Shame And Loneliness

After I had given a talk about the treatment of patients with severe character disorders some years ago, a questioner asked me what I thought about trying to treat a patient who was so shamed that she could not talk. Now it so happened that I had spent many years treating a patient who had just this kind of a problem. The silences were excruciating. Nothing that I tried in order to establish communicative links worked very well. The patient and I were intensely involved with each other, but it was not possible for me to map the involvement in any satisfactory way that would allow me to rest. I carried the conundrum with me wherever I went, as if there were no way to speak about it, but also no way to stop trying to speak about it.

Occasionally, the patient and I had a good time arguing with each other, with the patient insisting on what seemed to me to be the most outlandish positions just for the sake of their outlandishness. Her glee was manifest, but also troubling in that it revealed how much she was spoiling to fight.. I mean this in both senses. First, she was very eager to fight because it made some contact possible. Second, this fighting spoiled a great deal not only inter-personally, but also intra-psychically because it put so many alternatives for accord and compromise out of reach. The costs of the inability to cooperate are so large as to be almost unaccountable, adding another dimension of loneliness.

A venerable and, in my experience, truthful clinical maxim has it that, while guilt brings material into treatment, shame keeps it out. Sometimes shame can keep so much material that is so central out that treatment makes no sense. In fact, when a treatment is making no sense, shame is an important topic to think about. Sullivan provides some creative guidance that bears on thinking about shame. He divides the realm of the self into three compartments, “good me, bad me and not me.” “Good me” is the realm of the pleasurably owned self under the aegis first of an approving other and then of an approving conscience, while “bad me” is the realm of the self that is tainted by guilt, the mark of the disapproving conscience.

“Not me” is a fascinatingly contradictory realm of the self, that self that is disavowed, that is treated as not-self, that is marginalized to the extent that it almost disappears. Its presence is the presence of an absence. It is a hole in the presumptively whole self. If “bad me” is constituted by guilt, then “not me” is that exile of elements of the self constituted by shame. It is a realm of secrets and silence, of icy intensities. It can rule the self while being in exile. Its rule can be ruthless, excluding grieving, forgiveness, compromise and compassion.

So many people whom we treat and whom we know have secret lives, often compelling ones, that are carried on by a persona of the “not me” that is radically different than the out in the open self. In fact, I believe that, if we were to examine ourselves and what we do, what we fantasize doing, how we are and how we fantasize being, we would discover that each of us has the elements of a secret life, one or more secret sharers on board. Closets abound. What is closed off abounds. Often, much of what might be the best of us exists in the realm of the forbidden and unknown.

We know that shame is early, coeval with the birth of a beginning sense of self. We know that the capacity for shame is inborn and that the absence of this capacity would be the sign of a grave neurological deviation from the norm that makes social life possible. Shame is an important tool in the sculpting both of culture and of character. We know that shame has to do with being seen, with being caught by another’s gaze and taken over by that gaze, appropriated by it beyond possibility of either flight or fight. The Oxford English Dictionary notes that many etymologists trace shame to “hame” – “A covering, esp. a natural covering, integument, skin, membrane, slough (of a serpent)” – as far back as c1000.

We know that shame has to do with what is hidden, what is secret. We know that shame has a physiology. We know it often involves blushing and can involve fainting. We know even that people die of shame, their deaths mediated possibly through disturbances in heart rhythm when these deaths are sudden. Our habitual phrases testify, “I wouldn’t be caught dead doing that. “I’d die before I’d admit that I felt that way.” We can speculate, too, that the physiology of shame involves an intense arousal, mediated through the sympathetic nervous system, alongside an intense quelling response. mediated through the parasympathetic nervous system. It is a contradictory response in which two opposed powerful forces collide. The central neurophysiology of shame remains to be explored.

II
Shame is primordially realized in the dyadic mother-child relationship. By “mother” I mean primary mothering person, not necessarily biological mother. A great deal is ruled in and a great deal is ruled out early in this relationship. Imogene, my patient whom I discussed briefly at the outset of this essay came into the world when her mother was in a state not far from that of Bartleby the Scrivener in Melville’s novella of the same name. Bartleby responded to all overtures with a simple “I would prefer not to,” giving no explication or explanation of why he would prefer not to. In fact, he persisted in this mantra or tantrum literally unto death. It was a stubbornness unto death.

For a whole variety of reasons, beginning in her own very early history, Imogene’s mother found herself in a severe state of depletion when Imogene, her fourth child, was born. She felt the pregnancy might destroy her, but looked forward to this not just with dread but as a possible salvation, a way out of a tangle of difficulties. When Imogene was born, she responded to her more out of a sense of duty than out of a sense of pleasure and zest. Given her own deprivations, Imogene’s mother was extremely dutiful, well beyond the call of duty. Her ministrations still held a tinge of affection and attachment.

Imogene, in this context, developed a sense of herself as burdensome, a trial and a tribulation to others. This sense of herself as a burden, even a catastrophe for others, and the attendant shame and rage stayed with her for the duration. She became alienated from her own needs, probably the substrate for a serious eating problem later on. “Alienated” means unlinked. What links us to our needs is the relationship with a caregiver who finds satisfaction in satisfying them, so that we learn to handle ourselves kindly as we have been handled.

Feeling shame over basic human needs and their expression, feeling contempt for “neediness” in oneself or in others is a basic problem resulting from early attachment vicissitudes that push towards insecure attachment styles. We might term this attachment shame. As has been well said, it is not so much our feelings that cause us trouble but our feelings about our feelings. It is in the crucible of attachment that our feelings about our feelings come into play, bearing the stamp of particular dyads in particular cultures. Attachment shame is a nuclear shame with profound consequences.
It starts near the beginning and starves many potentials of what they require for a more fruitful development. It is an interesting, if dismaying commentary on our culture that in the United States in the early twenty-first century “needy” is a term of opprobrium.

Early on that which is responded to pleasurably by a caretaker whose response decreases tension and brings pleasure has a privileged aura. Cycles of positive reinforcement consolidate this aura of acceptance and comfort. That which is annoying or irritating or burdensome to the caretaker presents a dilemma to the one who expresses a need, an urge, the beginnings of desire. If the very young child stays with the need, there is the chance that he will lose the caretaker, perhaps through receiving less attention, perhaps through receiving less positive attention, perhaps even through being the victim of a burst of aggression from the caretaker. How this dilemma, this set of states of danger is represented in the mind of a very young child is an exceedingly complex question. But it is a very big and fateful dilemma for many young children. How can I be a pleasure to my mother, not a burden, not a pain? If I am an unwelcome burden, what is wrong with me? Is there a fundamental flaw in my own nature? A lonely intuition of the self as a toxic potential isolates as perhaps nothing else does.

One avenue of thinking we can suggest is that robust transitional process buffers the child against these dangers, providing him with a road towards making himself a satisfying inner world of animated and animating symbolic play and display. The development of transitional process and the emergence of shame overlap. Of course, transitional process requires a mother’s support to go forward in a vital playful way. A mother has to be there and also not to be there too much, that is, not to be predominantly intrusive. Mothers who are too stressed and in states of psychological agitation and deprivation are likely to err both on the side of being too absent (and neglecting so much) and on the side of being abruptly too present in ways which have little to do with cues coming from the child.

What Winnicott calls the first not-me possession undoubtedly has a prehistory in the child’s relationship to and with the mother, in how he makes use of different aspects of her and of his experience of and with her. (The mother is the first not-me who possesses us and helps us on the road to self-possession or imposes obstacles.) Relating to and with part objects — a finger, a wrist in a bracelet, an ear, a breast and so much more – may underpin a child’s ability to hold on to inner experience and extend it inside in a way that edges toward the symbolic. How this process goes will depend not just on the child’s endowment and predilection but on the mother’s states, how relaxed and ready to be appropriated in part she is, how much she enjoys the play back and forth and so on. A rigid mother, an empty mother, a sudden mother may not support this process well at all. The miracle is that some children develop rather well even in the face of such formidable obstacles. They make more of less and learn to be themselves and to enjoy.

It is as if the child who is on the way to living the life of shame and of shame based character reasons as follows: If I hold to myself and my urge to experience, then I will lose my mother, my other, that other who is still so much a part of myself that I lose myself in losing her. In order to avoid this isolation in which I have neither one, I will
let go of the train of my own direction in experience, rule that away into silence, secrecy and shame . I will put my becoming at the disposal of the other in order to avoid a radical abandonment in which I can not be, in which I can not survive. “Half a loaf is better than none” is one way to put this. Also, one could say that changing the self to suit the other, even in radical ways, is manifestly the lesser of two evils as it appears to so many young children. Urges toward a more authentic self bring on immediate internal threats of loss of the essential other. The isolation of the shamed person is cued by internal fantasy of loss that has the force of the real and the immediate. If we wonder why a rigid and sterile conformity is such a large part of social life, we need look no farther than here.

Young children do not reason these fateful matters out in any formal symbolic way These powers of observation and description are at best in early stages of development. However, when we come to describe what goes on, we say that it is “as if” the child had reasoned in such and such a way. That is, we adduce certain principles to account for what we observe or think we observe. We theorize that motivational factors inside the child operate in a way that our theoretical description usefully approximates. It is we who reason that it is “as if” the child had reasoned.

What is active in the creation of shame goes beyond the loss of love danger to what may well impact the child as a loss of investment danger, a loss of psychological existence danger. As people who are so much farther along in life and in development than very young children, we may miss the immediacy, the intimacy, the immensity, the intensity of a facial expression from mother that says, “No, not now, not in any way…how could you ask that of me when I’m so pressed…” In fact, when it comes to describing how very young children interpret and respond to looks on mother’s face, we are again forced to use rather advanced symbolic language to describe what goes on face-to-face most often without the intervention of words.

It takes a special kind of imagination to return ourselves to when the world was so much smaller, so much more charged, so variable for us from moment to moment. The faculties of abstraction and of symbolizing seem to be purchased at the cost of decreases in immediacy and intensity. These faculties make the world more predictable, safer and also most often paler. It is less subjective, less implicated in our inner processes. We admire the childlike facility of artists because we miss our own child selves. Often we miss them without knowing what we miss. One of the joys both of having children and of working with children is that they help us regain entrance to this vital and invigorating kingdom of the human.

An anecdote from a little boy a few years older than the children we have been discussing may be useful. He had watched a television program that his mother thought might be too scary for him. She told him that the monster had seemed scary to her. She asked him whether the monster had scared him. No, he replied, the monster hadn’t scared him at all. What was scary, he told his mother, was the look on her face when she was mad at him. That really frightened him. This boy was already old enough to tell the difference between a symbolic frame and a frame of actual enactment. The characters on television did not frighten him. What scared him were some aspects of his mother’s character and no doubt his own untamed anger. Very little children live in frames of enactment before the symbolic has been constructed. Their worlds are, to appropriate Keats’ marvelous phrase, “proven on (their) pulse(s).”

Shame creates a two-faced loneliness, on the one hand a longing for another who could comprehend and accept and, on the other hand a longing for parts of the self, for pathways in the self that have been rendered off limits and inaccessible. Shame has to do with turning away, with withdrawal, but it is hard to turn away from certain longings for the other, from the expression and pursuit of tendencies in the self that are vital and central. For the shamed one to disavow what is the occasion for shame in himself and to maintain that disavowal, he must institute what amounts to repressive tyranny inside himself. He must align himself with the shaming other and turn against himself, sending much of himself into exile in the compartment of not-me. But contents do not go gently into the cold night of this exile without intermittent revolt and without creating states of
tension along the border. Any improvement of the situation is very difficult, because compromise without communication is very close to being a contradiction in terms.

III
Imogene would walk into my office almost noiselessly, sit down and position her head so that her hair hung down in such a way as to deny me any view at all of her face. She would sit there in silence. She could sit in silence for indefinite periods, stubbornly
withholding herself, but also, with this withholding, accusing me of not being available. It felt to me as if she maintained that the need for the hair curtain arose from my insensitivity, my terrible obtuseness. It stated that I was dangerous and not to be trusted. Since all this took place in the era before the end of the Cold War between the USSR and the United States, I spent a good deal of time fantasizing about life behind the hair curtain and what sort of cultural exchanges might be begun to reach there and start to change the atmosphere of isolation. The hair curtain reappeared many, many times over the course of many years of work.

It was not a good sign. On the days when Imogene appeared and took her place behind the hair curtain, there was trouble. Something inside was stirred up and she was having a hard time managing. If we could manage to communicate a little bit, there were bursts of aggression directed back at herself and at me, too. Sessions often ended with her storming out and declaring that she would not be back. Usually this threat carried the implicit explanatory subtext that the reason she would not be back was that she would have killed herself and as she often put it “solved everyone’s problem.” The fact that she had young children who were dependent on her made this kind of threat all the more frightening. Often, I could tell how frightened she was by how frightened she made me.

This kind of description is at once truthful and, if not a falsification of the experience of psychotherapy, then at least a processing of the process that moves it farther away from its roots in immediacy in order to render it a bit more intelligible. Most of what is most important in psychotherapy, especially with the severely shamed patient, we know or approach knowing through immersion. The river flows on and on and on and we enter into it, bringing out of it bits of this and that that may pass for knowing another person, almost the way myriad tiny tiles must be designed and produced before it becomes possible to make a mosaic of larger design. We immerse ourselves with and in the other on many channels. verbal and non-verbal, in the back and forth of the relating that is psychotherapy. By now, I think psychotherapy is mature enough to outlive the label of “talking therapy.” It might make much more sense to think of it as a “being therapy”, with talking a major channel but not the only one by any means.

I have often had the experience of not knowing what was going on in therapy, where we were headed, whether there was a map of any kind. This flavor of experience is extremely common in taking care of a profoundly shamed patient This kind of experience is often a sign of the patient’s profound distrust not only of the therapist but, perhaps even more importantly, of herself. She is afraid to make sense not only because of fears about how the therapist might react, but because of fears of how she will react. Making sense can threaten the most archaic object loyalties, These loyalties are tantamount sometimes to a delusional reconstruction of a terribly unavailable primary caretaker. Making sense can threaten the most archaic loyalties to the self, too. These loyalties can be tantamount to a grandiose recasting of the self as without needs and therefore inured to disappointment, even unaware of it and the attendant rage that often has no bounds. It makes sense – there is the dreadful phrase again – that a delusional revision of the self and of the primary caretaking object should go hand in hand. For the severely shamed patient what is at issue is nothing less than a remaking not only of her world but of herself in the world.

We may speak of false selves, artificial selves, defensive selves, compromised selves. Whatever name we give to the phenomenon, we must remember that this is the self that the patent actually has, that this is the self that the patient is, so that promises of liberation, promises of new ways and of better days may seem like threats of destruction.
They may seem like ways to increase terrors that are already enormous far beyond what can be tolerated. To try to change someone, as opposed to trying to be with that person while she contemplates what she needs to contemplate, or to try to help a shamed person, as opposed to being with that person and trying to understand and to accept what the shamed person can share, can seem like attempted murder to the shamed person. Again, feels the shamed person, there is something wrong with me, something that can not be accepted, something that does not suit a powerful other who should be a source of succor but is actually a new source of hurt. In a strange transformation, this situation feels all too familiar.

When Imogene was out from behind the hair curtain and we could go back and forth in more explicit ways, one of Imogene’s central topics was her distaste, her distrust, even her disgust for psychotherapy. It was not real. It was not authentic. It was not honest. It was pretentious. It could not really make a difference. It could not change the past and it could not even change the present, let alone change the future. It was a colossal waste of time and money. She did not understand why she was so naive as to be involved in it. Her involvement showed that she was a stupid fool, an all too easy mark. Her critique was biting, buttressed by her wide reading in, among others, Dostoevsky, who spoke to her of the world in ways she could recognize as kin to her own experience.

Her criticism of psychotherapy was not just a theoretical criticism that spared me. I was, she said, not really interested in her. I did not take her seriously but instead used my alienating and objectifying theory to translate everything she said into something that it most certainly was not. The attack I found most wounding was the insistence that I looked at her like a bug with a pin stuck through it, a specimen and nothing more. She delivered this attack with what I can only describe as triumphant horror. It was years into the treatment before I could say to myself that these attacks had to do with complaints about how little she felt her mother had been able to spend on being with her and enjoying her, how inflexible her mother was, how much distance and defeat there was in that relationship, how cold the temperature of the relationship was. That is to say, it was years into the treatment before all this made sense to me in a living way as a maternal transference.

Imogene kept coming. Despite the lure of suicide, despite the idiocy of psychotherapy, despite the remoteness of her not genuinely invested psychiatrist, Imogene voted with her feet in favor of the agonizing mess that was psychotherapy. Meanwhile, I felt more and more puzzled and aggravated, more and more inadequate, more and more unsure both about myself as a therapist and about psychotherapy, something that had been enormously helpful to me during a hard period in my own life. We went forward –or perhaps not forward but in circles, or in an awesomely peculiar zigzag – in the atmosphere of “can’t live with it, can’t live without it.” For me there were horror and fascination both. I think the same was true for her. I looked forward to and dreaded the hour when I saw her. Although she saw me as uninvested, this hour with Imogene got a disproportionate share of my attention.

“Maternal transference” is easy to think, easy to speak, easy to write, but like all such abstractions it is skeletal, at best a framework for more work towards a lively understanding, at worst – and in line with my patient’s accusations – a substitute for this work, a barren stopping place. With Imogene – and with other patients who have resembled her in some important ways – I have started out with a quiet resolve to be different from her mother, even a settled conviction that I was different from her mother.
What was impressive to me was how over time Imogene worked to sculpt a rather good approximation of her mother from what I presented. Before going any further, I should say that my own mother had her own considerable capacities for depression, depletion, distraction and denial of the emotionally essential.

Imogene was so difficult to work with, despite my commitment and despite the fact that I found her very engaging and interesting, that there were days when I awoke in the morning dreading the encounter and organized the whole passage of the day around this dread. There were more days like this than I find it easy or pleasant to remember. I longed sometimes to be free of her, imagining that my world would go back to being more manageable if I could simply find a way to give up this most unreasonable of tasks. I did not like this line of feeling in myself. It ran quite emphatically counter to my own ideal view of myself. Yet there it was, undeniably and insistently, even intransigently there, so that I had live with my dismay at myself.

Although I never met her – at least not in the literal, physical sense intended by ordinary usage of the term “met” – I got to know Imogene’s mother intimately as Imogene worked the spell that turned me into a facsimile of her mother. Imogene provided for me the privilege of meeting her mother as myself inside myself. I describe this as a privilege because it changed me. It changed my perceptions of Imogene, of her mother and of what they lived together in a variety of important and nuanced ways. I felt very directly for Imogene and the difficulty of what she had experienced as a child, with a mother who wouldn’t and couldn’t and from whom there was no appeal. I felt for Imogene that she had to meet the feeling states I was generating inside myself, the irritation, the agitation, the deadening, the hardening, the coldness. But I also came to feel for Imogene’s mother as a real person in a real set of quandaries from which she could find no exit. I understood that Imogene loved and cherished this impossible and unavailable mother every bit as much as she feared, resented and hated her.

As it has been said that the next best thing to having a mother is being a mother, so the next worst thing to being a mother seriously compromised in her mothering capacity is to be the object over time of a maternal transference that evokes, invokes and provokes the felt internal image of such a mother. “Maternal transference” is not just a label, not just something to be seen through and named, but rather a program for living through the vicissitudes of a personal history that endures, looming into the present and imposing its considerable burden. As I struggled to accommodate the force of Imogene’s maternal transference, its searching explication of the past, its questioning of why what was had had to be, I found myself feeling sadder and more resigned, more able to understand not just how Imogene was and how she had come to be that way, but also more able to accept how Imogene’s mother had been and how she had come to be that way. She could not give what she did not have. In a way, I knew this from inside on the days when I did not do well with Imogene, when I was abrupt, not well attuned, irritable, cold and in such diverse ways not present. If I had judged her early on, I rued the judgment and sought to make amends, keeping always in mind the real hurt that had befallen Imogene in relating to her mother.

Transference is not far from tragedy, except that, with the waning of our enthrallment with interpretation, there is no deus-ex-machina and the two participants are both the cast and the audience, watching and staging a drama that is both passing strange and passing familiar. It makes visible what has been previously made invisible. It turns toward what has been turned away. It is hideous in that it brings alive experience that has been hideous. It has monstrous powers to demonstrate beyond the shadows of doubts. It is always puzzling because it is always in the process both of being born and of being borne. Transference helps us to know what we do not know that we know. It enacts
on, in and between therapy’s participants. It leads to catharsis, but the catharsis is often draining, bringing in its wake sorrow and exhaustion, something very different than triumphal liberation. Transference catharsis makes it possible to recognize defeats and difficulties for what they were and are. It breaches the walls of the castle of defensive illusions and helps establish the capacity for realistic limit setting. If transference is
an alchemical process, it is at least as likely to lead to ashes as to gold.

IV.
The erotic transference is, among many other things, an attempt at a jailbreak from the prison of shame. It is through the erotic transference, often experienced as at least as much life threatening as life saving, that the severely shamed person can become reacquainted with needs and feelings for so long ruled beyond the pale and exiled into the domain of the not-me. What connects erotic transference and early need? Our language,
wise from an immense depth of experience beyond the ken of its ordinary speakers, leads us to call our romantic and erotic partners, “Baby.” “Baby, I love you.” “Baby, I can’t live without you.” “Baby, you’re breaking my heart.” “Baby, come back to me. Life don’t mean a thing without you.” This small catalogue could be extended virtually indefinitely. At the pinnacle of adult love and attachment, we find that endlessly evocative word from the beginning of life, “baby.” “Baby” undergoes a change of meaning which is not really at all a change of meaning. “Baby, I’m helpless in your arms.” “Baby, your smile makes me forget all my troubles.”

Erotic transferences that can surge into existence between persons of the same sex as well as persons of different sexes, between persons of the same or different generations, under the most diverse of circumstances do not declare themselves in words. They come first in terms of gestures, glances, attitudes, silent appeals, ways of moving and of not moving. An erotic transference can appear as a long lost stranger in a treatment to the astonishment of both patient and therapist. An erotic transference can appear as an inconvenient long lost stranger, one who complicates everything. Attachment is so much a part of us that it turns up wherever we turn up. We can become attached where we did not mean to be attached, where we could not imagine becoming attached. An erotic transference appeals for an erotic counter-transference. In most cases there is a response along these lines, so that the discourse, the experience of therapy falls under the sway of eros, the urgent, the impulsive, the heedless.

With Imogene, this produced an atmosphere that was intense, troubling, but very real for both participants. I looked on Imogene as an enormously talented and appealing person whom life had treated quite arbitrarily and unfairly, denying her the opportunity fully to exercise and enjoy her gifts. She looked at me with hungry eyes when she looked at me at all and gave me occasional swift melting smiles. Interestingly enough, this aspect of therapy was laden with shame for both of us, as if there were something deeply illicit about connecting. If the erotic transference is an attempt at jailbreak from the prison of shame, there is always the danger that a posse of shame rangers will be sent out to effect a recapture. There was mutual recognition in the experience of this erotic transference and mutual recognition in the mutual shame over this involvement.

But what was the shame about? It was not about actions, but about intent, attitude, the full range of fantasy. Each eroticized transference, each response to such a transference,
each eroticized passage between therapist and patient imagines an entire world, one that is not quite in existence, not quite wholly out of the range of coming into existence. This makes it dangerous. It is play at a margin. You will note here that I am making no pretense of speaking the language of neutrality. There is no way to meet what could as well be called a coming-to-life transference or a thawing transference as an erotic transference, except as a participant-observer, sometimes even more a participant than a participant-observer. These vitalizing transferences, for all their force, are fragile. The least hint of the frost of neutrality, of an unwillingness to meet emergent vitality with vitality can blast and shrivel the bloom yet once more. Yet, it is vital not to become overly literal, not to go over to enactment, not to intrude on the drama of emergence, even if such intrusion is being sought at every step because it is, under the original paradigm, so devastatingly familiar. An erotic transference requires at once a hands off and a heart on response. This is not simple, nor always in any way comfortable.

The shame is over the fantasy, over what is imagined, not acted, it being one of the remarkable features of our consciences that they often take fantasy for action, as if what was represented in the mind happened in reality. What is proposed in an erotic transference unfolds and takes place in the realm of the very serious play of therapy, a place with its own boundaries and rules. This place, this very particular play space, can have remarkable suppleness and expanse if it is handled properly with the discretions of attachment more than the discretions of neutrality. This is no simple task, but rather an art that calls for an enormous range of judgments. How to make these judgments can perhaps be learned, but it is inordinately difficult to teach. As in any other art, each must grope his or her own way to a style that works, that is helpful to patients, that makes the work sustainable for the individual artist of psychotherapy who has his or her own absolutely individual experience, quirks and capacities,

Imogene had tremendous deficits in self-regulation. These showed in the realm of self-care. It was not unusual for her to have eaten so little that when she got up at the end of therapy she was so light-headed that it seemed like she might faint. Occasionally, she would collapse back down on the couch and then try again to get up after a few seconds. She never did faint across all the years, but she often left me wondering what I would do if she passed out on the rug right there in front of me. In fact I wondered this so often that it became almost as if it had happened. This illustrates how a repetitively enacted fantastic phrase can become almost tantamount to reality in the mind. Once, I was so worried about how faint and pale Imogene seemed that I offered her something to drink and a little something to eat. Needless to say, she took neither a bite nor a sip. I felt a bit sheepish afterwards and yet, for all I know, I might act the same way again if a similar situation presented itself. By my gesture, I did indicate to Imogene that I felt the situation was out of the ordinary and that I was concerned enough to do something well out of the ordinary.

My worries about Imogene’s fainting and about her not eating sketch a piece of the relationship in which I was led to experience relating to her as not so different from relating to a baby, that is, a highly dependent infant. I felt the urge to take responsibility
for the states of deprivation in which she maintained herself. I experienced them as reproaches to my caretaking, stifled cries for help. I also experienced them as invitations to intimacy, pleas to move closer and to become more active in ways that are not so usual in therapy. At the same time that she issued these invitations, she warded off all attempts to help with her eating, as if she needed to be stuck just where she was. The impasse was stable. Imogene presented at once a study in neediness and a study in the grandiose rejection of neediness, grandiosity as usual appearing as a reparative device in the face of overwhelming difficulties.

Imogene used a mixture of books, music and cigarettes to help her with highly problematic affect regulation. What was distinctive was her imaginative absorption in all three media. It may seem odd to include cigarettes, which can be lethal over the long term. with books and music as artistic media that can help with self-regulation. Imogene could disappear into a book, into a piece of music and also into a cigarette, a place of calm and imaginative freedom. If the test of a work of art is, as Heidigger said, that it “worlds forth a world,” Imogene was extremely gifted in entering these worlds. For her as well, the smoke from a cigarette could swirl forth a world, one into which she could go for a mixture of respite and satisfaction. Even with all the transitional devices used Imogene could become so angry and so paralyzed by her anger that she could not function. She would move out of relationship, adopting an infuriatingly passive aggressive stance that caused her many difficulties in many different settings. I tried to stay with her, near her during these phases, using my presence and what there was of my patience to urge that affect could be tamed, contained, expressed. I held that feeling did not impose a lonely doom.

In Imogene, erotic transference and an enraged set of transference configurations nestled very close to each other, so that every step was fraught with doubt and insecurity. Each episode of coming closer seemed precarious. Both the losing danger and the fusing danger were in play all the time. This was not a treatment that told its story in a continuous narrative but the main drama was the drama of coming out from isolation,
of challenging the wordless sway that shame held over. There was, too, a secret pride that went with the shame, the pride of frustrating everything around her, a pride not very far sometimes from that of Bartleby the Scrivener. The erotic transference testified to the robust character of her capacity to love and to try, to meet a very difficult life with
resources unique to her.

V.
What is the treatment for a person who is too shamed to speak, who lets her silence speak for her, who keeps herself in a lonely shamed exile, as if she were not just unspeakable, but also an untouchable? The notion that there is a treatment algorithm, a way to mechanize this human process, makes no sense. The treatment for the shamed lonely isolated isolating person is exquisitely difficult relating, most often carried out on non-verbal channels as much if not more than on verbal channels. In order to be with a person like this, we must be willing to come up against it. By “it” I mean the nebulous set of character fortifications that the patient has used to frustrate herself and to protect herself against being frustrated. By “it” I mean long periods of not understanding and not knowing and exploring feelings inside ourselves that are uncomfortable until some elements of familiarity can be glimpsed in them. By “it” I mean a perpetual state of reevaluating ourselves and our efforts and intentions.

One of the factors that held me in the work with Imogene was my dawning awareness that I might easily have been her, that her predicament was not so alien and that her responses were not unreasonable when I looked at them from a slightly different position inside myself. Sullivan’s celebrated postulate that “we are all more simply human than otherwise” is more than a slogan. It asks of us that we question the compartment of “not me” to which we often relegate others, that is, without links to me. Perhaps Imogene had a point when she used to rail at me that I saw her as a bug with a pin through it, a mere specimen, not that I meant to do this. However, neither she nor I may have been in such good contact with what connected us, with what related us as persons. Perhaps the measure of a treatment of a seriously shamed person is how much a human connection can release from the “not me” compartment both intra-psychically and interpersonally. Whenever we work with people who are seriously shamed, we are in the presence of extreme vulnerability and despair, but also there are fugitive hope and warmth.