A. Braux addresses the disorders arising from the relationship between the adolescent and their body within several clinical problem areas in this difficult process, which has both familial and social aspects:
Drying up of the body and rendering it inactive (anorexia nervosa and psychosis), the body being attacked (risk behaviors and suicide attempts), the body being constrained (asceticism and spiritualization), the body being idolized (phobias and narcissistic disorders), the body being injured (physical disabilities and ailments).
Above, the constraint of the body (asceticism and spiritualization) was mentioned, albeit superficially. Here, due to the nature of my work, I will focus more on the body being attacked (risk behaviors, suicide attempts).
Affect is an emotional state, joyful or sad, that manifests as an intense discharge.
Adolescence is a period in which the management of affects is difficult. The self withdraws from parental images and the narcissistic support they provide and is left face to face with a new causal framework. All of childhood pleasures and all inhibitions have been organized according to the parents’ gaze. The restructuring of the self depends on defining affects as one’s own affects and directly managing them. In this difficult effort, of course, some defense mechanisms are used.
Thus, the self keeps internal tension at a tolerable level. The defense mechanism we will focus on here, denial, appears especially as the denial of bodily changes and, as denial of reality, splits the subject in two.
The denial of concrete and material reality and the repression of drive and representation, the coexistence of these two defense mechanisms, leads to splitting. That is, while repression operates horizontally on the conscious–unconscious plane, splitting divides the subject longitudinally in two. In other words, on the one hand, the adolescent defends themself against incestuous desires, while on the other hand trying to deny pubertal changes. This is a source of anxiety from two directions. First, there is no appropriate representation that can be linked to the drive-based impulse; that is, it has no name. Second, the psychic apparatus is weakened because it is itself undergoing change. On the other hand, the ego ideal has not yet formed. Meanwhile, the pressure of the id is also compelling.
In the formation of bodily pathologies, especially in projective test records applied to adolescents who display self-mutilative behaviors, we see that they use denial and repression simultaneously (both intensely), that is, they resort extensively to splitting. What might be the connection between these two defense mechanisms and self-harming behaviors? Why are we talking about such a thing? Before moving on to the answers to these questions, I will mention some psychoanalysts who have worked on and focused on adolescents’ harming their bodies. I believe this will help us grasp the meaning of this small study more quickly.
Anna Freud encourages one of her best students, Moses Laufer, to establish an adolescent treatment unit connected to the child psychoanalysis center she directed, the Hampstead Clinic. Thus, in the early 1960s, the Young People Consultation Center, which would later become today’s Center for Research into Adolescent Breakdown, was founded. Later, he came to London to become a psychoanalyst. While attending the London Psychoanalytic Institute, he also worked at a center that dealt with the education of troubled young people.
Starting from the analyses of his adult patients, M. Laufer first makes the following determination: all psychopathology in adulthood is based on a breakdown that occurs during adolescence. What Laufer defines as breakdown is the adolescent’s rejection of their newly sexualized body and the new possibilities created by bodily development. Breakdown emerges in adolescence as a defense mechanism against a reality that is difficult to accept, and its internalization causes severe pathologies seen in adulthood. Laufer views adolescence as a developmental process and calls the halting of this process a breakdown. This is what gives rise to pathology. The goal of the developmental process in adolescence is the formation of sexual identity in a stable and irreversible way by the end of the process.
Another important point in Laufer’s approach is the importance he attributes to the body. The pathology that appears in adolescence is manifested especially as destructive behaviors toward the body. He works on the hatred felt toward the body that lies behind these behaviors.
Laufer (1991) accepts Freud’s concept of the “Oedipal complex.” That is, he thinks that a girl must grasp the Oedipus complex by accepting that she does not have a penis. He has oriented his work in this direction; he saw self-harm, anorexia, bulimia, and suicidal behavior as a reaction to the image of a severe, punitive mother, an image that appears when the girl begins to masturbate during adolescence and after, that is, when the body becomes sexualized.
Here, in line with the aim of this book, I will not go into lengthy descriptions of adolescence and the general characteristics of the adolescent period. However, because these self-harming (self-mutilative) behaviors, which usually begin in adolescence and, if not attended to in this period, can continue later in life, must be prevented from re-emerging, or must be attended to and given meaning as soon as they appear in this period, I believe we need to talk about what happens in adolescence, how this process unfolds, why such self-harming behaviors appear in this period, and why they flare up in relation to the characteristics of this period, which is a crisis period in its own right.
In adolescence, there is a narcissistic regression. Because this is the period of giving up the support objects that existed in childhood. In childhood, parents and other caregivers are a serious source of support for the child. Giving up these supports creates a serious vulnerability. In adolescence there is a kind of “symbolic death” of the parent. This period is already difficult enough. There is a radical change. It is the death of the child within the adolescent and, if you pay attention, we are constantly talking about separation, about parting. In adolescents who self-harm, we always encounter a psychic collapse (depression) behind these self-harming behaviors. Normally, a psychic collapse (depression) is experienced during adolescence, and this is not very strange; it is even expected. In many adolescents, self-mutilative behaviors accompany what is frequently diagnosed in Europe as masked depression. Therefore, the depression of these self-mutilative adolescents is different from the ordinary sadness or depression of normal adolescence.
Both clinical observations and the literature show that adolescents who self-harm have significant deficits in their capacity for representation. Normally, their expression of depression can only be achieved with the word “I’m bored.” The adolescent who already has difficulty describing affects, when faced with an added problem of not being able to link violence and action to a representation, appears before us as a self-injuring adolescent. Self-mutilative adolescents experience affects as a “flood of feelings.” This flood of feelings is the intensity of the drive life experienced during adolescence. Under normal circumstances, an adolescent is not afraid of the drive itself but of the intensity of the drive. As I mentioned earlier, this flood of drives is related to the lack of control over the drive life. If this intense drive activation, which is characteristic of adolescence, cannot be controlled, and if the individual lacks adequate coping methods, this situation creates panic. Adolescence is a temporal repetition of the libidinal and drive-based period in childhood. In both childhood and adolescence, a relatively weak ego faces a stronger id. That is, these are periods in which the ego is weak and the id is strong. In adolescence, with the intensification of drive demands, the individual’s efforts to gain mastery over the drive also increase indirectly. During periods when the drive life flows calmly, the tendencies of the ego do not attract much attention, but in this situation they again become prominent. There is an intense affect, an intense emotional state, but its cause is unknown, and it cannot be described. As we will later discuss in detail, in the descriptions we hear almost unanimously from all self-mutilative individuals, we see phrases such as “When I cut, when I harm myself, I feel relieved, I control my distress.” This is a way of soothing inner pain. Because it is difficult to cope with a pain or distress whose source is known to be internal but whose how and why are unknown. And these self-mutilative individuals, as a result of the inadequacy of their internal resources, have discovered these primitive coping methods as a way to protect the self. Affects, excitement, and other pre-verbal images that cannot be represented in words are expressed by working on the body. Of course, this is a temporary, primitive method of calming, relieving pain, and relaxing. As we see in adolescents, their way of experiencing distress is different from that of adults. Because adolescents have quite low motivation to seek help like adults do. They tend to use denial more. Ultimately, the equivalent of this distress in this period is emancipation. It is a time of separating and breaking away from supports and sources of security. That is, it is a period in which the adolescent undergoes restructuring. Nevertheless, adolescents who have no abnormal behaviors other than the difficulties inherent in this period do not experience the same difficulty in symbolizing and somehow find a reason for what they feel, linking it to affects. As I said before, there is a “symbolic death” of the idealized parents in childhood and a kind of loss of security. The increase in drive intensity during this period dangerously advances the sense of insecurity experienced in the face of later drive intensity. The feelings and experiences of childhood such as “I can lean on them and feel safe,” are replaced by the necessity of moving away from and losing these supports. This alone is a source of anxiety—naturally, as a price of freedom. Anna Freud likens the adolescent to an adult in mourning: hence, as a result of this mourning and anxiety, a depressive state is already experienced, and the loss must be worked through. In later years, this depression as a product of mourning continues, though diminishing. The ability to link painful affects to a representation of loss is important. One of the most important differences between a normal adolescent and a self-injuring adolescent is this. That the depressive position can be worked through and linked to a representation. Normally, adolescents experience tension and a distress that we are used to hearing about. But normal adolescents either link this to a reason or find a justification for it and live with it. Most importantly, they live it; and as it is experienced and expressed, it is worked through. Another important difference is related to the use of defense mechanisms. During adolescence, defense mechanisms are restructured. The ability to use defense mechanisms is important because being able to use them means being able to control. Their control ensures affective regulation and prevents affective explosions. As is known, one of the most important features of adolescents who self-harm is that they cannot successfully achieve emotional regulation (affective regulation).
Adults and adolescents alike say the same thing: I cannot cope with my pain, the distress and sadness inside me, and my anger, and to eliminate it (postpone it or temporarily eliminate it), I harm myself. As a result of what I have described so far, even though there is a drive overflow and intensity, normally these should be regulated and controlled by the defense mechanisms that develop and are restructured after a certain age. However, in these individuals who self-harm, there is a deficit in this area. Therefore, in this section, we will discuss some views related to emotion regulation, its adjustment and control, and why this capacity does not develop or cannot be effective in individuals who self-harm.
The emotion regulation model can be associated with psychoanalytic theories, particularly object relations theory, that investigate why self-harming behavior is common in adolescence. Anna Freud (1958, cited in Suyemoto, 1998) stated that the task in adolescence is separation from the mother. She attributed the anxieties and related pathologies in adolescence to the need for the adolescent to sever their ties to the love objects of childhood. The inability to sever these ties causes love to turn into hatred and attachment into rebellion. In addition to changes in affects, these hostile feelings toward the love object become increasingly unbearable. Thus, this intolerable state turns inward, toward the self. In this situation, the hated person becomes the subject themself. The adolescent who thinks that harming others would be worse prevents the harm that could be inflicted on others by harming themself instead.
At the same time, the intense emotions experienced may also cause the person to experience certain dissociations. Self-harm behavior may be an effort to end this dissociative state.
Laufer (1991) agreed with Freud’s view that the girl accepts femininity only together with her mother and understands that she cannot take her father’s place because she does not have a penis, with the comprehension of the Oedipus complex. Laufer saw self-harm, anorexia, bulimia, and suicidal behavior as a reaction to the image of a severe and punitive mother, an image that appears when the adolescent girl begins to masturbate during and after adolescence. The adolescent girl sees her body as a punishing object attacking her. Thus, for Laufer, the object relationship with the mother determines the girl’s body image. Here, Laufer is in agreement with Chasseguet-Smirgel (1988). They said, “The primary category is the parents.” For Chasseguet-Smirgel, the difference between man and woman does not depend on the person’s own anatomy but on the difference between the primary objects. Parens (1991), in opposition to Laufer, explained that the girl begins in an ambiguous way and develops a female identity in the late pre-oedipal period.
According to Fisher (1989), early relationships with parents determine later sexual behavior. Fisher says that primary object relations precede anatomy in the development of body image. He did not take into account the effect of the development of later sexual understanding on the memory of early parental relationships. Such linear thinking prevents an understanding of female development. According to Ritvo (1989), “the formation of sexual identity is not a simple dichotomous variable or a fixed end point in a linear developmental process.”
“I know that my life remained somewhere around there, as if it froze and stayed there. As if I lived some things by skipping them, especially that period. I stayed at that age; I did not grow up, I could not move forward; it is a period that I skipped.” This is not a line from a text or a poet’s verse, but what adult patients say about adolescence when working with them. They describe it as a period they passed through without ever really living adolescence. It is as if it were a period to be rushed through; yes, they have occupied themselves with various things that would help them rush through this period, just as in the latency period, and they have treated adolescence like a latency period despite all its storms. The reason for this is to escape from what the storm makes them experience and feel. And indeed, they do escape, only to be caught in an even more violent storm. Experiencing the storm within the impulsivity of that period is different; because going through these conflicts with the accompaniment of affect and emotions is easier with the help of the drive, whereas in a postponed period, we are faced with the difficulty of living these compressed drives under pressure together with the partial calm of adulthood—that is, the proverb “strike while the iron is hot” applies.
In the United Kingdom, 142,000 people deliberately self-harm every year, and approximately 25,000 of them belong to the young population.
