While it is already difficult to define adolescence, in the postmodern era, alongside more limited pathologies, fluid, slippery and chaotic pathologies have begun to predominate, making it necessary to reconsider the adolescent process. New diagnoses have been added to the nosology and the classification ranges have narrowed. With these changes and developments, adolescence – which is itself another name for “change” – has become even harder to understand, and we have found ourselves thinking more and more about distinctions such as “is this pathology or process?”, which in turn has made it even more difficult for us to make sense of it. In simple terms, the familiar complaint we are used to hearing from previous generations, which has now become almost a joke – starting with “Where are the young people of our time?” and continuing with a dissatisfied tone, or the expression “today’s youth” – actually carries a grain of truth. Because something has indeed changed in adolescence; there are now additional factors layered on top of what existed in the past.
When I look at the various definitions of this period whose description is already difficult, the one that strikes me the most and fits best is Anna Freud’s definition: “Adolescence is, among all periods of life in which the importance of instinctual life comes clearly to the forefront, the one that stands out the most.” This single sentence, on its own, summarizes the whole process. Adolescence is impulsivity. Anna Freud, agreeing with her father’s ideas, states that the instinctual surge that appears in puberty disrupts the balance between the Ego and the Id and weakens the Ego, and as a result, it becomes increasingly difficult to rein in the drives. The other possibility is that the Ego maintains its supremacy.
In that case, the personality formed during the latency period is preserved. The latency period is one of the psychosexual developmental stages described by S. Freud and is the period in early childhood when Oedipal conflicts go to sleep. I think of this period as analogous to the psychosexual development entering a tunnel. The second stage is puberty, when the train emerges from the tunnel; at this stage childhood sexuality is given its normal and final form – provided everything proceeds as the process requires.
The “Id impulses” of the growing, developing adolescent remain confined to the area defined for the instinctual life of childhood. In order to restrain the increasing but unusable libido, constantly opposing counterbalances, defenses must be established, activated, and symptoms formed. On the one hand, the instinctual life becomes impoverished; on the other hand, a triumphant ego turns stagnant – these are lasting damages for the individual.
Ego structures that withstand the assaults of adolescence without yielding generally become rigid and frozen later in life; they are not open to the changes demanded by changing reality. Every increase in instinctual demands leads in turn to an increase in the Ego’s efforts to love. The absolute intensity of the drives in adolescence does not by itself provide an idea of how adolescence will unfold. What determines the course of adolescence are relative factors: on the one hand, the intensity of Id impulses determined by the physiological process of puberty, and on the other hand, the Ego structures formed during the latency period and their tolerance or intolerance of the drives.
In this struggle between quantitative magnitudes, another important qualitative factor is the structure of the Ego – for example, whether it has hysterical or obsessive–compulsive features – and, depending on the individual’s development, the type and effectiveness of the defense mechanisms at its disposal. These will also be decisive for how adolescence progresses. As instinctual demands intensify, the individual’s efforts to gain mastery over the drives likewise increase. While the tendencies of the Ego attract little attention during periods when instinctual life flows relatively calmly, they once again become prominent under these conditions. Ego mechanisms established in the latency period or adolescence may gradually strengthen and even lead to personality disorders. From what Anna Freud has said up to this point, it is not hard to imagine how exhausting and challenging the intensity and severity of the inner struggle within the adolescent process can be. In 1957, when Anna Freud gave this talk, half a century had passed since the birth of psychoanalysis, yet adolescent psychoanalysis was still far from satisfying, both theoretically and in practice. Whereas significant advances had been made in adult psychoanalysis and in psychoanalytic work with children. Even after another fifty years, is adolescence still, as Anna Freud said, not given sufficient importance?
Of course, there were psychoanalysts of that period who did not agree with Anna Freud. The famous contemporary psychoanalyst M. Klein emphasizes the crucial role of the earliest phases of childhood in the formation of psychic life and argues that adolescence is merely a simple repetition of the childish Oedipal conflict. I think Klein’s view imposes certain limitations on understanding adolescence, because although adolescence may appear to be a repetition of the Oedipal conflict in childhood, we risk missing some developmental deviations in the course of adolescent development. There is, after all, a “tunnel entrance” – the latency period – that should not be skipped over. Ignoring the libido that accumulates and builds up there and its discharge would mean overlooking an essential dimension of the process. Naturally, the central significance of Oedipality as the beginning, essence, and core of all developmental phases is an undeniable fact. However, to describe adolescence as merely a simple repetition deprives us of the chance to understand the trajectory of these developmental stages. Because adolescence, both physiologically and psychologically, is the “peak” point of development. To explain the material that brings the individual to this peak, this speed and momentum – in short, the struggle – it is useful to examine adolescence in its own specificity while also taking childhood into account.
In the course of the adolescent struggle – and here I think Jacobson’s use of the term “struggle” is important – the defenses established during the latency period are heavily battered and are partially shattered under the assault of instinctual impulses. How can the adolescent succeed in rebuilding, reorganizing, and consolidating the defensive system? We know that in adolescence the Superego is recalibrated and strengthened; but how exactly does this consolidation process take place? The partial rebuilding and reorganization of defenses requires a major restructuring within the Superego system. Since Superego formation is connected with Ego development, and because the Superego is formed through partial identification with idealized parental images, along with their standards, demands, and prohibitions, the issue of identification comes immediately to the fore. Superego formation helps the child resolve Oedipal and ambivalent conflicts and, even at an early stage, allows a certain degree of independence from external social and cultural influences. The adolescent’s efforts to separate from his or her childish love objects do not by themselves give rise to an entirely new psychic system. However, his or her struggle for maturity and eventual liberation from family ties necessarily receives support from major changes in the Ego and Superego and from the emergence of new structures. We may infer that the adolescent, who now must relinquish his or her Oedipal love objects, can only accomplish this primarily through stronger identifications with them at the Superego level. At this point, if we recall that identifications arise from the child’s long-standing psychobiological dependency on the parents, and that the child’s Ego formation is based on identifications, we can better understand the situation. Helene Deutsch (1944) states: “The weaker the child’s Ego, the more it needs to establish identifications with adults during the process of adaptation to the adult world.” Inevitably, conflicts will arise between the adolescent’s need to cope with the loss of childish love objects by strengthening identifications with them and the fact that these identifications must gradually become more renounceable. We must recognize that the aims and functions of the Superego – at least with respect to sexuality – have to undergo significant changes in adolescence compared to the Oedipal stage. During childhood, the Superego, through defenses that allow the child to more or less suppress and inhibit forbidden instinctual impulses and sexual activities, helps the child resolve Oedipal conflicts. In adolescence, as the Superego once again has to enforce the incest taboo, it must also overcome the obstacles to repression and lighten the load of counter–investments. When we observe that the adolescent’s identifications with parents have lost some of their importance, or when we speak of the grief associated with the loss of incestuous love objects, we must also add that the final severing of Oedipal ties in adolescence, the establishment of new object relations and new structure formations and reorganizations are only possible as long as they do not deplete libidinal investments or completely extinguish past identifications.
Indeed, Anna Freud (1958), in her article describing the various tools adolescents use to break their ties with their families, points out that the “internal loss” of childish love objects during this period can lead to serious problems. Pathology may develop when the adolescent, unable to control the extremely strong ambivalent conflict toward his or her childish love objects, withdraws libidinal investment from them once and for all. In such cases, persistent and even irreversible deep regressive processes can be seen throughout the system. It is important to recognize that even within the normal range of development, adolescents may experience transitional periods in which they move from a narcissistic escape to a state of true “internal” object loss and identity loss. What is decisive is less whether these states are brief than whether they are reversible. Under normal circumstances, they are followed by a return to the world of objects and a renewed advance. But, as Anna Freud emphasizes, the adolescent’s rejection of drives is related to the refusal of instinctual pleasures. The adolescent fears not the quality but the quantity of the drive; he or she harbors a general suspicion of pleasures. This distrust of the drive may extend from genuine instinctual wishes to everyday bodily needs.
The truly dangerous point is this: in adolescence, unlike in neurotic conditions, substitute satisfactions are not allowed (such as the conversions of hysteria or the defenses used in obsessive–compulsive disorder). This type of drive rejection also differs from repression in another respect. Under neurotic conditions, when instinctual gratification is blocked by repression, a substitute satisfaction is put in its place. In adolescence, however, drive denial does not allow such satisfactions. It does not consent to compromises equivalent to neurotic symptoms, nor does it employ the usual mechanisms of displacement, regression, or turning against the self. Instead, sudden instinctual outbursts occur. During such outbursts, everything previously forbidden is suddenly permitted, all at once, completely disregarding external limits. When the Ego manages to carry drive denial through to the end, vital activities are paralyzed; that is, we are confronted with a catatonic state, which we must regard as a sort of psychotic change that cannot be explained by the normal course of adolescence.
In pathological adolescence, where the quantitative intensity of the drive is first met with total drive rejection – a rejection of all pleasures extending even to simple everyday events – and where this proves insufficient, another method of coping is developed: a return to the drive in the form of renewed outbursts. It is useful to reflect further on the tendency to reject drives that appears in adolescence, and to distinguish it from the ordinary repression of the drive. The conceptual basis of this distinction is, at the outset of the process, the fact that fear provoked by the quantitative aspect of the drive – its magnitude – outweighs the fear created by its qualitative aspect, and at the end of the process, that there are no substitute satisfactions or compromise formations but rather periods of either drive rejection or acting out of the drive in phases of instinctual excess. Even in the usual neurotic repression, the quantitative libidinal charge of the rejected drive is of great importance, and even in obsessive–compulsive neurosis it is quite common for prohibitions and permissions to alternate. Nonetheless, compared with true repression, drive denial in adolescents appears to be a more primitive and more rudimentary process, likely a special form of repression or a preliminary stage.
In my view, what differentiates adolescent drive denial from other neurotic states is that, unlike in neurosis, the ground on which the process unfolds is undefined, not yet organized and without clear boundaries. The inability to establish this ground in a healthy way pushes the adolescent into a pathological process and leads to various disorders and illnesses. The most serious outcomes are psychoses and personality disorders. Many borderline adults give the impression of “unmatured adolescents” and display attitudes and behaviors typical of adolescents. In both, the Ego is weakened and anxiety is prominent. In adolescence, the Ego is weakened by increasing instinctual pressures; in the borderline adult, the Ego is weakened by the deprivation created by unsatisfied drives and the emergence of the death drive. In both, the Superego is excessively powerful. Both use similar defensive arrangements. When we consider the difficulty and the enormous energy required in the treatment of Borderline Personality Disorder, there is no doubt that adolescence is a process that cannot be underestimated and that the struggle the adolescent undergoes is worth understanding.
Within the adolescent process, we mentioned that existing defenses are battered and must be rebuilt and reorganized. In fact, we are talking about a reorganization or a struggle for organization. Until this formation is complete – and even afterward, during the phase in which it is being consolidated – the ground remains unstable. It is like walking on a road that has just been paved with asphalt compared to one that was paved long ago. Because some of the structures formed in early childhood and during the latency period will be repaired and altered again. Depending on the course of adolescence, in order to free itself from the powerful pressures of the Ego, Superego, and Id, the adolescent may again resort to primitive defense mechanisms such as isolation and denial, as well as to the childlike mechanisms of introjection and projection (Jacobson, 1957) – at least until a genuine organization and structure emerge. As a result of this healthy structural formation, more advanced mechanisms are established, and this structure in turn affects adulthood. If the opposite occurs, the adolescent may attempt to escape from genital drives toward aggression or from the genital stage back to pregenital levels; from masculine–aggressive aims to passive–feminine aims; from object ties with peers to ties with older partners or even incestuous objects; or he or she may flee in the exact opposite direction.
All this shows that adolescence is not, in fact, a neurosis. In neurosis there is a clear and crystallized opposition between desire and prohibition; the camps are defined, the desire is clear and the prohibition that prevents its gratification is clear. The adolescent’s oscillation between submission to authority and stubborn rebellion, between calculating materialism and intense idealistic feelings, living with the discipline of a warrior and suddenly gratifying the most primitive drives, switching between a light-hearted, carefree optimism and a deep pessimism – all this shows how much contrasts dominate adolescent life. Of course, here too the starting point is the forbidden focal points of instinctual life: the preadolescent incest fantasies or the increased tendency to concrete masturbation used to gloss over such wishes. But in adolescent drive denial, the young person’s choice is related not to the gratification or frustration of specific instinctual wishes but to the acceptance or rejection of instinctual pleasures in general.
Those who argue that adolescent development and identity formation are best explained by supplementing libidinal theory with object relations theory, and by emphasizing the impact of adolescent object relations, find Peter Blos’s views particularly satisfying. Blos divides the adolescent process into five stages and defines adolescence as a second individuation process, emphasizing that, in order to establish new object relations, the adolescent must distance himself or herself from the internalized primary object. According to Blos, the Oedipus complex is truly resolved in adolescence. Another psychoanalyst who has proposed concepts regarding adolescence is Pierre Mâle, who, in his analysis of the “male adolescent crisis,” distinguishes between a pubertal crisis occurring roughly between ages 10–15 and a youth crisis extending from about 15 into the twenties. For Mâle, the pubertal crisis is the period in which bodily changes give rise to anxieties about self and body, and in which the first sexual experiences take place. When this crisis exceeds normal limits, he speaks of “pubertal disharmonies.” Here, defense mechanisms prove inadequate in the face of instinctual awakening. The youth crisis, on the other hand, is defined as a period that encompasses the emotional and mental processes of individuation, in which the young person strives to be original. Mâle’s approach is quite close to Debesse’s notion of the “crisis of freedom” in youth.
Philippe Gutton, a student of Pierre Mâle, defines the psychic change that emerges in puberty as “pubertaire” (erinsel). What marks this pubertaire is the turmoil created by incestuous and parricidal fantasies. Gutton calls the later period in which the wounds opened by the pubertaire begin to close “adolescentaire” (ergensel). What characterizes the adolescentaire is the formation of the Superego and Ego ideal. In other words, the pubertaire repeats a preoedipal period, while the adolescentaire corresponds to the oedipal period. The Superego was defined by S. Freud in his 1923 paper “The Ego and the Id.” The internalization of parental authority during the Oedipus complex leads to the differentiation of a part of the Ego and to the formation of what psychoanalysis calls the Superego. Freud summarizes this process with the sentence: “The Superego is the heir to the Oedipus complex.”
In childhood, the Superego is the voice that says, “If you identify with your parents’ moral standards, demands and prohibitions, you will earn the right to sexual freedom in adulthood”; in adolescence it must say, “You gain the right to the adult’s sexual and emotional freedom, to freedom of thought and action, to the extent that you renounce your childish instinctual wishes, free yourself from childhood ties, and accept the adult’s ethical standards and responsibilities.” In this way, the adolescent is confronted with the complex and bewildering task of softening the idealized, sexually prohibitive parental images, reconciling them with realistic parental concepts, and at the same time constructing new sets of moral and ethical standards based on a stable reestablishment of the incest taboo.
We must take into account that inconsistencies in parental attitudes and standards, or contradictions between the home and the school environment, can interfere with the Ego and Superego’s ability to form consistent identifications and may lead to early identity problems that can gain dangerous momentum in adolescence. These dangers are connected to the changes that the Superego must undergo during this period. Failure to resolve these contradictions can lead to absurd conceptions of adulthood, ranging from the fantasy that growing up means achieving absolute instinctual freedom to the idea that it means absolute renunciation of instinct. The specific emotional tone of the adolescent’s mood, the oscillations between emotional extremes, the temporary loss of organization that leads to a partial dissolution of the old psychic system, the shift from a state in which drive neutralization is disturbed and regression occurs, to one in which libidinal forces and renewed drive neutralization predominate and drive the reorganization of psychic demands – all of these reflect the transition to psychic progress. During these psychic oscillations, the adolescent may once again pause at various levels of childhood, forming primitive narcissistic object relations and identifications that can reactivate fantasies of fusion with the object (Geleerd, 1961).
When we consider these processes adequately, we understand that the adolescent’s depressive and manic states can have very different meanings and reasons and thus contain many different conflicts and mechanisms. The adolescent’s unhappiness may express sorrow over the childhood objects and activities that must be relinquished and may bear the traces of painful longing; for he or she can neither return to these objects nor has yet reached new levels of achievement, personal investment, and pleasure. Sometimes the sorrow may be due to a failure to gain the love of a desired person, or to failures at work or in other pursuits, leading the adolescent to feel physically and personally inadequate, intellectually and emotionally inferior, and not yet mature. At other times, his or her sadness may stem from guilt conflicts arising from sexual and disproportionate, excessive hostile feelings. Depressive moods may sometimes be free of regressive features, and sometimes they may require regression to homosexual or sado–masochistic positions; indeed, they can even be the expression of a withdrawal from the world driven by hostile and deep narcissistic feelings. Beyond this, for his or her psychic development, the adolescent also needs periods of withdrawal and introspection in which he or she will not feel depressed and lonely but will find a quiet space to listen to the self. Similar factors can be observed in the adolescent’s states of happiness and elation.
From an economic point of view, we must also consider the adolescent’s tendency to suffer from the libidinal storms he or she experiences and from the occasional explosive outbursts of aggression. One day he or she may feel as if dying of sexual hunger, another day may be consumed by hate and self-hatred.
The adolescent’s ecstatic states are, of course, a sign of the intensity of narcissism. While this may allow the self to expand lovingly toward the object world and flood both with a torrent of libido that is liberated but not yet bound to new individual objects, such narcissistic overexpansion and long periods of striving for grandiose goals and highly narcissistic values undoubtedly carry a dangerous potential and are responsible for these manic and depressive moods. Even in adolescents who do not seem gravely disturbed, narcissistic regression, with its depth, can give rise to transient depressive states marked by paranoid and hypochondriacal features, intense feelings of loneliness and isolation, and identity problems reminiscent of psychotic depression.
Adolescence and Bodily Pathologies
A. Brraux considers disorders that arise from the relationship between the adolescent and his or her body during this difficult process, which has familial and social dimensions, under several clinical problem areas: drying up or nullification of the body (anorexia nervosa and psychosis), the body under attack (risk–taking behaviors and suicide attempts), hindering the body (asceticism and intellectualization), idolization of the body (phobias and narcissistic disorders), and wounding the body (physical disabilities and illnesses). Above, bodily hindrance (asceticism and intellectualization) was touched on superficially. Here, in line with my own work, I will focus mainly on the body under attack – that is, risk behaviors and suicide attempts.
Affect is an emotional state, joyful or sorrowful, that emerges as an intense discharge.
Adolescence is a period in which it is difficult to manage affects. The Ego is moving away from parental images and the narcissistic support they provide, leaving the adolescent face to face with a new causal network. All the pleasures and inhibitions of childhood were organized according to the parents’ gaze. The reorganization of the Ego depends on defining affects as one’s own and learning to manage them personally. In this difficult effort, certain defense mechanisms are of course used. In this way, the Ego keeps internal tension at an acceptable level. One of these defense mechanisms, denial, manifests particularly as the denial of bodily changes and, as denial of reality, splits the subject in two. The denial of concrete, material reality and the repression of drive and representation – the simultaneous use of these two defenses – gives rise to splitting. While repression operates horizontally, on the conscious–unconscious axis, splitting divides the subject vertically in two. That is, on the one hand the adolescent defends against incestuous desires, on the other hand he or she tries to deny pubertal changes. This is a source of anxiety from two directions. First, there is no appropriate representation to which the instinctual impulse can be bound, that is, it has no name. Second, the psychic apparatus is weakened because it is itself undergoing change. Meanwhile, the Ego ideal has not yet formed. At the same time, the pressure of the Id is intense.
In the formation of bodily pathologies, especially in adolescents who show self–mutilating behaviors, we see in projective test records that denial and repression are used simultaneously (both intensely), in other words, that they frequently resort to splitting. What could be the relationship between these two defense mechanisms and self–injurious behaviors? Why bring this up at all? Before moving on to the answers to these questions, I will briefly mention some of the psychoanalysts who have worked on adolescent self–harm and their contributions. I think this will help us grasp the meaning of this small study more quickly.
Anna Freud encouraged one of her best students, Moses Laufer, to set up an adolescent treatment unit within the child psychoanalysis center she directed, the Hampstead Clinic. Thus, in the early 1960s, the Young People’s Consultation Centre was founded, later to become what is today called the Center for a Research into Adolescent Breakdown. Laufer later came to London to become a psychoanalyst. While attending the London Psychoanalytic Institute, he also worked at a center dealing with the education of troubled young people.
Starting from the analyses of his adult patients, M. Laufer first made the following observation: the entire psychopathology of adulthood is linked to a breakdown that occurs in adolescence. By breakdown, Laufer means the adolescent’s rejection of his or her newly sexualized body and of the new possibilities created by bodily developments. Breakdown emerges as a defense against a reality in adolescence that is difficult to accept, and its internalization leads to the severe pathologies seen in adulthood. Laufer sees adolescence as a developmental process and calls the halt of this process “breakdown.” It is this that brings about pathology. The aim of development in adolescence is the formation of a sexual identity that is stable and irreversible at the end of the process.
Another important point in Laufer’s approach is the importance he assigns to the body. The pathology that emerges in adolescence manifests particularly as destructive behaviors directed at the body. He works on the hatred felt toward the body that underlies these behaviors.
Laufer (1991) accepts Freud’s concept of the “Oedipal complex.” That is, he believes that the girl must acknowledge that she does not have a penis in order to grasp the Oedipus complex. He has carried out his work in this direction; he sees self–injury, anorexia, bulimia and suicidal behavior as a reaction to the harshly punitive maternal image, which appears when the girl begins to masturbate in adolescence and thereafter.
