his pants. Over the course of about four weeks,
Stevens mother continued to disappoint him by not picking him up for
visits and not calling him. At the same time, my own mothers health was
worsening, eventually resulting in her death. During this period of the
analysis, a pattern developed with Steven letting go of gas or expelling
small amounts of his feces into his pants whenever he felt disappointed
by his mother. Feeling assaulted by the smell of feces and my own recent loss, I began to search for a way to comfort myself. At some point
in my search, I remembered the handkerchiefs my mother had given
me. I began to develop my own pattern and repetition. Each morning
as I dressed, I took out one of my mothers handkerchiefs, sprayed it
with her perfume, and tucked it in my sleeve, just as I had watched my
mother do when I was a child. I would leave a corner of the handkerchief out so that I had easy access to the scent and the comfort of the
memory of my mother. As an anticipated spring break neared, Stevens
excitement grew. When Steven arrived for our last session before vaca2. The term fatal gift is used in reference to Orgel and Shengolds 1968 paper on gift
giving (p. 380).
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tion with stained pants and smelling particularly foul, I wondered if he

might be disappointed by not seeing me over the break, or maybe something else had happened. Steven angrily refused to answer verbally; he
answered by turning red in the face. As the smell began to increase, I
asked Steven if he needed to use the restroom. I suggested we talk about
his anger and wondered if he knew how offensive the smell was. What
smell? he replied. I said I was certain he could smell what he was doing
and wondered why he was trying to make a smelly mess today. Crying,
Steven replied, It doesnt smell. Pointing to the handkerchief in my
sleeve, he said, It doesnt smell to you, does it? What I do doesnt smell,
not to me. A smell is something bad, and this is not bad to me. Did you
know that my mother is not coming to get me? Everyone wants me to
stop doing this, and I cant. I want to sometimes, but I cant. It doesnt
smell, because it reminds me of being with my mother. The objects
that held the scent of our mothers were as different as the memories
they held. Steven held within his mind, and his body, the reality of his
preverbal experiences with his mother and the comfort of his fantasy of
a blissful union with her. He held on to a wish that she would smell his
need to be cared for, even if she could not see or hear him. By holding
on to his feces, he held on to an object that no one could take from
him, and to the reality of his earliest relationship with his mother.
case 2: michael
Michael began his analysis because of his difculty with writing. He was
nearing the completion of a literary work that would change the course
of his career, allowing him opportunities for increased creative expression and nancial stability. The closer he came to completing his project, the more he drank and engaged in sexual escapades that resulted
in humiliation and that could have jeopardized his career. From the
beginning of our work together, Michael was aware of a link between his
draw to sadomasochistic relationships and his past, yet he was reluctant
to offer childhood memories. Michael was suspicious of his memories,
saying they were dreamlike or reminded him of lms he had seen, and
therefore he could not trust their accuracy. He was also hesitant to seek
verication that could lend clarity to his past. In time, Michael was able
to disclose his fear that the only thing he or anyone would remember
about him was that he was an angry mess as a child and adolescent.
As Michaels curiosity increased, he began to make inquires about his
past, allowing him to verify memories. Michaels mother informed him
that his sister Jodys birth marked the beginning of several difculties
for the family. His mother became pregnant when Michael was three
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months old, and in her preoccupation with her pregnancy and the familys mounting nancial struggles, she admittedly became lax in her care
of him. Michael believed that his mother was not just lax in caring for
him, but had difculty allowing him to separate from her. His mothers
responses to his queries about toilet training were offered as an example
of the difculty she had allowing him to become independent. He was
told that although he was ready to move ahead with bowel and bladder
control, his mother continued to put him in diapers. She rationalized
her actions saying she believed it would be easier to train both children
at the same time. It was around this time that Michael rst began to
withhold his stool, sometimes to the point of abdominal cramping and
eventual soiling. His mother was also reluctant to send him to kindergarten and held him back a year ignoring signs of school readiness,
including his ability to read uently by age four. Michaels symptom of
encopresis came to be understood as an expression of his rage as well
as the unconscious dynamics between Michael and his mother. After
learning of his fathers affair with a woman in another city, it seemed
likely that his mothers actions were in part displaced aggression at
Michaels father for betraying her and the children. It appeared that
both Michael and his mother were invested in keeping him small and
soiled.
Through continued talks with his mother and an increased trust in
his memories, Michael became convinced that his independence was
threatening to his mother and that she appeared to feel betrayed by
him for not staying her baby. His mothers wish to keep him a baby
matched his own wish to be a baby again so that he could be cared for
and loved, as he believed his sister was. Laughing anxiously, Michael
recalled bathing with his sister until elementary school. Hesitantly he
recalled their last bath together: I remember feeling very excited. Mom
was not with us at rst but came in when Jody started yelling. One of
us pooped in the tub. I remember telling my sister it was a ship. My
mother was furious when she pulled my sister out of the tub. She left
me in there. Afterward I began to take showers, although Mom always
criticized, saying I smelled. I guess I learned to separate and gain independence by sitting in my shit and stinking.
After several months of analysis, Michael no longer drank, and he
had resumed writing. In the face of these gains, he continued to have
sex with women who were emotionally unavailable to him. My attempts
to make transference interpretations were met with extreme hostility,
denial, or cancellations. It seemed to me that Michael, like Steven,
needed more people to play with. Michael lled his life with people
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73
who were unpredictable and hurtful, like the crazy lady in Stevens
town. In session, he lled the room with words. Despite his verbosity, I
felt left out. A circle of words began to form, with Michael as the hub.
Michaels words built a boundary around him, excluding me from direct
discussions of his transference reactions and his emotional life. In what
appeared on the surface to be a masochistic surrender, he complied
with the analytic rule of saying what comes to mind while expressing
his rage through hostile and sadistic detailing of his interactions with
others and his sexual encounters. The transition from anal expression
of emotion to the use of words included Michaels anal expulsion of
words as a means to express his wish to draw me in and repulse me.
The unconscious goal was to stop any growth in the analysis recreating
his relationship with his mother.
In addition to his copious use of words, Michael began to come to
session without bathing. The scent of his sexual activities lled the room
along with his words. He would arrogantly announce that he despised
the ease with which he could seduce the women he met. Michaels
worry that he was interchangeable and unremarkable was mixed with
his fantasy of omnipotence and his contempt for those he could seduce.
Michael became increasingly depressed as each sexual conquest became
proof that he could seduce or be seduced by a woman but never truly
loved. I wondered if Michael was worried that I too might be seduced
into some action, proving that I was as interchangeable and corruptible
as all the other women were. Michael replied, My wish is to nd someone innocent and incorruptible, yet I know I will feel rejected because
someone like that would want nothing to do with me.
In a subsequent session, Michael recalled the following dream: In
the dream I walked to the top of this perfectly round hill, and at the top
of the hill was a woman. She was someone I knew, but Im not sure who
it was exactly. We stood facing each other for a long time. We were both
naked but not touching each other. We were just looking at each other.
We held hands and turned toward the sun. As we turned, we somehow
became one. We united. Its always what I am looking for. I believe that I
will nd someone that will join with me, and the feeling will be perfect.
I will totally and willingly lose myself in a perfect union. Michaels association to the dream was a memory of giving a mirror to a girl he was
smitten with in middle school. He found out that she wanted nothing
to do with him and only took his mirror to see herself and not because
she cared about him or the gift he had given her. Michael feared that
his feelings and memories would not be reected back to him or understood by me and he would again feel rejected and alone.
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74
Michael continued to bring the scent of the women he was with into
session, along with other body odors. I regarded his actions as some
remnant of his earlier encopresis and his way of expressing something
about his relationship with his mother. However, without Michael verifying his early childhood experiences, I could only speculate that this
was his way of showing me what he found unable to say. The answer
became clear through an enactment in the form of a parapraxis. During the height of Michaels sexual exploits, he came to session with a
strong smell of incense on his clothes. The smell was so strong that I
became irritated. In response to my annoyance, I commented, You
smell strongly of incest today. My slip took us both by surprise. After a
burst of anxious laughter and playful utterances of surprise, Michael responded in a somber tone, Its funny you should say that; I had a dream
last night that really troubled me. I wasnt going to tell you, but now that
youve said that, I will. I dreamt about having sex with my mother. Who
the hell actually dreams of having sex with their mother? Well, I do, I
guess! As Michael continued to speak, his dream became melded with
memories of sleeping in his mothers bed while his father was away. He
slept on the oor of their room until he was almost twelve years old.
In his place on the bedroom oor, he was witness to the sights, sounds,
and smells of his parents nighttime activities. Michael felt invisible, like
an audience in a theater observing a lm. His parents, the actors in this
nighttime lm, behaved as if he were not there. Yet Michael was both
participant and observer. He participated in their experience, just as I
was a participant observer in his sexual activities in the analysis through
his words, the smells, and sounds he brought into the room with him.
After telling me about his special place in his parents room, as he
and his mother called it, Michael was able to explore the relationship
between his longing for a perfect union and his jealous and competitive feelings toward others. Michael was also better able to discuss his
wish to excite and repulse me. He longed to make me feel jealous and
discarded, as he had felt as a child and in the transference.
Another aspect of Michaels use of smell became evident as we continued to explore his reluctance to shower and use deodorant. I wondered
aloud if he was marking his territory or making sure my other patients
knew he was there. Michael laughingly agreed, adding, Thats part of it,
but I also think its because I want you to notice me and not forget me
when I leave. Michael associated his feelings of being forgotten to the
birth of his sister and to being in his parents bedroom. He believed that
he went unnoticed unless he was making a mess or a smell that would
announce both his presence and his annoyance at being forgotten and
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75
rejected. Michael lled the room with his scent and his words just as
Steven had lled the room with his smell and his soiled clothing in an
effort to be remembered and to remember.
During his associations to his use of smell, Michael recalled scenes
from a movie that he felt summarized his relationship with his mother
and father. In the movie, a baby was born to a husbandless shmonger.
Just after delivering the baby, the shmonger pushed her infant son
onto a mound of garbage, leaving him to die. However, the baby did not
die. He was found and brought to an orphanage, and his mother was
executed for attempted murder. The shmongers infant son looked
and smelled ghastly, as if he had taken in the smell of the garbage
and the disdain his mother had for life. His pallor and stench left him
undesirable to other children and adults. An interesting twist in the
characterization of this child was the notion that he had a keen sense of
smell, yet he could not smell himself. As a young man the shmongers
son learned how to extract the essence from the women whose scent
he found enticing. He longed to make the perfect scent, the scent of
innocence, a scent he had never known and never possessed. Michael
also longed to make the perfect scent.
Michael tearfully described how he felt responsible for not being
wanted or loved. He believed that somehow he had been born evil. In
his fantasies, he murdered each of the women he slept with and took
their souls, just as the shmongers son in the story stole their scent.
Michael believed he had been born without a soul. He, like the man in
the movie, was without the essence of innocence. His scent had been
fouled, and as such, Michael held on to his bodily smells to communicate what he had witnessed and felt. Michaels scent and his words
were used by him to exist outside of me and within me, the way an
infant takes up the spaces of the mothers body and later her thoughts.
In subsequent sessions, Michael expressed his belief that giving up his
scent would leave him without the memories of a time with his mother
when he was held as an innocent.
Discussion
Although there are several differences in the two cases presented, in
part related to developmental differences, there are a number of important similarities. Both Michael and Steven wanted to deny their feelings of being unloved, unwanted by their mothers, and abandoned by
their fathers. Both felt disposable and therefore acted as if their lives
and their relationships were disposable. Although their sadomasochistic
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76
struggles for independence account for many of the problems both

Steven and Michael encountered, they do not adequately explain their
need to hold on to their symptoms or the smell associated with their
early childhood memories. While it could be argued that Steven and
Michael became both male and female in their sexual fantasies, by using
feces as an eroticized part-object, it seemed more likely that the smell
and the feces held for them the only connection to their early childhood experiences with their mothers. Without the words to explain the
events of their earliest memories, and with an internalized part-object,
they held their memories in a partially internalized form that they could
create and that could not be taken from them. In essence, their smell
and bodily productions were used as transitional phenomena, which
allowed a furthering of development despite the psychic trauma of neglect (Greenacre, 1969).
Both Steven and Michael longed for the acceptance of their bodily
productions and their scent the way a child longs for the mothers acceptance of their gift of feces (A. Freud, 1963). For Steven, feces came
to represent his mother and his preverbal memories of lying next to
her in their smelly apartment. He created something that came to represent his vigil of waiting for his mother to wake from her binge and to
represent a part of a fantasy of being merged with her. Initially, Steven
experienced his symptom of encopresis as similar to the daemons in the
novel The Golden Compass (Pullman, 1995).3 Removal of their daemon
would result in death because of a loss so great they would not be able to
endure the pain. Similarly, Michael believed that if he lost his scent he
would lose all connection to his eeting childhood innocence and his
wish to be cared for and loved. Their narcissistic omnipotent solution
to the painful realization of being unwanted resulted in the compromise of holding on to the fantasy of a blissful union in a concretized
form. Their use of scent allowed them to remain separate while invading every part of the other person with their essence. For Michael and
Steven, smell allowed them to express rage and excitement simultaneously while maintaining a connection to their mothers in the form of a
fantasized union with the other. Just as I used the scent of my mother,
they used the scent of their experiences with their mothers to express
their connection and their early knowledge of self and other.
3. In the story The Golden Compass, a humans daemon, or spirit, was depicted as being
outside of ones body. When the spirit was removed from the child, or the essence of the
child was removed from the spirit, the child died, alone. Their death was due to a starving
off of the emotional link to others and to a part of the self that functioned as an external
ego and superego structure.
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77
According to Winnicott (1953, p. 93), true transitional objects are

soothers not comforters, and the transitional object may, because
of anal erotic organization, stand for feces. I am suggesting that the
use of the body and its hidden contents can be a transitional phenomenon and that for Steven, Michael, and possibly others who feel they
were disposable children, feces is a form of transitional phenomenon.
Stevens true transitional object, (Winnicott, 1953, p. 92) his teddy
bear, was taken from him by his mother in a time of developmental
and physical movement. In response to the traumatic removal of this
transitional object and neglect, Steven used internally held objects to
move about the world at a safe distance from others. He feared that
his objects and his link to his mother would be discovered, thus taking away the scent of his relationship and fantasized tie to his mother.
Michael held a similar fear with respect to losing his bodily smells. For
Michael the objects were not fetishistic in the sense that they were not
needed to experience orgasm or sexual pleasure (see Greenacre, 1969,
p. 145) yet he, like Steven, believed he could not live without his objects
because of the safety they provided. For Steven and Michael smell afforded them safety from overstimulation, denial of their separateness,
and an expression of their need for independence. Their smell and
body products took on the same importance as the safety feature and
soothing action of a transitional object allowing growth in other areas
of development.
It is my contention that our current view of transitional objects and
transitional phenomena does not take into consideration traumatic ties
to the parental object or the tie to a partially internalized object in
which both the trauma and the soother exist as one complex experience
held by the child or adult. For individuals with traumatic pasts who use
encopresis and its derivatives as a link and solution to their preverbal
experiences, the transitional object may not be able to be external to
them in the same way it is for others whose experience of independence
is not tainted with rejection and abandonment. Just as a child is unable
to relinquish a transitional object until there is an internalization of the
soothing capacity of the caregiver, the sense of self and other was not
internalized in these two individuals with recurrent encopresis, until
they were able to nd a different object to internalize.4 Both patients
identication with the analyst allowed for a modication of the negative
4. In each case, object loss and mourning were able to take place during the analysis
after an object from my ofce was chosen as a new transitional object for them to hold on
to, as they let go of their experience of earlier relationships.
Y6040.indb 77
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78
introject into a more benign object, which became internalized during

the course of their analysis. The internalization of the analyst and the
analyzing function allowed for a gradual dissolution of the need for
their particular form of transitional objects. It is my understanding that
this slow fading through the development of the ability to use fantasy
and an increased sense of self is consistent with Greenacres (1969) and
others (Bach, 2001; Benson and Pryor, 1973; Winnicott, 1953, 1960)
description of the fate of the transitional object.
Summary
I have presented two cases in which the connections between preverbal
experiences of self and other were expressed using bodily smells and
bodily productions. In both cases, an underlying fantasy of a blissful
union could easily be linked to the murderous rage and emotional
merger they experienced in reality. Both Steven and Michael were disposable children who expressed their feelings of being disposable in
conjunction with their wish to gain attention and be recognized using
smell. To each of these individuals, the use of medical interventions
felt like bodily invasions and as forceful separations from something
that was precious to them. Steven and Michael were not yet emotionally disconnected enough from their early experiences and fantasies to
allow them a self and other whole representation.
The tenacity of the symptom of encopresis is well documented in
the literature and is often linked with oppositional deant disorder
or conduct disorder (DSM-IV-TR, 2000). Consideration of the intrapsychic dynamic meaning and origin of the symptom to the individual
can increase our understanding of the resolve with which an individual
holds on to the symptom of encopresis and its derivatives. Understanding the underlying dynamics involved in symptom formation can assist
us in our understanding of why different treatment modalities aimed
at symptom resolution in fact exacerbate the primary symptom and
increase associated symptomatic behavior. In the case presented in this
paper, as well as those offered in the literature, it appears that attempts
at removal of the symptom of encopresis resulted in angry battles. It
is likely that others with encopresis and its developmental derivatives
tenaciously hold on to their symptom because of a deeply held belief
that they will be lost, forgotten, or disposed of if their scent does not
announce their presence or linger after they have gone. I am also proposing that until the individual develops a positive sense of self with
an enhanced integration of self and other, the symptom will remain
intact. Just as a child is unable to relinquish a transitional object until
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79
there is an internalization of the soothing capacity of the caregiver, the

sense of self and other is not internalized in individuals with recurrent
encopresis.
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The Scent of The Other (Encopresis)

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The Scent of the Other

BERNADETTE S. KOVACH, Ph.D.