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The Psychoanalytic Study of the Child

Yale University Press

Chapter One

WENDY OLESKER, Ph.D.

Based on a study of five analytic cases (three reported here), and using a modern classical psychoanalytic perspective in which both biology and social forces are integrated, our study group on gender investigated why for some gender assumes a distorted and exaggerated role in the subjective sense of self. Clinical material was used because we wanted data allowing us to study patterns emerging from an exploration of patients' unconscious fantasies as they shed light on the psychological significance and function of gender. We found that in each case gender disturbances were never primary but secondary to difficulties in integration, cohesiveness, separateness, stability of solid sense of self and of the object, to depression and especially to problems with aggression and rivalry which had to be analyzed first. Conflicted gender gave rise to solutions that were literal and concrete. Not suprisingly, ineach case mothers wished for a child of the opposite gender and treated gender expression in highly ambivalent ways. In terms of technique we learned that ways of coping with rejection, evolving paternal transferences which allowed for metabolysis of the maternal relationship, and ego building techniques had to take place before conflicts around gender could be analyzed productively.

Introduction

GENDER ISSUES, OF GREAT CONCERN TO MANY OF OUR PATIENTS, ARE subject to much controversy. Freud (1905, 1933), explaining the origins of what we call gender, refuted the notion that femininity and masculinity correspond by nature to the two biological sexes. Gender issues came to occupy much of his attention in part because in his mind they presented as the most intractable resistance. In women striving to possess a male genital (penis envy) and in the male, a struggle against a passive feminine attitude, were bedrock issues (Freud, 1937). We no longer view these issues as bedrock or universal. At the present time there are many different psychoanalytic conceptions of gender: some writers highlight the influence of culture and social forces (Dimen, 1991; Harris, 2000; Money and Ehrhardt, 1972), while others stress the impact of biology, anatomy, and the body experience (Downey, 1998; Friedman and Downey, 1995). We take a psychoanalytic developmental perspective in which both biology and social forces are integrated through the lens of the increasing gain from gender identifications in solving phase-specific conflicts. This may suggest that, in addition to constitution and environment, the developmental process itself is a force contributing to gender identity as well as to character formation.

Using a modern classical psychoanalytic perspective, our study group on gender asked why in some cases gender issues took the fore whereas in others were minimal; why, for some, gender assumed such an overriding part of the subjective sense of self, a central organizing perspective by which one sees oneself and experiences with others (Bem, 1993; Yanof, 2000). We chose only analytic cases in which gender, its constituents, its developmental path, and its transformation were revealed in individuals through their conflicted gender issues. Only through the analytic process could we really come to know the meaning of gender for that individual in order to shed light on the phenomena, to see nodal events traversed and opportunities offered by related conflicts or the developmental process. Rather than converting repeated themes into universal developmental schemes, we wanted data affording us a glimpse of patterns emerging from an analytic lens that took into account both the observed and the subjective experience of gender. We hoped to discover whether gender conflicts are primary and bedrock or a presentation behind which many conflicts and compromise formations lie. Only an exploration of the patient's unconscious fantasies sheds light on this question as well as on the psychological significance and function of gender.

Five cases were presented, three are reported in the papers that follow, the other two will be included in the conclusions. One was the six-year analysis of Andy, a seven-year-old boy who was brought for treatment because his friend's mother could not tolerate Andy pretending he was a girl, refusing to let her son play with Andy. Andy showed feminine proclivities since age two-and-a-half, was extremely timid, avoided competitive sports, was terrified of even minor injuries, had few friends, and was fearful of anything new. Femininity was his initial way to fortify himself from outside impingement and protect his shaky sense of his body and unstable self image. Another was Margo, a five-year-old girl who underwent a six-year analytic treatment, presenting with difficulties interacting with peers, severe mood swings, inability to control anger, and with the wish to be a boy; she also felt half male and half female, a he/she. She too suffered from problems with self and agency, attachment problems, affect regulation problems, and an inability to go beyond the dyadic in relationships. A third case was the eight-year analysis of Mona, a divorced woman in her late fifties, who sought treatment for vague complaints about other treatments not working, though the analyst sensed a profound depression. The gender problem, though not experienced as such, was a long-standing fantasy that she was half male and half female; consciously she knew she was female. Striking was the fact that the analyst could not form a coherent picture of the patient or the people in her life, leading the analyst to see Mona as suffering from a shaky sense of self and a problem with object constancy-she did not have the comfort of a solid internal image of a safe and good mothering object.

Striking in all three cases was the marked concreteness. It seemed in each case that disturbance in the self came so early when the self schema was primarily experienced in physical and bodily terms, bringing into the solution tangible body features-gender, as an umbrella to cover many other issues. In particular, as these individuals came to understand their sense of rejection, they linked it to their gender. In each case an opposite-sex sibling was seen as preferred. With each new level of development the use of gender to solve phase specific problems continued and became elaborated, a proposed solution to each new developmental phase. Thus, in these three cases the psychological organization consisted of several features: constitutionally (though not all of the cases) they had salient cross-gender features-either sturdy, aggressive female or passive, timid male. They also had difficult temperaments-one hyperalert to any changes in the environment, another with some features of Attention Deficit Disorder, and a third with bipolar tendencies. Historically the interactions with their mothers led to a sense of rejection which father did not temper enough, the timing of these features began very early, body experiences and developing sexual and aggressive fantasies augmented dispositional difficulties and pushed toward the use of gender to provide organization.

Review Of The Literature

More contemporary viewpoints directly and indirectly informed our work. In contrast to Freud's (1905, 1933) proposal of an early masculine identification in both sexes, thus ascribing to the little girl a primary masculine gender identity, Stoller (1985) posits that the boy isn't born masculine and heterosexual but traverses an earlier phase in which he is merged with mother; he must first separate himself from her female body and femininity and experience a process of individuation into masculinity. Thus, for Stoller, the mother is the primary identificatory object for both genders, and the boy must free himself by disidentifying from mother and from the negative oedipal complex. (As a consequence, core gender identity might be more stable and secure in women than in men and homosexual leanings more threatening to men than to women [Kernberg, 2000]). Stoller believes there is a developmental conflict, a protofeminity, built into maleness that females are spared. There are problems with Stoller's views. First, it is noteworthy that while Stoller's clinical accounts include the subjective experience of the body as a source of pleasure and meaning, in his theoretical discussion of gender, parental behavior and attitudes are the key factors in the development of core gender identity. Second, imprinting, a nonmental mechanism acting directly on the brain, bypasses subjective experience. Third, as Person and Ovesey (1983) point out, there is no evidence that the symbiotic state prior to self-object differentiation consists of a primary identification that confers gender behavior or identity on the infant child, since there is no behavioral surface of the infant's femininity until after one year of age, when the feminine state may be covered over by masculinity, and gender markers appear. Person and Ovesey (1983) suggest that a merger fantasy, not a prolonged protofeminine state, contributes to ambiguous core identity. Such a fantasy disrupts a sense of self, object, and certain ego functions, and the resolution of separation-individuation conflicts has different consequences for each sex; males do not necessarily have more difficulty adaptively.

Along somewhat similar lines Coates, Friedman, and Wolfe (1991) emphasize that a confluence of awareness of gender differences, without establishment of self and object constancy, and with an experience of loss of mother, engenders a strong desire to be like her to regain connection with her. Feminine identification (and merger fantasy) in gender identity disorder boys was a way of handling separation and annihilation anxiety, a way of warding off aggression, a variant of identification with the lost object: these boys became mother to have mother. These investigators did not take the longer developmental perspective but focused on the earliest stages of development. Most compatible with our view is one that incorporates a full psychoanalytic developmental perspective, one that recognizes the role of constitution (biology), the environment (social and cultural forces), the interaction between constitution and environment, and the developmental process, a biological proposition in which biological potential becomes a psychological actuality as an expectable sequence of discontinuous, hierarchically ordered steps evolve in the form of discrete phases directed to a mature end point after this pull foward wanes. Development produces change by pulling new organizations and structures into existence when actualized by experience (Abrams, 1990). Applying the developmental perspective to gender some (Chused, 1999; McDevitt, 1995; Galenson and Roiphe, 1965, 1980; and Olesker, 1998) think that each new stage of development contributes and believe that the above described early experiences set the stage for intense castration anxiety that affects later conflicts and compromise formations, particularly oedipal phase and adolescence. Dahl (1989) suggests that in adolescence the girl must overcome her sexual inhibition, an expression of unconscious guilt over the oedipal implications of sexual intimacy, as well as her bisexual conflicts in relationship to her mother, in the context of the capacity for a romantic love relation. For the boy, the oedipal period is crucial to the divergent development of gender, an achievement of a separate self and different sex from mother, while father must assert himself as a rival for mother and be available as a model for masculinity (Chused, 1999). Blos (1985) emphasizes that in adolescence the boy must master his separation individuation conflicts as well as his bisexual love for his father. The boy also needs the opportunity to yearn for his mother and to fear the consequences of yearning for her: his masculinity could be taken from him. It is only after a struggle to work through oedipal conflicts that the adolescent boy is able to abandon the unconscious selection of his mother as his primary love object, to resolve ambivalence and unconscious oedipal prohibitions, and to invest in an in-depth relationship with a woman (Kernberg, 1995). While development is not always linear (Mayes, 1999), taking into account a developmental trajectory will allow the most complete understanding of gender.

Clinical Discussion

Whatever theoretical emphasis one may have, we believed that a thorough study of analytic case material would help shed light on the multiple functions, influences, and meanings of gender. Having reviewed five cases (two as yet unreported) we found, although not generalizable beyond our sample, that in each case gender identity disturbances were secondary manifestations. When we studied the changing course of each analysis, we were struck by how gender issues were reworked and reorganized, often as one component of a symptom or character disturbance. Analytic observation did not allow for a conclusion that our notions of gender were ever bedrock, but highlighted the primacy of conflict and compromise. This is consistent with Grossman and Kaplan's (1988) finding that gender is a construction with multiple references-social, cultural, biological-that may be pulled into conflict, and that gender disturbance is yet another compromise in a developmental process, even in the gender-disordered patients we studied who used gender to mask or to solve other problems, and modified their use of it at different points in life.

In all our cases, gender issues, though a presenting problem, were not primary but secondary to difficulties with integration, cohesiveness, separateness, and stability of a solid sense of self and of the object; to struggles with depression; and to problems with aggression. Feeling identified with the opposite sex, in addition to the use of other defenses, served to handle these issues. In all our cases facilitating organization, integration, identifications, and building structure had a larger role than usual. Cross-gender identification was employed to protect the genitals: boys hid their penises via feminine identifications, and girls expressed fears of genital damage by imagining a tower or a phallus, not a hole. Each family had a mother who preferred a child of the opposite sex or rejected the sex of the child. Either blatant rejection or the parent's depressed or narcissistic state led to intense rage, sadness, despair, and/or confusion in the child. The fathers did little to offset these attitudes, often compounding the child's feeling of rejection. Seething with more anger than ordinary defenses could contend with, all seemed to have ambivalent attachments to their parents, perhaps a source for more than usually intense reactions to anatomical differences when these came into awareness (Galenson and Roiphe, 1965). For the girls, the penis became the magic wand that would provide them with love, sexual release, strength, protection against abandonment and injury, and safety; feminine identification provided the same needs for the boy. In one boy's case, the main need was to make sure he was intact and not helpless, not necessarily female. Femininity was instituted to fortify himself against outside impingement.

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Excerpted from The Psychoanalytic Study of the Child by ROBERT A. KING PETER B. NEUBAUER SAMUEL ABRAMS A. SCOTT DOWLING Copyright © 2003 by Robert A. King, Peter B. Neubauer, Samuel Abrams, and A. Scott Dowling.. Excerpted by permission.
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