The Struggle Against Mourning

The Struggle
against Mourning
The Struggle
against Mourning
ILANY KOGAN
Jason Aronson
Lanham • Boulder • New York • Toronto • Plymouth, UK
To
Noam and Tal
Once beloved children, now themselves beloved parents
Published in the United States of America

by Jason Aronson
An imprint of Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of

The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland
20706 www.rowmanlittlefield.com
Estover Road
Plymouth PL6 7PY
United Kingdom
Copyright 2007 by Jason Aronson
All rights reserved. No part of this publication may be reproduced,

stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of the publisher.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data

Kogan, Ilany.
The struggle against mourning / Ilany Kogan.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7657-0508-2 (cloth : alk. paper)
ISBN-10: 0-7657-0508-7 (cloth : alk. paper)
ISBN-13: 978-0-7657-0507-5 (pbk. : alk. paper)
ISBN-10: 0-7657-0507-9 (pbk. : alk. paper)
1. Defense mechanisms (Psychology) 2. Grief therapy. 3. Holocaust survivors
—Mental health. 4. Children of Holocaust survivors—Mental health. I. Title.
[DNLM: 1. Defense Mechanisms—Case Reports. 2. Grief—Case Reports.
3. Psychoanalytic Therapy—methods—Case Reports. 4. Psychotherapeutic
Processes—Case Reports. 5. Stress Disorders, Traumatic—Case Reports. WM
193 K78s 2007]
RC455.4.D43K64 2007
616.89 14—dc22 2007010274
Printed in the United States of America

The paper used in this publication meets the minimum requirements of
American National Standard for Information Sciences—Permanence of Paper for
Printed Library Materials, ANSI/NISO Z39.48-1992.
Contents
Acknowledgments vii
Introduction 1
1 Revisiting Defenses against Pain and Mourning 9
PART I: Obstacles to Individual Mourning 21
2 Forever Young 23
3 Lust for Love 47
PART II: Unresolved Mourning and Its Bearing on Society 69
Introduction 71
4 Romania and Its Unresolved Mourning 73
5 From Enactment to Mental Representation 89
6 Trauma, Resilience, and Creative Activity 107
7 On Being a Dead, Beloved Child 123
PART III: Obstacles to Mourning in an Age of Terror 157
Introduction 159
8 Who Am I? Trauma and Identity 161
9 The Role of the Analyst in the Analytic Cure during Times of

Chronic Crises 177
v
vi CONTENTS
10 Working with Sons and Daughters of Holocaust Survivors in

the Shadow of Terror 199
Epilogue 211
References 219
Index 251
About the Author 263
Acknowledgments
This book has grown out of my own struggle against mourning, on the
professional as well as on the personal level. It illustrates the pathway
from absence of mourning to an emotional awareness of pain and loss,
includ-ing the therapeutic dilemmas involved in such a journey.
The book is the result of many invitations to lecture on this topic, for
which I am grateful to my friends and colleagues abroad. I wish to thank
my friends from the United States: Salman Akhtar, Ira Brenner, Dori
Laub, Henri Parens, Warren Poland, and Vamik Volkan for their encour-
agement and appreciation. To my German colleagues—Marianne Leu-
zinger-Bohleber, Werner Bohleber, Peter Brundl, Manfred Endres, Peter
Riedesser, and Hediaty Utari-Witt—I am grateful for the creative oppor-
tunities they sent in my direction.
I am also deeply thankful to my friends and colleagues on the Israeli
scene—Alice Buras, Anna Gertler, Dahlia Lapidot, Cila Smolarsky, and
Gisele Vered—who have been a source of knowledge and support, espe-
cially in difficult moments in therapy.
At Rowman & Littlefield, I want to thank Art Pomponio who, from
the very beginning, gave me the support and appreciation needed for
com-pleting this project. I am also grateful to Mary Catharine La Mar
and Karen Ackermann for their industriousness and involvement with
this book.
I wish to express my appreciation for the outstanding skill and
devotion of Ms. Chava Cassel, my English editor, whose help was
invaluable to me all along the way.
To my family members, husband, and children, who gave me the
strength to realize this book, I am greatly indebted.
vii
viii ACKNOWLEDGMENTS
Finally, I am grateful to my patients who allowed me to accompany

them on their analytic journey.
The following chapters have appeared elsewhere, as noted, and are re-
printed with permission.
Chapter 2. Presented at the Thirty-eighth Congress of the IPA, Amster-

dam, August 1993. Published under the title: ‘‘Termination and the prob-
lem of analytic goals: Patient and analyst, different perspectives,’’
International Journal of Psychoanalysis 77 (1996): 1013–29. Copyright
Institute of Psychoanalysis, London, UK. Reprinted by permission.
Chapter 3. Presented at the Fortieth Congress of the IPA, Santiago de Chile,

August 1997. Published (shorter version) in The Edge of Experience (2001),
ed. Grigoris Vaslamatzis and Andreas Rabavilas, London and New York:
Karnac Books, pp. 67–89. Also in Idantitat und Differenz—Zur Psy-
choanalyse des Geschlechterverhaltnisses in der Spatmoderne (2000), ed.
Hil-degard Lahme-Gronostaj and Mariane Leuzinger-Bohleber. Published
(full version) in Psychoanalytic Psychology 20, no. 1 (2003): 117–30, under
the title ‘‘When words are used to touch.’’ Copyright 2003 by the Edu-
cational Publishing Foundation (American Psychological Association).
Reprinted by permission.
Chapter 4. Presented at the Conference on Migration, Bressanone, Italy, July

1997; at the Conference of the Arztliche Akademie, Hamburg, Ger-many,
March 1999. Published (shorter version) under the title ‘‘Psychoan-alytishe
Behandlung einer Migrantin’’ in Zeitschrift fur Politsche Psychologie, ed.
Freihart Regner and Elise Bittenbinder, Jahrgang 4 2000: 523–33. Published
(full version) in Mind and Human Interaction 2, no. 12 (2001): 95–107 under
the title ‘‘Romania and its unresolved mourning— Those who emigrated and
those who stayed behind.’’ Published (full ver-sion) under the title
‘‘Rumanien und seine umbewaltigte Trauer: die Emigranten und die
Zuruckgebliebenen’’ in Zwischen den Welten— Psychosoziale Folgen
kommunistischer Herrschaft in Ostmitteleuropa, ed. Petra Morawe, Baden–
Baden: Nomos Verlagsgesellschaft (2004), pp.121–
31. Also in Kindheit jenseits von Trauma und Fremdheit—
Psychoanalytische Erkundungen von Migrationschicksale im Kindes und
Jugendalter, ed. Peter Brundl and Ilany Kogan, Frankfurt: Brandes & Apsel
(2005), pp. 274–87.
ACKNOWLEDGMENTS ix
Chapter 5. Presented at the Conference on Remembering, Acting and En-

acting, Gottingen, 1999. Published (shorter version) in Errinern, Agieren
und Inszenieren: Enactments und szenische Darstellungen im therapeu-
tischen Prozess, ed. Ulrich Streeck, Gottingen: Vanderhoeck & Ruprecht,
2000, pp. 127–43. Published (full version) as ‘‘Enactment in the lives
and treatment of Holocaust survivors’ offspring’’ in The Psychoanalytic
Quar-terly 71 (2002): 251–73. Copyright The Psychoanalytic Quarterly,
2002. Reprinted by permission.
Chapter 6. Presented at the IPA Congress, Rio, 2005. Published (shorter

version) in Adoleszenz-Bindung-Destruktivitat (2004), ed. Annette
Streeck-Fischer, Stuttgart: Klett-Cotta, pp. 343–64. Published (full
version) in Reprasentationen des Holocaust im Gedachtnis der
Generationen (2004), ed. Margrit Frolich, Yariv Lapid, and Christian
Schneider, Frankfurt: Brandes & Apsel, pp. 90–112. Also in Trauma Der
Psychoanalyse? Die Ver-treibung Der Psychoanalyse Aus Wien 1938
Und Die Folgen (2005), ed. Wie-ner Psychoanalytischen Vereinigung,
Wien: Mille Tre Verlag Robert Schachter, pp. 199–219.
Chapter 7. Presented at the German Psychoanalytic Society (DPG),

Berlin, October 1999; at the Munchner Arbeitskreise fur Psychoanalyse,
Munich, 1999. Published in The Psychoanalytic Quarterly 72, no. 3
(2003): 727–67. Copyright The Psychoanalytic Quarterly, 2003.
Reprinted by permis-sion.
Chapter 8. Presented at the Conference on Trauma and Youth Culture,

Bressanone, Italy, 2005; at the APsA, winter meeting, New York,
January 2006.
Chapter 9. Presented at the EPF New Style Conference, Sorrento, 2003. This
article was originally published in the Journal of American Psychoana-lytic
Association 52 (2004): 735–59. Copyright 2004 by the American
Psychoanalytic Association. All rights reserved. Reprinted by permission.
Chapter 10. Presented at the IPA Congress, New Orleans, March 2004, in
the panel on ‘‘Working with psychotic and non-psychotic patients in situ-
ations of terror and military dictatorships.’’ Reported (shorter version) in
x ACKNOWLEDGMENTS
International Journal of Psychoanalysis (2004) under the title ‘‘Working

with psychotic and non-psychotic patients in situations of terror and mili-
tary dictatorships.’’ Report of panel held at the Forty-third Congress of
the IPA, New Orleans, 85: 1247–49. Copyright Institute of
Psychoanalysis, London, UK. Reprinted by permission.
Introduction
Give sorrow words: the grief that does not appear
Whispers the o’er-fraught heart and bids its break
—William Shakespeare, Macbeth, Act 4, Scene 3, Lines: 209–210
‘‘We all mourn: C’est la condition humane,’’ eloquently states the

psycho-analyst Henri Parens (2001). It is impossible to shield our lives
from the impact of the inevitable, be it loss of familiar surroundings,
bereavement, aging, or death. But, in fact, we are not always able to
mourn, because we often distort reality or deny our losses.
What is mourning? In brief, and in the context of this book, mourning
is the conglomerate of favorable processes that develop in the face of
loss. It includes acceptance of reality and readaptation to it. Mourning
means acceptance of one’s perpetual vulnerability to loss and betrayal, as
well as to one’s own limitations and to the finality of life. The pain
incurred in having to acknowledge these reactions to loss sometimes
make us unable to go through the mourning process. Often, this pain is
warded off by means of various defense mechanisms.
Mourning is necessary because it permits us to relinquish attachments and
attitudes that have lost their realistic usefulness, thus facilitating growth and
development. Freud defined the outcome of mourning as fol-lows: ‘‘The task
of mourning is to detach the survivor’s memories and hopes from the dead’’
(1913, p. 65). Anna Freud refined this definition by stating, ‘‘mourning,
taken in the analytical sense, is the individual’s effort to accept a fact in the
external world (the loss of the cathected object), and to effect corresponding
changes in the inner world (withdrawal from the lost object)’’ (1960, p. 58).
Bowlby (1960) saw mourning as the psycholog-ical process set in motion by
the loss of the loved object, and suggested that it commonly leads to the
relinquishment of the object.
1
2 INTRODUCTION
The elaboration of mourning eventually leads to a better

differentiation between self and object, past and present, reality and
fantasy. It also leads to a reorganization of the ego, and a smoother
interaction between the inner and outer world. The mourning process
facilitates the integration of dissociated parts of the self and the
consolidation of the sense of identity (Grinberg 1992).
In this book I deal with obstacles on the road to mourning. I use case
studies to help provide an understanding of the impediments to the work
of mourning in specific situations, and to describe the therapeutic tools
that were employed to achieve a healthier outcome. The book focuses on
various defenses, their function and importance, and the difficulty of re-
linquishing them. It also highlights my own dilemmas in these contexts.
I have found that I convey my thinking most effectively by means of
case illustrations. Thus, using detailed descriptions taken from analyses, I
explore the long and anxiety-provoking journey to mourning of patients
who have employed an array of defenses in order to avoid facing the
pain-ful feelings inherent in mourning. Often, the cases are illustrated
with ver-batim exchanges from the sessions. The reader is invited to be
‘‘present’’ and follow the intimate patient-therapist dialogue from a close
perspec-tive, learning about the problems and dilemmas of both patient
and thera-pist when confronted with loss.
A remark made about my first book, The Cry of Mute Children (1995),
which struck a responsive chord in me, served as one of the triggers for
writing this book. ‘‘All of the cases described in your book end in success,’’
was the comment. Reflecting upon this, I wondered how much we analysts
determine the patients’ final choices in analysis as well as in life. Poland
(2006) makes a beautiful observation in this regard: ‘‘The analyst is a
translator, and the translator has no right to determine how the patient-author
unfolds that story, not even what ending the author chooses. The analyst’s
responsibility to question never diminishes the patient’s full right to unique
personal answers.’’ And, indeed, in many of the cases that I treated, the
successful result was in great part the patient’s choice. How-ever, in my
former book, I nevertheless chose to mostly present cases with successful
results. This apparently was an expression of my omnipotent fantasies about
what therapy can achieve. This realization led me to also include here cases
that were less successful and, subsequently, to work
INTRODUCTION 3
through my therapeutic narcissism, redefine my analytic goals, and

mourn the limitations of therapy.
Schafer described the powerful, personal way that therapists are af-
fected by the limitations of therapy. ‘‘Through them, he must recognize
that his effectiveness as a healer is quite limited, which means that
impor-tant narcissistic ideas about himself and ideals for himself are
forcefully contradicted by experience. The roots of these ideas and ideals
lie in infan-tile fantasies of omnipotence, which no one ever renounced
completely’’ (1973, p.138).
The present book includes cases that brought me face to face with the
limitations of my ability as a therapist, cases with varying degrees of suc-
cess in achieving the analytic goals. The issue of defining the analytic goals
and the different meanings of ‘‘successful’’ therapy from the respective
viewpoints of therapist and patient are discussed in some of the chapters.
The first section of the book explores the theme of manic defenses and
denial. It is illustrated with cases studies of patients whose manic
defenses had survival value and were used by them to prevent
fragmentation and psychic death. This section also describes my doubts
and dilemmas as an analyst with regard to the price patients may pay for
relinquishing these defenses, and my deliberations about leading them on
their difficult jour-ney to mourning.
Going beyond the individual, the second section of the book is an at-tempt
to describe the impact of unresolved mourning on large groups. Specifically,
it focuses on issues of mourning in Romania, my country of birth, based on
my supervisory work there, and on the transmission of the Holocaust trauma
from one generation to another in Israel. The first chapter of this section
integrates my psychoanalytic understanding of the patient’s unresolved
mourning due to the loss of primary objects and fa-miliar surroundings with
my analysis of Romanian society’s unresolved mourning. The other chapters
deal with the impact of the transmission of the trauma of the Holocaust, with
its accompanying traumatic fantasies, to an entire generation. The integration
of perpetrator and victim self-representations, which had an impact also on
those not directly affected by the Holocaust (Moses 1993; Volkan 1998;
Volkan et al. 2002; Brenner 2002a), left its mark on a major portion of Israeli
society. This too is dis-cussed in this section. The clinical material illustrates
the means employed by Holocaust survivors’ offspring to deal with the pain
and mourning
4 INTRODUCTION
transmitted to them by their parents. The mechanisms of ‘‘enactment,’’

as well as reparative defenses such as creativity, are explored.
While the second section of the book deals with the impact of unre-
solved mourning of Holocaust survivor parents on their offspring under
normative life situations, the last section deals with the inability to mourn
in life-threatening situations and the problems of conducting psychoanal-
ysis in the shadow of terror. The first chapter in this section differs from
the others in that it presents a psychoanalytic review of the movie
Europa, Europa, which deals with the absence of mourning following
loss and its impact on the hero’s identity. The last two chapters deal with
the topic of psychoanalysis in the shadow of terror and with the intrusion
of external traumatic reality into the treatment. The last chapter in this
section dem-onstrates how external traumatic reality may become
interwoven with internal reality, and thus intensify manic defenses,
particularly among off-spring of Holocaust survivors, who are often
haunted by the traumatic past of their parents.
Although I discuss the intrusion of external traumatic reality into the
treatment from the perspective of my clinical experience in situations of
chronic crises in Israel, I believe it is an issue of universal relevance. The
events of September 11, 2001, in the United States, and the bombings in
Madrid and London, which maimed and killed their victims, caused mas-
sive suffering and destruction, and left in their wake both individual and
collective traumatization. Working as an analyst during such times pre-
sents enormous problems: ‘‘I am not sure that one could ever be prepared
or ‘trained’ enough to know what to say or do at such times,’’ states
Bren-ner (2002b). In my experience, conducting analysis in the shadow
of ter-ror necessitates that the analyst deal with certain treatment-related
issues: the impact of traumatic reality on the defenses of both partners of
the analytic couple and a rethinking of the role of the analyst in a shared
life-threatening situation, which includes the recognition and
acknowledg-ment of the analyst’s own reactions to external reality.
The main questions that I wish to raise in this book are: How does the
analyst help the patient be in touch with pain and mourning? Is the
relinquishment of defenses always desirable? And what is the analyst’s role
in these cases? Should the analyst struggle to help patients relinquish these
defenses, which they may experience as vital to their precarious psychic
survival? Or should s/he accompany them on their way to self-discovery,
INTRODUCTION 5
which may or may not result in the patients’ letting go of their defenses when
faced with the pain and mourning inherent in trauma? The utiliza-tion of
various defenses and the resulting unresolved mourning reflect the magnitude
of the anxiety and pain that is found on the road to mourning. The ability to
mourn and the capacity to bear some helplessness while still finding life
meaningful are the objectives of the analytic work in this book.
The clinical chapters in the book illustrate the journey to pain and
mourning, and ultimately to a more intact self.
A brief description of the clinical chapters of the book follows. Chapter 2
—Forever Young. This chapter describes the patient’s journey
from manic defense to mourning, as viewed from the perspective of the
termination phase of analysis. The termination phase confronts both pa-
tient and analyst with the limits of omnipotent ideas about life, as well as
about psychoanalysis. This theme is illustrated by a case study of a forty-
year-old woman striving for everlasting youth and immortality through
compulsive attempts to bring a third child into the world. The birth of her
child was an omnipotent enactment that served to deny and replace inter-
nal as well as external reality. The discussion highlights the impact of the
fear of growth and aging on both partners of the analytic couple, and de-
scribes the analyst’s temptation to collude with the patient in avoiding
the depressive anxiety aroused by aging and death.
Chapter 3—Lust for Love. This chapter examines the case of a patient
who attempts to deal with her inner emotional deadness and self-destructive
fantasies by means of various forms of eroticism—such as homosexual love
affairs and working in a sex therapy clinic—for infusing herself with a sense
of life. In analysis, this took the form of demanding to touch and be touched
by the analyst, which threatened the continuation of analysis. The chapter
illustrates the analyst’s predicament in dealing with a patient who threatens
to act out violently and dangerously if the analyst does not acquiesce to her
demands in some way. It also shows how a verbal interac-tion with the
analyst, which was experienced by the patient as a physical touch, enabled
the continuation of the analytic work and the working through of the
patient’s manic defenses.
Chapter 4—Romania and Its Unresolved Mourning. The problem of
un-resolved mourning is illustrated in this chapter. The working through
of the traumatic elements of migration with a patient of the same national
origin as the therapist is interwoven with the therapist’s own unfinished
6 INTRODUCTION
mourning for her country of origin. The chapter illustrates how Romanian
society is trapped, to this very day, in its unresolved mourning.
Chapter 5—From Enactment to Mental Representation. The chapter
deals with the impact of the traumatic past of Holocaust survivor parents
on their offspring. These damaged parents, who suffered from a state of
unresolved mourning, often transmitted feelings of aggression and pain to
their offspring, who carried these feelings for them; this affected an entire
generation and had an impact on society as a whole. The chapter explores
an attempt of Holocaust survivors’ offspring to avoid the mourning trans-
mitted to them by their parents by means of a mechanism called
enactment. The chapter uses case material to illustrate the process of
transforming enactment into mental representations, which then allowed
the work of mourning to begin.
Chapter 6—Trauma, Resilience, and Creative Activity. The link
between trauma, resilience, and creative activity is explored in the
analysis of a Ho-locaust survivor’s offspring. In this case, resilience is
defined as the off-spring’s ability to acknowledge and work through the
pain, guilt, and mourning deposited in her by her mother. Creative
activity is one of the pivotal factors in resilience to trauma and hardship.
It serves as a tool to facilitate acknowledgment and working through of
the painful feelings transmitted by the offspring’s traumatized parent.
Chapter 7—On Being a Dead, Beloved Child. The chapter presents a
long, detailed analysis of a patient who was a replacement child for par-
ents, each of whom had lost a child during the Holocaust. At the core of
this analysis is the bereaved mother’s omnipotent fantasy of resurrecting
her dead, beloved child by means of the living child, the way this fantasy
shaped the mother-child relationship, and the impact it had upon the
character structure of the child. In addition, the discussion of the case
study highlights the countertransference difficulties of the therapist, who
belongs to the same traumatized large group as the patient.
Chapter 8—Who Am I? Trauma and Identity. This chapter presents a
psychoanalytic review of the movie Europa, Europa. It deals with a young
adolescent who, during the Holocaust, flees from one country to another and
from one culture to another in order to save his life. He spends several years
in an elite Nazi school for Hitler Youth, where he passes as an Aryan. The
chapter reveals the survival value of the absence of mourning in life-
threatening situations and the emotional price paid for survival.
INTRODUCTION 7
Chapters 9 and 10. These two chapters involve cases in which manic
defenses are reinforced as a result of the encounter with external
traumatic reality, and in which analysis becomes difficult under the
shadow of terror. Both chapters describe how the perception of external
threatening reality activates the Holocaust trauma in the unconscious of
individuals who have been directly or indirectly affected by the
Holocaust, thus having an impact on a major portion of Israeli society.
Chapter 9—The Role of the Analyst in the Analytic Cure during Times of
Chronic Crises. This chapter deals with the problem of the analyst’s role
during times of chronic crises and the impact of a shared life-threatening
situation on the defenses of both members of the analytic couple.
Chapter 10—Working with Sons and Daughters of Holocaust
Survivors in the Shadow of Terror. The focus of this chapter is the impact
of external traumatic stimuli on the perception of reality and on the
defenses of Holo-caust survivors’ offspring.
1
Revisiting Defenses
against Pain and Mourning
Mourning is a concept that originally appeared in papers dealing with de-

pression and melancholia. It has been defined in many different ways, be-
ginning with the work of Freud (1917) and Abraham (1924). One of the most
complex aspects of mourning, and one that has not yet been com-pletely
elucidated, is the distinction between normal and pathological mourning
(Volkan 1981). Referring to this subject, Grinberg (1992) con-tends that the
psychoanalysts who have written about these two forms of mourning have
not been able to state precisely which were the specific factors conditioning
the two pictures. Even the use of the terms describing them has given rise to
controversy. There are authors who insist that mourning should be restricted
to the pathological state, reserving the term grief for the reaction that is
considered normal. Others use the term mourning for the healthy processes
of dealing with loss and bereavement for a more desolate and pathological
reaction. Bowlby (1961) emphasizes that the word grief denotes only the
sequence of subjective states that fol-low loss and accompany mourning. In
his view, mourning includes the entire psychopathological process caused by
object-loss.
In this book mourning includes overcoming pathological defenses and
shedding the regressive elements that block the way to the establishment
of the adult aspects of the personality when one is confronted with loss
and bereavement, aging and death, stress and trauma. Mourning involves
the various functions of the ego, including the attitudes and defenses of
the individual.
I will first examine the more diffuse concept of psychic pain, which is
9
10 CHAPTER 1
inherent in mourning, and then explore various defense configurations

employed to avoid pain and mourning. The journey along the road to
mental health includes working through these defenses. In the absence of
mourning, we remain attached to early internal objects, which are frus-
trating and often defensively idealized. These unmourned fragments of
the psyche, which include internal objects and parts of the self that are
con-nected to them, are usually repressed. The individual is thus depleted
and his knowledge of self is impoverished.
I will review the following clusters of defenses illustrated by the clinical
material in this book basing myself on early and contemporary literature:
(1) manic defense; (2) enactment; (3) denial; and (4) reparative defense.
The objective of this book is not to present a comprehensive review of
defenses but rather to show how the various case studies described here
add to a deeper understanding of these defenses.
PSYCHIC PAIN
The early literature dealing with psychic pain is meager. Freud (1926) in-
troduced the concept into the psychoanalytic literature under the rubric of
Seelenschmerz (pain of the soul). His reference was to a child crying for
his mother, and he viewed it as analogous to bodily injury and loss of
body parts.
Freud regarded psychic pain as a phenomenon parallel to physical
pain. In ‘‘Project for scientific psychology,’’ he suggested that this kind
of pain resulted from a marked increase in the quantity of stimuli
impinging upon the mind, thus causing ‘‘a breach in the continuity’’
(1950, p. 307) of the protective shield. In ‘‘Mourning and melancholia,’’
Freud related pain to object-loss and compared melancholia to ‘‘an open
wound’’ (1917, p. 253). Later on, in ‘‘Inhibitions, symptoms and
anxiety’’ (1926, pp. 169– 72), Freud linked his economic explanations to
his object-related hypothe-sis regarding the origins of mental pain. He
suggested that the libidinal energy (cathexis) invested in the longing that
is concentrated upon the lost object, and which causes anxiety, is similar
to the libidinal energy in-vested in the injured part of the body, which
leads to pain. The prolonged nature of the above psychic process, and the
impossibility of halting it, produces a state of mental helplessness which
is similar to the helplessness induced by overwhelming pain, thus, the
painful character of object-loss (Freud 1926, addendum C).
REVISITING DEFENSES AGAINST PAIN AND MOURNING 11
Weiss continued this line of thinking. ‘‘Love objects become, as we

know, libidinally bound to the ego, as if they were parts of it. If they are
torn away from it, the ego reacts as though it had sustained mutilation’’
(1934, p. 12).
Grinberg (1964) also referred to the connection between physical and
psychic pain, but from the perspective of object-relations theory. He be-
lieved that if pain appears in any mourning situation resulting from
object-loss, it is because object-loss is experienced by the unconscious
fan-tasy as an attack upon the body-ego; this attack provokes physical
pain, which in turn is experienced as psychic pain.
Joffee and Sandler (1965) pointed out a further aspect of psychic pain
connected to object-loss. They regarded psychic pain as the discrepancy
between the actual state of the self and the ideal state of well-being.
When a love object is lost, we not only lose the actual object, but also
lose the aspect of our own self that is the complement in us of that object,
as well as the well-being that is intimately bound up with it.
Pontalis also connected psychic pain with object loss. Pain stems from
the fact that the object is irrevocably lost but eternally retained: ‘‘Where
there is pain, it is the absent lost object that is present; it is the actual,
present object that is absent’’ (1981, p. 90).
Basing himself on the writings of Kahn (1979), Joseph (1981), and
Kogan (1990) on this subject, Akhtar summarized the concept of psychic
pain as consisting of ‘‘a wordless sense of self-rupture, longing and
psychic helplessness that is vague and difficult to convey to others. It
usually fol-lows the loss of a significant object or its abrupt refusal to
meet one’s ana-clitic needs’’ (2000, p. 229).
DEFENSES AGAINST PAIN AND MOURNING

Schafer (1968,1976) claimed that defenses have meaningful content, in-
cluding wishes and fantasies concerning the self and objects. Defenses
are unconsciously intentional, complex actions with the aim of warding
off some unpleasurable affect.
There are many defenses aimed at avoiding or controlling pain and
mourning. These defenses can lead to either healthy or pathological re-sults,
especially on a temporary basis and depending upon the individual’s overall
psychic economy and external environment. Joffee and Sandler (1965)
included indignation, de-idealization, and enhanced individuation
12 CHAPTER 1
among the healthy responses to pain, and an attitude of hopelessness and

helplessness among the pathological responses to it.
Defense configurations explored in the different chapters of the book
include manic defense, enactment, denial, and reparative defense.
Manic Defense
Manic defense is the common thread that binds the various chapters of
the book. I will present a brief review of this concept.
Freud (1917) described manic defense as a retreat from depression,
but it was Klein (1935) who detailed the underpinnings of this defense,
and Winnicott (1935) who broadened the understanding of it. A large
part of the psychiatric and psychoanalytic community evinced little
interest in this concept, and although there are many references to it in
contempo-rary literature, only a few authors (Ogden 1986; Burch 1989;
Grinberg 1992; Akhtar 2001) have explored it comprehensively.
Freud (1917) pointed out that the most singular peculiarity of melan-
cholia is its tendency to turn into mania. In such a case the ego apparently
supposes that it has dominated the object-loss and is free from the suffer-
ing it has had to bear. It then tries to exert omnipotent fantasies in order
to both control and dominate objects that have become dangerous and
persecutory and also to try to save and repair the objects that it feels it
has damaged.
Klein (1935) defined manic defense as a set of mental mechanisms
aimed at protecting the ego from depressive as well as paranoid anxieties.
She delineated many forms of manic defense and often used the term in
the plural. She described manic defense essentially as the individual’s at-
tempt to evade the exquisite pain of guilt in the early depressive position.
The defense is really a collection of defenses involving a denial of
psychic reality and therefore of the importance of the objects that are
loved and taken in, a denigrating contempt for the objects that are loved
so that their loss will not be experienced as important, and a triumphant
and omnipo-tent form of putting everything right. Thus, the ego
‘‘endeavors ceaselessly to master and control all its objects’’ (1935, p.
277), escaping dependency and potential loss.
In Klein’s view, the constituents of manic defense are omnipotence,
de-nial, and idealization.
Omnipotence is the main characteristic of mania. It is utilized to control
and master objects, so that a sense of separateness and envy are avoided.
Omnipotent defenses may create confusion between self and object, and
this confusion is expressed through omnipotent narcissistic object-
relations (Rosenfeld 1987) leading to an enduring state of narcissism
(Segal 1983). The illusion of omnipotence, which makes the manic de-
fense effective, derives from omnipotent fantasies that are an essential as-
pect of the infant’s inner world. The destruction of the object in fantasy
provides the infant with a mechanism for handling negative experiences
and tolerating aggressive impulses. Klein pointed out that by means of
the manic defense the subject may destroy his internal objects, but
because he is omnipotent, he can immediately resuscitate them (a
mechanism called ‘‘suspended animation’’). The child’s feelings of
omnipotence also make marginal reparation possible in fantasy after
aggressiveness has run its course. Klein regards the disparagement of the
objects’ importance and the contempt for them as a specific characteristic
of manic defense. As a result, the ego effects a partial detachment from
the objects while at the same time a longing for them.
Denial refers specifically to the denial of psychic reality. It serves to
mit-igate the individual’s awareness of his dependence upon others and
also his dread of what may be a persecutory experience as a consequence
of this dependence. (I will explore this defense more in depth later in this
chapter).
Idealization is a mechanism that helps avoid the pain inherent in am-
bivalence by a paranoid retreat into separating the good feelings from the
bad. This is achieved by splitting the good from the bad aspects of the
object to create an ideal object and a persecutory one. Idealization tena-
ciously retains a view of a world and oneself that is ‘‘all good.’’ This, in
turn, defends against the individual’s guilty recognition of having injured
others, whether in fact or in fantasy.
The previous three mechanisms are interrelated. According to Rosen-
feld, ‘‘It is typical to find an idealization of the good object so that it can
be kept as far away as possible from the persecuting bad object, and thus
avoid confusion with it. This defensive process is combined with the
mechanism of denial that in its turn is backed up by omnipotence: it is
omnipotent denial that can completely deny the existence of bad objects.
In the unconscious this process is equivalent to the annihilation of the
whole disturbing object-relationship, so that it is clear that it involves the
14 CHAPTER 1
denial not only of the bad object, but of an important part of the ego,
which is in a relationship with the object’’ (1983, p. 262).
Winnicott broadened the understanding of manic defense, emphasiz-ing
that it is intended to ‘‘deny the depressive anxiety that is inherent in
emotional development, anxiety that belongs to the capacity of the indi-
vidual to feel guilt, and also to acknowledge responsibility for instinctual
experiences, and for the aggression in the fantasy that goes with individual
experiences’’ (1935, pp. 143–44). Winnicott’s important contribution was
that he ascribed to manic defense the individual’s inability to give full sig-
nificance to inner reality. It is an attempt to fly away from internal reality,
especially if this reality includes depressive anxiety or mourning. In a situ-
ation where manic defense is used, mourning cannot be experienced.
Winnicott outlined four components of manic defenses: denial of inner
reality; flight from inner reality to external reality; suspended animation;
and denial of sensations of depression through the reversal of depressive
feelings.
Denial of inner reality involves a repudiation of internalized bad
objects, which by becoming generalized can include the rejection of good
inner objects. ‘‘Many who live normal and valuable lives do not feel they
are responsible for the best that is in them’’ (p. 133).
Flight from inner reality to external reality involves omnipotent
fantasies that are not so much the result of the inner reality itself as a
defense against the acceptance of it. Fantasy thus fulfills an intermediary
role be-tween internal and external reality. The flight to external reality
in order to avoid a painful internal reality may also take the form of
exaggerated fear of death and exploitation of sexuality (as I illustrate in
chapters 2 and 3 of this book).
Suspended animation, which refers to omnipotent control of bad inter-nal
objects, may also destroy good relationships. As a result, the individual may
feel dead inside and the world may appear to be an emotional desert.
The reversal of depressive feelings and the use of exalted opposites for
reassurance are important elements of manic defense.
In his comprehensive exploration of the subject of mourning and guilt,
Grinberg (1992) maintained that the manic defense is used especially
when depressive anxiety is very intense. Grinberg added splitting to the
cluster of mechanisms of manic defense (denial, omnipotence, idealiza-
tion). In his opinion, manic defense includes all the defenses that belong
to the paranoid-schizoid position, and that form a powerful, integrated

system directed against psychic reality and depressive experience. Hate,
guilt, despair, the need for reparation, ambivalence, and so on, are all de-
nied by means of the manic defense.
A different view of manic defense in contemporary psychoanalysis is
that of Ogden. Ogden regarded manic defense as a normal part of devel-
opment, because the conflict between the pain of dependence and the
need for objects is always present to some degree. He described manic
defense as an ‘‘in-between phenomenon, incorporating elements of the
psychic organization of both the paranoid-schizoid and the depressive po-
sitions’’ (1986, p. 84). He contended that everyone relies on this defense
to varying degrees in times of difficulty. When dependency needs are an
unacceptable part of reality, this defense is mobilized. It returns to the
ego the illusion of omnipotence or self-sufficiency. Intensely negative
interper-sonal experiences that preclude trust render dependency both
excruciat-ingly painful and ultimately unsafe. This impossible situation
may be tolerated only through ongoing reliance on the manic defense, in
which dependency is abruptly denied.
Enactment
In this book, I explore the mechanism of enactment as it relates to in-
tergenerational transmission of the trauma of the Holocaust, another sub-ject
examined in the book. Enactment is typically employed by Holocaust
survivors’ offspring in dealing with the burden of pain and guilt transmit-ted
to them by their parents (see chapters 5, 6, 7, 9, and 10).
Enactment, which has the purpose of externalizing conflict, is based
on projection that is acted out (Hinshelwood 1991). Freud (1916) used
the term projection when he described delinquent acts performed by
criminals who, in his view, act out because of an unconscious sense of
guilt. Projec-tion was defined by Klein as a mechanism that ‘‘helps the
ego to overcome anxiety by ridding it of danger and badness’’ (1946, p.
6). She found this mechanism important in the externalization of internal
conflicts played out with external objects.
In the more recent literature, Renik (1990) viewed the enactment of
wishful fantasies as an unconscious, persistent effort to attain unobtain-able
goals by magical means, thus defending against the depressive affect.
Arguing with Dorpat (1977), who suggested that the depressive affect elic-
16 CHAPTER 1
its relinquishment of unobtainable goals with eventual formulation of

new, obtainable ones, Renik claimed that the depressive affect creates
many maladaptive responses; the goals, even if realistically unobtainable,
are not relinquished. Renik believes that through the enactment of fanta-
sies, the individual fights his feelings of helplessness in relation to unob-
tainable goals.
I wish to distinguish between enactment in reality and enactment in
fan-tasy, as it relates to the offspring of Holocaust survivors.
Enactment in reality (termed concretization by Bergmann [1982]) is de-
fined by her as the compulsion of Holocaust survivors’ offspring to recre-ate
their parents’ experiences in their own lives through concrete acts. It refers to
the externalization of traumatic themes from the past and func-tions as a
‘‘substitute-for-mourning’’ mechanism. In chapter 5, I review the concept of
enactment as it pertains to the Holocaust, and I define it as a general term
that includes the attributes of both acting in and acting out.
Enactment in fantasy occurs when the offspring, in his endless effort
to understand the parents and thus help them, recreates the traumatic
expe-rience and its accompanying effects in fantasy (Auerhahn and
Prelinger 1983; Laub and Auerhahn 1993). Thus the offspring becomes
‘‘the protag-onist in scenes from the parents’ unconscious fantasies—
fantasies that are almost always a sadistic distortion of narcissistic
struggles for survival with objects from the parents’ past’’ (Metcalf 1977,
p. 259). The shared fantasy between parents and offspring helps the
parents survive psychically and prevents the parents’ collapse under the
burden of pain and mourning connected to their own traumatic past.
At the core of the compulsion to enact the parents’ traumatic experi-ences
in reality or in fantasy we find another mechanism that hinders the work of
mourning. This mechanism—primitive identification (Freyberg 1980;
Grubrich-Simitis 1984; Kogan 1995, 1998)—is a unique form of
identification whereby the offspring completely identifies with the parent
and assumes the parent’s traumatization. Completely absorbed in his par-
ent’s feelings, the offspring often unknowingly becomes the bearer of the
parent’s burden of mourning and guilt in his own life; this may lead to a loss
of the offspring’s separate sense of self and to the inability to differen-tiate
between his self and the damaged parent. This phenomenon is similar to the
identification that takes place in pathological mourning. Freud (1917)
described this identification as a process whereby the person in
mourning avoids working through the loss by maintaining a fantasy that

he or she is the lost loved one, or will become the lost loved one, thus
magically reversing a calamity that has occurred (Abend and Porder
1986).
Denial
Denial is one of the main defenses employed when an individual is con-
fronted with aging and death, loss and bereavement, stress and trauma. This
defense weaves its way in various forms through all of the chapters in this
book. In its psychoanalytic application, denial is defined as a de-fense
against painful or unpleasurable ideas, effects, and perceptions.
Denial has always been a complex concept that has acquired many
meanings and connotations, depending on the context. In addition to its
dictionary definition—‘‘the act of saying no’’—the term denial and its
synonyms disavowal and self-deception refer to the reality-repudiating
as-pect of defensive activities and not to a discrete defense mechanism
(Dor-pat 1987; Fingarette 1969; Hilgard 1949; Weisman 1972).
Freud (1923) was the first to describe the denial defense. Using data
accrued in psychoanalytic treatment, he hypothesized that some young
boys, seeing the absence of a penis in girls, reject the evidence of their
senses and imagine that they did see the girl’s penis after all. He termed
this defensive activity ‘‘denial’’ (or ‘‘disavowal’’).
Early psychoanalytic accounts of denial by Sigmund Freud (1940) and
Anna Freud (1936) limited the scope of denial to the perception of exter-
nal reality. Many have disagreed with this restricted view of denial. Klein
(1935) viewed denial specifically as one of the important components of
manic defense, particularly the denial of the reality of some part of the
mind, or of psychic reality. In the same vein, Hartmann (1964), Jacobson
(1959), Lewin (1950), and Waelder (1951) discussed the denial of
various affects such as anxiety, guilt, and anger, claiming that internal
reality may also be denied. From a different viewpoint, Dorpat (1979)
argued that de-nial is the crucial defensive activity involved in the
formation of contradic-tory attitudes.
Denial also has adaptive value (Klein and Kogan 1989). It was utilized
by Holocaust survivors during times of massive trauma (see chapter 8),
and may also be employed in times of chronic crises (see chapters 9 and
10).
18 CHAPTER 1
The elaboration of this defense, as illustrated in the various chapters,

enables the patient to get in touch with and work through pain and
mourning, leading to an eventual readaptation of the ego to both external
and internal reality.
Reparative Defense
Klein (1920) viewed ‘‘reparation’’ as the strongest of the constructive
and creative urges. She believed that reparation is the fantasy of putting
right the effects of the aggressive component, and is intended to mobilize
creative activity (Klein 1929). This process is different from sublimation,
a term coined by Freud (1908), which is the conversion of sexual
impulses into sophisticated, creative skills.
Creativity can be a defense against pain and mourning. Ella Freeman-
Sharpe, in her article ‘‘Pure art and pure science’’ (1935), expresses the
idea that creation leads to a fundamentally good experience, psychically
and physically linked to harmony and rhythm, at the same time that it
represents a triumph over aggressiveness and anguish.
The creative act may have direct access to the deepest layers of the psy-
che, which is where psychic pain usually originates and resides. Creativity
speaks from the unconscious and facilitates the mentalization of the non-
verbal substrate of the psyche. Creative activity involves a certain amount of
self-holding, illusory though omnipotent manipulation of objects, and a
certain mastery of pain through ‘‘self-dosed’’ (Cooper 1988, p.125) suf-
fering and surviving of that suffering. The relationship between object-loss, a
frequent precipitant of mental pain, and creativity has drawn con-siderable
attention (Pollock 1975, 1977; Hamilton 1969, 1976, 1979). Poetry, as an
expression of creativity, may occupy a special place in the ego’s efforts to
manage, mourn, and master mental pain (Akhtar 2001).
In this book I deal with the function of creativity from two perspectives:
(1) Creativity as an attempt to repair both the object and the self. Klein
(above) maintained that the offspring, believing that his hate and hos-
tility has damaged the loved object, must now repair it. Basing himself
on this premise, Grinberg viewed creativity as ‘‘the re-creation of a
loved object that has been felt as being in ruins . . . it is the re-creation of
an internal world and an ego in ruins’’ (1992, p. 233). Chasseguet-
Smirgel (1984) expressed a different view of creativity. She argued that
there are two categories of reparation, which are expressed through

two radically opposed creative acts: one, which enriches and fills up
the ego (and which can generate guilt), and the other, which indeed
repairs the object. In this book, I use a case illustration to show a dif-
ferent viewpoint from that of Chasseguet-Smirgel. In my view,
repara-tion of the damaged object and reparation of the self actually
operate together (chapter 7).
(2) Creativity in search of an internal source of anguish. In therapy, this
form of creative act helps convey information about the patient’s
inner world, thus enhancing empathy with the self and facilitating
mourning (see chapter 6).
(3)
I
OBSTACLES TO
INDIVIDUAL MOURNING
2
Forever Young
[I]n the unconscious everyone is convinced of his
own immortality.
—Freud 1915, p. 289
In this chapter I will explore and illustrate the difficult journey from
manic defense to mourning undertaken by both members of the analytic
couple, as viewed during the termination period of analysis and after it. I
will examine it from the different perspectives by which patient and ana-
lyst viewed the termination of analysis and the ‘‘analytic goals.’’ 1
Analysis consisted of a struggle with the patient’s manic defenses—her
denial of inner reality and her omnipotent attempt to replace it with
delusional fan-tasies that she felt compelled to enact.
The case study is that of a thirty-eight-year-old woman who, in analy-
sis, revealed bisexual longings, which culminated in parthenogenesis—
the wish to have a baby without a man (Deutsch 1933; Fast 1979).
During the treatment, this became a psychotic obsession that she felt
compelled to realize, in spite of the tremendous obstacle of being unable
to achieve a successful pregnancy for years and give birth to a live baby.
Much psychic work was needed to enable the patient to overcome
feel-ings of hatred and destruction, as well as to moderate her fear of
death. The emotional experience in analysis enabled her to work through
her maternal internal representation and her identification with an angry
and destructive introject. After a long and painful analytic journey, she
was able to experience something life-giving in herself and was able to
identify with a procreative mother. This identification was a psychic
factor that facilitated pregnancy and birth.
Reflecting on the apparently positive outcome of this analysis, I some-
2
3
24 CHAPTER 2
times asked myself whether our difficult struggle with the fear of death
and with psychic pain had truly been crowned with success in the birth of
a child. Was this result, as we—both patient and analyst—assumed, an
affirmation of life-giving forces within the patient? Or was this immacu-
late conception—having a baby without a man—a ‘‘manic defense’’
(Klein 1935; Winnicott 1935; Aktar 2001) that helped her avoid the
mourning and pain inside herself? Was psychic change in this case a
reality or an illusion?
THE CASE
The Omnipotent Needy Child

Before quoting a few fragments from the patient’s analysis to illustrate
the previously mentioned theme, I would like to introduce her and pro-
vide a glimpse into our first meeting. Dina, a scientist, married for the
second time, and mother of two, sought help because of recent crippling
panic and near-delusional experiences of being watched and intruded
upon. She described the scenario of her panic with ease. Someone, a man
of course, was peeping through the window and planning to break in,
rape, and murder her. The first anxiety attack occurred as she roamed
about her kitchen, naked, in the middle of the night, after intercourse
with her husband. Subsequently, she could no longer stay alone at home
in the evenings or drive alone after dark, because of the recurring attacks,
and this greatly restricted her independence. Dina sought help in order to
‘‘ex-orcise the devils.’’
At our first meeting Dina’s vivacity seemed to fill my office. She was
in her mid-thirties, big, blond, and pretty, though not sophisticated in her
dress. She gave me a firm handshake, a big, warm smile, and addressed
me in a loud, booming voice. I was aware that I immediately felt drawn
to her witty remarks and warmth.
Dina related her history without much difficulty. She was the third child
in a single-parent family. Her mother had been abandoned by her second
husband (Dina’s father) when Dina was around two years old. The mother
struggled to raise her three children, a son from her first marriage, Dina, and
Dina’s younger brother from her last marriage. Dina’s father, a distinguished
writer, lived in the big city surrounded by authors and fa-mous actors. He
visited his family frequently, but mostly when he was sick
FOREVER YOUNG 25
and needed care. Dina remembered the lovely vacations she would spend
with her father in the city; he introduced her to the magical world of the
theater and to his interesting friends, and treated her to ice creams topped
with whipped cream in theater cafe´s.
Dina’s first marriage was unsuccessful from the start. Her husband’s
first wife had walked out on him, leaving him with a one-and-half-year-
old son. While she admired his fine qualities as a father and his
intellectual prowess, he reminded her of her own father, who was
physically repulsive to her. From the start of her marriage, Dina was
unhappy and obsessed with suicidal wishes. She sought help and was
referred to analysis, which she left after nine months. Dina and her
husband went abroad for a period of two years. While overseas, Dina
became pregnant. In her fifth month she left her husband and returned to
her mother to give birth to her son. Dina’s second husband was an old
family acquaintance. He was twenty-two years her senior and twice
divorced, with a son around Dina’s age from his first marriage.
In the initial interview I realized that on a nonverbal level, mainly
through her smiles and appreciative glances, Dina was intent on seducing
me into liking her. She addressed me in a way that was flattering to us
both. I must be very good since she had been referred to me. She admired
young, successful, professional women like herself. She definitely
wanted a female analyst, since she believed that only a woman possessed
the wis-dom and sensitivity necessary to understand her. Men are mostly
small boys at heart, and they achieve high positions in this world because
of social prejudices. ‘‘There is a weak sex and an inferior one,’’ Dina
con-cluded her speech with a smile. Our session drawing to a close, Dina
de-cided that she felt comfortable enough to disclose her biggest secret.
Her second child, a daughter, had been conceived by artificial
insemination, as her present husband was sterile.
Impressed by her verbal ability, the richness of her associations, and
her complex life story, I recommended analysis to Dina (four times a
week) as the treatment of choice. She readily accepted my suggestion and
appeared eager to begin treatment. Little did I know of the tremendous
obstacles that would lie ahead of us on our analytic journey.
The first problem was the use of the couch, which was difficult for Dina
because of losing eye contact with me. She felt that not seeing my facial
expressions spoiled our togetherness. At the same time, I became aware
26 CHAPTER 2
that Dina was making fewer attempts to charm me. Only later in analysis did
I realize that by losing my ‘‘face’’ Dina could reveal her own ‘‘face,’’ and be
in touch with her angry and destructive feelings toward me.
An episode at the conclusion of her long analysis confirmed this. At
the end of our last session, when she got up off the couch, Dina looked at
me and said: ‘‘You look much nicer than the person I saw in my mind’s
eye throughout these years.’’ We both smiled. I knew then that using the
couch had been the right way for Dina to find the hate, as well as the
love, in herself.
Phase I: Struggling with Denial of Death and Separation

In the first phase of treatment, we struggled with Dina’s manic de-
fenses—her need to avoid separating from her mother and, as a result, to
avoid mourning her.
Dina had been very attached to her mother, whom she had loved and
admired greatly. Her mother had been a courageous woman who, while
often bitter and dissatisfied, had coped admirably with the unfortunate lot
that had befallen her. Dina portrayed her father as weak and incapable of
dealing with family responsibilities. Dina felt that her mother regarded
her, her only daughter, as a partner with whom to share her life. From
early childhood, Dina strove to make her mother happy. Dina claimed
that she never got angry at her mother and never rebelled against her. She
believed she looked so much like her mother that when she looked in the
mirror, she would see her mother’s image rather than her own. Later in
life, funny incidents, such as meeting men who had courted her mother
and who mistook Dina for her, only reinforced this belief.
Listening to Dina, I was struck by her use of the present tense in de-
scribing her relationship with her mother who had been dead for over
eight years. When I remarked about this, Dina confirmed my silent hy-
pothesis that she had never really accepted her mother’s death and never
mourned her. After the funeral, Dina had enlarged photographs of her
mother, framed them, and hung them throughout the house. In times of
need she would talk to these photos, and she also taught her children to
communicate in that way with Grandmother. For a long period of time,
Dina had many dreams about bringing Mother back from the dead.
Several months after Dina left her first husband and returned to her
mother’s home to have her baby, her mother suffered a stroke and was
FOREVER YOUNG 27
hospitalized in critical condition. The stroke occurred the day after the
two had had a violent quarrel. Dina remembered it as one of the few
quar-rels she had ever had with her mother. She left, slamming the door
behind her, not knowing that that was the last time she would ever
communicate with her mother. Dina was in labor in another hospital on
the night her mother died. She related with wonder that at the time her
mother was dying, she dreamed that her mother was falling out of her
arms and calling to Dina for help, which she was unable to give. Dina
delivered her first child, a son, the next day, and several hours later was
informed of her mother’s death. Thus, giving life and losing a beloved
object became in-separably linked for her.
Much psychic work was devoted to the first treatment goal of
overcom-ing Dina’s manic defenses—her denial of the loss of her mother
and in-ability to separate from her. Through her unconscious fantasies
and dreams, Dina conveyed to me how terrified she was that I might take
her mother away from her. In one of her dreams, while her garden was
unat-tended for a short period of time, a man came by and uprooted her
trees. Her associations revolved around me in the role of a new mother,
uproot-ing her own mother (the old trees): ‘‘Maybe you are the best
mother in the world, but who wants to give up one’s own mother?’’
With the strengthening of the therapeutic bond, Dina was able to work
through her ambivalent attachment, the mixture of love, guilt, and uncon-
scious, destructive wishes toward the internal maternal object. I will
illus-trate this with some fragments from analysis:
Dina claimed that lately she had been feeling uncomfortable around
her eight-year-old son because he liked to touch her breasts when he
came near her. She decided to forbid it, and subsequently her son drew
the fol-lowing pictures:
Her son explained the meaning of his drawings as follows: The first
drawing is of a child standing facing a breast. Between the two is a heart
pierced by an arrow (the symbol of love). The second is of a child facing
a bitten breast. The child, who has taken a bite out of it, says ‘‘tasty.’’
The third drawing shows a child calling to a snail, ‘‘Mummy, Mummy,
do come out.’’
I realized from the boy’s drawings that Dina was conveying a message
to me from the little girl inside herself. Since the child was calling to a
mother who was hidden in a shell, covered by a protective shield, I won-
28 CHAPTER 2
child breast
bitten
child breast
tasty
child snail
Mummy,
Mummy,
Do come out
FOREVER YOUNG 29
dered whether Dina might have experienced my reactions to her in analy-

sis as insensitive and unempathic.
Examining my countertransference feelings made me realize that I
sometimes felt overwhelmed by the flood of associations and fantasies
that Dina directed toward me in treatment. I noticed that they made me
recoil into a kind of silence to protect myself from the flood. Perhaps
Dina expe-rienced my silence as a protective shield against her
neediness, and she was crying out to me through her son’s drawings.
I suggested to Dina that perhaps she was feeling frustrated by me in
analysis, as I understood from the drawings that the little girl inside
herself was asking me not to barricade myself in, which she herself had
recently done when confronted with her son’s passionate love.
Dina reacted to my interpretation by relating a dream. In the dream,
she took her children to a live show, where a naked woman danced in
front of them. The woman, who somewhat resembled her mother, had a
body that was far from perfect, not a body that should be exhibited in
public. The woman moved in a way that revealed an enormous vagina,
the size of almost half her body. Dina said that she was afraid of the
influ-ence that this show might have on her children. She continued by
bringing up a childhood memory. The memory dealt with an episode that
had oc-curred when she was three years old. She was left at home with
her brother and desperately wanted to go to the toilet, but the door to it
was locked. She then defecated in her pants and her mother found her
curled up in the drawer under her bed, feces smeared all over her.
Relating Dina’s childhood memory to her dream, I realized that her
unconscious longing, as well as her fear, was to become a meconium-
covered fetus in my womb. I suggested to Dina that perhaps she was
frightened by the longed-for closeness she experienced in analysis, and
that she assumed it was also frightening for me. But, I added, I felt she
wanted me to be a strong mother who, by taking her out of her ‘‘drawer’’
and cleaning up her ‘‘shit,’’ would help her give birth to her new and
sepa-rate self, purged of her angry and depressive feelings.
Dina accepted my interpretations gratefully. Though aware of the long
and difficult road ahead of us, I realized that, in spite of her initial fear,
she could now give up some of her manic defenses and work through the
mourning connected to the separation from her mother. The treatment
goal of this phase suited her own life goal of individuation.
30 CHAPTER 2
Phase II: Accepting Her Monosexual Destiny

Another manic defense of Dina’s—her inability to mourn and resign
herself to the fact that she is ‘‘only’’ a woman, and that she does not pos-
sess the qualities and attributes of both sexes (her monosexual des-tiny)
—is shown through her bisexual tendencies. First, I will describe the
homosexual tendency of Dina’s libidinal desires, her experiencing herself
as a man, and her lesbian attraction to women.
Dina claimed that she loathed older women who ‘‘make passes’’ at
her, yet she sometimes shared her husband’s attraction to younger
women. She vividly described an incident in which a female friend from
a local theater group in which she was a member took a shower in her
house. She helped the woman into the shower, noticing her ‘‘firm
breasts, flat belly and beautiful triangle with black curls.’’ In analysis
Dina expressed her interest in having a lesbian experience. In my
countertransference feelings, I be-came aware of Dina’s incestuous
wishes toward me, as well as of her at-tempts to seduce me.
The difficult obstacles posed by an eroticized transference were not
im-mediately obvious to me. Dina’s associations seemed so rich and she
was so enthusiastic about treatment that I was mostly aware of the
positive aspect of our relationship. Only later were we able to discover
and work through the hatred lurking beneath it (as will be seen in
vignettes from the fourth and fifth years of analysis).
Dina recalled memories of her mother roaming around the house
nearly naked or showering in front of her. She remembered feeling re-
pulsed by her mother’s body, and often found it difficult to undress in
front of other women because they might be harsh in judging the flaws in
her own body. She always felt naked from head to toe under her mother’s
scrutinizing gaze. In analysis, Dina felt ‘‘naked’’ when lying in front of
me on the couch.
Throughout the first year of analysis, Dina projected upon me the
image of a close girl-friend of hers, whom she greatly loved and had
lived with for several years after divorcing her first husband. Her friend
had been with her at the birth of her baby and had handed her the baby to
be breastfed. Dina believed that this was ‘‘their’’ baby.
During this period, Dina expressed the wish to have another child, if
possible, without the humiliating procedure of artificial insemination that
she had undergone to become pregnant the second time. In this phase of
FOREVER YOUNG 31
analysis, I still believed that Dina, in the transference, was expressing her
unconscious wish to have a baby with me.
Dina had always involved her mother in her sexual exploits. At the age of
eighteen, deciding to put into practice the liberal sex education she had
received from childhood, she ‘‘used’’ a man in order to lose her virginity.
She felt it important to inform her mother about it, placing a note on her bed,
and thus making her a partner to the deflowering. In the transference, I was
assigned a similar role: Dina informed me that while making love with her
husband she fantasized about me. She revealed feelings of resent-ment
toward me that this aroused in her, similar to those she felt toward her
mother when she turned her into a partner to her first sexual experi-ence.
Dina continued, comparing analysis to lovemaking. She felt that in
treatment, as in intercourse, she ‘‘undressed’’ and bestowed upon me her
most secret inner place. Dina claimed that in contrast to sex, which she
seldom initiated or particularly enjoyed, she came to treatment of her own
free will and was devoted to it. Analysis was, in her words, ‘‘a situation of
constant hunger, an infinite stimulation without orgasm.’’ In the transfer-
ence, Dina bluntly expressed her libidinal wishes toward me: ‘‘Why is it that
there is no touching in treatment? There is something irrational here, not that
I am conscious of my longing to make love to you. You don’t see only me,
you are supposed to help me, you are supposed to remain aloof. This also
means not sleeping with me. I feel an emotional and physical closeness with
women. That’s why I sought out a female analyst.’’
My inquiry into the unconscious anger and guilt underlying her inces-
tuous wishes met with a wall of manic defenses. ‘‘I like women,’’ Dina
said, ‘‘and I am proud of it. Nobody can really explain to me why I can’t
make love to my mother or my daughter; they are the closest to me.’’
I began to wonder if Dina could really be treated, as she defended her
perverse tendencies and her incestuous wishes with such force.
Gradually, I realized that Dina was attempting to live out her florid
fantasies in the transference to avoid the disintegration that was
threatening her psychic life. We were able to understand this threat only
much later in analysis. Sensing her underlying vulnerability, I refrained
from touching upon the feelings of depression and destructiveness, which
were hiding beneath her manic defenses.
It became clear to me that Dina was rejecting the treatment goal of
resigning herself to her monosexual destiny. Since her life goal was to
32 CHAPTER 2
avoid feeling the limitations to power resulting from having the attributes
of only one gender, the treatment goal of accepting that she was ‘‘only’’
a woman was experienced by her as threatening and dangerous.
Phase III: Discovering a Part of the Denied Inner Reality

In this phase of treatment, we struggled with Dina’s manic defenses
that she used to deny her inner reality. The understanding of her symp-
toms, achieved by the elaboration of her relationship with her father and
her ‘‘full’’ brother, was a step toward reaching this goal.
Dina’s father was old and senile when he died in a nursing home. Dina
would visit him occasionally, resenting the fact that he had outlived her
mother. Life and death collided with each other once again when Dina’s
father died several days after the birth of her daughter. Dina’s feelings of
guilt over her being absent during her father’s last moments were rein-
forced by her fantasy that her giving life had caused her father’s death.
I do not intend to describe the whole course of analysis here.
However, I would like to describe a dream from this period, in which
Dina saw her father and brother as two blind men, a murderer and a
robber, standing trial.
Dina described her brother as possessing antisocial tendencies in
child-hood. He would steal animals and then kill them in a very cruel
way. Dina vividly described how he repeatedly beat her. Unable to
control his violent outbursts, during which he beat and hurt Dina as well
as other children, her mother placed him in an institution for emotionally
disturbed chil-dren when he was thirteen years old. Dina felt that analysis
helped her ‘‘see’’ things her brother will always be ‘‘blind to’’: ‘‘I am
aware of the physical attraction between myself and my brother, a thing
he has never seen.’’
In the transference, I was aware of the pleasure Dina appeared to derive
from her vivid descriptions of her brother’s cruelty. I then realized that Dina
wanted me to ‘‘see’’ the kind of behavior that turned her on. Here, I
refrained from making a transference interpretation, but instead pointed to
the dominant affect accompanying her stories of her brother’s cruelty,
namely, that this kind of behavior seemed to excite her. Is it possible then, I
commented, that she herself might have written the script of her phobic
attacks? Dina was angry and perplexed by the possibility that she herself had
invented the cause of her torment: She despised violent behavior of
FOREVER YOUNG 33
any kind; she considered rape the greatest crime in the world, even loath-
ing films that dealt with the subject. How could I then claim that in
fantasy she was bringing rapists upon herself? Was this why she always
carried pepper spray in her handbag, to ward off any attacker? At this
point, Dina vehemently complained about analysis, the cruel method that
destroyed her defenses, with no promise of the happiness she longed for.
It became clear that Dina’s life goal, which she called ‘‘happiness,’’ was
not compati-ble with the pain incurred in understanding her symptoms
and in taking responsibility for them.
Now Dina continued to talk about her cruel father who, though con-
sciously repulsive to her, was an object of attraction for many years. In
the transference, I felt like the violent, exciting father-analyst whom she
resented, but toward whom she also felt a forbidden attraction. Working
through some aspects of her panic attacks, I connected her fear of the
‘‘peeping Tom’’ with the anxiety she felt in her relationship with Father.
She remembered that Father used to kiss her on the eyes, wet, sexy kisses
that she liked.
Working through her relationship with Father facilitated Dina’s re-
counting of a family romance in which her husband, who for many years had
been a friend of her parents, had had an affair with her mother. Dina claimed
he had always denied it. I reminded Dina of her first phobic at-tack, which
had occurred when she roamed about naked in the kitchen, after intercourse
with her husband. I pointed out to her that even if this story were only the
creation of her own fantasy, she might have invented the rapist-killer so as to
bring upon herself the punishment she uncon-sciously felt she deserved for
breaking the taboo of incest. We had to invest many months of analytical
work in working through this interpretation before Dina could accept that she
herself had written the anxiety-arousing script, and that the figure of the
rapist-killer was also a personal creation.
In spite of her initial defensive reaction, in the end Dina was able to
recognize the value of understanding her symptoms. Since one of her life
goals was to free herself of her symptoms and to restore her
independence, she was ready to discover this part of her inner reality and
to stop denying it.
Phase IV: Accepting the Limitations of Age and Gender
In order to illustrate Dina’s manic defenses against the limitations of age

and gender, I will describe her inability to give up childhood omnipo-
34 CHAPTER 2
tence and bisexuality, which were expressed through her wish for parthe-
nogenesis. During this stage of the treatment, Dina experienced this
manic defense as vital to her psychic survival.
From the earliest stages of analysis, Dina toyed with the idea of
having a third child. She was not deterred by the fact that she was over
forty, that her husband was sixty-three and sterile, and that he did not
want any more children.
Thus, she underwent artificial insemination. After prolonged unsuc-
cessful monthly artificial inseminations, she underwent gynecological
tests, followed by complex abdominal surgery to ascertain the cause of
her infertility. Pregnancy became an enormous challenge for her, a way
of overcoming the limitations of age, and a means for conquering death.
Her entire discourse in analysis at this point, her dreams and fantasies, re-
volved around her wish to become pregnant. Her daily routine was en-
tirely taken up with checking her temperature each morning, taking urine
tests, undergoing artificial inseminations, and awaiting results. Dina de-
nied any anxiety over not knowing the identity of the donor of the sperm
or its quality. She convinced herself that the donors were probably
medical students who needed the money but who were highly intelligent
and tal-ented individuals.
Dina seemed to be living for one single goal—to become pregnant.
After each insemination she was convinced she had conceived and would
come to analysis in an elated mood. With the appearance of her period,
Dina felt that she had lost a baby and went into a state of mourning and
depression: ‘‘Each time I miscarry a dream,’’ she said.
In the transference, for the first two years I believed that Dina wanted
to have this baby with me, as I represented her mother (Pines 1993). I
was the partner with whom she shared all of her exhausting efforts to
become pregnant. But, at the same time, I felt like a helpless, castrated
partner, as she did not accept any intervention from me. Even my meek
reference to the tremendous efforts that she was willing to undergo to
reach her goal was experienced by her as lacking in empathy. I felt as if I
were a ‘‘dead’’ partner, not yet realizing that Dina’s partner was not
actually dead but nonexistent.
After two-and-a-half years of attempts and frustration, Dina decided
that if she did not conceive within the next three months she would aban-
FOREVER YOUNG 35
don the idea. This period was then extended to five months, at which time
Dina became pregnant. After a short while, she decided to leave analysis.
I felt the powerful aggressive nature of the blow that Dina directed
against me by her decision. I felt frustrated, used, and discarded. It was
clear to me that Dina had placed me in the role of her first husband,
whom she left five months after becoming pregnant. Dina had never
loved her husband, but had always praised his ‘‘high quality sperm.’’
Gradually, it dawned upon me that Dina herself must have been
through such experiences of being held and discarded during her child-
hood. Only later in analysis were we able to link this episode to her com-
plex and painful relationship with her mother. My attempts to make her
aware of her hate, of using me as a provider of sperm (penis) or milk
(breast), and then discarding me after ‘‘having her fill’’ were pointless.
Dina declared her love for me and explained her decision to leave
analysis as her fight against her ‘‘addiction to treatment.’’ Over the next
few months we tried to understand Dina’s wish to stop analysis at this
stage. It then became clear that not only was she fighting her powerful
depen-dency needs, but she also regarded me as a dangerous agent who
was forc-ing her to be in touch with her own feelings of impotence and
mourning in the face of aging and death. ‘‘Analysis makes one both wiser
and sad-der,’’ said Dina. ‘‘I don’t want that; being mature is not my goal.
I came here pursuing happiness. Now that I am pregnant, I can leave.’’
Further attempts to point out to Dina that she was using her pregnancy to
ward off depressive feelings fell on deaf ears. On parting, I stressed that I
would be here for her should she need me. Dina left analysis in her fifth
month of pregnancy.
A month later Dina’s husband phoned to inform me that Dina had
miscarried the previous night. She asked him to call and inform me that
she had been through a terrible experience, and also to possibly arrange a
session at the hospital. I went to see Dina in the hospital the next day.
She was overwhelmed emotionally, and spoke incessantly of the trauma.
Apparently the fetus had died some time ago and she had to undergo an
induced delivery. The problem was that despite running a high fever for
days, Dina had refused to cooperate with the doctors. Only after being
told that her life was in danger did she agree to the induction, feeling sure
that she was destroying a live baby and hoping all the time that someone
would halt the murder. Nor was this the end of her plight: After she was
36 CHAPTER 2
persuaded to push and deliver the dead fetus, she was told that some of it
had remained in her womb and must be surgically removed. Dina sur-
prised her doctors by asking them the sex of the fetus. She was told that it
was female. The physical pain of the delivery was small compared to the
pain of her aching psyche.
I listened to Dina very quietly, feeling overwhelmed by feelings of
loss and impotence. ‘‘What can I do for her?’’ I thought to myself. This
baby had been an investment of her entire life and future, and now it was
lost. Gradually I realized that these must also have been partly Dina’s
feelings, which she was projecting upon me and with which I was
identifying. Dina was now relying on my promise to be there for her in
case of need. Before I left the hospital, Dina said smilingly that she was
grateful I had agreed to see her under such unusual circumstances.
Two weeks after leaving the hospital, Dina came to me in a state of
anxiety that masked her depression. She couldn’t keep still for a moment,
couldn’t sleep, and had developed all sorts of compulsive rituals. She
asked for help, to which I immediately agreed. Clearly, we still had a
long and painful road ahead of us.
A short while after resuming treatment, it became evident that Dina
was unable to accept her feelings of loss and mourning. In spite of my
efforts to ease her suffering by being an empathic listener, Dina denied
her feelings by attempting artificial insemination again. Thus, the
monthly cycle of hope and depression was renewed; so was the wall of
manic de-fenses. This time, however, I felt that I was struggling with a
psychotic obsession, which had the function to defend against unbearable
psychic pain as well as against the danger of disintegration.
During this period, I was first cast in the role of the ineffective gynecol-
ogist who had performed an unsuccessful ‘‘plumbing job.’’ Like him, I was
obviously impotent, since I could not impregnate her through analysis and
thus fulfill her wishes. Later on, there was a shift in her feelings in the
transference, and she began to view me as the murderer of her babies. The
following dream, which she dreamed during this period, illustrates this: ‘‘I
dreamt I came to the hospital; before I had time to get into a bed I deliv-ered
a baby, but the baby wasn’t coming out of the amniotic sac. I shouted to the
midwife ‘Open the sac quickly, he can’t breathe.’ She slapped him
halfheartedly and he still couldn’t breathe. She said there was nothing she
could do, that the baby was dead. I was angry with her, she did nothing
FOREVER YOUNG 37
to save him.’’ In the transference, I referred to Dina’s feelings of being

my aborted fetus whom I was unable to save.
Dina confirmed this interpretation through her recurring dreams. A
bus almost ran over Dina and her little daughter, or she found herself on
a ship that was steered into a typhoon by its incompetent captain. In both
cases, she felt that she had to leave analysis, to run for her life.
Dina bestowed upon me the power of the rapist-killer, the murderer of
her most pressing wishes: ‘‘If this baby is going to be born, it will
happen in spite of you and not because of you. I feel that to give up
becoming pregnant is to give up life; for you it is probably a beginning,
for me it’s the end.’’ It became clear to me that Dina’s struggle against
the acceptance of the limitations of aging and death, our present
treatment goal, was vital for her psychic survival.
It eventually occurred to me that throughout this period, in which I
was cast in different roles with regard to her pregnancy, I had been un-
aware of Dina’s fantasies of having a baby without a partner. I slowly
real-ized that Dina was denying the need for a partner (me in the
transference) for purposes of conceiving. When I pointed this out to her,
she accepted it without any resistance. This was indeed what she felt; she
wished to create this baby with herself.
The negative feelings in the transference now became increasingly
stronger. Resuming the process of artificial insemination that she had
abandoned for a short while, Dina was haunted by nightmares of recur-
ring miscarriage as a result of her doctor’s incompetence. In her dreams,
she saw a fetus with a smashed head, severed limbs, and a squashed
abdo-men with its guts hanging out.
In the countertransference, I began to feel guilty for my detrimental
impact on Dina’s life through analysis. I would emerge from the analytic
session with her booming voice and powerful arguments pursuing me
everywhere: If she couldn’t have a child, was getting old, with death just
around the corner, what was the meaning of life? And what about the void
she would feel in her life if I were unable to fill it with meaning? Dina
claimed that she came to analysis to find meaning, but somehow, through the
same process, she had come to the conclusion that she had to give up what
was most meaningful to her—having another child. I felt lost, impo-tent to
answer her questions and overcome by depression. I now realized
38 CHAPTER 2
that we had switched roles, and felt that Dina has almost demolished my
analytic prowess. Being cast into the role of the victim, I dreaded Dina’s
attempt to shatter my belief in myself and my analytic role. In this difficult
phase in analysis, I understood that I, myself, had been drawn to believe the
worthiness of Dina’s goals, that I was almost persuaded that her goals were
commendable. This realization helped me reassume my analytic role.
It then occurred to me that the transference-countertransference prob-
lems we encountered were a reflection of her complex relationship with
her mother. I consequently pointed out to her my belief that beneath her
anger and aggression toward me was a great need for love and support. I
also added that she was probably unconsciously trying to make me feel
the painful experience she herself had undergone in childhood.
For the first time in a long while Dina listened to my interpretation
without immediately rejecting it. The following session she brought me a
gift, a cloth on which she had painstakingly embroidered the following
words: ‘‘Ambivalence is the basic condition of the human mind.’’ This
was a breakthrough in her hate and a turning point in the transference
relationship toward me.
Working through the therapeutic relationship, Dina elaborated upon the
difficult relationship with the maternal representation. Dina could now
remember that, throughout her life, Mother had suffered from an affective
disorder of the manic-depressive kind. She had never been insti-tutionalized,
but was treated with lithium. Dina remembered Mother’s mood swings, and
when they would change for the worse, she would feel let down and
discarded. Mother would lie in bed for days, bitter and angry with everyone.
She would complain about her unfortunate lot in life, about being abandoned
by Father, about the fate of women. During those times, Mother was
irritable, dissatisfied with whatever she did. Dina had a painful memory of
Mother being angry and slapping Dina’s face, which made Dina feel
ashamed and humiliated. Dina did everything to appease Mother’s wrath,
imagining that through her good deeds she could restore her loving mother,
yet at the same time feeling impotent and frustrated.
Reviewing the different phases of the analysis, I understood that through
the transference relationship Dina was playing the roles of herself and her
unstable mother, placing me in the complementary roles. In the first phase,
Dina was my adoring and idolizing little girl who wanted to
FOREVER YOUNG 39
merge with me narcissistically, while harboring the murderous wish of

swallowing me up and destroying me. This fantasy made her afraid of my
retaliation, of being devoured and lost inside me. This phase gave way to the
more powerful feeling of being my ‘‘victim,’’ transforming me into a
dangerous and aggressive mother who not only neglected her babies but
actually murdered them. We connected her feeling of being my victim to the
female aspect of the rapist-killer that was projected upon me. Alter-nately,
Dina bestowed on me the role of the girl whose psychic existence was
threatened by a ferocious and aggressive woman, embodied by herself. My
countertransference feelings of impotence caused by not being able to help
her, and my being threatened by her engulfing wrath, must have been exactly
what Dina had experienced for many years from her mother.
The long and painful working through of Dina’s relationship with her
mother resulted in greater understanding and forgiveness, her hate of her
mother to a certain extent mitigated by her love for her. As a result, Dina’s
feelings of guilt and persecution diminished. This became apparent through
the disappearance of her phobia. Since the fantasy of the rapist-killer was
now no longer threatening her, the pressing need to counteract her murderous
wishes by producing life decreased greatly. Dina still occa-sionally
underwent artificial insemination, but now felt better able to ac-cept the fact
that she might never realize her wish of having another child. She no longer
felt that I was the killer of her babies, and I was again aware of her
attachment to me and the diminishing of her hate.
It was during this period that Dina became pregnant. Dina believed
that she succeeded in becoming pregnant because the pressure that she
had felt to vanquish death had diminished. She expressed doubts about
whether this baby would ever be able to fill the ‘‘void’’ that she felt in
her soul, but ‘‘a concrete solution,’’ said Dina, ‘‘just postpones dealing
with aging and death. I will still need analysis for that.’’ In contrast to her
previ-ous pregnancy, Dina felt no urge to run away from analysis. Her
preg-nancy, however, was regarded as high-risk. Dina asked the doctors
to sew up her womb so that she would not miscarry. In the transference,
we un-derstood on a symbolic level that she was asking me to sew up the
analytic womb so that the new aspect of her personality, which had just
budded in her, would not miscarry.
Dina delivered a baby girl and remained in analysis until her daughter
was almost two years old. The relationship with her child brought a new
40 CHAPTER 2
dimension into the transference relationship, through which we were able

to continue the elaboration of her own infantile experiences with her
mother. This, in turn, increased her capacity to love her child, as well as
to better accept herself as a woman. ‘‘I found the bluebird of happiness in
my very own kitchen,’’ she said.
We were both aware that through a lengthy process of growth, in
which she struggled with so much pain, mourning, and the fear of death,
Dina was finally able to ‘‘give birth’’ to some good parts in her own self.
DISCUSSION
I wish to discuss what this case can teach us about the movement from
manic defenses to mourning in light of the following:
(1) The extent to which fear of psychic pain aroused manic defenses
against change and growth in both members of the analytic couple.
(2) The extent to which manic defenses were given up in order to be in
touch with mourning and work it through.
Fear of Psychic Pain

In his brilliant paper ‘‘Termination of psychoanalysis: treatment goals,
life goals,’’ Ticho states: ‘‘The analyst should know what he considers a
mature human being to be’’ (1972, p. 318). This statement, which de-
mands of the analyst secure knowledge regarding the goals of the treat-
ment, made me feel uneasy. As I have described earlier, I harbored
doubts and felt insecure about my analytic goals in this case.
It was, however, quite clear to me what maturity required from my pa-
tient. Maturity, in this case, meant the giving up of her manic defenses— her
infantile omnipotent fantasies—and her graceful acceptance of the
limitations of age. But for Dina, maturity and growth could be achieved only
by mourning for losses she felt were irretrievable (such as childbirth and
youth). Acceptance of these losses meant full acknowledgment of the
passage of time and the relinquishment of omnipotent fantasies and im-
mortality. At certain points in analysis, I felt that not only was this an
impossible task for Dina, but it was actually detrimental to her. As analysis
progressed, it became clear that Dina’s wish for parthenogenesis was a psy-
chotic obsession that served as a manic defense against fragmentation. Not
only was Dina denying reality, she was also trying to replace it with delu-
FOREVER YOUNG 41
sional fantasies that she felt compelled to enact. She used this enactment
to avoid a psychotic breakdown that threatened her at this stage in her
life. This became the source of a grave dilemma for me: Since pregnancy
and childbirth seemed to be so vital for Dina’s psychic survival, was I
sup-posed to fight against this need of hers? Was it at all possible for
Dina to give up her manic defenses, and if so, at what cost? And if my
role was to put her in touch with unbearable psychic pain, could I take
the responsi-bility for the outcome?
Today, looking back at this analysis after many years have elapsed, I
wonder to what extent my questions about whether it was possible to
achieve maturity in this case stemmed from the massive projective identi-
fication that the patient used throughout the treatment, and to what ex-
tent they were due to my own countertransference feelings, which were
evoked by her intense encounter with a ‘‘mid-life crisis’’ (Jacques 1965).
The painful issue of aging and relinquishing childbirth and youth was not
foreign to me—it is universal to all women of this age. I became aware
that Dina, who was only five years my senior, evoked conflicting feelings
in me about the passage of time and its accompanying limitations. This
was one of the main reasons why, at a certain point in analysis, I was al-
most persuaded that her manic defenses (becoming pregnant once more)
might contain a positive element. In this regard, I wish to quote Grinberg,
who so eloquently describes the impact of maturity and change on both
members of the analytic couple: ‘‘It is a painful truth and one which has
been avoided until then: that of the full recognition of the passage of time
as much in the analyst as in the analysand, in which illusory timelessness
is transformed into a real temporality with the limitation of the
omnipotent fantasies and those of immortality. These limitations are
experienced many times as a partial death’’ (1980, p. 29).
I believe that Dina’s resistance to change, along with her fear of growth
and aging, constituted part of an unconscious death anxiety that affected us
both and was expressed through her obsession with generating life.
From another perspective, I could understand why Dina tried to post-pone
aging and death with omnipotent, magical, everlasting life-giving. She felt a
tremendous pressure to achieve this concrete solution because she was
unable to achieve sublimation and thus change her goal of pro-creativeness
into creativeness. Sublimation as a process that underlies cre-ativeness was
inhibited and had failed. But sometimes I would wonder—
42 CHAPTER 2
wasn’t Dina’s struggle to postpone aging and death a universal one?

Aren’t we all in the same boat, in this regard? Freud’s wise words about
our in-ability to consciously realize the existence of death come to mind:
‘‘We were of course prepared to maintain that death was the necessary
outcome of life. . . . In reality, however, we were accustomed to believe
as if it were otherwise. We showed an unmistakable tendency to put
death on one side, to eliminate it from life. We tried to hush it up . . . as
though it were our own death . . . in the unconscious everyone is
convinced of his own immortality’’ (1915, p. 289).
Manic Defenses
I would now like to examine the problem of termination and the extent
to which the treatment goal of relinquishing manic defenses were met in
this case.
The psychoanalytic literature that deals with the theoretical and techni-cal
problems related to termination of analysis offers a series of criteria that take
into account the patient’s development and his achievements in different
areas of life. These criteria have been described in a wide variety of ways
(Symposium 1937, 1948, 1950; Pfeffer 1963; Firestein 1969; Hurn 1973;
Balkoura 1974; Robbins 1975) and have been reviewed on the basis of
different theoretical constructs (Firestein 1982; Schachter 1992).
I will briefly mention some of these criteria. Weigert (1952) wrote that
the appearance of a markedly increased capacity for candor on the part of
patient and analyst was a harbinger of termination. Greenson (1967) be-
lieved that if the patient had never experienced an intense, prolonged
angry reaction towards the analyst, then the analysis had probably not
reached termination. Novick (1982) focused on the patient’s ability to ex-
perience and to maintain an oedipal transference. Siegel (1982) empha-
sized the amelioration of a harsh, judgmental superego. Rangell (1982)
was of the opinion that the terminal phase had been reached when the
patient had achieved the capacity to choose.
The criterion for termination that has probably received the most at-
tention is the capacity for self-analysis (Hoffer 1950; Kramer 1959; Siegel
1982; Schlessinger and Robbins 1983; Berenstein and Fondevila 1989;
Kantrowitz 1990; Schachter 1992). Grinberg (1980) expanded on this topic,
viewing self-analysis as an outcome of the ‘‘interminability’’ of the process
of searching for mental growth and integration. According to him,
FOREVER YOUNG 43
the termination of the dynamic interaction between analyst and patient allows
the analysand to reach a new ‘‘take-off ’’ point, from which he can control
the development of his mental growth and maturation by himself. The
‘‘interminability’’ of the process fits the current view that there is no such
thing as an ideal termination; that the symptoms never disappear completely;
that the patient does not achieve all of the structural changes one would like;
nor does he manage to acquire a totally integrated person-ality. The literature
of the last few years has dealt with interruptions, situa-tions of ‘‘impasse,’’
and reanalysis. This view supports Freud’s early opinion that ‘‘We do not
always achieve our aim to its full extent—that is, do not achieve it
thoroughly enough . . . portions of the old mechanism remain untouched by
the work of analysis’’ (1937, p. 229).
With these different criteria in mind, I wish to examine to what extent
the treatment goal of relinquishing manic defenses was met in this case.
For this purpose, I shall address the following issues: Did termination
really take place? What were the satisfactory aspects of termination and
for whom were they most satisfactory? What was the analyst’s attitude
toward the apparently successful outcome of the treatment at the end of
this analysis, and has it changed now, many years later?
I believe that termination did take place in this case, and from the pa-
tient’s point of view, as well as my own, some positive results were
achieved. In my opinion, Dina’s working through her disappointment and
hatred in the transference inclined the prevailing balance between hate
and love more toward love. She was able to recall deep, unconscious
mem-ories of hate toward the maternal object because they were
mitigated by love. Her fear of death and destruction was somewhat
moderated by her emotional experience in analysis, and by the work of
mourning that ac-companied the entire analysis. Dina felt she had been
able to conceive as a result of feeling less threatened by death. Possibly,
she was now able to become pregnant and give life because she
experienced something in her-self as life giving. From this angle, the
treatment had a positive outcome for patient and analyst alike.
On the other hand, I frequently wondered what structural changes had
taken place in my patient. The immaculate pregnancy, producing a baby
without a man, was a manic defense with a successful outcome. As a result
of her manic defenses, she had obtained her life’s goal—the avoidance of
pain and mourning inherent to growth. In contrast with the first time that
44 CHAPTER 2
she had become pregnant during treatment, this time she remained in
analysis, stating clearly that she did not regard the pregnancy and the
baby as a means of ‘‘filling her life with meaning.’’ But could she ever
complete the process of mourning necessary for accepting her
monosexual destiny and the inevitability of her death, which she had
begun before the birth of this child? To what extent did this ‘‘success’’
help her avoid her death anxi-ety? Could this success have been the result
of an unconscious defensive collusion on the part of both of us in the face
of the threat of intensive psychic pain? From this point of view,
termination was less satisfactory for the analyst than for the patient.
Analysts’ difficulties with the incomplete results of analysis have been
reviewed by Schachter (1992). Ticho observed that ‘‘countertransference
difficulties play a larger part in the termination phase than in other phases
of the analysis’’ (1972, p. 328). Siegel stated that ‘‘The story of the well-
analyzed patient is a myth which is told and retold by analysts and
patients alike in the interests of hope or to justify the long and expensive
treatment process or for other reasons associated with problems in self-
esteem’’ (1982, p. 396).
Dewald (1982) similarly noted that the limitations of analytic
treatment may evoke narcissistic injury in the analyst. This may lead to
an indefi-nitely prolonged analysis in the attempt to avoid such injury.
Cooper wrote about this as follows: ‘‘It is during the termination phase
that we become most intensely aware of all the personal and professional
hopes with which the analysis began. . . . We are likely to experience
with a new clarity the disappointments, the unresolved, and even
untouched issues of analysis, as well as the gratification of knowing how
much was achieved’’ (1985, p. 1).
Over a long period of time I was unable to complete the recording of
this interesting and apparently successful treatment because of my doubts
as to its success. Some of the many questions that preoccupied me were:
Did the patient understand herself better at the end of the work? Should
this analysis be regarded as a partially successful one? If so, what would
have been a fully successful outcome?
These questions were answered unexpectedly about a year ago when I ran
into Dina by chance on the street. I was struck by the fact that al-though
looking older, Dina was smartly and more femininely dressed than I had ever
seen her before. She shook my hand warmly and, as if sensing
FOREVER YOUNG 45
my unvoiced questions, said: ‘‘I am all right, you know. I am working as

a teacher and am very happy with my work. I like the high school
children; teaching is creative, important for future generations, and it also
satisfies my need for an audience. I am very happy with my family; my
children are wonderful.’’ She was quiet for a moment, then added,
smiling: ‘‘I’m about fifty-four years old now and I know it, but I don’t
mind my age any more. I am not always in a euphoric mood but I’m
quite satisfied with who I am and what I have. And I am very grateful to
you for what you did for me.’’
Listening to Dina for just these few minutes on the street, I realized to
my satisfaction that her analysis was not only terminated but, indeed, had
been successful. Dina appeared to be clearly able to deal with the
conflicts she encountered without me, by using what she had learned in
analysis. I knew then that, at the end of the work, she understood herself
better, and also had acquired the tools to enable her to achieve further
growth. In her case this meant that she could, to a certain degree, realize
her limitations and give up her perfectionist and infantile expectations,
thus in great part overcoming her manic defenses.
Arlow’s words about the experience of termination in analysis very
much reflect what transpired at the end of this treatment: ‘‘The fantasies
and conflicts involved in the experience of termination cover a wide
range that not only recapitulates separation from the mother in early
childhood but also activates fantasies about completion vs. incompletion,
castrated vs. phallic, life vs. death, and disappointment over the fact that
the analysis has failed to fulfill all those unconscious childhood fantastic
wishes that the patient brings into the analysis under the guise of the wish
to get well’’ (1970, p. 52).
The working through of these feelings by my patient and myself,
which began during the closing phase of analysis and continued after it,
enabled both of us to achieve some tolerance of the psychic pain
contained in mat-uration and growth, and facilitated our ability to mourn.
Both of us, pa-tient and analyst alike, were better able to move on from
our manic defenses and do the work of mourning necessary for
continuing life in a creative way.
NOTE
1. The issue of termination and analytic goals has been a relatively neglected
subject in the psychoanalytic literature (Blum 1989). It was through my clinical
46 CHAPTER 2
work that I became involved in this topic. Over a long period of time I was
unable to complete the recording of this interesting and apparently successful
treatment that ended some years ago. In trying to understand what was hindering
my writ-ing, I came to the conclusion that it was probably connected to my
countertrans-ference feelings about the patient’s ‘‘treatment goals’’ and ‘‘life
goals’’ (Ticho 1972). Ticho defines ‘‘treatment goals’’ as the removal of
obstacles to the patient’s discovery of his potentialities. ‘‘Life goals’’ are the
goals the patient would seek to attain if he could put his potentialities to use.
In this paper, I defined ‘‘treatment goals’’ and ‘‘life goals’’ differently. I
define ‘‘treatment goals’’ the way both analyst and patient view the aims of
treatment; ‘‘life goals’’ will be defined as the way in which both partners of the
analytic couple refer to the goals the patient would seek to attain in life.
3
Lust for Love

Touch, but no contact.
—Rechy 1967, p. 57; quoted in Bollas 1992, p. 147
In this chapter I deal with the problem of the extent to which devices of
analytic technique can be legitimately modified in order to facilitate
some kind of change in a patient who uses homosexuality as a manic
defense against suicide and psychotic dissolution. In the case under
discussion, the manic defense was not completely relinquished, but the
patient became more in contact with her feelings and less frantic in her
search for a homo-sexual partner.
I have been plagued by questions and doubts concerning the partial results
of this treatment. What can we hope to achieve from psychoanaly-sis in cases
in which homosexuality serves as a ‘‘manic defense’’ (Klein 1935; Winnicott
1935) against fragmentation and psychic death? And what is the role of the
analyst in these cases? Is it the analyst’s role to help patients relinquish their
homosexuality, which they may experience as es-sential to their psychic
existence? Or should s/he help them along their path to self-discovery, which
may or may not entail their letting go of the homosexuality that helped them
avoid the pain and mourning inherent in trauma? I do not presume to have
the answers to these difficult questions but I would like to tackle this issue by
means of a case study.
In this case study, the patient’s demand for touching and being touched by
the analyst (the wished-for homosexual partner in the transference) was
crucial for her to continue the analytical work. The discussion demon-strates
the great difficulty involved in (1) helping such patients analytically and (2)
withstanding the threat that they will act out violently and danger-ously if the
analyst does not acquiesce in some way. It also shows how a verbal
interaction with the analyst that was experienced by the patient as
47
48 CHAPTER 3
physical touch enabled the continuation of analytic work and the working
through of the patient’s manic defense.
Before describing the case, I will review the topic of touch in the ana-
lytic treatment from a historical as well as a contemporary perspective.
For a long period of time, the subject of touch in analytic treatment was
viewed not only as a sensitive and controversial topic but also as a forbidden
one. After being an ‘‘untouched area’’ in classical psychoanaly-sis, it then
became a hot topic, widely discussed in recent literature. For example, the
Psychoanalytic Inquiry (20, no. 1, 2000) devoted an entire issue to the topic
of touch in the psychoanalytic situation.
The interdiction against touching was codified with the development
of the rule of abstinence. As early as 1910, Freud wrote, ‘‘The patient
should be kept in a state of abstinence or unrequited love. The more af-
fection you allow him, the more readily you reach his complexes, but the
less definite the result’’ (Jones 1955, p. 448). This statement was further
elaborated by Freud in 1915 and 1919. The theoretical rationale underly-
ing this approach was that preventing the patient’s instinctual drives from
being discharged would force their transformation into verbal representa-
tions. The now-conscious repressed instinctual wishes could then be
worked through to achieve their renunciation and sublimation.
On the basis on this model, Casement (1982) refused to hold his pa-
tient’s hand, out of conviction that to do so would gratify the patient’s
longing for a good object (not infantile sexual wishes) and would
interfere with the full reliving of the trauma, including the aggression
generated by the trauma.
Despite the rule of abstinence, psychoanalysts have reported occasions of
considered use of touch to facilitate treatment. Ferenczi (1953) would permit
behavioral enactments that at times included affectionate kisses (Shapiro
1992). Fromm-Reichmann stated that ‘‘at times it may be indi-cated to shake
hands with a patient or in the case of a very disturbed per-son to touch him
reassuringly’’ (1950, p. 12). Searles indicated that ‘‘declining to provide
physical contact’’ may be helpful, yet he mentioned the undesirability of
‘‘being neurotically afraid of physical contact’’ (1965, p. 701). Winnicott
(1965) reported, in his own writings and in those by his patient Margaret
Little (1990), that he would hold his patient’s hand in an effort to create a
sufficient ‘‘holding’’ environment. Little (1966) de-scribed a patient who
despaired over his discovery that his ‘‘accidental’’
LUST FOR LOVE 49
self-injuries were intentional, and needed the analyst to touch his hand.
In a lecture, Kohut (1981) described offering his two fingers for a patient
to hold when the patient was in a state of deep despair (also reported in
Bacal 1985). Pedder (1986) as well described a deeply regressed patient
who needed physical touch.
Although published reports typically address the use of touch with very
disturbed or deeply regressed patients, Mintz (1969) has suggested that
physical touch may also be useful with the ‘‘healthy neurotic’’ in periods of
deep regression when the patient is temporarily unavailable for verbal
communication. Balint still further expanded the circumstances of the
emergence and meaning of touch, and described his patients’ desire for touch
toward the end of treatment when the patients are better integrated and better
able to communicate affection, mutuality, and a deeper con-nection. Touch
under these circumstances is not erotically stimulating but a powerful form of
communication that leads to a deeper intimacy and a ‘‘tranquil quiet sense of
well-being’’ (1952, p. 231). Breckenridge (2000) described a clinical
situation in which allowing physical contact conveyed a sense of acceptance
and helped modify a profoundly negative self-image. McLaughlin observed a
general shift in the classical position on touch. McLaughlin noted being
increasingly comfortable with holding a patient’s hand, including when a
patient on the couch reaches back for his. A pa-tient may be reaching for
‘‘support, consolation, or for my presence in the face of the patient’s not yet
speakable yearnings’’ (1995, p. 441). He found that ‘‘this responsiveness
facilitates, rather than hinders, the patient’s con-sequent analytic seeking’’
(1995, p. 442).
The complexity of this topic has been eloquently described by
Maroda: ‘‘What I have found is that the request for physical contact has
many dif-ferent meanings, and that the answer to the question of ‘to
touch or not to touch’ lies in the adequate understanding of the patient’s
request and the analyst’s emotional response to it. Understanding the
patient’s intra-psychic meaning, placing this in an appropriate emotional
context, under-standing how the current request for touch represents a re-
enactment in the transference-countertransference interplay, and then
making the right decision, are exceedingly daunting tasks. They require
intellectual and emotional depth on the analyst’s part’’ (1999, p. 143).
I will now describe a case study in which the patient experienced a ver-bal
interaction as a physical touch in the psychoanalytic situation, an expe-
50 CHAPTER 3
rience that led to direct emotional contact. This verbal interaction and the
elaboration that followed it enabled the patient to partially give up her
manic defenses and facilitated the process of mourning.
THE CASE
The First Encounter—Desire and Fear

Before quoting some fragments from the patient’s analysis to illustrate
the previously described theme, I will introduce her and provide a
glimpse into our first meeting. Deborah, a forty-five-year-old woman,
married with seven children (aged seven to nineteen), came to me for
psychoana-lytic help. The reason she turned to me for analysis emerged
through the following story. Deborah was a career woman, the director of
a private enterprise. Several years previously she went abroad with her
husband and children, where she became interested in sex therapy and
took some pro-fessional courses. During her stay abroad, she underwent
psychological treatment, which escalated into a sexual affair with her
therapist, a woman. This therapist initiated her into lesbianism.
For Deborah, the bond with her therapist became very strong, affect-
ively and sexually. When she returned home with her family, Debora ex-
perienced their separation as tremendously difficult and painful. The
relationship with her husband lost whatever affective meaning it had had
before.
The previous summer, Deborah went abroad to take part in a sex ther-apy
program for students. There, she had an affair with a female colleague from
the group. She again was exulted by the love she experienced for this
woman. Recently, she received a letter from the woman informing her that
she had a new woman friend who was living with her. Deborah, confused,
restless, and not knowing what to do, decided to seek help.
In the first interview, Deborah explained to me why she sought a
female analyst: being familiar with the prohibitions of the profession, she
was sure that I would not seduce her. She expressed a wish to do
everything possible to prevent this treatment from becoming a love
relationship, as had happened with her former therapist.
I observed the woman seated opposite me, speaking in a monotonous,
quiet voice. She was of ordinary appearance, blond, plump, with regular
features, and unsophisticatedly dressed. I noticed a certain lack of expres-
LUST FOR LOVE 51
sion on her face, a lack of color and vitality in her demeanor. What struck
me most of all was the gap between her lack of affective expressiveness
and her description of the intense feelings that accompanied her lesbian
love affairs.
I gathered from her story that now, abandoned by her second lover and
trying to fill a void, she hoped to find in analysis a potential new lover,
like the one she had found in her first therapy abroad. At the same time, I
believed that she might be terribly afraid of the realization of her erotic
wishes, especially as the fulfillment of her desires was connected to
separa-tion and pain. The conscious fear of her unconscious desires and
wishes toward me was a theme that accompanied us throughout the entire
treat-ment.
Anamnesis
Deborah was the daughter of Sephardic Jews who had emigrated from
South America to Israel before World War II. Her parents both came
from large families, and each had several brothers and sisters.
Deborah had only one sister, six years her junior. She had virtually no
recollection of her childhood years. She knew that her mother had suf-
fered from depression while pregnant with her, having been told this dur-
ing adulthood. When Deborah was twenty-six years old and already
married with two children, her mother, suffering from psychotic depres-
sion, was hospitalized in a psychiatric ward. The sister became a profes-
sional in her field; she never married or built a life of her own.
Deborah’s mother had a brother who was diagnosed as schizophrenic.
He lived with his mother (Deborah’s grandmother), who was considered
an unstable person. Several months after the grandmother’s death, this
uncle committed suicide.
Deborah’s father had been an important figure in the Jewish commu-
nity in South America and was greatly admired by Deborah. She
perceived him as a rational person and tried to identify with him.
Her husband, who was fifteen years her senior, was already a well-known
industrialist when they met. It was a flattering match for Deborah. In spite of
this, before her wedding she became depressed and had what she termed a
‘‘nervous breakdown.’’ Then, like now, she felt the absence of an expression
of his love in words. She regarded her husband, who was by now famous and
successful, as a workaholic, always busy ‘‘saving hu-
52 CHAPTER 3
manity.’’ Deborah viewed her marriage as unsatisfactory. She felt she was
always searching for somebody to whom she could be genuinely close.
Desire and Inner Deadness

After our initial meeting, I accepted Deborah for analysis and we
began treatment four times a week, on the couch. I do not intend to
describe the entire course of the analysis. However, I would like to refer
to the first year of analysis, during which I became acquainted with
Deborah’s wounded self and her inner deadness, themes that preoccupied
us over many months of analytic work. I learned about her inner
deadness from the way she tried to revive it, by watching people in types
of situations where they expressed feelings. For example, she used to go
to the arrivals hall at the airport to watch people meeting and embracing
passionately. She would watch for hours, never getting bored, thirstily
drinking in the expressions of emotion from strangers.
This inner deadness infiltrated almost all the emotional spheres of Deb-
orah’s life, even her motherhood. When her children were little, she felt she
could not relate to them. She would go to playgrounds where mothers
watched their children and would observe the mothers talking to their
children. Deborah tried to feel motherly feelings by identifying with and
imitating normal mothers. She was not always successful in this endeavor.
Deborah claimed that the only two things that succeeded in reviving
her inner deadness were giving birth and falling in love. Only these
power-ful experiences enabled her to feel emotionally alive.
Listening to Deborah describing her plight, I felt as if I were gazing
into an abyss, a frightening black hole, a deadly wound that had opened
up in the place where normal human emotions should have been. What
was the terrible experience of lack, I asked myself, that had dried up the
spring of feelings, creating a desert, an inner emotional deadness, which
could not but make her life meaningless? Or was this the inner deadness
of the mother, which was now part of the daughter’s psychic life?
Desire and Persecutory Fears

I now would like to explore Deborah’s self-destructive tendency, as
re-vealed through her associations and fantasies, mainly during the third
year of analysis. First, I will present a dream from this period.
‘‘In my dream’’ said Deborah, ‘‘you came up close to me, touched me
LUST FOR LOVE 53
and told me something personal about yourself. I looked at you—there

was a woman dancing to the rhythm of jazz music, the woman didn’t ac-
tually look like you, she was darker, had curly hair, another face. She was
not somebody I knew, but I felt it was you.’’
Deborah’s associations regarding the dream revolved around her chil-
dren. Her two daughters, fifteen and twelve years old, danced jazz. She
felt it was much more difficult for her to relate to her daughters with their
budding femininity than to her sons, with whom she was much closer. A
memory now surfaced about her younger daughter who, when frustrated
and angry, appeared to Deborah as if she wanted to jump out of the win-
dow and commit suicide. We first attempted to explore Deborah’s wish
to get close to me, her longing to be touched by me, as well as the fear
this closeness entailed. But where did her self-destructive tendency,
which was expressed by how she perceived her little girl, come from?
Was it possible, I asked myself, that the encounter with a female analyst
who did not fulfill her erotic wishes provoked so much anger, frustration,
and desperation that Deborah, who actually wanted to destroy me, turned
the aggression inward and wanted to destroy herself?
Deborah’s further associations continued to revolve around death. She
described the way her uncle, her mother’s schizophrenic brother, had
committed suicide. When nobody was guarding him (shortly after his
mother’s death), he left the house, submerged his head in a swamp and
inhaled the dirty water. He suffocated to death in the mud.
I understood the message Deborah was conveying to me through her
story: I have to guard her against her self-destructive impulses, otherwise
she might drown in them. But what was Deborah’s ‘‘swamp,’’ I
wondered. Was she indeed threatened by psychosis, and to what extent
would her defenses against psychic death prevent it?
The answer to these questions was revealed through the exploration of
Deborah’s persecutory fears, which were combined with her desire for
erotic love. I illustrate this through an episode from the third year of anal-
ysis.
Deborah had worked abroad for several months in a sex therapy clinic
run by a female therapist, well known in her field. Deborah claimed that
the therapist was very fond of her. Childless and searching for a profes-
sional female heir, she even offered to adopt Deborah. The clinic em-
ployed women therapists as surrogates, whose role it was to help invalids
54 CHAPTER 3
function sexually. Deborah worked as a surrogate for a while. During this

period, she was occasionally troubled by a secret fantasy that she didn’t
understand. Deborah sometimes felt like slashing her wrists. She had no
idea where this feeling came from. Life seemed so very interesting. It
was, indeed, a very strange thought.
Through her story, I realized how much Deborah had reenacted her
unconscious conflicts and wishes regarding life and death in this kind of
work. Functioning as a surrogate, she consciously fulfilled her wish to re-
pair a damaged, sexually dead person by giving him the ability to make
love. This required of her only erotic love without any emotional
involve-ment, which suited her perfectly. However, in her unconscious
fantasy, Deborah was herself the invalid who needed reparation of the
vital ability to give and receive love. By being a surrogate, she was
attempting to reviv-ify the dead part in herself; but, as can be seen from
her suicidal thoughts, she was unsuccessful in her attempt. Working
through this episode, we understood that Deborah wanted to take her own
life because the physical act of making love far from satisfied her
emotional needs. At this point I realized that Deborah’s manic defenses
were not working for her. Giving and receiving love on a physical level
had not made her inner deadness and the meaninglessness of her life
disappear. I therefore began to inter-pret Deborah’s needs and
expectations to her, hoping to put her in touch with her feelings.
I pointed out to Deborah that, in analysis, she was the emotional crip-
ple who needed revivification of her dead inner self. In this role, she was
asking me to be her emotional surrogate who, by giving her feelings, was
supposed to revive in her the ability to love and enable her to feel alive
again.
Until now, there had been two things that had succeeded in revivifying
Deborah’s inner emotional deadness: giving birth (hence her large num-
ber of children), and falling in love with a woman. Now that she was
older and no longer able to have children, Deborah’s entire life revolved
around the desperate need for a love relationship with another woman.
Lust for Life

I explore the issue of Deborah’s struggle for emotions through an epi-
sode taken from the fourth year of analysis. Deborah gave a detailed de-
scription of a farewell party she had attended when abroad with her
LUST FOR LOVE 55
husband; the party was given in honor of a famous actor who was suffer-
ing from a terminal illness and was on his deathbed. She and her husband
had been invited along with many television people, actors, and friends.
The party, given at the actor’s request, was a very special event. For
seven hours, people spoke to him and about him, each of them receiving
a small farewell gift from him. After the party, there was a program on
television in which the actor’s doctor stood on the stage for more than an
hour, showing everyone slides of the actor’s damaged organs and
explaining about his illness.
In the transference, I asked Deborah whether I was supposed to
become the doctor who publicizes his patient’s internal state. Deborah
furiously rejected my interpretation. She often expressed irritation and
anger when-ever I referred to our relationship. ‘‘You are always pushing
yourself into things that belong to reality,’’ she said. ‘‘This has nothing to
do with you.’’ It was true that she wanted fame and recognition, she
added; actually, there was a journalist from a local women’s magazine
who had recently been asking her for an interview about her successful
career. Such a person could bring her fame and advertise her business.
It was clear to me that in the transference Deborah regarded me as a
potential instrument for advertising herself, under which lay the hidden
need to exhibit herself in public. That was the reason that for many years
I had been unable to write about this case. Only now, years after the
analy-sis ended, and after ‘‘dressing her up’’ in proper disguises, was I
able to describe this treatment and the difficulties I encountered in it.
Deborah’s reaction brought to my mind what I already knew about her
perverse, exhibitionistic needs, revealed to me through her stories about
different courses in sex therapy that she had taken abroad and that she
described with great gusto. In one of these ‘‘experiential’’ courses, a
group of about twenty women sat in a circle with their legs spread apart,
explor-ing their vaginas in front of each other. In another course, the
students were shown about two hundred slides of female genitalia.
Deborah claimed that these courses were intended to help the students
overcome their inhibitions.
In my countertransference feelings, I was aware that Deborah wished
to play a perverse game with me of comparing our genitalia, in order to
ensure that she was a woman. Apparently, only by exhibiting herself in
56 CHAPTER 3
public (in the proximity of women) could she feel that her femininity
truly existed.
Continuing her story about the actor, Deborah mentioned that she had
been very impressed with the party, as well as with the actor himself, whose
life story had become public knowledge at this stage of his life. He had
arrived in Israel from Eastern Europe as an adolescent, after his par-ents had
been murdered by the Nazis. He had lived a very creative though immoral
life, being sexually promiscuous, mainly with women but also with men,
losing contact with his family, his wife, and his children. It was rumored that
he had been seduced by his mother when he was thirteen years old and that
throughout his life he had exhibited antisocial behavior by seducing minors
who were around the same age. Nothing had ever been proven against him,
but the scandalous story of his life became a newspaper scoop and was then
made into a television series.
Deborah expressed her admiration for the actor and for his way of life.
She believed that he had achieved complete acceptance of his body and
had derived a lot of pleasure from his sexual life. She also felt that, like
him, she too sought powerful life experiences. I was aware that Deborah
needed these manic defenses to feel alive.
The story about the actor being seduced in adolescence by his mother evoked
in Deborah memories of herself as a child being molested first by a man and
then by a woman. She remembered that when she was nine years old, a man
who worked in her parents’ house sat close to her and stroked her under her
skirt. He asked her if she liked it; it was a pleasant feeling. By contrast, the
second episode involved a woman, and was com-pletely masked by a facade
of love and affection. Only the context in which it was recalled hinted at
sexual exploitation. At age eleven, Deborah was in a car with an aunt, her
father’s sister, a nurse by profession. Deborah put her head in her aunt’s lap,
and the aunt stroked her head. She felt she wanted more and more. The same
experience was repeated later with her first female lover, her first therapist.
Once, performing a Gestalt exercise, the therapist put her to sleep like a
baby, by stroking her hair. It felt so good that Deborah wanted it to go on
forever and ever. She felt that she had missed out on that kind of physical
affection all her life. Much psychi-cal work was needed in analysis to make
Deborah aware of the traumatic elements of her molestation in childhood and
its later impact on her life. Deborah’s oedipal longings surfaced later.
Deborah was conscious of
LUST FOR LOVE 57
her oedipal attraction to her father, which was further transferred to her
husband. She remembered that her father had given her love and caring
in childhood, but she had always felt the tension of the physical attraction
between them. She felt his seductiveness toward her when he sang love
songs to her on his guitar. She believed that her love for her husband
stemmed from his similarity to her father.
In the transference, I was suddenly placed in the role of the admired
but rejecting father (husband)-analyst. Around the time of Holocaust Re-
membrance Day, Deborah chanced upon my name in a newspaper, along
with other Israeli researchers who dealt with the Holocaust. This made
her wonder: How important could she be for me, if my real interest lay in
life-and-death matters, similar to those that preoccupied her husband or
her father in the past?
Deborah believed that her preoedipal longings, which were lived out
in her lesbian relationships, stemmed from the affective and physical lack
of closeness that she had experienced with her mother. She was aware of
the frustration she had experienced in childhood, and held her mother re-
sponsible for it. She felt that her longing to be touched and caressed by a
woman had been evoked by the special relationship with her aunt.
In the transference, we got in touch with Deborah’s anger and rejection of
me, which were the result of her frustrated longing for physical contact in the
analytic situation. Deborah vehemently claimed that she was aware of her
‘‘real’’ needs—she longed for a relationship that would combine sexuality
and feelings and that would make her ‘‘whole.’’ Deborah felt that she could
achieve such a relationship only with a woman, the relationship with a man
only partially satisfying her. It was clear to me that a physical relationship
with a woman, and with me in the transference, was Debo-rah’s manic
defense against her inner deadness.
When I pointed out to Deborah that she was probably longing for
closeness on an emotional and physical level with me in treatment, she was
outraged. She believed that, again, I was pushing our relationship to the
foreground, a fact that she found very irritating. What did her dreams and
wishes, her anger and frustration have to do with me at all? She knew very
well how barren and intellectual analysis was; she knew I would never fulfill
her wish to be touched and caressed. ‘‘Why do I need such intensive
treatment?’’ she asked. ‘‘I am aware of my strong need for a relationship
with a woman. This urge bothers me more and more in analysis; it uses
58 CHAPTER 3
up a lot of my energy. I think if I had such a relationship, I wouldn’t need

treatment anymore. I wouldn’t feel the longing and the loss.’’
At this stage in analysis, Deborah began to ‘‘flirt’’ with the idea of
leav-ing treatment. I tried to show her how aggressive she was becoming
toward me and our work. I reminded her that at the beginning of treat-
ment, to avoid another failure, she had warned me not to seduce her as
her first therapist had done. Now she was claiming that the treatment
would be a failure unless it included a physical relationship, the only way
to save her life. It seemed to me, I added, that she had wanted to destroy
this treatment all along, even before it began.
The confrontation in the transference with Deborah’s dead and dead-ening
aspects remained unfruitful. My attempts to help her realize the cruel way
she was treating me fell on deaf ears. I felt that my interpreta-tions were
becoming repetitious, lifeless, and ineffective. I began to won-der whether
Deborah could ever give up her manic defense, the fulfillment of her
homosexual wishes, which was supposed to revive her emotional life. If so,
was the ‘‘holding’’—the love, care, and understanding I gave her in analysis
—enough to breathe life into her emotional deadness and to fight the death
forces expressed through her self-destructive tendencies? To what extent was
her homosexual solution vital for this purpose?
A particular dream that indicated Deborah’s fear of feelings toward
me in the transference elucidated certain matters for me. This is the
dream: ‘‘I was traveling with my husband, one daughter, and the famous
actor whose party I had attended. I had fantasies about the actor and
wanted to be alone with him. It was a difficult situation; half of his body
was para-lyzed because of the treatment he was undergoing. My husband
stated that I, too, was suffering from a terminal illness. He decided to
bury me. The idea was to put me in a grave so that I would suffocate and
not need to undergo this painful analytic treatment. I didn’t take leave of
my children, of friends. I didn’t choke, I got up and continued living.’’
In her associations, Deborah mentioned that the actor’s treatment had
not only been unsuccessful, but it had also caused him damage. She, like
the actor in her dream, came to analysis half numb (emotionally). But
what if analysis would harm her more than it would help? She felt that
since her emotional illness was fatal, she had to undergo a very painful
treatment in order to recover. But, at the same time, she was afraid that
the very treatment that was supposed to be life giving, by evoking her
LUST FOR LOVE 59
emotions, would be painful to the point of being life threatening. Deborah

felt that she would rather be numb, paralyzed, choking, than be con-
fronted with her feelings toward me. On the other hand, she wanted to get
out of the grave, out from her inner emotional deadness—she wanted to
feel alive.
What could I do to bring Deborah to life, I asked myself. I felt para-
lyzed, trapped between her aggressive behavior toward me and her de-
structiveness toward herself. Working through my countertransference
feelings, it suddenly occurred to me that the actor, who suffered from pa-
ralysis in half of his body, might also represent me and my impotence in
helping her realize her hostile aspects. And if this were so, how was I
going to escape from the place where I was being suffocated by her
rejection and hatred on the one hand, and by my fears for her physical
and psychic sur-vival on the other?
Since Deborah had never accepted my interpretations of her libidinal
needs and wishes or of her aggression and hostility toward me, I had to
find a different way of reaching her. I knew that I had to show Deborah
that I cared, I had to recognize her needs and wishes, without linking
them directly to me, without letting her feel that I was a separate human
being. Finally, I had to touch her positive feelings through my words, so
that she would be able to face both her love and her hatred toward me
with less shame and humiliation.
A beautiful verse by Rainer Maria Rilke (1904, p. 27) came to my
mind and I said, ‘‘You shouldn’t turn away from treatment. Love
consists in this that two solitudes protect and touch and greet each
other.’’ For some moments we were both silent and then I saw tears in
Deborah’s eyes. ‘‘I never knew that you really cared about me,’’ she
said. ‘‘Your words touched me.’’
This awareness was a breakthrough in Deborah’s hate and a change in her
transference relation to me. In the ensuing period, Deborah no longer wanted
to leave treatment. We now began a long and difficult journey of discovering
and exploring her feelings toward me. Much psychic work was needed to
help Deborah realize that physical contact from me, though it-self an erotic
act and a token of my love, would destroy our treatment. Because feelings
constituted a threat to her precarious sanity, touching was her way of
avoiding feelings and thus remaining on safe, but barren, ground. Deborah
had to understand that by using touching to survive psy-
60 CHAPTER 3
chic death, she was also keeping her emotional deadness intact. Though
still very ambivalent about this painful realization, she had at least
become aware of it. ‘‘It was always hard for me to have an emotional
experience without turning it into something sexual. It was so frightening
to have feelings that I needed sex to make it bearable. I wanted you to
touch me, to caress me, but deep down I did not want to have any
feelings toward you.’’
I could now point out to Deborah that her emphatic demand for an
unacceptable form of behavior stemmed from her need to repeat her
childhood trauma in treatment, by turning me into the sexual exploiter.
Cognitively, Deborah understood this easily; it took us a long time to
work through and achieve some ‘‘affective understanding’’ (Freud 1915)
of this realization. During this period, Deborah had many dreams that
indicated a heterosexual attraction as well.
A meaningful change occurred when, during the last year of analysis (the
fifth), Deborah acquired a new woman friend, Eve. This friendship, though
very intimate, never became sexual. Deborah had fantasies about what could
become a ‘‘real relationship’’ between them, but she refrained from
including sexuality. In analysis we understood that, for the first time,
Deborah could bear to have feelings toward me. Via Eve, Deborah ex-
pressed how grateful she was to me in analysis: ‘‘I do not need to have an
orgasm, for that I have a vibrator. Eve is alive, she is a person full of emo-
tions. I was alive on many different levels, but on a deeper level I needed
Eve, or you here in treatment, in order to feel alive.’’
In spite of her still-existing problems—her attraction to women and her
inability to feel completely happy in her relationship with her hus-band—we
were both aware of a change in Deborah’s attitude toward life. Manic
defenses expressed through powerful experiences were no longer vital for
her psychic survival. She thus gave up her frantic search for a homosexual
partner, no longer believing that it would solve all of her problems. She also
stopped fighting social conventions—her marriage and her children, which
previously she had complied with against her will. A kind of accommodation
or compromise solution was reached between what she wanted to be and her
family situation; she thus found her famil-ial situation more satisfactory.
Deborah was also able to have mutual (not necessarily sexual) relationships
with women friends. Deborah felt that she came out from the desert, the
inner emotional deadness that had made
LUST FOR LOVE 61
her life meaningless: ‘‘Now I know that I can’t always be in touch with
my feelings,’’ she said, ‘‘but I don’t feel an emotional cripple anymore.’’
DISCUSSION
Now I wish to explore the hypothesis that a verbal intervention can be
experienced as equivalent to touch, in light of the relevant contemporary
literature. I will then discuss the issue of manic defenses and their
function in cases threatened by fragmentation and psychic death. I
examine what can be expected from psychoanalysis in such cases, and
refer to the role of the analyst and to my doubts about whether or not it is
possible to achieve a complete move from manic defense to mourning.
Intervention as an ‘‘Interpretive Action’’ (Ogden 1994)

The case study presented in this chapter illustrates the great difficulties I
encountered in the treatment of a patient, who, to my mind, may best be
classified as the very disturbed hysteric described by Zetzel (1968/1972).
Deborah demanded that I repeat her infantile traumata (to exploit her
sexually) in treatment, regarding this as absolutely necessary for saving her
life. My attempts to help her understand this demand and confront her with
the cruel and hostile way she was treating me failed, as she was suffer-ing
from a kind of ‘‘malignant narcissism’’ (Kernberg 1992) and experi-enced
all references to our relationship as humiliating and persecutory.
Since the most decisive factor influencing the patient’s experience of
the analyst’s interpretations is the current status of the transference, I
tried to alter the negative direction that the transference had taken. For
this purpose, I resorted to an intervention that was completely different in
form and content from the usual interpretations employed in analysis.
In his interesting discussion of this case, Reppen (1999) pointed out
that the spontaneous, unplanned quality of the intervention I used in this
case is reminiscent of the ‘‘interpretive action’’ coined by Ogden (1994).
I used this intervention (‘‘action’’) in order to unlock a deadlock and it
was directed at the patient’s physical and emotional needs.
The intervention consisted of two sentences. The first addressed the pa-
tient in a simple, concrete, direct way, asking her not to leave treatment. The
second took the form of a verse of poetry—it was metaphorical, af-fect-
laden, and dramatic. It shared the need for love existing in both pa-tient and
analyst. I believe that the statement conveyed a clear emotional
62 CHAPTER 3
message, and the tone of my voice, impregnated with affects, enhanced

its impact. Perhaps my words and the way they were spoken functioned
as a ‘‘sonorous bath’’ (Lecourt 1990), creating an association between
touch and hearing. In contrast to insight, which is the outcome of a
correct in-terpretation, my intervention resulted in a feeling. While
insight correlates with seeing, feeling correlates with touching. It was
only through this emotional ‘‘touching’’ that the patient felt it was worth
her while to re-main in analysis.
Patients seem to vary considerably in their capacity to comprehend the
full implications of single interpretations. In this case, there was a single
interpretation that had a major impact on the continuation of the analytic
process. I believe that the emotional impact of the intervention described
earlier prevented the patient from enacting her destructive and self-de-
structive tendencies, because she was willing to continue with analysis.
Deborah’s ability to get in touch with her feelings was the result of the
long working through that ensued. The fact that every interpretation logi-
cally implies a number of other interpretations is important in
considering the process of interpreting during the course of an analysis,
since each interpretation can thus be seen as a member of an
interpretative series (Rycroft 1986). In this case, the ‘‘interpretive
action’’ was the beginning of a new series.
Intervention as a ‘‘Moment of Meeting’’ (Stern et al. 1998)

The moment when I took the decision to intervene in an unusual way
reminds me of the ‘‘now moment’’ (Stern et al. 1998), a ‘‘present mo-
ment’’ with a subjective quality that could alter the therapeutic relation-
ship. The ‘‘now moment’’ forced me into a response that was novel to
our habitual framework. Because at this moment I felt that I was at an im-
passe, but I also felt that I could seize it as an opportunity; it was a mo-
ment pregnant with anxiety as well as expectancy. The ‘‘now moment’’
occurred when the therapeutic frame was at risk of being broken. As de-
scribed by Stern, it may have played a mutative role, since it implied an
affective attunement and a cognitive reappraisal that stemmed from the
newly created dyadic state.
The Self-revealing Aspect of the Intervention

I am very much aware that the intervention described earlier was not
only a commentary on my patient’s deeper motivation, but it was also a
LUST FOR LOVE 63
self-revealing remark (Singer 1977). Renik claims that ‘‘anonymity for the
analyst is impossible, not only complete anonymity but any anonymity at
all’’ (1995, p. 468). Some authors claim that every intervention hides some
things about the analyst and reveals others (Chused 1990; Greenberg 1991).
In this case, I could give voice to the patient’s longing for love with-out
revealing my own longing for love. But the self-revealing aspect of the
intervention made the patient realize that her hungry need for physical
closeness and the pain and rage consequent to its lack resonated in me.
Only later in our work did we understand that underlying Deborah’s
unconscious wish to show me her vagina and to look at mine, was her
deeper need for a mutual relationship in which she had to ‘‘discover’’ my
feelings in order to get in touch with her own.
The Psychic Equivalent of Touching by Means of Words

in Analysis—Becoming an Emotional Surrogate
My verbal response to Deborah’s need for love initially stemmed from
my fear of her self-destructive tendencies. When the negative
transference culminated in her threat of leaving treatment, I was aware of
the implicit possibility of her becoming self-destructive if I were not to
acquiesce in some way.
I therefore had to take a different course of action. I had to become an
emotional surrogate, to offer her emotions to enable her to feel. To this
end, it was not enough to use an ‘‘objective’’ interpretation (Gedo 1994),
which named, in a kind of objective and neutral way, the feelings evoked
in her in the transference (with or without linking them to emotions
toward primary objects in the past). Instead, I had to ‘‘embody’’ the
affect-ive states by expressing them myself. Modell (1990) observed that
in spe-cial moments in treatment it is virtually impossible to discern
whether a specific insight originated with the analyst or with the
analysand. Here, too, the statement I made belonged to both of us.
The loss of my separate individuality possibly began at the moment I
attempted to render myself unconsciously receptive to being made use of.
Unconscious receptivity of this sort (e.g., Bion’s [1962/1989] state of
‘‘rev-erie’’) involves a partial giving over of one’s separate individuality.
By becoming the patient’s emotional surrogate, I made myself available
to a new object relationship that facilitated some understanding and growth.
Loewald has stated that new spurts of self-development may occur
64 CHAPTER 3
through the establishment of new object-relationships (1960, pp. 224–

25). Grunes believes that a new object-relationship in therapy increases
the pa-tient’s sense that ‘‘words do convey affectively alive experience
and can also be experienced as expressions of volition and desire’’ (1984,
p. 127; also cited in Reppen 1999). My view is that by becoming my
patient’s emotional surrogate, I responded intuitively to her regressive
need for ‘‘primary love’’ (Balint 1968) from a primary object. Anzieu
describes this eloquently: ‘‘It is only through his discourse that the
analyst can touch his patient. Through the internal view of elaborating an
interpretation, the analyst has to find words that are symbolic equivalents
of what was miss-ing in the tactile exchanges between the baby and the
mother. Through these words, which involve the body of the
psychoanalyst speaking on a pre-linguistic level, one can in fact touch the
body of the patient’’ (1986, p. 86).
Because it became possible to work through my patient’s demand for
further gratification after I had met her need verbally, I could conclude
that my response was necessary for turning the process that had begun in
a malign form of regression—the craving for satisfaction—into a benign
one—a ‘‘regression for recognition’’ (Balint 1968). By this I mean that
Deborah was able to use my reaction to continue her internal dialogue.
The Use of Words as a Means for Enhancing the

Capacity to Feel
The use of a verbal interaction to overcome the unconscious self-limi-
tation of the patient’s capacity to experience being alive was an important
factor in this case. The patient’s deadness was expressed in the constriction
of the range and depth of her feelings. By embracing this form of psycho-
logical deadness in order to avoid psychic pain, she sacrificed much vital-ity.
Therefore, at a certain point in analysis I had to actively, and even
passionately, find words to convey an emotional experience to her. These
words were, in Ogden’s poetic terms, not ‘‘lifeless effigies’’ but rather ‘‘liv-
ing tissue’’ (1999, p. 5), and were intended to revive her inner deadness.
In this context I would like to quote Goethe who, in his play Faust,
describes the yearning for the experience of being alive in the following
way: ‘‘[A]nd I’m resolved my most inmost being shall share in what’s the lot
of all mankind that I shall understand their heights and depths, shall fill my
heart with all their joys and grieves’’ (1808/1984, p. 46; also cited
LUST FOR LOVE 65
in Ogden 1999, p. 16). I believe that the analytic discourse in this case
enhanced the capacity of the patient to experience the ‘‘joys and grieves’’
of human emotion.
The Purpose of Manic Defenses

I would now like to return to the questions that I raised at the begin-ning
of this chapter regarding the manic defenses that were the underlying issue in
this case illustration. But I will first deal with Deborah’s need for her manic
defenses and the purpose they served in her life.
Kernberg (1975) pointed out that intense sexual strivings may prema-
turely develop in a child to deny frustrated oral and dependent needs. He
emphasized that such development powerfully reinforces oedipal fears by
pregenital fears of the mother, thus interfering with a positive Oedipus
complex. Adult sexuality is then characterized by a sexualized search for
the gratification of oral needs from an idealized mother, leading to homo-
sexuality, as it shown by this case study.
Deborah used her homosexuality to deny gender and sexual differ-
ences. Freud (1927) believed that this kind of denial, together with the
denial of castration and splitting of the ego, led to the formation of the
perverse structure. Contemporary literature emphasized the omnipotence
characterizing this defense. Chasseguet-Smirgel (1984) pointed to the
om-nipotent pretension inherent in denying the limits of sexual
possibilities as a way of protecting oneself from the terrifying awareness
of differences in gender and generation.
Deborah also used her homosexuality to deny an inner reality that was
completely unacceptable to her. She fled from an internal reality filled with
hatred and the repudiation of the maternal object, to an external real-ity in
which there was an ideal maternal figure, embodied by a female lover. The
‘‘suspended animation’’ (Winnicott 1935)—the attempt to om-nipotently
control the bad internal object by denying its existence through the flight to
this kind of external reality—obstructed her relationship with her children,
husband, and close friends. As a result, Deborah was unable to experience
warm feelings; she felt dead inside and her world became an emotional
desert. Deborah’s frantic search for a homosexual partner can be seen, in
Kahn’s (1979) words, as a compulsive attempt to conceal and partially
substitute for the absence of the feeling of being alive. By means of this
manic defense, she even tried to reverse the deadness into aliveness,
66 CHAPTER 3
but without much success. Using homosexuality, Deborah tried to create

a sense of her self, though at the expense of the self, and her sexuality
remained fragmented and infantile (McDougall 1978, 1986). Deborah’s
compulsive desire for a homosexual partner could also reflect the need to
convert her own infantile trauma into an adult triumph (Stoller 1975).
From Kohut’s (1971, 1977) point of view, this was a desperate attempt to
reestablish the self ’s integrity and cohesion in the absence of an
empathic response from an important other.
What Can We Hope to Achieve by Means of

Psychoanalysis in a Case Where Homosexuality Is Used
as a Manic Defense?
The analysis of this case shows the great difficulty in giving up homo-
sexuality when it is used as a manic defense against fragmentation and
psychic death. Nevertheless, we see that some important changes did in-
deed occur in this case.
A change occurred as a result of Deborah’s working through her con-
flicting attitude toward her maternal introject, the ‘‘dead mother’’ (Green
1986) who, herself tremendously threatened by emotions, had prohibited
the emotional life of the daughter. Deborah had to part from this cas-
trated, as well as castrating, maternal representation in order to become
emotionally alive and also to be able to appreciate the positive elements
in her life. Her separation from her mother also led to the diminishing of
her self-destructive, ego-alien tendencies, which stemmed from her
intermi-nable emotional frustration.
Another change was Deborah’s increased ability to deal with the
anxiety ruling her inner world, which resulted in her abandoning her
frantic search for a homosexual partner. In her interesting paper
‘‘Womanliness as a masquerade,’’ Riviere claimed that ‘‘what appears as
homosexual or heterosexual character-traits, or sexual manifestations, is
the end result of the interplay of conflicts and not necessarily evidence of
a radical or fun-damental tendency. The difference between homosexual
and heterosexual development results from differences in the degree of
anxiety’’ (1929, p. 303).
Deborah did not give up her homosexual identity; she continued to feel
attracted to women, but, and this was the greatest change, she became
sufficiently in touch with her emotions to appreciate what she had in life.
LUST FOR LOVE 67
As a result, she was able to give up her manic defense—her frantic

search for a homosexual relationship, the purpose of which was to mask
her inner emotional deadness.
What is the role of the analyst in such cases? It is now widely accepted
that analysis of deviant sexuality is not so much a matter of decoding and
interpreting fantasies, anxiety, or unconscious defenses that are acted out
or represented in this kind of activity, but rather a matter of understand-
ing and interpreting the transference phenomena constructed on the basis
of the patient’s internal world (Meltzer 1973; Ogden 1996). I believe that
in cases in which sexuality is uncoupled from its ‘‘natural’’ goals and
serves mainly as a manic defense against fragmentation and psychic
death, the analyst should use his countertransference feelings in a way
that can help the patient feel more alive and whole. However, I have great
doubts about the possibility of achieving a complete change in such
cases. The relinquishment of manic defenses may threaten the patient’s
fragile psy-chic survival, and fragmentation and psychic death may be
experienced as imminent. In the present case I had to reappraise my goals
and accept that a compromise solution was the only solution acceptable
to my patient. The treatment enabled Debora to be in touch with feelings
without giving up her homosexual identity. Far from solving all of her
problems, Debo-rah nevertheless emerged from the treatment better
equipped to face life as well as her homosexual conflict.
II
UNRESOLVED
MOURNING AND ITS
BEARING ON SOCIETY
Introduction
Mourning is an individual phenomenon as well as an enduring group

phe-nomenon. Group mourning, collective mourning, is a complex
phenome-non, because the group is not simply a collection of individuals
but the product of a combination of different characteristics.1
Volkan (1992) explored the phenomenon of collective mourning from the
perspective of large-group psychology. He stated that large groups, like
individuals and families, mourn too. Members of a group who share the
same loss collectively go through a similar psychological mourning proc-ess.
As with individual mourning, the work of collective mourning helps the
group accept reality, adapt to the shared losses, and continue life.
Traumatic events, which exacerbate feelings of humiliation and help-
lessness and which can cause post-traumatic stress disorder (PTSD),
inter-fere with the initiation or adaptive accomplishment of the work of
mourning. Volkan claims that the influence of a severe and humiliating
calamity that directly affects all or most of a large group forges a link be-
tween the psychology of the individual (his individual mourning) and that
of the group (collective mourning).
Chapter 4 attempts to illustrate this link by integrating the analysis of a
Romanian patient’s unresolved mourning over the loss of primary ob-
jects and migration to another country with an examination of the unre-
solved mourning of Romanian society. Romania’s societal mourning was
largely due to the loss of its corrupt leader, who in the collective uncon-
scious represented a father figure. The mourning stemmed also from the
ideological migration of Romanian society from Communism to a West-
ernized society.
Groups, like individuals, struggle against feelings of pain and mourn-
ing. Groups may avoid mourning by transmitting feelings of pain, shame,
and guilt from one generation to another. This phenomenon occurs when,
in the wake of a traumatic event, the mental representation of it that is
71
72 INTRODUCTION
common to all members begins to take shape. This mental representation

is the consolidated collection of the shared feelings, perceptions,
fantasies, and interpretations of the event. Also included in the mental
representa-tion are mental defenses against painful or unacceptable
feelings and thoughts. When mental representations become so
burdensome that members of the group are unable to initiate or resolve
the mourning, their traumatized self-images are passed down to later
generations in the hope that others may be able to mourn and resolve
what the previous genera-tion could not (Volkan 1991, 1992, 1997, 1999,
2002; Volkan and Itzkow-itz 1994).
Chapters 5, 6, and 7 deal with the transmission of trauma in cases of
Holocaust survivors and their offspring. This phenomenon is primarily the
outcome of the survivor parents’ unresolved mourning, which is trans-mitted
to the offspring. In this regard Barocas and Barocas (1979) state: ‘‘They
[children of survivors] seem to share an anguished collective mem-ory of the
Holocaust in both their dreams and fantasies, reflective of recur-rent
references to their parents’ traumatic experiences. These children wake up at
night with the terrifying nightmares of the Nazi persecution, with dreams of
barbed wires, gas chambers, firing squads, torture, mutilation, escaping from
enemy forces and fears of extermination’’ (p. 331).
The clinical chapters on this topic attempt to deepen our understand-
ing of two distinct methods used by Holocaust survivors’ offspring in
their endeavor to deal with the pain and mourning transmitted to them by
their parents:
1) a substitute-for-mourning mechanism called enactment

2) a reparative defense of creative activity
The transformation of enactment into mental representations and the

elaboration of creative activity in therapy enable differentiation between
the parent’s story and that of the offspring and facilitates mourning.
NOTES
1. In ‘‘Groups psychology and the analysis of the ego,’’ Freud (1921) distin-
guished between individual psychology—that is, concerns of the individual that
relate to the gratification of and defenses against instinctual drives and wishes—
and group psychology. Freud began by examining the late-nineteenth-century
theories of the French sociologist Gustave Le Bon, who postulated that an
individ-ual within a group loses much of his distinctiveness and acts instead in
accordance with the homogeneous urges that unite the group (p. 234). Freud
stated that the group was different from the sum of its parts.
4
Romania and Its Unresolved

Mourning
I would give all the landscapes of the world for that of my
childhood. I must add, though, that if I make a paradise
out of it, only the tricks of infirmity of memory can be
held responsible.
—E. M. Cioran 1982, p.12; quoted in Amati-Mehler
et al. 1993 and quoted in S. Akhtar 1999, p.89
In this chapter, I explore the phenomenon of delayed mourning due to

migration, both on an individual level and on a societal level. While mi-
gration is the more general term, strictly speaking, to emigrate means to
leave one’s country and to immigrate is ‘‘to come to a country of which one
is not a native, for the purpose of permanent residence’’ (Urdang 1968). I
will first describe the phenomenon of delayed mourning for pri-mary objects
due to migration on an individual level, basing it on a thera-peutic encounter
between a patient who had just emigrated from Romania to Israel and a
Romanian-born Israeli analyst. I will then examine the un-resolved mourning
of Romanian society, which was transplanted from one culture to another by
means of its transition from a Communist dicta-torship to the post-
Communist era—another form of migration. This un-resolved mourning was
also expressed through the longing of many Romanians for their infamous
leader, Nicolae Ceausescu, who functioned as a mental representation of a
father figure. The longing is a clear indica-tion that his followers internalized
his image and therefore found it diffi-cult to change their identification with
this leader, even long after he
7
3
74 CHAPTER 4
disappeared. In Romania, the influence of Nicolae Ceausescu continued

to have far-reaching effects years after his execution (Volkan 1998).
AN IMMIGRANT PATIENT AND AN ANALYST OF THE

SAME NATIONAL ORIGIN
Anna, a young doctor specializing in psychiatry, had emigrated from Ro-
mania to Israel several months before she was referred to me. Anna had
completed her medical studies in Bucharest and was now completing her
internship in a psychiatric hospital in Israel.
In the first session, Anna told me that she was referred to me by the
senior psychiatrist of the locked ward where she was working. This
psychi-atrist, a woman who had also emigrated from Romania to Israel
many years ago, befriended her and tried to help Anna adjust to her new
coun-try. Anna had been feeling quite depressed since her immigration to
Israel, and she derived strength from their friendship. Lately, their
conversations had revolved around having children, since Anna, although
married for seven years had not yet tried to conceive a child. These
conversations aroused much sadness in Anna, who claimed that she was
not fit to have children of her own. It was in response to this that the
friend suggested the possibility of therapy. Anna accepted the idea with
the request that the therapist speak her own mother tongue. The
psychiatrist friend then re-ferred her to me.
Although initially hesitant about conducting analysis in Romanian be-
cause of my lack of fluency in the professional terminology of the
language (I had emigrated from Romania as a child), I agreed to do it,
because it is nonetheless my mother tongue, and I thought that it could be
an enrich-ing experience for us both.
Anna was a pretty woman in her early thirties. She had brown hair and
brown eyes, an expressive face, and a feminine demeanor. Anna spoke to
me in Romanian, and I was impressed by her sophisticated and beautiful
use of the language.
From the very start of therapy, using my mother tongue had a strong
emotional impact on me. I felt excited and somewhat intimidated. My
mastery of the Romanian language is relatively good, so I am often told.
But relative to whom? I now asked myself this question while listening to
Anna. Relative to a twelve-year-old child, the age at which I had illegally
emigrated from Romania together with my parents, I silently answered
ROMANIA AND ITS UNRESOLVED MOURNING 75
myself. I had not forgotten the language, since it was the language I had
spoken at home with my parents in Israel throughout my adolescence, but
I had never acquired a more sophisticated Romanian in adulthood.
I was aware that my feeling of intimidation stemmed from a very deep
personal experience from childhood that echoed inside me from our first
encounters. The Romanian language represented a world of purely private
experiences for me. The story in the family was that although my parents
spoke German at home, I preferred to speak Romanian, which I had learned
from my nanny. The nanny was a very devoted Christian Advent-ist who had
taken care of me as a child and had showered me with love.
Although I have conducted analyses in foreign languages that I
learned to speak later in life, nothing was further from my professional
world than the language of my childhood and adolescence. Would I be
able to con-duct analysis in this language, so distant from my
professional work? It became clear to me that by accepting my patient’s
terms, I had lost the asymmetry necessary for a therapeutic relationship
(Zac de Filc 1992). Moreover, my simple, unsophisticated language
placed me in the position of a child, especially when confronted with the
elegant language of my ‘‘grown-up’’ patient. I began to wonder whether
this unusual situation, in which the therapist finds him- or herself
linguistically disadvantaged, with all its emotional implications, might
not have a negative effect on the treatment. What had I compromised by
accepting, albeit with some mis-givings, my patient’s request, I asked
myself. On the other hand, didn’t my patient have a right to treatment, in
spite of being a new immigrant to this country and not having command
of the local language? Did I have the right to condemn her to silence and
a childless fate, without giving her the opportunity to struggle against it?
I will not describe the entire course of this long and complex analysis.
Instead, I will focus upon Anna’s identity problem, which had become even
more pronounced as a result of her immigration to Israel. I will then deal
with the working through of her incomplete mourning for her par-ents, the
postponement of which had been aggravated by her immigration.
From the beginning of her treatment, I was aware of Anna’s nostalgia for
the country she had left behind. Anna’s memories centered more on places
than on people. She recalled the houses, cafe´s, street corners, hills, and
countryside of her homeland. During her sessions, my office was filled with
the colors, sounds, and smells of places familiar to both of us from
76 CHAPTER 4
our childhoods. This made me understand why Anna wanted to talk to

me in her mother tongue. She wanted to share her very early experiences
of a place that she hoped was familiar to me from my own childhood.
Anna was looking for a special kind of understanding.
The therapeutic relationship that emerged helped Anna, toward the end
of the first year of analysis, disclose an extremely important secret to me.
Anna spoke in depth about her feelings of estrangement in Israel. I could
easily identify with this, remembering my own feelings of uprooted-ness
and vulnerability as a new immigrant. The reason that Anna gave for
feeling so foreign was unexpected: ‘‘I am not Jewish. I do not belong
here,’’ she said. ‘‘Nobody knows about this; it is a secret.’’ I was very
sur-prised indeed. If there is a typical Jewish appearance, Anna had it. It
fleet-ingly occurred to me that her brown hair and beautiful brown eyes
would have definitely endangered her life during the Holocaust.
The story that followed revealed that Anna and her husband had had a
considerable struggle to get out of Romania. Since at that time this privi-
lege of leaving Romania was given only to Jews, she and her husband
searched for a Jewish connection. Anna’s husband discovered that his
mother’s first husband was Jewish. This fact, in addition to a heavy bribe
paid to the Romanian officials, enabled the couple to obtain the false pa-
pers necessary for being considered Jewish, thus enabling them to immi-
grate to Israel.
My gut reaction to Anna’s story was the wish to console her. ‘‘Who
cares whether you are Jewish or not?’’ I wanted to say to her. However,
aware that my impulse to deny Anna’s feelings of being a stranger proba-
bly stemmed from my own painful memories as a child in Romania, I
kept quiet.
My first memory evoked by Anna’s story was that of the complicated
world of a Jewish child from a rabbinic family growing up with a
Christian Adventist nanny, who faithfully took me to Adventist services
on Friday afternoons (of course, without my parents’ knowledge!). I
remember lov-ing Jesus and the beautiful pictures and sculptures of him.
How great was my frustration when I discovered that, being Jewish,
Jesus was not our God! Also, growing up among Christian Orthodox
children I learned that we, the Jewish people, were accused of having
killed Jesus and were there-fore damned forever. My Hebrew name made
the fact that I was Jewish, and thus a foreigner, obvious to everyone.
On the other hand, I remembered that coming to Israel, the country we

had longed for, and living among Jewish people, did little to alleviate my
feelings of being an outsider. In the new country, children looked and
behaved differently; they spoke a language totally foreign to me. It took a
long time for me to feel at home, and I never completely acquired the
sense of belonging that I had so desired.
Based on my countertransference feelings, I asked Anna if she thought
that her feelings of being a foreigner stemmed from immigrating to Israel.
Anna reflected and said quietly, ‘‘Actually, I have felt a stranger all my
life.’’ Anna added that in her neighborhood in Romania there were many
German-speaking people as well as Jews, and as a result, she understood
both German and Yiddish. ‘‘I always admired the Jewish people and wanted
to live among them. They are clever and witty,’’ she said, smiling.
What a strange world, I thought to myself. As a child I wanted to be-long
to the Christian majority, which I felt was all-powerful, and Anna wanted to
belong to the Jewish minority, which she imagined was supe-rior. This
childhood experience that we both shared, a longing to belong to another
nationality, had an impact on me as well as on the therapeutic relationship. I
realized that, as children, we unconsciously longed for a happier, better-
integrated family, and we projected the qualities of strength of body and
mind onto each other’s ethnic group. Based on my own realization, I pointed
out to Anna that she perhaps had always wished to have a happier family,
and that she imagined this family to be Jewish.
Anna was able to accept this interpretation, which facilitated the further
working through of the painful love-hate relationship that characterized her
attitude toward her own family. We first elaborated upon the feelings that
accompanied the loss of her parents. She recounted at length her mother’s
terrible suffering and death; her mother had died of brain cancer when Anna
was twenty-one. Anna and her older sister lived with their mother, who
devoted her life to the care of her daughters. Her parents divorced when
Anna was around twelve years old. She witnessed many violent quarrels
between her parents, and always felt that she had to pro-tect her mother from
her brutal father. She remembered the bitter day when her father left home
and moved to the city. He was a well-known musician with many women
friends. Her poor mother worked long hours as a cashier in a store and was
barely able to support her children. Her dream was that her daughters would
have an education and Anna, the
78 CHAPTER 4
brilliant medical student, fulfilled her mother’s dream. Anna was very
attached to her mother and did everything she could to make her happy.
When she was an adolescent, Anna occasionally visited her father.
Anna liked him; he was very charming and seductive. He took her to
concerts where he presented her as his young mistress and invited her to
restau-rants with his friends. After a while, her father became very
depressed. He became an alcoholic and abandoned his work at the
orchestra. Two years after her mother’s death he was found dead in his
apartment, probably as a result of alcohol and drugs.
During the year of her mother’s illness, Anna took constant care of
her. Though trying hard to study as well, she was unable to concentrate.
Her mother died and Anna failed her final exams.
Anna left home after her mother’s death and moved to the city. Her sister
was already married with children. Anna felt completely abandoned and was
unable to mourn her mother or, later, her father. She had an unhappy affair
with a man she did not love, followed by an abortion. Anna was depressed,
unable to continue her studies or find work.
In the midst of this chaotic, fragmented life, she regained control of
her faculties and decided to reregister at the university to retake the
courses she had failed. There, she met a young man, her future husband,
who gave her much love and support. The relationship had parental
aspects that Anna very much needed. She loved her husband, and they
decided to-gether to immigrate to Israel and build a new life.
Anna’s maternal grandmother, who lived in Romania, died while
Anna was in analysis. This event put Anna in touch with a great deal of
grief and pain. Working through this powerful outburst of mourning in
analy-sis made Anna aware that she had never actually mourned her
parents. Anna expressed a wish to visit her parents’ graves, as well as
that of her grandmother, to whom she had been very attached. I felt that
Anna had to go back to her country of origin in order to complete her
work of mourning. She had to mourn her lost beloved ones, as well as the
parts of her own self that had remained there. Anna longed to see the
color of the trees, the familiar streets and houses, and her childhood
home. She also wanted to visit her sister and family, to bring them
presents from Israel, and to bring back some of her personal belongings
that she had left be-hind. In analysis, I felt that Anna was asking me to
give her the courage and support to undertake the visit.
When Anna returned to analysis three weeks later, after her visit, she
looked different. The depression that had accompanied her before was gone,
and it was replaced by a statement of loss and pain. During this period, we
were able to work through her love and longing for her mother, as well as
her anger at being abandoned by her when she was so young and helpless.
We discovered that behind the bitterness toward her abandoning father were
feelings of pity and sorrow, as well as love and admiration.
Much psychic work was needed for the completion of Anna’s work of
mourning. The elaboration on the visit to her parents’ graves, its emo-
tional meaning, and the separation from her parents preoccupied us for an
entire year. At the end of this year, Anna came to her session smiling and
asked me if I was ready for a surprise. Radiant with happiness, she broke
the good news: ‘‘I am pregnant,’’ she said, ‘‘and it took me only one
month.’’
Anna was elated, and I rejoiced in her happiness. I accompanied Anna
through her pregnancy, which included all of the normal anxieties and
expectations of a young mother. Knowing that she would have a boy, she
raised the question of circumcision. (Jewish males are circumcised at the
age of eight days, this being considered a sign of the covenant between
the God of Israel and his people.) In the end, she made her decision: ‘‘I
want my boy to be circumcised. He lives in this country, and he will be
like everyone else.’’ Her husband was of the same opinion.
When her analysis ended some months later, Anna promised to come
back and visit me sometime. She indeed came to see me two years later
with a most adorable toddler. She had completed her internship, had
begun working as a psychiatrist, and the family’s economic situation had
improved. She had recently heard from some colleagues that I was plan-
ning to go to Bucharest for work and she was very excited about that. ‘‘I
would very much like to go with you, to take you around, to help you
there,’’ she said. ‘‘You helped me go back and find myself. You gave me
a lot and I would have liked to reciprocate,’’ she added in her beautiful,
elegant Romanian.
In the autumn of that year, thirty-six years after leaving the country, I
returned to Romania in a professional capacity. A colleague met me at the
airport and, at my request, we immediately set out to find my childhood
home. We reached my old neighborhood that was so familiar to me, and
80 CHAPTER 4
I easily found my way around. I looked at the houses, churches, and streets
that were imprinted upon my memory and walked about as if in a dream.
When I arrived at the square where my parents’ house was supposed
to be, I was struck by the strange sight that unfolded before my eyes: The
left-hand side of the square looked the same as I remembered it, but the
right-hand side, where our house once stood, had changed completely.
Stunned, I stood in front of the square, asking myself over and over
again, ‘‘But where is the house? Where is it?’’ My colleague, who had
already warned me that parts of Bucharest had completely disappeared
during the rule of Nicolae Ceausescu, patiently explained to me what I
already knew. Ceausescu, the former dictator of Romania, had destroyed
entire neigh-borhoods; beautiful historical buildings and churches that
had given the city its very special character had been torn down
indiscriminately. In their place, architectural monsters had been erected,
their ugly grandiosity reminiscent of the Fascist era, as well as of
Ceausescu’s megalomaniacal wishes, ruthlessness, and oppression.
The same traumatic experience confronted me when I attempted to
find my grandparents’ house. The house, which had also served as a
syna-gogue in the Jewish community and in which I had lived until the
age of four, held some of my earliest memories. I still remembered the
sun shin-ing through the leaves of the tree in the big yard where I played.
I also remembered the Torah scroll in the synagogue, as well as my
grandmoth-er’s big kitchen where, as a young child, I enjoyed cooking
with her. This house had been the container of feelings of warmth and
love, and my memories of it had served as a source of strength and
courage during dif-ficult moments of my life.
Staring at the new surroundings for some time, I realized that both my
parents’ and grandparents’ houses had vanished into thin air. Feelings of
anger overwhelmed me. After working them through, they gave way to
feelings of sorrow. I felt as if the houses were parts of myself that were
irretrievably lost. I became aware that, although I had done much work of
mourning throughout my life, it was far from complete. Working through
my mourning, I thought often of Anna, my Romanian patient. I realized
the impact that the treatment had had on both of us. Not only had I
helped Anna in the search for her self but, by assisting her on her journey
back to her homeland, I myself was better prepared for the visit back to
my birthplace. Thus, Anna’s wish to accompany me on my journey back

to my country of birth was realized, at least in fantasy.
THOSE WHO STAYED BEHIND—AN EMIGRANT SOCIETY

In January 2001, my book The Cry of Mute Children, which deals with the
understanding and treatment of second-generation Holocaust survivors,
appeared in Romanian, published by Editura Trei (Kogan 1995). The book’s
main themes are, first, the transmission of trauma from one gener-ation to
another and, second, the creation of hope and the reconstruction of the self-
image. I feel that these two themes are relevant to Romanian society and to
anyone whose life has been touched by the reality of war, violence, and
trauma. The Romanian people suffered the trauma of living under a
dictatorship that ruled by terror and violence. Not only did they live lives of
sheer misery, but they had also been humiliated and infanti-lized. In my
encounters with local Romanians, I have seen a lack of self-assurance, a
derogatory attitude toward themselves, and a lack of belief in their ability to
create a better future. The many years of oppression and terror left a deep
imprint on their psychic make-up.
Over the past few years I have taken an active part in the establishment
of the Psychotherapy Center for the Treatment of the Child and Adoles-
cent in Bucharest, the first of its kind in Romania. Here is how this center
came into being: On one of my visits to Romania in a professional capac-
ity, to work with Romanian therapists, I was met at the airport by a col-
league, Vera Sandor. It was December, the trees were covered with a
heavy blanket of snow, and there was a thin layer of ice on the ground,
which I was told was very slippery and dangerous. During our ride from
the air-port, I was deep in thought, looking at the beautiful patterns that
the snowflakes created on the windscreen, patterns that reminded me of
scenes from my childhood. At a traffic light, I saw a small dark figure
banging on the window. Startled, I asked Vera, ‘‘What is that?’’ ‘‘A
street child,’’ she replied calmly. Then she went on to explain about the
life of street children, which I was familiar with only from Western
literature on Romania.
The traffic light changed, and we drove off. However, the face of that
little child continued to haunt me for a long time.
It was during this visit that Vera talked about her dream of setting up
the Psychotherapy Center for the Treatment of the Child and Adolescent
in Romania. ‘‘There are houses for street children, but they usually run
82 CHAPTER 4
away from them. We should find better ways to deal with that, but it is also
vital that we prevent others from becoming street children. As you know,
there are lots of families in Romania with problematic children who are not
on the streets, and these children have no place to turn for help,’’ she said.
This is very true, I thought, and I wondered what was happening to those
children who did have families, food, and clothing, but who were also
suffering from psychic problems. Their future is grim, and they may end up
becoming thieves, criminals, psychotics, or drug addicts. Shouldn’t we use
our knowledge and experience to avoid such catastrophes that could affect
their lives and the shape of an entire society?
Leaving Romania for Hamburg to work with my colleague and friend
Professor Peter Riedesser, I shared with him the dream of setting up such
a center in Bucharest. Peter, a man of vision, enthusiastically became part
of this enterprise.
I will not go into the details of the long journey we both made in order
to realize this dream. Suffice it to say that after the many difficulties and
disappointments that we encountered along the way, there were people
who had faith in our work and goals, and who helped us set up the center
in Bucharest.
During my many subsequent visits to Romania, I supervised the work
of the staff as well as the center’s activities and goals, and I learned how
Romanian society had reacted to the abrupt change from a totalitarian
Communist regime to a Western lifestyle. Discussions with friends, col-
leagues, and students showed me that the general feelings toward the
total-itarian regime were disappointment, hatred, and impotence. In spite
of this, the Romanian people still felt some yearning for the past. This
phe-nomenon is frequently found in many countries that become
westernized. What is unique about Romanian society is that it suffers
from a state of unresolved mourning for a dictator who they themselves
eliminated. This pathological mourning for old values and for the image
of the lost dictator made it more difficult for Romanian society to
integrate the new attitudes and values of the new era.
Entering a new era, Romanians were first forced to reevaluate old
prin-ciples and adapt to different values. They could envision promising
oppor-tunities, but these were accompanied by alien, burdensome
requirements. They had to abruptly exchange the rituals and teachings of
a familiar cul-ture for a new, unfamiliar situation (Kahn 1997).
In addition, the totalitarian Communist regime had stifled the initiative

for private enterprise as well as the motivation needed to achieve a higher
work ethic and a higher standard of living. The state had provided a se-
cure, albeit very low salary for the people, independent of the quality of
their work. There was equality in this situation, since a miserable, poor
life was almost everyone’s fate. Basic needs, such as health and
education, were taken care of by the state. This infantilized the
population, making them unable to take responsibility for their own lives.
The new post-Communist era also created turmoil in peoples’ lives.
Despite the promise of freedom and opportunity, the immediate reality
required skills that had not been developed for a long time and a motiva-
tion to work, to which they were unaccustomed. The Romanian people
also experienced narcissistic hurt when comparing their lives to life in
the West and in particular to that of the other westernized countries of
Eastern Europe; this was accompanied by feelings of shame and
humiliation. In comparison with the West, their own living quarters and
attire took on a shabbiness that they regarded with the embarrassment of
the newly poor. For the most part, they still considered themselves
incapable of coping in a competitive economy; they were embarrassed by
their inexperience in carrying out the complex practices fundamental to
the democratic process.
As a result of these changes, the Romanian people came to feel the hu-
miliation of the breadwinner’s vocational worthlessness in the workplace and
resultant loss of status within his family. The purchasing power of their
savings and their modest pensions became insignificant. From my
encounters with the group that initiated the center, I learned that Roma-nian
society looked upon the West with awe and suspicion. When I told this
group about the efforts made in the West to help them construct the center,
they asked fearfully, ‘‘Why do they want to do this for us?’’ I then realized
that one of my first roles would be to serve as a bridge to the West, one that
would allow the people to build a future relationship of trust.
DISCUSSION
In my discussion, I first focus on the impact that emigration had on the
sense of identity and the mourning process of the patient described in the
first part of this chapter. I then briefly relate this process to mourning
processes on a societal level.
84 CHAPTER 4
The capacity to maintain a sense of consolidated identity (sameness

amid change) was first noted by Erikson (1950, 1956). More recently,
Stern (1985), through his recent concept of ‘‘self-history’’ (i.e., a sense
of continuation with one’s subjective past), refers to this same capacity.
In trying to clarify the concept of identity, Akhtar (1999) has noted that
indi-viduals with a solid identity retain genuine ties with their past while
com-fortably locating themselves in their current reality.
The drastic alteration of external reality resulting from migration from
one country to another produces a profound psychic flux and has an im-
pact on an individual’s identity. Loss of familiar landscape, music, food,
language, and customs mobilizes pain and mourning (Grinberg and
Grinberg 1989). Such mourning and ‘‘culture-shock’’ (Garza-Guerrero
1974) cause a destabilization of identity, and it takes considerable time
and intrapsychic work to settle and restabilize itself. However, in
instances where the preemigration character structure is problematic,
where the in-trapsychic separateness did not exist before emigration, the
consolidation of identity may be hindered all the more.
In the case of Anna, the patient came to treatment with conflicts that
had already afflicted her sense of identity. As a child, her ethnic or
national self-representation was laden with shame and she idealized the
Jewish identity. When she became an immigrant in Israel, she felt as
vulnerable as a child and her devaluation of her country of origin as well
as of her own self was reinforced. Much psychic work was needed to
change this devaluating attitude, which stemmed from early traumatic
experiences as well as from her incomplete work of mourning.
Anna suffered not only the loss of her mother and father; by emigrat-
ing, she also lost the support she had drawn from the familiar climate and
landscape, unconsciously perceived as the extension of the mother. Her
wish to return for a visit to her native land, which emerged in analysis,
was very much linked to her longing for lost primary objects as well as
the need to give them up and build a life of her own. Revisiting her
parents’ graves helped her achieve this aim and held great psychic
significance for her (Akhtar and Smolar 1998). By bringing back gifts to
relatives left be-hind and by bringing some of her personal belongings
back with her to her new home, Anna made the first attempts at
separation, like a toddler in the rapprochement phase.
Before she began analysis, the patient had not yet given up primary
objects or familiar places through the work of mourning, nor assimilated

them in the ego through identification. This resulted in a temporal ‘‘frac-
ture of the psyche’’ (Akhtar 1999). One of the aims of her analysis was to
help her put together the different fragments of her psyche, as well as the
various ‘‘pieces of her life’’ (Pfeiffer 1974). The ‘‘holding relationship’’
(Kogan 1995, 1996, 1998, 2000, 2002) in analysis helped her mobilize
forces and go back and face the ‘‘mental pain’’ (Freud 1926) incurred in
the acknowledgment of her losses. This dynamic shift helped Anna con-
tinue her work of mourning in analysis.
Working through feelings of idealization and anger toward her lost ob-
jects facilitated the possibility of meaningful living. This helped her trans-
form a devalued self-representation into a new self-representation, as a
resident of her ‘‘adopted’’ country. The search into the past and the at-tempt
to complete the work of mourning facilitated the creation of a sense of future
that, in this case, was expressed through the creation of a child.
The ‘‘sonorous wrapping’’ (Anzieu 1976) of the treatment conducted
in our native language had an impact on Anna, as well as on myself. It
connected us both to the early maternal image and to early childhood ex-
periences. For the patient, and for myself as well, migration had caused a
ruptured self-experience, which was mended by the emotional refueling
of revisiting the native country. From this point of view, we both
emerged from this analysis with better-integrated selves.
On the societal level, the temporal ‘‘fracture of the psyche’’ caused by
the incomplete work of mourning, is a phenomenon that characterizes
Romanian society as a whole. The people belonging to this society were
not forced to relocate. No one had to leave home. Romanians were
neither forced to cross the borders of their country nor give up their
mother tongue. They did not have to part from their families, or bid
farewell to their friends and neighbors. They did not have to learn a new
language, get used to new customs, eat strange food, or find new friends.
In spite of this, through my acquaintance with Romanian society due to
my work as a psychoanalyst in that country, I realized that emotionally
they were immigrants, people transplanted from one culture to another.
The loss of the old cultural environment threatened established
identifications and the ensuing self-image, and was followed by
mourning that has not been completely resolved even today.
The great disparities between their lives before and after the fall of
86 CHAPTER 4
Communism, as well as the abruptness of the change, left people yearning

for what they had left behind. In this new situation, which had its uncom-
fortable and painful aspects, many felt nostalgic for the past Communist
ideals, and even dared to secretly express a longing for the lost dictator. The
corruption, betrayal, and terrorization by the former Communist government
were partially experienced as an idealized parent who had been exposed as
corrupt or inhuman. The experience of loss of the old culture intensified,
accompanied by anxiety, hostility, and a ‘‘sense of dis-continuity of
identity’’ (Garza-Guerrero 1974). The destruction of former identifications,
as well as the loss of the accustomed life, brought with it depression and
feelings of loneliness. The prolonged despair was due in great part to the
difficulty of working through processes of mourning.
Freud defined mourning as ‘‘the reaction to the loss of a loved person,
or to the loss of some abstraction which has taken the place of one, such
as one’s country, liberty, an ideal and so on’’ (1917, p. 243). For the indi-
vidual, mourning is an obligatory psychobiological process. In normal
sit-uations, if someone dies, we have to do much work to let that person
die psychologically. Without going through the work of mourning, we
cannot genuinely accept the reality that something is lost. And if the lost
person is needed for our psychological well-being, or if he or she forms a
part of our own ego-ideal (Joffe and Sandler 1965; Sandler, Holder, and
Meers 1987), we may slip into a state of pathological mourning.
Romanian society was for a long time marked and characterized by
un-resolved mourning for their dreadful leader, Nicolae Ceausescu.
Volkan (1998) convincingly bases his analysis of the relationship
between Roma-nians and their dictator on Freud’s (1913) psychoanalytic
understanding of primitive man. Volkan claims that although the
Romanians killed Ceausescu, they allowed him to live on in many ways
—most important, through the actions and policies that followed his
death. Their pathologi-cal mourning was expressed through the fact that
they never eliminated the image of the leader (the father figure) but kept
it alive through hatred as well as nostalgia.
Romanians rejoiced over the removal of their dreadful leader but after
the initial excitement, most eventually felt that little had changed. Many
considered the National Salvation Front (NSF) merely an anti-Ceausescu
faction within the Romanian Communist Party and regarded the new re-
gime simply as the replacing of one group of Communists with another.
The Romanian people never fully realized that, although the reign of
Nicolae Ceausescu had ended, his ‘‘sons’’ had not only ‘‘murdered’’ him
but also kept him alive. Having ruled the Romanian people for two dec-
ades, Ceausescu had become a part of them. With his death, a part of
each Romanian also died (Grinberg 1964), but their shame of being
associated with him and their hidden guilt for ‘‘killing’’ him had to be
denied. How-ever, through their identification with him they were also
keeping the dic-tator alive.
In June 1990, nationalists launched a weekly publication called Roma-nia
Mare (Great Romania), a reference to the centuries-old traditional ral-lying
cry of Romanian nationalists before Ceausescu’s rise to power. The paper,
which developed the largest circulation of any Romanian weekly newspaper,
succeeded in keeping Ceausescu ‘‘alive’’ through an undis-guised nostalgia
for his regime. In the year 2000, the head of this weekly publication,
Corneliu Vadim Tudor, became the head of the largest oppo-sition party to
the new government, almost endangering its existence. The party received a
great number of votes, promising to ‘‘purify’’ Romania of the gypsy
population, the Hungarian minority, and the Mafia, while emphasizing
Romanian nationalism. Despite the fact that the NSF was re-elected, the
rejection of democracy by many Romanians and the longing for the past
dictatorship became quite obvious. By identifying with the aggressor, the
Romanians had internalized the image of the dreaded leader and made it part
of themselves (Volkan 1998).
As in the case of my patient and myself, the efforts and willingness of
my Romanian colleagues to accompany me on my journey back to my
childhood may perhaps be viewed as an expression of their own need to
search for their past in order to complete their own work of mourning.
5
From Enactment to Mental

Representation
Over the last twenty years I have dealt with the subject of
intergenerational transmission of the Holocaust trauma and its impact on
the lives of Holo-caust survivors’ offspring, approaching it from different
angles. In this chapter, I focus on a substitute-for-mourning mechanism
expressed through enactment (termed concretization by Bergmann
[1982]). This phenomenon is often found in cases of children of
survivors, especially in the initial stages of their analysis.
I first define enactment, and then discuss it within the context of the
existing literature. I show the aspects of it that are unique to Holocaust
survivors’ offspring, highlighting its function of avoiding mourning and
pain. I illustrate this with clinical material taken from some of the case
studies that I have published (Kogan 1987, 1989, 1993, 1995). Finally, I
offer some technical suggestions that may be used by analysts to help pa-
tients understand the origin of enactments connected to their parents’
traumatic past and facilitate their road to mourning and to the achieve-
ment of a better integrated self.
DEFINING ENACTMENT
Enactment, putting into action, is a nonverbal behavior that reflects what
occurs between patient and therapist in the analytic situation, with the
emphasis on the way the analyst participates in the process. This may be
compared to acting out and acting in. Acting out is the attempt to avoid
painful knowledge in treatment by means of acting instead of remember-
ing and communicating. Acting in is defined as acting in the transference;
89
90 CHAPTER 5
it may be the only way available to the patient to relive an experience and
to convey it to the therapist. The fact that the term enactment was coined
only during the last decade and a half (much later than the other two
terms) reflects the development and change that took place in psychoana-
lytic thinking in this regard. Eshel (1998a) refers to these changes in her
excellent review of enactment, which I briefly summarize below:
Freud, who considered psychoanalysis to be a talking cure, regarded nonver-

bal activity as a problem in analysis. He believed that acting out (agieren) was
an expression of resistance to remembering and communicating, thus
constituting an obstacle to treatment (1905, 1914), as evidenced by the fol-
lowing statements: ‘‘The patient does not remember anything of what he has
forgotten and repressed, but acts it out. He reproduces it not as a memory, but
as an action; he repeats it, without, of course, knowing that he is repeat-ing it’’
(1914, p. 150). But, further on in the same article, Freud indicated that he
viewed acting out in a much more complex way than in his above description
in that article. Apparently, he regarded it not only as resistance to treatment,
but also as a way of remembering: ‘‘As long as the patient is in treatment, he
cannot escape from this compulsion to repeat, and in the end we understand
that this is his way of remembering’’ (1914, p. 150).
Freud’s dual attitude to acting out has been dealt with by other psycho-
analysts. For example, Etchegoyen (1991) agrees completely with Freud’s
earlier notion of acting out as resistance to treatment. On the other hand,
Boesky views acting out as totally necessary for the working through proc-
ess, which he believes ‘‘can never happen without acting out since in this
sense the whole transference is ‘acting out’ ’’ (1982, p. 43–44).
Toward the end of his life, becoming more aware of the close relation-
ship existing between transference and acting out, Freud showed
evidence of a more positive attitude toward acting out. He indicated that
communi-cating through acting was at least as valid as communicating
through re-membering: ‘‘Another advantage of transference, too, is that
in it the patient produces before us with plastic clarity an important part
of his life story, of which he would otherwise have given us only an
insufficient ac-count. He acts it before us, as it were, instead of reporting
it to us’’ (1940, p. 175–76).
This newer attitude of Freud’s, as well as the more recent attempt in
psychoanalytic literature to give greater legitimacy to acting in psychoanal-
FROM ENACTMENT TO MENTAL REPRESENTATION 91
ysis, led to the appearance of two new concepts, acting in and enactment.
These two concepts viewed acting in analysis as a way of remembering
and expressing, and as a nonverbal way of communicating, rather than as
a way of avoiding painful knowledge, as in the case of acting out.
Defined as ‘‘acting in the transference’’ or ‘‘acting in the analytic
situa-tion,’’ acting in has been considered a useful concept by some
analysts (Hinshelwood 1989). A problematic aspect of this concept,
however, is that it is defined by a local or technical situation rather than
by a theory or metapsychology (Etchegoyen 1991; Laplanche and
Pontalis 1973). Con-sequently, a further concept was coined in the last
decade—enactment. First suggested by Jacobs (1986), enactment was
accepted as a far more useful concept than acting in, which was
contaminated by the negative connotations involving resistance to
treatment that were attributed to act-ing out. Enactment differs from
acting out in that it is primarily an inter-active concept, reflecting what
occurs in the relationship between patient and analyst, and stressing the
analyst’s participation in the process (Schafer 1982).
With the continuing development of psychoanalytic thinking, the con-
nection that was postulated between acting out and early, traumatic, non-
verbal experiences reinforced the communicative aspect of this phenomenon.
In cases of trauma, for example, acting out was seen as the expression of an
inner experience. This connection between acting out and trauma was first
made by Fenichel (1945), followed by Greenacre (1950, 1963), Bion (1962),
Rosenfeld (1965), and Meltzer (1967). Kinston and Cohen linked acting out
with trauma and ‘‘primary repression,’’ seeing it as a manifesta-tion of a
‘‘catastrophic, unthinkable, past-but-ever-present trauma and as-sociated
confusion, terror and hopelessness’’ (1986, p. 339).
I define enactment, in the context of the Holocaust, as a general term
that includes the attributes of both acting out and acting in. In this sense,
enactment may serve the purpose of avoiding painful knowledge and
memory (similar to the objective of acting out), while at the same time it
is the only way available to the patient to relive an inner experience that
he wants to convey to the therapist (as in the process of acting in).
My usage of the concept enactment in the context of the Holocaust differs
from that of analysts’ who primarily stress its interactive aspects. These
analysts believe that enactment (or actualization, as it is termed by Sandler
and Sandler 1978) reflects what occurs in the relationship between
92 CHAPTER 5
patient and analyst and the analyst’s part in the process (Schafer 1982;
Chused 1991; McLaughlin 1992; Renik 1993; Jacobs 1991, 2000). I am
de-fining enactment as the compulsion of Holocaust survivors’ offspring
to recreate their parents’ experiences in their own lives through concrete
acts. Thus, enactment refers only to the externalization of traumatic
themes from the past and not to what occurs in the relationship between
patient and analyst in the analytic situation.
THE ROLE OF ENACTMENT

Children of survivors often carry their parents’ unresolved mourning for
their lost loved ones, and therefore engage in a variety of displacement
mechanisms, which can be called ‘‘substitute-for-mourning’’
mechanisms (Bergmann 1982). One of these mechanisms is enactment,
the function of which is the avoidance of psychic pain. In this sense, it is
similar to the phenomenon of ‘‘pensee operatoire’’ (Marty and de
M’Uzan 1963), which is defined as a restricted, pragmatic way of
thinking about people and events, and implies a lack of emotional
response to crucial moments or traumatic losses in the lives of the people
concerned. In trying to avoid psychic pain, both enactment and pensee
operatoire have the quality of acting out.
In cases of Holocaust survivors’ offspring, enactment includes some
as-pects of manic defense, which are expressed through mechanisms of
de-nial, omnipotence, and idealization. Enactment is expressed through
symbolic, displaced actions, which are lived out with current objects, but
are unconsciously addressed to lost loved ones. Shared fantasies of
parents and children are concretized by the children, in the sense that
they are grafted upon the environment and woven into current reality
rather than verbalized. As long as fantasies are active, both parents and
children can omnipotently deny that members of the parents’ families
were killed. Ide-alization of the dead often takes the place of mourning;
archaic fantasies regarding the dead continue to exert an influence on
affects and actions. Keeping the dead alive in fantasy necessitates
enactment in a concrete way to prove that they are still alive. This kind of
enactment leads to living in two realities, that of their parents’ traumatic
past as well as their own pres-ent reality.
Another aspect of enactment in cases of Holocaust survivors’ offspring is
expressed in the fusion of past and present, which is another form of
denial of reality. In such cases, an individual causes another to act toward

him in a certain way by imposing fantasies upon the relationship that are
linked to the parents’ traumatic past. Such enactment expresses a striving
toward the realization of object-relationships with both real and fantasized
objects. In this sense, enactment is a subcategory of actualization (Sandler
and Sandler 1978), a process through which an individual, instead of ver-
bally asking another person to fulfill his wish, causes that person to act in a
certain way in order to fulfill it. It is thus similar to actualization in its wish-
fulfilling aspects, but it differs from it in that it applies only to trau-matic
themes from the past, which gives the need a particular urgency.
These enactments, especially those appearing in the first stages of analy-
sis, constitute the patient’s only means of reliving an inner experience that he
or she wants to convey to the therapist. In this sense, enactments in-clude the
attributes of acting in, which can eventually be used to help the patient
realize the origin of the fantasies that led to the enactment.
THE SOURCE OF ENACTMENT

For children of survivors, there is no memory of a time when the Holo-
caust did not exist in their awareness, whether articulated or unconscious.
The remembrance of the Holocaust is constructed out of materials or sto-
ries—those spoken aloud, told and retold, as well as those silently borne
across a bridge of generations (Axelrod et al. 1978; Barocas and Barocas
1973; Kestenberg 1972; Klein 1971; Laufer 1973; Lipkowitz 1973;
Rakoff 1966; Sonnenberg 1974; Laub and Auerhahn 1993; Auerhahn and
Laub 1998; Brenner 2000). This remembrance marks those who carry it
as secret bearers (Micheels 1985). Children who become burdened by
memories that are not their own (Auerhahn and Prelinger 1983; Fresco
1984) often echo the dramas existing in their parents’ inner worlds by
enacting them in their own life (Krell 1979; Phillips 1978; Laub and
Auerhahn 1984; Kogan 1995, 1998a). These often violent enactments
involve an intermin-gling of death wishes with potentially dangerous
situations (Kogan 1998b). In many cases, they are caused by persecutory
anxieties that grow into delusional fantasies of paranoid proportions,
anxieties that include a lack of differentiation between self and others,
past and present, and inner and outer reality.
At the core of the compulsion to enact the parents’ traumatic experi-
ences in their own lives is a kind of identification with the damaged
94 CHAPTER 5
parent, which is termed primitive identification (Freyberg 1980; Grubrich-

Simitis 1984; Kogan 1995, 1996, 1998). This identification leads to a loss of
the child’s separate sense of self and to an inability to differentiate be-tween
the self and the damaged parent. I find this phenomenon similar to the
identification that takes place in pathological mourning. Freud (1917)
described this identification as a process whereby the person in mourning
attempts to possess the object by becoming the object itself, rather than
bearing a resemblance to it. This occurs when the mourner renounces the
object, while at the same time preserving it in a cannibalistic manner
(Grinberg and Grinberg 1974; Green 1986). It is this type of identification
that is at the core of the offspring’s inability to achieve self-differentiation
and build a life of his or her own.
The coexistence of the offspring’s global identification on the one hand,
and the denial or repression of the parents’ trauma on the other—a co-
existence present in many of these cases—creates a gap in the child’s emo-
tional understanding, a gap I have labeled a psychic hole. The psychic hole
can be seen as a state in which conscious ignorance of the Holocaust (the
hole) is one side of the coin, while unconscious knowledge of it is the other.
In order to convey more vividly the meaning of the psychic hole, I will use a
metaphor from the world of astrophysics—the phenomenon of the black
hole. This term, reviewed by Eshel (1998b, p. 1115), is pregnant with
meaning in psychoanalysis as well as in astrophysics.
I first define this concept as it appears in both fields. I then refer to
various hypotheses regarding the way such a hole is formed, pointing out
its uniqueness in cases of Holocaust survivors’ offspring. In the world of
astrophysics, the black hole is defined as a body that sucks into it all the
forces of gravitation. It is described as a ‘‘region of space-time where
infi-nitely strong gravitational forces literally squeeze matter and photons
out of existence’’ (Penrose 1973; cited in Gribbin 1992, p. 142; cited in
Eshel 1998b, p. 1115).
In psychoanalysis, the term black hole is used to describe the nature of
early traumatizations caused by physical separateness from the primal
mother, which lead to primitive mental disturbances. This concept was first
applied clinically by Bion (1970) in reference to the infantile catastro-phe of
the psychotic. It was further developed by Tustin (1972, 1986, 1990, 1992)
with regard to psychogenic autism of children and also by Grotstein (1986,
1989, 1990a, 1990b, 1990c, 1993) to psychotics and borderlines. As
opposed to these authors, who were referring to mentally ill patients,

Eshel (1998b) used the term metaphorically regarding individuals who
seem to function in their social and professional life; in these cases, Eshel
sees the black hole as the product of the impact of a ‘‘dead’’ parent,
particularly the ‘‘dead mother’’ (Green 1986).
The psychic hole, as I see it, is also a body, as is the black hole of
space; it is the encapsulation of all the fantasies regarding the parents’
traumatic past, an encapsulation that has an impact on the patient’s entire
life. My usage of the term psychic hole differs from the formulations of
Kinston and Cohen, who consider it to be an ‘‘absence of psychic
structure’’ (1986, p. 338), or that of Laub and Podell, who define it as an
‘‘empty circle’’ (1995, p. 992). It does not belong to the category of
blankness (negative hallucination, blank psychosis, blank mourning, all
connected to what Green [1986] calls the problem of emptiness or the
negative), or to Quino-doz’s nonexistent ‘‘hole-object’’ (1996).
I believe that the psychic hole in cases of Holocaust survivors’ offspring
is formed in a different, quite unique way: It is created through the denial or
repression of the trauma by the parents (a trauma that, by means of
‘‘primitive identification,’’ the offspring attribute to themselves), as well as
through the offspring’s repression of the traces of the trauma. In cases in
which parents have succeeded in working through the feelings of mourning
and guilt connected to their traumatic past, and in conveying their history to
their children in a healthier way, the children are much less likely to
experience a psychic hole in their psychic reality.
Let us try to understand how the psychic hole was formed. Even in
those families where a pact of silence prevails, a child would still be able
to guess some of the details of the parents’ severe traumatization. When
cognitive development is sufficiently advanced, he or she will begin to
in-vestigate the parents’ past. At this stage, the parents’ wish to deny or
re-press the traumatic events could force them to unconsciously convey
to the searching child that the object of their investigation is not
something that really happened in their lives. Rather, it is the child’s
wicked thought, a bad dream, something that ought to be forgotten
(Grubrich-Simitis 1984). Thus, the parents’ redefinition of the traumatic
events in their lives as something horrible emanating from the child’s
inner world, resulting both from what they tell the child as well how the
child experiences it, makes the reality of the trauma unreal.
96 CHAPTER 5
Through these processes, what was known or almost known becomes

unknown. It is the unknown, or that which cannot be remembered, that
becomes the source of the child’s unconscious fantasies about his or her
parents’ traumatic past, and the compelling need to enact them in his or
her present life.
I now present some examples of the enactment of delusions that stem
from the ‘‘unknown’’ past of parents.
CLINICAL EXAMPLES
Rachel1
Rachel was the daughter of a man who had survived the Holocaust, but
whose first wife and child had perished. Rachel’s father kept the loss of his
first family secret from his second wife and children. He never spoke about
his bereavements and injuries, but worked hard and advanced himself. At the
age of twelve, Rachel became anorectic. By means of her anorexia, she
enacted a fantasy world belonging to her father’s traumatic past: She at-
tempted to starve herself and survive, just like the people who had sur-vived
the concentration camps (Kestenberg 1982).
At the age of thirty-one, Rachel went to Israel, where she fell in love
with a painter who was on the verge of divorce. This man was the father
of a two-year-old child whom he had left with his wife in another
country. In choosing a man who had left his wife and small child in a
faraway coun-try, Rachel was attempting to reenact an aspect of her
father’s past in her own life.
The following episode of enactment, which occurred during Rachel’s
analytic treatment, illustrates her identification with the roles of victim/
killer (belonging to her father’s traumatic past) as well as the meaning of
this enactment in therapy. Rachel had adopted a kitten that served as a
substitute child for her. As she was planning to be out of town for a day,
she cancelled her analytic session, locked the kitten in the bathroom, and
left the heater on so it would not be cold. When she returned home, she
found the animal lying dead near the heater. Rachel thought that since the
kitten had recently suffered from diarrhea, it had died of dehydration
from the heat. She buried it, thinking of the many soldiers who had died
in battles. That night she forgot to turn off the gas heater in her living
room. She awoke the following morning to a strong smell that made her
aware that the gas had been on all night.
We attempted to understand this morbid episode of enactment through

the transference relationship and in view of the impact of her father’s
trau-matic past. Rachel identified with the kitten that was desperately
searching for warmth. When I wasn’t there for her, she burnt herself and
dehydrated to death, thus becoming my victim. At the same time, she
was also the murderess who killed the baby inside herself by putting it
into the furnace. Through the enactment of this role, she was punishing
herself by dying in a gas chamber, like those who died in the
concentration camps. In the transference, the unconscious meaning of the
enactment was that Rachel perceived me as a source of warmth and
protection (the heater), as well as of destruction. Thus, when separated
from me, she felt totally insecure and lost, but when reunited, she felt
swallowed, absorbed, and threatened by the loss of her individuality.
Over the course of five years of analysis, we worked through—among
other things—the details of her father’s traumatic story, which Rachel
had just discovered before beginning analysis, causing her to reenact his
past in her own life. We elaborated upon her feelings of mourning and
guilt, which belonged to her father and had been transmitted to her in
nonver-bal ways through the atmosphere prevailing in her home. The
realization of the meaning of her enactments and their working through
during later stages of analysis enabled Rachel to free herself from the
burden of the past and build a life of her own.
Hannah2
Hannah was a foreigner living in Israel who sought analysis because of
feelings of derealization and an inability to cope with life. She was the
daughter of a Holocaust survivor whose first wife had perished in the Ho-
locaust and who had spent much of the war in hiding. He had suffered from
masked depression throughout his life, and had never disclosed his past to
his new family. But during the first year of analysis, Hannah heard through a
cousin about his first wife and how she had died. The secret was at long last
revealed to his wife and children, and Hannah’s father donated a sum of
money to an institution in Israel in his first wife’s memory.
Following this, there were many episodes of enactment, which ex-
pressed Hannah’s unconscious attempt to re-create the fate of her father’s
first wife in her current reality. Furthermore, the fact that she was living
in Israel, surrounded by Arab hostility, was very much connected to her
98 CHAPTER 5
fantasies about her father’s past. A description of one of her enactments

follows.
Hannah rushed back to analysis from a trip to Europe in a state of panic
and tremendous anxiety, and related that she was in great danger because
‘‘an Arab is after me.’’ It turned out that she had met an elegantly dressed
man in the lobby of her hotel, who appeared to her to be an Arab spy.
Despite the fact that she did not have Israeli citizenship and that she had
been living in Israel for only a few months, she immediately told him that
she was an Israeli citizen. After going out together to dinner and a film,
Hannah went with him to his room, where the two had sex without uttering a
single word. Suddenly Hannah realized that she didn’t even know his name,
and panic-stricken, she immediately made up an excuse that she had to go to
the toilet, dressed hurriedly, grabbed her handbag and left the room. Two
hours later she was on a plane to Israel.
Upon arriving home, Hannah phoned the hotel where she had stayed
to inform them that she had left a pair of shoes there, and gave her
address so that the shoes could be forwarded to her. Immediately
afterward she came looking for me in desperation, convinced that the
‘‘Arab spy’’ would pursue her.
Hannah connected this episode to the film The Night Porter, which
she had seen many years before. She related that the film took place
some time after the Nazi concentration camps had been liberated, and it
described an encounter between a Jewish woman who had been
imprisoned in a concentration camp as an adolescent and the Nazi officer
who had been her tormentor there. In this encounter, the past prevailed
over the present, and the protagonists, propelled by a force greater than
themselves, re-sumed their concentration camp roles of victim and
persecutor. The man sexually abused the woman, and then—unable to
return to reality—killed her.
Attempting in the transference to understand Hannah’s need to enact
her unconscious wishes and fantasies related to her father’s first wife (the
psychic hole), I pointed out that she was assigning me the role of her sav-
ior, while attempting to bring this woman back to life by becoming her.
But, I added, she was trying to kill her father’s first wife by placing
herself in danger of being killed by the Arab/Nazi.
During this phase of treatment, Hannah achieved some ‘‘affective un-
derstanding’’ (Freud 1915) of her enactments. Without my describing this
phase in detail here, suffice it to say that, following the above-mentioned

episode, and feeling supported by her analyst, Hannah plucked up the
courage to question her father about his traumatic past. Their discussions
produced an unexpected result. Concerned that he was nearing the end of
his life, her father decided to write an autobiography, and asked Hannah
to be his editor.
In analysis, we understood that by accepting this work, Hannah was
demonstrating her readiness to become acquainted with concrete details
of her father’s trauma and, moreover, place it in a past that was not her
own. Only then could we work through feelings of mourning and guilt
that belonged to her father, which had been transmitted to her in nonver-
bal forms of communication. This long process of working through even-
tually enabled Hannah to achieve a better differentiation between herself
and her father, between past and present, between reality and fantasy.
Kay3
Kay was the stepdaughter of a Holocaust survivor who had been cas-
trated by Mengele’s doctors. Kay communicated with me (in the first phase
of treatment) through infantile drawings. One of her pictures, bear-ing the
title ‘‘Electricity,’’ depicted a man with a wiry flower emerging from his
head. Only at a later stage in analysis, when Kay was able to com-municate
with me verbally, were we able to understand her unconscious fantasy: The
flower of death symbolized her stepfather’s traumatic experi-ence of having
to avoid death by spending an entire cold night standing naked between the
electric wires of the concentration camp.
Kay was referred to treatment after attempting to jump from the eighth
floor of a building. In analysis, we were able to understand her attraction
to death by jumping off high places as an attempt to enact the torment
associated with her stepfather’s survival and close encounters with death.
For her stepfather, falling would have meant touching the wires,
electrocu-tion, and a horrible death. When Kay went up to the eighth
floor, intend-ing to throw herself out of the window, she was convinced
that she would survive. Her delusional, paranoid fantasies of magically
and omnipotently conquering death were endangering her life.
The following episode illustrates Kay’s compelling need to enact the
reparation of her stepfather’s castration upon her own body. After my
summer holiday, she informed me that she had undergone breast surgery
100 CHAPTER 5
during my absence. She stressed the fact that she had chosen to do it
when I was away because she did not want to cancel her sessions after I
returned home. Elaborating, she explained to me that the operation was
the ful-fillment of a wish she had had since she was young—to enlarge
her breasts with silicone implants.
Kay had visited a doctor who examined her breasts, after which he de-
scribed them as empty rather than small. He indicated that an operation
was possible but was not without risks. She was warned of the possibility
of her body rejecting the silicone, a condition that is accompanied by tis-
sue inflammation, fever, and pain, and one that would necessitate further
operations. She was told that she might never be able to breastfeed a
child. Despite being terrified of these prospects, Kay nevertheless
decided to go ahead with the operation. She was referred to a shop where
she was mea-sured for implants and selected them from a catalogue,
choosing a me-dium size, which she felt would make her look much more
like a whole woman.
Kay came to analysis on the appointed date, two weeks after her opera-
tion. She entered the room walking upright and, pulling her blouse against
her breasts, asked if I could see any change. Only afterward, when lying on
the couch, did she tell me the whole story. She was overjoyed and stressed
her satisfaction with her ability to conquer her fears.
In my countertransference feelings, I felt a heavy weight burdening
my heart. This made me aware that Kay was not in touch with her
sadness, which was conveyed to me by massive projective identification.
Attempt-ing to understand what had compelled her to do this deed during
my ab-sence, I pointed out to Kay that she had begun feeling that her
breasts were empty only when I was not around, when she wasn’t getting
the feed-ing and support from our regular sessions. Kay laughed a short
laugh and then confirmed my hypothesis in an angry voice, ‘‘I don’t need
you; I don’t need anybody. I want to depend only on myself.’’
I showed Kay that her need to ‘‘fill’’ her breasts stemmed from her
anger and frustration at feeling abandoned by me. Gradually, she became
aware of these feelings and accepted them. Working through these
feelings in the transference led her to reveal her fantasies of flirting with
death on the operating table. She had undergone the operation in order to
repair her femininity, but thought she might die as a result. Of course, she
now felt that she had once again overcome a terrible danger.
Kay associated her victory over possible death on the operating table
with a story from her stepfather’s life. After the war, he had met one of
the few other men who had survived castration in the Mengele experi-
ments. The man told Kay’s stepfather about a Jewish doctor in Paris who
performed restorative surgery on these people—that is, implantation of
testicles—free of charge. Her stepfather decided to go to Paris and have
the operation. It was successful and he was able to resume sexual
relations with women, though he remained infertile.
Kay and I then began to find out what was filling her psychic hole, the
unconscious fantasies that compelled Kay to enact her stepfather’s life
story on her own body. I pointed out to Kay that she might have been
trying to implant her femininity into her breasts in the same way that her
stepfather had had his manhood implanted into his empty testicle sacs.
A pregnant silence filled the room as Kay absorbed my words. Then,
understanding the meaning of her choice to undergo surgery, she was
overwhelmed by a powerful surge of emotion. It took us a long time to
work through the feelings of fear, depression, and pain that replaced her
euphoria. Furthermore, we tried to elaborate on the complex needs she
had expressed through her deed. Consciously, she was trying to attain a
better, repaired sexuality. Unconsciously, she was attempting to endanger
herself in a concrete way, to come as close as possible to an imagined
death in order to omnipotently overcome it.
Kay did not know many details of her stepfather’s experiences during the
Holocaust, because he kept them mostly to himself. The atmosphere at home
was one of silence, concealing a past full of terror and violence. Her
stepfather had been writing his memoirs of the Holocaust for the last twenty
years, but Kay had never had the courage to ask to see them. In analysis,
after working through her fear of discovering what had really happened to
him, and encouraged by my supportive attitude, she decided the time had
come to do so. To her great surprise and excitement, her stepfather sent her
his complete autobiography, which he had dedicated to his adopted children.
Kay read it avidly, and brought it to me so that I too could read it. I did that,
feeling that I had to participate in this action; thus, I ‘‘actualized’’ (Sandler
and Sandler 1978) her wish to make me her partner in ‘‘the search for the
self through family secrets’’ (Gampel 1982).
The elaboration of this episode enabled us to begin an exploration of
the way Kay had communicated with me during the first part of treat-
102 CHAPTER 5
ment, and the way she had lived her life until then, using her body to
express unconscious fantasies pertaining to bodily sensations, anxieties,
and emotions that were experienced by her stepfather during the Holo-
caust.
We could now understand her constant preoccupation with her body—
physical fitness, weight, and muscle tone—as part of her survival
complex. It was based on her unconscious fantasy that ‘‘I feel my body,
therefore I exist.’’
All through her treatment, Kay complained at length about her defec-
tive sense of smell. Only now could we make the connection to her
stepfa-ther’s story about the awful stench emanating from people dying in
their excrement and vomit, not being able to make it to the public latrine.
Thus, impairment of the olfactory sense became a survival mechanism
for him. Kay’s constant state of hunger, as well as her suffering from cold
and her inability to find suitably warm clothing, were primary aspects of
her step-father’s wartime experiences as well.
Kay had a fear of incontinence (which she showed by often running to
the toilet during sessions). In this regard, she brought up a story of woe
and humiliation from her stepfather’s memoirs: ‘‘Father stood for hours
at roll call, peeing in his pants, knowing that any movement could incur
the death punishment.’’ Urine was the substance used by her stepfather to
treat a wound on his leg caused by a brutal kick from a German soldier.
During this phase of analysis, in which she recounted these stories,
Kay felt that she was treating the wounds in her soul with bits of
information from her repressed consciousness, things that she had known
but had for-gotten over the years.
FROM ENACTMENT TO MENTAL REPRESENTATION

I believe that the most effective way of transforming the compulsion to enact
(the defense against mourning) into a cognitive mode is by helping these
individuals find the meaning of the trauma in their parents’ lives and bind 4 it
in a meaningful context, thus consigning it to the past of the parents. During
the first phase of analysis, the analyst deals with cognition and emotions that
were severed by the parents’ repression of the trauma, leaving traces of the
repression in the child. Finding the parents’ ‘‘un-known’’ story and lifting
this repression, followed by a process of working through, transforms the
possible enactment into an ‘‘affective understand-
ing’’ (Freud 1915). This kind of understanding links thoughts and

feelings, greatly decreasing the need to repeatedly enact the parents’
stories in the children’s current lives.
The quest for information—the purpose of which is to enable the pa-
tient to give up these enactments—is a difficult experience for the survi-
vor’s offspring. It is my view that in the initial stages of analysis, only a
supportive, nurturing environment, which includes a holding relationship
(one that decreases the patient’s tremendous anxiety) and holding inter-
pretations (those that help the patient mobilize his or her forces to find
the meaning of the trauma in the parents’ lives) can strengthen the pa-
tient’s mental organization to the point that the flow of fragmenting, po-
tentially life-threatening reenactments is halted (Kogan 1995, 1996, 1998,
2000, 2002).
The quest for information also serves the purpose of differentiation
and the creation of a new and separate self. On this level, it might be
accompa-nied by torment and anxiety. Consciously, the child is afraid
that his ques-tions about the past will force the parent to relive painful,
traumatic memories that may threaten his psychic survival.
Unconsciously, the child experiences the wish to know his parent’s
history as a step toward differ-entiation and a relief from the burden of
the past, which he feels may be potentially destructive for the parent.
This search is usually facilitated by the holding atmosphere in analysis
and by the patient adopting the analyst as an ally in his quest.
Treatment often does not end here, and there is much psychic work to
be done in further stages of analysis. It is only after the initial phase of
holding, in which the patient’s self is strengthened, that interpretations of
his or her unconscious life become not only acceptable but also
necessary. During these later phases, it is possible to work through the
missing piece of the parent’s history, which is often connected to the
child’s feelings of shame and guilt.
In some cases, the parent’s story does not emerge easily, but has to be
actively sought. The therapist’s supportive attitude facilitates the patient’s
discovery of that part of the parent’s history that will fill the hole through the
acquisition of concrete details from the parent’s past. Examples from the
cases described earlier are Kay’s request to read her stepfather’s book of
memoirs in order to learn—among other things—about his castration
104 CHAPTER 5
by the Nazi doctors and Hannah’s agreement to become the editor of her
father’s autobiography of his Holocaust past.
The construction of an unbroken narrative—one that fills the gaps in
the child’s knowledge, that makes it permissible to mention the unmen-
tionable, that interweaves the awareness of the realities and horrors of the
Holocaust with the present—enables the offspring of survivors to gradu-
ally gain some comfort from the split-off knowledge, which has been
accompanied by unacknowledged affects and fears. The events and narra-
tives that formed the starting point of the child’s traumatic wound can be
reconstructed, so that the split-off and diffusely reenacted memory frag-
ments from a persecutory world are elucidated. Thus, the interpretation of
fragmentary, defensive reenactments leads patients to an awareness of the
reality of the trauma—an awareness that becomes part of their flow of
life. Although, this is only a beginning phase of treatment, the patient will
now be able to at least partially relinquish his struggle against mourning.
The work of mourning that continues during the latter phases of analysis
will eventually free him from the burden of the past and will enable him
to achieve a stronger, better integrated self.
NOTES
1. See Kogan (1989, 1995) for additional descriptions of this case.

4. The concept of binding was first described in Freud’s (1920) theory of why
certain events have a traumatic effect upon the mind, and how the personality takes
account of and adapts to the resulting changed internal conditions. The con-cept
appears in connection with his famous metapsychological explanation (1920, p. 31)
of trauma as an ‘‘extensive breach made in the protective shield against stimuli,’’
which occurs only when the mental apparatus is not prepared for anxi-ety, that is, the
parts of the system that are to receive the excessive stimulation are not properly
hypercathected and therefore ‘‘the inflowing amount of excitation could not be
bound.’’ It is hard to be sure what precisely Freud meant by binding, since he used
the term at different stages of his work in different ways (Laplanche and Pontalis
1973). However, by 1920 it had taken on the general meaning of a defensive
operation that restricts freeflowing excitation. Once the catastrophic breach in the
protective shield has taken place and mental functioning is in tur-moil and disarray,
the problem is one of ‘‘mastering the amounts of stimulus
which have broken in and of binding them in the psychical sense, so that they
can then be disposed of.’’
In the recent literature (Garland 1991, 2002), binding is described as a process
by which the ego creates links between the freeflowing excitation and functions
of the mind. In this way the ego attempts to recreate structures of some
permanence in which ego functioning is possible.
6
Trauma, Resilience,
and Creative Activity
Unlike play, artistic creativity involves much pain.
—Segal 1991, p. 108
THE NATURE OF RESILIENCE

The immediate and long-term effects of the massive psychic trauma in-
curred by different ethnic groups have been studied primarily from a
pathological perspective. It has become almost axiomatic that individuals
who experience persecution and multiple losses are more vulnerable—
they suffer from post-traumatic stress disorder (PTSD) and continued
manifestations of annihilation anxiety, such as lack of trust, a tendency to
isolation, and a numbing of feelings.
Nevertheless, many such individuals appear to lead productive lives
and have even forged intimate relationships. Recent years have been wit-
ness to a new approach, one that examines the resilience of those
survivors of trauma and their descendants, who have succeeded in
making some-thing worthwhile of their lives in spite of its ravages.
Resilience, according to the dictionary, means recoiling or springing
back to the original shape after bending, stretching, or compression. Psy-
chosocial resilience implies a similar springing back after subjection to
se-vere stressors (Valent 1998).
Resilience—which may be regarded as the opposite of vulnerability—is
thus a new concept. It originated in observations of children who seemed to
emerge relatively unscathed from even the most adverse social condi-tions.
These observations gave rise to the initially rather optimistic con-cept of
invulnerability (Anthony 1974), which, with time, gave way to the concept
of resilience. This concept was further explored in recent litera-
107
108 CHAPTER 6
ture by Boris Cyrulnik (1993, 1997, 1999, 2001, 2003, 2004), the
president of the International Observatory of Resilience at the University
of Toulon, France.
Resilience, which reflects the strength of the human spirit, is an objec-
tively useful concept that may also include elements that can mitigate the
long-term effects of severe stressors, as I discuss in this paper.
How can we explain resilience in the face of adversity? Endowment,
temperament, and familial or environmental factors that preceded perse-
cution may be advanced to explain resilience-producing traits. An
individ-ual’s intrapsychic structure may also contribute to this resilience.
It is important to note that resilience in one area of functioning is not
neces-sarily indicative of resilience in all areas (Rutter 1993). Rutter
(1987) maintains that resilience is not a fixed attribute, but rather that it
hinges on a balance between the mechanisms and processes of protection
and vulnerability. The factors affecting a person’s resistance to adversity
are both environmental and constitutional and may change over time,
making it impossible to distinguish between what may be attributed to the
envi-ronment and what is constitutional.
In this chapter, I explore one of the pivotal factors of resilience—
creative activity—as it is manifested in the analysis of a Holocaust
survivor offspring and its connection to mourning. The intimate
relationship be-tween creativity and resilience in stressful situations is
such that the more we master creative problem-solving skills, the more
we will be able to re-spond to stressful situations (Flach 1988).
In the case of offspring of Holocaust survivors, I define resilience as
the offspring’s ability to acknowledge and work through the guilt and
mourn-ing deposited in them by their parents. Managing emotional pain
is most difficult, calling for such survival forces as faith, hope, and the
will to live. Creativity may serve as a tool to facilitate acknowledgment
of the painful feelings transmitted by the parents. By working through the
hidden truths discovered through creative activity, the offspring are able
to bind it (see note 4 in chapter 5) in a meaningful context.
Vulnerability, as I define it here, includes the denial and repression of
cognitions, emotions, and meanings inconsistent with survival and hope-
ful attachment figures, which may lead to the failure to recover from
trauma. Herein, I first relate briefly to the generation of the parents,
touching on their vulnerability and resilience. I then consider in greater
TRAUMA, RESILIENCE, AND CREATIVE ACTIVITY 109
depth the generation of the offspring, focusing on their resilience. I

discuss one of the important factors of resilience—creative activity,
which leads to the elaboration of mourning—as it is illustrated by
segments of an anal-ysis of a Holocaust survivor’s daughter.
VULNERABILITY AND RESILIENCE IN THE

GENERATION OF THE VICTIMS
The first studies of the vulnerability of survivors were conducted by
Nied-erland (1964) and Eitinger (1964). These researchers insisted that
persecu-tion had left long-lasting, perhaps permanent effects on
survivors; the end of the war, the liberation of concentration camp
inmates, and the resettle-ment of refugees did not mean an end to the
effects of Nazi atrocities. Subsequent articles stated that the intense
depression felt by survivors led to complete social withdrawal, seclusion,
and profound apathy (Lifton 1978). It was further hypothesized that
survivors had difficulty ‘‘rein-vesting in life’’ and were deeply
ambivalent about founding new families (Krystal 1968). Vulnerability
and resilience of survivors were explored in depth by Danieli (1998).
A characteristic trait found in survivors, which has been mentioned in
Holocaust studies, is the shallow quality of their emotional response, re-
ferred to as ‘‘psychic numbing’’ or ‘‘psychic closing off.’’ Experiencing
overwhelming losses and stress during the Holocaust, along with the
resul-tant intolerable anger and fear, survivors blocked out all capacity
for emo-tion in the interest of continuously adapting to a changing,
hostile environment. Emotional awareness would have carried with it the
poten-tial for demoralization, and would have distracted them from the
task at hand—of surviving one day longer. Although this defense was
invaluable at the time and contributed to their resilience, its lingering
deployment was obviously maladaptive (Lifton 1968; Hass 1996).
Kestenberg and Brenner (1996) did important research in the realm of
the impact of trauma on the lives of child survivors. They found that the
disruptions of rules and regulations in the lives of infants and children,
born during the Holocaust, left as an aftermath a recurring affecto-motor
or somatic state of feeling bad, which is conceptualized as being bad. The
younger the child, the more likely he was later in life to reexperience
trauma as feeling bad, whereas feelings of emotional relief were remem-
bered by things that made the child feel good, such as milk or sugar. The
110 CHAPTER 6
superego that is built to a great extent on feelings of comfort and discom-

fort, on pain and pleasure, that come and go unaccountably, could be-come
fragmented. In analysis an ego strength was revealed, which showed that the
ego of the child survivor could be quite resilient and flexible.
A famous example of the resilience of child survivors is found in
Sarah Moskovitz’s Love Despite Hate (1983). This book described the
story of a small number of orphaned child survivors who came to
England after the war from Terezin, Auschwitz, hidden in private homes
or by nuns, and from orphanages. These children, ranging from toddlers
(also described by Anna Freud and Sophie Dann) to young teenagers,
were cared for by a caseworker named Alice Goldberger, herself a war-
time refugee, and her small staff with funding from British and Jewish
sources. These children did remarkably well as a group, especially those
few who survived with their siblings. Some of the most competent group
members drew comfort from their religious ties, whether Christian or
Jewish. Goldberger had the talent to foster each child’s individual
interests, and thus make each one feel worthy and special. This volume is
a valuable source of information with early documentation of the severity
of childhood trauma, follow-up interviews showing the resilience of most
individuals, and evidence about the unique importance of one person who
made a helpful connection with all these children.
As a result of my extensive professional experience with offspring of
Holocaust survivors, I am constantly overwhelmed by the richness of the
many avenues of resilience with which their survivor parents dealt with
trauma. The qualities needed by them to endure, cope with, adapt to, and
survive massive atrocities and mass murder have been referred to vari-
ously as psychic strength, fierce determination, inner resources, persever-
ance, life-affirming acts and attitudes, indomitable spirit (Lee 1988), and
defiance, as well as a stubborn determination not to give up (Hogman
1983).
Resilience factors that contributed to these qualities were mental at-
tachments to good objects and the hope of retrieving them (Brenner 1988),
the wish to live life, to create it, to hope in the face of adversity. Love of life
itself, a spirit of survival, stamina, courage against fear, the sustaining
quality and power of love, and capacities of repair and integra-tion are all
factors of resilience. Higher mental and spiritual levels of resil-ience
emerged from the resourcefulness developed under these traumatic
conditions. Creativity, whenever possible, helped with survival by

express-ing hope. Creativity was expressed through drawings made in the
ghettos and concentrations camps, even in games. Developmental drive,
creativ-ity, and curiosity, which were maintained against all odds, helped
survi-vors conquer the destructive and self-destructive forces unleashed
by massive traumatic experience.
The vulnerability and resilience of the parents, which I have touched
upon only briefly, is a major part of the background against which their
children grew up. I now discuss resilience in the generation of the off-
spring, focusing on creativity as one of its important elements.
VULNERABILITY AND RESILIENCE IN THE

GENERATION OF THE OFFSPRING
Many investigators assume the inevitability of transmitting pathology
from survivors to their children (Kestenberg 1972; Trossman 1968; Bren-
ner 2002). They claim that since Holocaust experiences negatively
affected the survivor’s capacity for human relations, he or she is unable
to be an effective parent, and this disability has had damaging
psychological rami-fications for children raised by these adults. Barocas
and Barocas (1973) state: ‘‘[B]ased on clinical experience with such
patients (children of survi-vors) our impression is that these individuals
present symptomatology and psychiatric traits that bear a striking
resemblance to the concentration camp survival syndrome described in
the international literature’’ (p. 821).
The legacy handed down to the second generation is that they often
carry in themselves the denied mourning of their parents. Denial of
mourning was part of a long-term post-Holocaust process of adaptation,
which for most included earning a living and raising a family. The
energy needed to live life did not allow much time for grieving.
Forgetting trau-matic memories was an adaptation in the service of life,
but it also served the forces of Thanatos by causing a loss of parts of the
self that belonged to the past (Laub and Lee 2003). Thus, although there
was resilience in the survivors’ adaptability, they and their offspring paid
an emotional price. The feelings that survivors deposited in their children
created vul-nerabilities in the next generations—feelings of pain, shame,
and guilt, and the compelling need to reenact the story of their parents in
their own lives in order to master the trauma.
112 CHAPTER 6
These offspring often echoed what existed in their parents’ inner

worlds through the reenactment of the past (Bergmann 1982; Kogan
1995, 2002). Reenactment precludes symbolization of the past and thus
prohibits memory via symbolization or representation (internal images).
The past is endlessly respun and no resolution of the trauma is possible.
There is a space, however, between reenactment and representation. This
can be regarded as a transitional space in which symbol formation begins to
unfold. In Winnicott’s terms, this is a ‘‘potential space’’ (1971a), which
allows for the emergence of representational modes, transitional phenomena,
and creativity. Creative activity of offspring who ‘‘have al-ways known’’
about the Holocaust, yet whose parents could not speak about their
experiences, often contains symbols of the Holocaust that re-side in this
transitional space. These symbols tell the story through their unverbalized
meanings. Creative activity thus becomes a kind of short-hand—a language
beyond words—that evokes the texture and embodies the meanings of the
past. As opposed to works of art that are unrelated to treatment, which may at
times mask the as yet unworked-through and unknown aspects of trauma
(Laub and Podell 1995), I believe that creative activity during treatment is a
means of unmasking hidden truths. It thus helps fill the psychic hole, the gap
in the offspring’s emotional under-standing of the parents’ traumatic past.
Creative activity facilitates resil-ience by serving as an important tool that
enables the offspring to reveal and work through the history of their survivor
parents, and to elaborate feelings of pain and guilt transmitted to them. Thus,
they are eventually able to integrate their parents’ suffering and mourning—
which had be-come their own—into a bearable experience for themselves.
I will present a vignette from one of my case studies to illustrate how

creative activity leads to the discovery of feelings of pain and guilt trans-
mitted from one generation to the other, and how it facilitates the work of
mourning in treatment, enabling the patient to integrate the parents’
trauma into his or her own life.
The Case
Shelly, a thirty-two-year-old woman, sought professional help because
she had lately become unhappy with her life and work. She had been
mar-ried for seven years, had two sons (aged four and six), and worked as
a scientist in a large institution. She disliked the institution where she
worked, and regarded her professional dissatisfaction as the main source

of her unhappiness. She also felt that she was a big disappointment to her
parents, who ever since her childhood had expected her to become rich
and successful, something she could never achieve.
Shelly was the younger daughter of scientist parents. Her older sister,
who had not obtained a higher education but worked as a hairdresser,
was considered a disgrace to the family. Her brother, who worked in a
high-tech company and traveled a lot abroad, was the one who brought
the family ‘‘fame.’’ Compared to her successful brother, and compared
to her mother who had been a physicist and a feminist, Shelly felt that
‘‘she never made it.’’ She considered herself a good mother to her
children, the only realm in which she believed she had surpassed her
mother.
Shelly’s fear of analysis was enormous. When I greeted her at the door
the first time, she turned as if to run away. During the initial process of
analysis, I realized that Shelly was unable to lie on the couch while I sat
behind her. That position left her feeling abandoned and overwhelmed by
paranoid fears. I let her choose a position that would be suitable for her;
and after trying to sit up in a chair, she lay down and asked me to sit
facing her so that she could maintain eye contact with me.
At the beginning of analysis Shelly spoke about the way she had often
endangered herself when she was younger. On her frequent travels
abroad she hitchhiked with strangers. Once she slept in a farmer’s house;
at night he came into her room and tried to touch her. She ran away from
him, climbed up to the roof of the house, and jumped. She was lucky to
fall on a pile of hay and was only badly bruised. In Israel, Shelly used to
walk at night in dangerous neighborhoods. Once, she was attacked by a
man who tried to rape her; she screamed, and fortunately the man ran
away. Throughout her adolescence she abused drugs and alcohol, was
often bu-limic, and would induce vomiting.
I will not go into the painful and complex analytic journey of the last
seven years. Instead, I will proceed to demonstrate how the impact of the
Holocaust was expressed in analysis through Shelly’s creative activities
(poems and paintings) and the role of these activities in her healing
process.
At a certain point during the first phase of therapy, when I informed
Shelly that I would be going abroad for several days, she began bringing
to therapy paintings and poems that reflected her feelings about our up-
114 CHAPTER 6
coming separation (see drawing 1, ‘‘Airplanes that take you away from
me’’ and drawing 2, ‘‘Shelly with the ropes’’).
Shelly wrote a poem about these two drawings:
You are my savior

I am pulling on invisible ropes
And try to climb up to you
To hold on to you
But I remain down here with
A bunch of ropes that cover almost all of me
And I try to pull again and again
On the ropes—towards you
In my fantasy—I see you in your room
I pull on your strings
You inflate like a balloon
And get up and fly out the window of your room
Out and up—up—up.
Shelly associated these ropes with the umbilical cord. Through these
poems and drawings, as well as through her dreams from this period, we
came to understand that Shelly was reacting to our separation with tre-
mendous fear and anxiety. Recurrent themes in her dreams revolved
around her children who were in danger of being hurt or lost. Shelly felt
that my going away meant leaving her alone to cope with death and de-
struction.
Some of the drawings she brought to the sessions enabled us to
discover the damaged child within herself (see drawings 3 and 4, ‘‘The
damaged child’’ and drawing 5, ‘‘The child’s head—a pot filled with
earth and a tree growing out of it’’).
These drawings helped Shelly recall once more the various episodes
of self-destructiveness from her youth described by her at the beginning
of the treatment, her attraction to death, and her fear of it. Only later on
in analysis could I help Shelly become aware that the pot filled with earth
could indeed symbolize death, but the tree growing out of it, the symbol
of life, showed her resilience.
In the transference, Shelly’s aggression and wrath, which had been
evoked by my plans for going abroad, had no limits. An episode from this
period illustrates this. Shelly referred to a Band-Aid I had had on my cheek
some weeks prior to the current session, following a skin operation, and
said, ‘‘Two weeks ago I saw a Band-Aid on your cheek and I decided
that you were going to die; now you are going abroad. I would rather
have you dead than going away!’’
In my countertransference, I felt that Shelly had intruded into my ‘‘pe-
rimeter of safety’’ (McLaughlin 1995), especially since my skin
operation had actually been a biopsy that had turned out to be benign.
What a cruel, ruthless love this is! I thought to myself.
I first had to work through fears of my own evoked by her ‘‘need-
relationship’’ (Winnicott 1964) in order to enable Shelly to elaborate
upon her feelings toward me, which were a reflection of her painful and
com-plex relationship with her mother. After much psychic work, Shelly
ar-rived at the following conclusion, which she expressed through a
poem. ‘‘You said that behind this big love for you there is a lot of anger. I
wrote a poem about devouring love.’’
A fish swallows a fish that

Swallows a fish that swallows a fish.
A mother swallows a child that
Swallows a mother that swallows a child.
This poem expressed Shelly’s feelings about the mutual engulfment of

a mother and a child generation after generation. By elaborating upon
this phenomenon, we discovered its connection to Shelly’s relationship
with her mother and Shelly’s bearing the painful legacy of the Holocaust
for her.
Shelly’s mother was a child during the Holocaust and fled Eastern Eu-
rope with her parents when she was twelve. Shelly’s grandmother, the sole
survivor of her immediate family, was a bitter, angry woman. She never
forgave her husband for tearing her away from the members of her family
who were left behind and who perished in the Holocaust. Nor did she ever
forgive her daughter, Shelly’s mother, whom she regarded as the reason the
family left Europe and came to Israel. Shelly’s mother grew up with the
double message of being her parents’ savior as well as the perpetrator of her
relatives’ death. She developed paranoid traits and often felt guilty for being
‘‘bad.’’ She attributed her mother’s wrath and unhappiness to her own
‘‘poisonous’’ qualities, and later in life feared that she was ‘‘poi-
116 CHAPTER 6
sonous’’ to her own children. The grandmother, who had suffered many
losses, might have been projecting her burden of depression and guilt
upon her daughter, who bore this burden for her. Shelly’s mother, unable
to contain the guilt and pain within herself, projected it onto her own
child, thus turning the daughter into a container of pain (Bion 1962). This
can be seen in particular in one of Shelly’s drawings (see drawing 6,
‘‘Mother, child and the demon’’) and the poem that she wrote about it.
As if I fought a huge demon

All day long
And I fell asleep
And dreamt
Of wars and bad people
And dangers and gas chambers.
Shelly connected the demon inside her head, which was persecuting her
mother, to the Holocaust. She felt that this demon was now engraved on
the child’s arm (here came to mind the numbers engraved upon the arms
of concentration camp inmates). Thus, Shelly saw herself as this child
who was bearing the mother’s feelings of mourning and guilt. (Upon
rereading my original wording of this family history, I observed that I
had written it in a rather confusing way, and I realized that there was no
differentiation in my own mind as well between mother and daughter.)
Shelly brought to the sessions a drawing of a woman with one face su-
perimposed upon another (see drawing 7, ‘‘Woman with two faces, one
superimposed upon the other’’).
In the transference, Shelly referred to her ambivalent perception of me.
‘‘Sometimes I think that you are the best analyst around, that I was lucky
that you accepted me in treatment; other times I think you are worthless, and
that maybe you are crazy, like my mother.’’ Elaborating upon our
relationship in the treatment, we discovered that in this painting she had
superimposed the successful outward facade of her scientist mother upon a
sick woman. Her mother suffered from many physical illnesses and had
undergone several operations. There were times when she experienced what
could very probably have been psychotic episodes. Shelly described
occasions when her mother had been totally unkempt, wearing dirty clothes,
and leaving sanitary napkins around the apartment. Her mother
would dismantle kitchen utensils in order to clean them, and could never
put them back together again, thus giving concrete expression to her feel-
ings of fragmentation. There was little communication between Shelly’s
mother and her children. Whatever needed saying was communicated via
the father. The mother was often haunted by paranoid delusions; she was
afraid that she was feeding her children spoilt food that would poison
them, that hereditary illnesses might destroy them. Catastrophe and death
were always looming on the horizon. Shelly often felt abandoned by her
mother, both physically and emotionally. These situations left her feeling
terrified, threatened by annihilation. As a result of her childhood experi-
ences, Shelly was extremely afraid to leave her own children for even a
short while. For her, leaving as well as being left meant abandonment and
destruction.
The drawing of the woman with one face superimposed on the other
enabled us to discover that Shelly, too, had more than one face. Shelly was
not only the damaged child, as seen in the previous paintings; by com-pletely
identifying with her mother, she herself became the poisonous, de-structive
mother. Her paranoid fears often changed into paranoid delusions about
destroying her own children, and she was terrified that she might harm them
(see drawings 8, 9, and 10, ‘‘The castrated child’’).
The ‘‘primitive identification’’ (Kogan 1995, see previous chapter)
with her mother included a state of pathological mourning (Freud 1919).
The long journey of working through this mourning began with the
discovery and elaboration of the hidden truths embedded in her paintings.
We elaborated upon Shelly’s morbid feelings by reexamining her
paint-ings from earlier stages of analysis. An example of this was the
painting of the child with a pot of earth in its head and a tree growing out
of it. Shelly now connected it to a grave, to death, and the Holocaust. She
felt an aban-doned child, helpless and overwhelmed by archaic fears,
because the child inside her, like the one inside her mother, bore the
death and destruction of an abandoned family upon its head.
By elaborating upon her poems and pictures we were able to discover
her longing for fusion with me (her mother in the transference) as well as
her fear of it. Shelly became aware of her special link with her mother
that enabled the transmission of feelings of anxiety, anger, and
destructiveness as if through a permeable membrane. Shelly realized that
these might have been her mother’s feelings, which became her own.
118 CHAPTER 6
Through other drawings, we discovered Shelly’s terror and guilt about

having been born into this world (see drawings 11 and 12, ‘‘Terror and
birth’’).
The main questions that preoccupied her about these drawings were:
‘‘Should I have been born or not? Should I be living in a world where so
many have perished?’’ Searching for an answer to these questions, we
attempted to reconstruct her parents’ history and the impact it had on her
life.
Shelly’s feelings regarding the legacy of the Holocaust were also ex-
pressed through her dreams. An example follows.
‘‘I dreamt that my grandmother isn’t dead, and she and my mother are
attending a funeral. They are both wearing enormous hats, very elaborate
ones, and they are wearing big, black mourning dresses. They appear
short and grotesque in these clothes. I don’t want to be like them.’’
Through this dream, Shelly expressed her wish to be free of the burden of
mourning, aggression, and guilt that had clad her mother and
grandmother through-out their lives.
Working through her Holocaust-related pain and guilt in her present
life enabled Shelly to better differentiate between herself and her mother:
‘‘My biggest fear was that I would be like my mother! Now I know that
we are different; we lived in other times, different realities. I have my
own life and I have to make the best of it.’’
This differentiation was followed by a long elaboration of her complex
relationship with her mother. In this period, a dream about a former boy-
friend reflects this relationship. In her dream Shelly saw her former boy-
friend and, realizing how much she missed him, felt a powerful longing for
him. The dream was triggered by the fact that several days earlier she had
heard an interview with him on the radio. Apparently he had become quite
famous; he was now a neonatologist. Shelly recalled how this man had
evoked strange reactions in her. Once, in the middle of the night, she had
asked him to bring her ice cream, and he had obliged. His love had made her
angry. She had behaved aggressively toward him, treated him badly,
humiliated and offended him. Trying to understand her longing for this man,
Shelly raised several possibilities: Had she treated him the same way her
mother had treated her as a child? Or perhaps she was now allow-ing herself
to long for the love that in the past had frightened her and made her so
angry? In the transference, I pointed out to Shelly that per-
haps I was the doctor who was treating the infant inside her, and that she
was allowing herself to long for my love now that she was less afraid of
this longing.
This elaboration led to an upsurge of loving feelings toward her
mother. On the occasion of her mother’s birthday, a close friend of the
family brought some letters Shelly’s mother had written to her from the
United States. She was then a young woman with three little children,
working hard for her Ph.D. in physics. Shelly read these letters avidly
and was very impressed by the fact that her mother loved and cared for
her, a fact she had not realized before.
Memories about the mother of her childhood were evoked, and with them
feelings of admiration for the talented woman her mother had once been.
Shelly remembered that, in addition to being a gifted scientist, her mother
had had a great talent for architectural design, with no formal studies in this
field, and she had created beautiful interior designs for their house as well as
for their friends’ houses. Shelly now raised the possibility that she might
have inherited her talent for painting from her mother.
At one point Shelly’s mother was hospitalized for a hip operation. It
was then that Shelly became aware that her anger toward her mother par-
tially stemmed from her fear of losing her. After she recovered from the
operation, though still on crutches, her mother insisted on visiting Shelly,
in spite of the fact that this meant climbing three flights of stairs. Shelly
appreciated her mother’s effort and regarded it as a sign of her love.
Shelly brought to the session a diary that she had kept when she was
ten years old. In this diary she found a story that she had written about
her mother. The mother, who was a little girl in the story, and the moth-
er’s little sister went on an outing in the forest with their parents. Shelly’s
mother did not watch over her sister carefully enough, and the sister got
lost in the forest. Her mother grew up and remained sad over losing her
sister. In her story, Shelly tried to repair this traumatic event: Her mother
went back in time and became anew the child who went with her family
on outings to the forest. Shelly warned her mother to take good care of
her sister. Thus, the mother got a second chance to save her sister and
became much happier.
Shelly’s story expressed her childhood wishes and fantasies of curing
her depressed mother and making her happy. In her associations, Shelly
talked about her mother’s family that had disappeared in the Holocaust,
120 CHAPTER 6
and the burden of guilt that lay upon her mother. Shelly was aware that
even as a child she had wanted to relieve her mother of this guilt. I asked
Shelly whether perhaps her mother had lost not only her sister in the for-
est, but also the happy aspect of her personality. By giving her a second
chance to save her dear ones, Shelly had tried to bring her mother back to
the place where she could find this lost aspect of her own self.
Through her creative activity, Shelly allowed us entry into the painful
terrain of the past, where we found clues to the plight of two generations
that had been marked by the Holocaust. Therapy helped Shelly give up
her manic defenses and touch the pain that had been transmitted to her,
often without words. A poem written by Shelly illustrates this most elo-
quently:
In my heart there are capsules of pain

That were carefully packed many years ago
By my mother and grandmother,
Capsules full of little pills of pain
In various colors
Packed in transparent wrapping of orange and blue.
There are days when the wrapping melts
And a slight twinge of pain spreads through my body.
There are days when
There is no capsule breaking.
And yesterday, in your room,
Many capsules suddenly broke.
And the pain began to stream through
My body and overwhelmed me and passed
From my center to my sides.
FINAL WORDS
The most systematically worked out psychoanalytic views of artistic cre-
ativity have been those of Freud (1897, 1908, 1916) and views that are
based on Kleinian ideas of art as a reparative activity that emanates from
the depressive position (Segal 1952; Klein 1930). Segal’s view of
creativity, in Kleinian terms, is more positive than Freud’s. Whereas
Freud regards the need to create art as a defense, which a person who is
freer of neurotic conflict would not require, Segal relates it to a universal
process of devel-opment.
In line with Segal’s ideas, described previously, I have attempted to

show that creative activity of an offspring of Holocaust survivors during
treatment is an element of resilience that facilitates the work of mourning
and an ensuing developmental process. I will summarize it as follows:
1) Creative activity represents movement, by which reenactments shift to

metaphors. In this sense, the movement is a transitional object and
embodies ‘‘betweenness.’’ What constitutes an object is the unfolding
of a process (Parsons 2000).
2) Creative activity introduces a playful element into the reality of the
trauma, thus enabling some distancing from the traumatic event. The
imagery of the trauma becomes more colorful and plastic, the event is
no longer recreated as if it were the offspring’s own story, and it be-
comes more of a metaphor. This enables the working through of proc-
esses of mourning, which occur unconsciously in silent modes of
expression such as enactments.
3) Creative activity is based on a reparative impulse, the patient seeking
ways to repair the damage caused by fantasies shared with his trauma-
tized parents. In these cases, creative activity may serve as a means
for controlling regression (thus becoming a ‘‘regression in the service
of the ego’’ [Kris 1952]) and for making use of primary processes,
rather than compulsively reenacting these shared fantasies.
4) Creative activity is the moving force behind the search for an appro-
priate vehicle of expression. It stems from the need to master external
historical reality, as well as from the need to reorganize the internal
experience of this reality (Auerhahn and Laub 1998).
5) The parents’ Mythos of Survival (Klein 1981; Klein and Kogan 1986),
which consists of conflicting emotions and unconscious wishes about
living and dying, has a great impact upon the offspring, intensifying
their own conflict over life and death. Children of survivors who at-
tempt to create during therapy are often struggling not only against
neurosis or danger to internal objects, but also against the threat of not
being. Creative activity expresses the conflict and the union between
life and death instincts (Grinberg 1992), and therefore is of utmost
im-portance in these cases. Since, as Winnicott has so eloquently
stated, ‘‘There is a link between creative living and living’’ (1971b, p.
81), cre-ative activity is mobilized in the struggle for life.
122 CHAPTER 6
In the case illustration that I have presented here, the creative activity
in the analytic situation was the first step in the patient’s efforts to search
for her internal source of anguish. The second step was the elaboration of
her feelings of mourning and pain, which enabled her to integrate, resti-
tute, and achieve resolution of the burden of depression and guilt trans-
mitted by her mother.
The evolution of creativity moves toward the psychological healing of
traumatic memory (Laub and Auerhahn 1993). Creative activity that in-
volves the legacy of the Holocaust (as we often see in cases of Holocaust
survivors’ offspring) is thus a quest for mastery and redemption. By ap-
pearing in the transitional space between reenactment and representation,
creative activity ultimately allows the patient to be in touch with mourn-
ing and enables its working through. It affirms the forces of life, thus
over-coming silence and death. As an act of imagination, it is a path to
hope and a profound beginning.
7
On Being a Dead,
Beloved Child
Only his children Job did not receive again double,
because a human life is not a thing that can be duplicated.
—Kierkegaard 1941, p. 126
In this chapter I explore the impact of unresolved mourning of parents on

the emotional and cognitive development of their offspring. I will illus-
trate this theme with a detailed case study of a replacement child, born to
parents who had each lost a child during the Holocaust. The mother used
various defenses to deal with her loss, denying its reality and
omnipotently wishing to resurrect the dead, beloved child by means of
the living one. I demonstrate the effect of the bereaved mother’s
unresolved mourning on the mother-child relationship and on the
character structure of the child. As a result of the long process of therapy,
the offspring’s obsessive-com-pulsive symptoms diminished and were
transformed into reparative de-fenses against pain and mourning.
Creative activity helped the patient differentiate between herself and her
mother, and facilitated the work of mourning.
INTRODUCTION
Children of Holocaust survivors are born into families in which their par-ents
experienced the sudden disintegration of their normal world, a world
replaced by one in which appalling cruelty, loss of loved ones, and con-stant
fear of death became the everyday norm. When the survivors are also parents
who lost a child in the Holocaust, one or both of them often view a new child
as a replacement for the one who was lost. This has profound
123
124 CHAPTER 7
effects on the development of the new child, who then concretizes the
par-ents’ unconscious fantasies and expectations in his or her life goals
and practices. The replacement child’s self-perception is often as a loved
and narcissistically valued being, but only on the condition that he or she
ful-fills the destiny of the child who was lost. Since it is impossible to
compete with an idealized rival whose sins have been paid for by death,
the dead child becomes a hated ‘‘sibling’’ who destroys the autonomy of
the surviv-ing child’s ego ideal.
The child of survivors, whether primarily neurotic or afflicted by a
more damaged psychic structure, often exhibits anxieties whose origins
lie in the effort invested in fulfilling the role assigned by the parents or in
attempting to undo the destruction wrought by the Holocaust. When par-
ents encounter their children’s antagonism or hostility—a result of the
pressures they themselves have put upon the children to fulfill this task—
they tend to treat the children as though they were reincarnations of Nazi
oppressors. The underlying reason for this behavior is the parents’ identi-
fication of the child with an introjected aggressor (Kestenberg 1982).
This phenomenon results from the parents’ attempt to externalize
disavowed aspects of their own self-representations, which were
internalized under extreme stress when identification with the aggressor
was the only major adaptational means of survival (Bergmann 1982).
For the child of the survivor, empathy and identification with the
parent as a persecuted victim or as a Nazi aggressor lead to splitting in
the ego and superego representations. In cases where the child is assigned
a role of restitution in the parents’ fantasies, which cannot be fulfilled,
dif-ficulties in thinking and reality testing often ensue, since it is unclear
what is real and what is not. I wish to illustrate this theme through the
presenta-tion of a case study.
As a result of the obstacles I encountered in the attempt to make the
unconscious conscious in this analysis, I will also focus on the special
countertransference problems resulting from the fact that the analyst and
the patient shared the same large-group identity (Volkan, Ast, and Greer
2002). In such cases, analyst and patient may collude in the attempt to
avoid feelings of aggression and guilt, which are connected in both their
minds to dreadful historical events.
ON BEING A DEAD, BELOVED CHILD 125
THE CASE
Nurit, a scientist, married, and the mother of three, sought help because
of her compulsive behavior, which affected her everyday life. She was
gen-erally satisfied with her life and content with her family and work.
She never had difficulty making important life decisions; she loved her
hus-band and children and was happy with her profession and lifestyle.
Her problematic behavior expressed itself in minor details of her life: in
the need to check and recheck that she had turned off the gas stove, or
that she had closed the refrigerator door, the garage doors, or the little
bottle of talcum powder she kept in her bathroom. Other daily tasks of
minor importance, such as setting her alarm clock and writing addresses
on let-ters, had to be repeatedly inspected to ascertain that they had been
per-formed correctly.
In our first meeting, Nurit described her symptoms as time- and energy-
consuming; she wished to be rid of them as they were ruining her self-image
of a mature, self-assured woman, which in many respects she felt she was.
Also, she had recently had some fierce clashes with her older daughter, an
adolescent, and her symptoms worsened. This led her to seek professional
help to overcome her problems. Some years earlier, she had undergone
behavioral therapy but had derived little benefit from it.
Nurit was an attractive woman in her early forties. She was tall, slim,
neatly dressed with an elegant touch, her silvery white hair adding a regal
quality to her appearance. To me, she appeared an intelligent, talented
woman. Her manner of talking revealed the sophistication of a person
who had spent her life in different places around the world. She had mas-
tered several languages almost to perfection. ‘‘I like languages and they
like me,’’ she told me smilingly.
Listening to Nurit during our first encounter, I was struck by the tone
of her voice, which was completely devoid of emotional inflections. Her
voice had a metallic quality to it, as if it were a metal shield preventing
emotions from breaking through. ‘‘What a painful wound must be hidden
beneath these metallic sounds!’’ I thought fleetingly.
I recommended psychodynamic psychotherapy to Nurit as the treat-
ment of choice at this stage, so that we could establish some emotional
contact before embarking upon a long and painful analytic journey.
126 CHAPTER 7
Anamnesis
Nurit was the only child of two Holocaust survivors. Her mother came
from a middle-class Polish family with several siblings. Her mother had
always described her family as warm and loving, and Nurit believed that
her mother had derived a lot of strength from this. Her mother’s entire
family (a brother, a sister, and their children) had perished in the Holo-
caust.
At nineteen, her mother married a man considerably older than herself,
and they soon had a little girl. When war broke out, the rumor spread that
Jewish men were in danger, while women and children would be safe.
Many Jewish men therefore fled to Russia, leaving their families behind.
Her mother’s husband also fled to Russia, and she remained in Warsaw
with her child until they were forced to move into the ghetto. One day, on
her way back from work to her little girl, who was looked after by a
caretaker, she was told that both child and caretaker had been killed in an
‘‘aktion.’’ Nurit’s impression was that the girl had been approximately
seven years old when this happened.
After a while, Nurit’s mother was transported to Bergen-Belsen, where
she was held for several years. When the war ended, her mother came to
Israel and met Nurit’s father. As had her mother’s husband, he, too, had fled
to Russia during the war, leaving his father, his wife, and his little daughter
behind. They were all murdered in his absence. Nurit thought that her
father’s daughter had been about the same age as her mother’s daughter
when she was killed, perhaps even in the same ‘‘aktion.’’
In Israel, her mother and father fell in love; however, the mother was
still married, as her husband had survived and was living in Poland. The
mother traveled to Poland to obtain a divorce from her husband, remain-
ing there about a year. Nurit believed that this might have been an unsuc-
cessful attempt on her mother’s part to renew the bond with her husband.
The story told in the family was that while there, her mother received a
Bible that had been smuggled in by an acquaintance, and among its pages
was a sum of money and a note from Nurit’s father that read ‘‘Come
back home!’’ Mother made her decision. She obtained a divorce,
returned to Israel, and married Nurit’s father. Nurit was born when her
mother and father were approximately forty years old.
The family lived in Israel until the child was two years old. After the
father established a successful business, they moved to Europe, living in
different countries. Nurit had wonderful memories of her childhood. She

was loved and adored by her parents, her governess, and her paternal
grandmother, who lived with them. She did well in school, was popular
socially, was adept at learning new languages, and adjusted easily to new
places and people.
At the age of eighteen, Nurit left home and returned to Israel to live
with her grandmother, who had moved back some years earlier. She
com-pleted her studies in science, married a man who provided her with
con-stant love and support, and who succeeded professionally. Nurit
viewed her successful marriage and her three children, two daughters and
a son, as important life achievements.
Phase 1: Learning a Forgotten Language

During the first months of treatment, Nurit filled the sessions with sto-
ries of her terrible experiences and suffering at the hands of her mother
from age eleven until she was eighteen, when she left home. These stories
stood in stark contrast to the wonderful memories of her early childhood.
They conveyed an oppressive, persecutory style of parenting, the impact
of which was still present in the patient’s life. The striking feature of
these stories was that, in spite of their painful content, they were told in a
man-ner completely devoid of affect. Nurit never mentioned the pain,
humilia-tion, and fear that accompanied her terrible experiences. She also
had great difficulty expressing emotions in the here and now of the
analytic situation.
In spite of what appeared to be a good therapeutic relationship, it was
difficult to help Nurit disclose the feelings that I felt were lurking
beneath her defensive armor—her vulnerability, dependency needs,
deeper fears, and longings. The transference had a shallow quality. I felt
that I was not really able to touch her emotions. To help overcome this
obstacle, I had to make Nurit aware of her difficulty in expressing her
feelings. In addi-tion, since I felt that the face-to-face nature of
psychotherapy was not fa-cilitating a spontaneous expression of feelings,
I suggested that the form of treatment be changed to psychoanalysis,
which I believed would help stimulate spontaneity in her.
After asking me several questions about this, Nurit agreed to undertake
psychoanalysis at the frequency of four times a week, on the couch. She
cooperated with the requirements of the process and free-associated with
128 CHAPTER 7
ease. However, the obstacle of my inability to touch her emotions

seemed as insurmountable as ever. I realized that my commenting on the
lack of affect in her speech would not enable her to express emotions.
Instead, I explored the reasons underlying this lack of affect. I shared my
feeling with Nurit that the root of her problem might be her long-
continuing anxiety over being hurt, abandoned, or destroyed, and that
together we would have to discover the reasons underlying her inability
to express emotions, as well as its adaptive purpose. She acknowledged
the existence of a protective shield that concealed her emotions, and we
embarked upon the long, arduous journey of discovering the
circumstances that had forced her to construct this heavy armor that, I
believed, enabled her to cope with life. Only much later in analysis could
Nurit express feelings of appreciation for my approach, which had
encouraged introspection rather than feelings of inadequacy and guilt.
Though devoid of affect, Nurit’s accounts of the atmosphere at home
during her adolescence were horrifying. She described her mother’s
unex-pected outbursts of anger, her habit of ignoring Nurit and not
talking to her for days, her accusations that Nurit was the cause of her
unhappiness. The idyllic childhood relationship had evidently changed
into a compli-cated, painful one during the patient’s teenage years.
Nurit declared that she had felt totally alone in the face of her
mother’s unexpected fury and senseless resentment. At first, she had tried
every-thing possible to appease her mother’s wrath and win back her
love, but to no avail. To ward off her mother’s aggressive attacks and
outbursts, as well as her own feelings of helplessness and humiliation,
she learned to hide her feelings from her mother. We came to the
conclusion that the shield Nurit had constructed to protect her vulnerable
young self had been vital for her psychic existence. But although
irrelevant to her present life, it was still part of her.
Listening to the account of her adolescence, trying to imagine the hurt,
humiliation, and anxiety caused by her mother, I considered another
angle: the part that Nurit herself might have played in constructing her
wretched life. This thought, which would have been totally unacceptable
to Nurit at this stage of treatment, kept recurring to me throughout the
analysis. It would be a long time before I could investigate it in the trans-
ference relationship.
During this period, by identifying her emotions and labeling them for
her, I felt I was teaching Nurit a language once known to her but long
forgotten. With her talent for languages, she was willing to relearn the
language of feelings, which she had erased in her adolescence because of
her fears of hurting her mother or being hurt by her. Relearning how to
express emotions would hopefully result in Nurit’s being less afraid of
hurting me or being hurt by me in the transference.
An episode described by Nurit in the second year of analysis reflected
her difficulty in expressing her feelings. She spoke of a recent experience
she had had while in Europe: a visit to a hospitalized acquaintance, a
young man, who after discovering his Jewish origins, had gone to Israel
for a visit. During the visit, he was badly injured in a terrorist attack, and
the explosion made him a quadriplegic. He returned to his native land in
Europe for medical treatment, and Nurit’s visit was welcomed by the hos-
pital staff, who asked her to translate the patient’s words to the Israeli
spe-cialist who had been invited for a consultation. Nurit was very
impressed with the young man who, though almost totally paralyzed (he
could move only his head), still wanted to return to Israel to build a life of
his own and not be dependent on his parents.
In the transference, I told Nurit that she would need to translate her
feelings into words for me so that I, in the role of specialist, would be able to
understand her and help her become inwardly independent of her own
parents. However, I added that this might be difficult for her because of her
terrible fear of my leading her into an explosion of emotions on our analytic
journey. Nurit rejected the second part of my interpretation, ve-hemently
denying any fear, either of me or of analysis. I then asked Nurit whether she
identified with the young man, the quadriplegic, on those oc-casions when
only her head was working, while her emotions were para-lyzed. Nurit’s
reaction was that she had recently learned to ride a motorcycle in spite of her
fears, because her teacher was there behind her, guarding her. I pointed out
that perhaps, since she knew I was behind her, she was hoping to gradually
master her fear of expressing emotions.
Nurit’s insecurity with regard to her perception of reality was a com-
plex phenomenon that was related to her doubts about her sanity. I shall
illustrate how we began working this through with an episode from the
third year of analysis. Nurit was asked by friends to arrange the hospital-
ization of an acquaintance, the daughter of a friend of the family whose
mother had died of a brain tumor. The mother, a survivor of Auschwitz,
130 CHAPTER 7
had been hospitalized on and off in psychiatric hospitals throughout her

life. The daughter had studied and held a job when younger, but later
gave up everything to care for her mother. She never married or had a
family of her own; instead, she lived with her mother in a situation
defined by Nurit as a ‘‘total symbiosis.’’ When the mother died, the
daughter appar-ently fell apart and had to be hospitalized.
In analysis, Nurit became aware of the anxiety caused her by the en-
counter with the psychically ill woman whose history was different yet
similar (their mothers were both Holocaust survivors). I suggested to
Nurit that this woman, though obviously mentally ill, might be a reflec-
tion of herself. At this stage, Nurit was able to accept this without resis-
tance, even referring to the weak, dependent, fragile woman as ‘‘my alter
ego.’’ It was clear to me that Nurit’s newly acquired ability to openly and
undefensively acknowledge her weaker aspects was an indication that she
was becoming stronger.
However, the attempt to understand the meaning of ‘‘total symbiosis’’
of mother and daughter brought to the surface the problems that still re-
mained. I considered various ways of understanding the situation, such as
when I asked Nurit whether she felt she might be as unstable and de-
pressed as she believed her mother was. The patient vehemently rejected
this possibility. Following her rejection, I silently asked myself whether
the feelings of hatred and aggression that she attributed to her mother
were actually her own. In addition, I wondered whether she was afraid of
be-coming so attached to me that she would fall apart if I were to
disappear or die. In order to broach this subject, I frequently inquired into
her feel-ings about my occasional trips abroad. My inquiries were always
met with a consistent denial of any emotional reaction to our separations.
This de-nial made me aware that, despite becoming stronger, Nurit was
still en-cumbered by tremendous fears.
Phase 2: Remembering the Unknown

During her childhood, Nurit was told very little about her parents’
pasts, but this was no less traumatic for her than the stories she did hear.
Her mother’s undue anxiety over Nurit’s getting lost in the street, over
the eventuality of illness, or that catastrophe might strike, undoubtedly
conveyed to her her mother’s fear and dread of violence and loss.
A transferential incident—finding a hair on the pillow on the analytic
couch—enabled us to elaborate upon some painful memories. I illustrate

the attempt to work through these memories with accounts of two consec-
utive sessions from the third year of analysis. These sessions also demon-
strate the difficulties I experienced in working with Nurit’s feelings in the
transference.
Session 1. Nurit walked into my office, arranged the pillows the way she
al-ways did before lying down, and suddenly said, ‘‘There’s a hair on
the pillow. Whose hair is it? Who are your other patients?’’ After a
moment of silence, she continued by relating a memory.
Nurit: I remember a time in my childhood when I first noticed a pic-

ture of a little girl on my father’s desk and asked who she was. I
was told that it was a picture of my sister, who had died a long time
ago. I thought this meant that she was Father’s daughter. When I
was older, I found out that she was actually Mother’s daughter.
This made me feel very insecure. I used to wonder, ‘‘Who does the
child belong to—Father or Mother?’’
I listened to Nurit in silence.
N: (continuing) You know, sometimes, when I was walking down the

street and saw a cat or a dog that was run over, I tried to look away.
I: Do you think your reaction might be the same as your reaction to
your sisters, who were run over by the Nazi machine?
N: Well, yes. When I was younger, I would try to block out the stories
of the dead. I wanted to grow up without letting them affect me.
I: It couldn’t have been easy growing up in the shadow of the dead.
N: The truth is, I enjoyed being an only child. I had so many privileges.
I: Today, when you noticed a hair on the pillow, you asked me who
my other patients were.
N: Right. I never actually thought about the others. For me they just
don’t exist, even though of course I know that they come here.
I: You wish you were an only child, and like with your sisters, you try
to ignore my other patients so that their existence won’t affect you.
N: [after a silence] When I first came to you, I was so worried about my
oldest daughter. She is such a talented girl, but she was an under-
132 CHAPTER 7
achiever in school. She also had this awful boyfriend from a low-
class family; maybe he was even on drugs. She was always
rebelling against us—her successful, achievement-oriented parents.
I always felt that what she was doing was directed against me; she
was so angry with me.
I: Perhaps you were angry with your mother and your sisters in the
same way your daughter was angry with you?
N: [After a moment of silence, she spoke nonchalantly.] That’s an in-
teresting piece of information.
I was struck by the remote, intellectual nature of Nurit’s reaction. I felt

that my interpretation had fallen on deaf ears, that I was not really touch-
ing her. It seemed that there would be no point in inquiring in the trans-
ference about a possible parallel between her daughter’s way of relating
to her and her way of relating to me, as this would likely result in an
immedi-ate rejection.
N: I never did that to my mother [i.e., got angry with her]. I was a
good girl, a good student in school. My parents never had to worry
about me. But, as soon as I became a teenager, my mother was no
longer pleased with me. She accused me of being egoistic and
selfish. I was terrified by her threats. She told me that I would
never have any friends because I was so cold and inconsiderate. I
remember my mother saying, ‘‘You’ll see—your child will do
exactly the same thing to you that you’re doing to me!’’
I was struck by the way the patient experienced her mother’s reaction.
Aspects of my own mother, her aggression and critical attitude toward
me, sprang to mind.
I: You probably felt she was cursing you.

N: Yes, definitely. Today I know that I have good relationships with
people; a lot of people like me. But then I didn’t know that and I
believed her. It completely shook my self-confidence. You know,
when I was around eleven years old, Mother became so demand-
ing—everything had to be done perfectly! I remember the first time
it happened, it left such a strong impression on me. Mother accused
me of not turning off the light in my grandmother’s room. I was so

sure I had turned it off that I argued bitterly with her about it. But in
the end, I felt confused and wasn’t really sure anymore. This began
happening so often that I no longer knew when I was right and
when I was wrong. Maybe this caused the symptoms that I’m
suffering from now.
Nurit’s distress left a deep impression on me. Evidently, years of

being told that she was completely untrustworthy had left her feeling that
she could not trust her senses.
N: [speaking suddenly] This plant in your office, wasn’t it much

smaller two days ago, or am I imagining it?
There were various ways to react to this question. I could have

inquired further about what she thought of this. I could have tried to link
her anxi-ety over the replaced plant to her anxiety and guilt over being a
replace-ment child for her parents (Brenner 2001)—but this was an idea
that we would be able to deal with only later in the analysis. I chose
instead to reassure the confused child revealed in the analytic situation.
At the time, I felt that this was the only way to help her regain faith in her
perception of reality.
I: Your question about the plant brings into the room the confused
child who could not trust her senses. Yes, you are right, the plant
was much smaller. I brought in a new, larger one yesterday.
In this session, we can observe my avoiding the attempt to touch upon

unconscious, ‘‘dangerous’’ subjects, such as Nurit’s wish that her
siblings had never existed and her hatred of her mother. Instead, I totally
accepted her conscious feeling of being the victim of a mother who had
under-mined her child’s perception of reality. Nurit was afraid that I
would not believe her version of the reality of life in her parents’ home,
just as her mother had not believed her reports of reality.
On the other hand, I felt something was missing in this analysis, and
that was the work of making the unconscious conscious, due to my fear
134 CHAPTER 7
of arousing Nurit’s anger and becoming her victim. The following state-
ment by Nurit showed that she, too, felt something was absent.
N: In the beginning of analysis, I expected you to ask me all sorts of

questions so that you would know more about me, but you never
did.
Since from the start, I had explained the role of free associations to
Nurit, I speculated over the deeper meaning of her remark. Was she refer-
ring to questions regarding her feelings toward me in the transference that
I did not dare to bring up? Or perhaps to elements hidden in her story that
I did not know about? I chose to pursue the latter, feeling that it would be
more acceptable to her (and possibly safer for me, as well, at this stage of
the analysis).
I: Perhaps you see me as yourself, the little girl who wanted to know so
much about the secret past of her parents, but never dared to ask?
We were both silent and the session ended.
Session 2. Nurit entered the room, lay down on the couch, and immedi-
ately began talking:
N: You know, yesterday I paid a visit to Hanna, Mother’s close friend

from Bergen-Belsen. I took the opportunity of asking her some
questions about Mother’s past.
Nurit had told me about Hanna, who had a traumatic story of her own.
After her little boy was killed in an ‘‘aktion’’ in the ghetto, Hanna
discov-ered a little girl at Bergen-Belsen, a cousin’s daughter who had
lost her parents. She took the child into her care, thus saving her life.
N: Yesterday, Hanna described to me her first encounter with Mother at

Bergen-Belsen. When Mother initially saw Hanna with her little girl,
she exclaimed, ‘‘You’re so lucky you saved your daughter—I couldn’t
save mine!’’ ‘‘How wrong you are,’’ Hanna had answered, and
painfully recounted the loss of her son. Comparing their similar
fates, the two women discovered that their children, both approxi-
mately eleven years old, had been killed in the same ‘‘aktion’’ in
the ghetto. ‘‘There were no words to describe the bond between
us,’’ said Hanna.
Hanna and my mother became soul mates. They supported each other
physically and emotionally and raised the little girl together. And I found
out that my half-sisters were killed at around the age of eleven, not when
they were seven, as I had always thought. So Mother lived alone with her
daughter for four years.
We were both silent.
N: I picture my mother as a lonely, frightened woman, living with her

child in dreadful circumstances, under the threat of death and de-
struction. I can imagine the special closeness between mother and
daughter in this terrible situation. They probably existed for each
other. I envy their closeness, but I also feel sorry for them.
This was the first time I had heard Nurit express any sympathy for her
mother.
N: Something else left an impression on me in my meeting with Hanna:

the fact that now, fifty years later, Hanna is still haunted by painful
memories of her son’s last moments. For example, Hanna continues to
be tormented by the fact that her little boy was cold and was wearing
uncomfortable shoes when he was snatched away from her and taken to
his death. I think that this irrational, gnawing pain that still torments
her also tormented my mother throughout her life. [After a moment of
silence, Nurit continued.] I recently saw a movie about a Holocaust
survivor who destroyed his relationship with his son when the child
turned nine. The survivor himself was
nine years old when his parents were taken away, leaving him alone
in the world.
I: Do you think this movie might reflect something about your rela-
tionship with your mother?
N: Yes, it could; I never actually thought about it. My problems with
Mother began at around the age of eleven, the age when my half-
136 CHAPTER 7
sister was murdered. Mother loved and adored me as a child. That

changed completely when I grew up. Mother wanted me to be a
copy of herself, her double. [Then, without the slightest hint of
emotion, she added the following.] I lived and her daughter died.
I: [I was amazed by this statement.] Her daughter? Aren’t you her
daughter?
N: I was Father’s daughter. Mother always said that I was like Father
and his family. I got along better with him. Mother was very
jealous that I lived and her daughter perished. She never forgave
me for that. [Silence.] Mother made me feel that I wasn’t connected
to reality, that I couldn’t perceive it correctly, that I couldn’t
possibly be trusted. I felt I’d done terrible things, that I was
apologizing all the time. I think my only crime was that I grew up
instead of her daughter.
Following this session, myriad thoughts passed through my mind re-

garding this last comment of Nurit’s. How horrible it must have been for
the mother—the disappearance of her little girl, followed by the news
that the girl and her caretaker had been killed in an ‘‘aktion.’’ And then
an-other separation, when the daughter who was slated to replace the lost
child grew up and entered adolescence. By leaving childhood behind and
becoming different from the person the mother had destined her to be,
the daughter was no longer able to fulfill her mother’s unconscious
fantasy of resurrecting her dead, beloved child. Nurit felt that in her
mother’s eyes she had become the embodiment of her father’s daughter,
and, as such, Mother envied and resented her existence.
And what about this child, I further wondered, who had failed in the
competition with her dead, idealized sibling and who was also unable to
fulfill her mother’s unconscious wish that she repair her grief? How she
must resent her dead sibling and how angry she must be toward the
mother who made her feel a complete failure and as though she were the
cause of her mother’s unhappiness!
Also, Nurit’s persistent claim of a clear conscience, stating that her only
crime was that she grew up instead of her mother’s daughter, made it very
difficult for me to delve into her unconscious wishes and her guilt over the
‘‘terrible things’’ her mother had accused her of. Consciously, Nurit
remembered that her mother had regarded her as the cause of her unhap-
piness. Consequently, throughout adolescence, she saw herself as a bad,

egotistical person, and felt guilty about it. I believe that, unconsciously, Nurit
felt guilty about her aggressive wishes toward her little sister— Mother’s
child—and toward Mother herself, wishes that stemmed from feeling
wronged by them. But if this were so, why wasn’t I able to touch her hateful,
murderous feelings toward me in the transference, I again asked myself. Was
I so afraid of arousing her anger and thus becoming her victim? Or was I
afraid of becoming her persecutor, who, by interpreting her aggressive
wishes, would inflict even more pain and humiliation upon the victim? This
dilemma preoccupied me at length without my being able to solve it. Only
later on in analysis would I be able to deal with this issue.
Nurit continued to share with me her painful feelings over her lost
place in her mother’s heart. Her associations regarding the refugees who
lived in DP (displaced persons) camps near her childhood home in Eu-
rope reflected her feelings of alienation from her mother. Nurit described
the DPs as refugees: poor, uprooted people who belonged to no place in
the present world, and who could not return to their past, nonexistent
world. In analysis, we understood that Nurit had identified with these
DPs during her adolescence. Not only had she been divested of her role
as her mother’s beloved child in the present, but she felt she could not go
back to her loving mother from the past. Nurit was the DP who had
arrived in place of her mother’s ‘‘real’’ daughter, but who had not
succeeded in re-placing her. From a transferential viewpoint, Nurit felt
like a poor, up-rooted, displaced person, rejected by her mother,
searching for a new home in analysis.
Another memory from Nurit’s adolescence surfaced in analysis: Her
mother, bitter and dissatisfied, had frequently spoken of adopting a child.
This wish never actually materialized. However, her mother had a special
relationship with Dina, an acquaintance, a young woman who had been a
child during the Holocaust. Nurit believed that, on a fantasy level, her
mother had found her ‘‘real’’ daughter in the ‘‘adoption’’ of Dina.
Nurit’s accounts of her present-day visits abroad to her parents enabled us
to elaborate upon her complex relationship with them. These visits were
never easy or pleasant for her, and in spite of now being a mature adult, she
still felt criticized and unwelcome in their home. She often asked her
husband or one of her children to accompany her, to serve as a buffer
between herself and her mother. Nurit felt that her visits to her
138 CHAPTER 7
parents were important to them so that they could show the world what a
good, devoted daughter they had. However, her mother’s complaints
about the additional work for her cleaning woman made Nurit feel that
her visits were a bother for her mother.
Nurit described in detail an episode from one of these. The following
exchange took place between mother and daughter behind closed doors,
at her mother’s insistence. Mother began the discussion by saying, ‘‘You
are a courageous person, aren’t you? So, why do you hate me so much?’’
Completely overwhelmed by this question, Nurit asked, ‘‘Who says I
hate you?’’
‘‘Everyone knows you do,’’ answered Mother, and to prove her point
named three cleaning ladies who had worked in the house some thirty years
earlier. ‘‘The first one,’’ said Mother, ‘‘told Grandmother that one could
easily see that you’re Father’s daughter from his first marriage. The second
one said that it’s obvious from your behavior that you don’t love your
mother. I overheard the third one repeating the same statement.’’
At this point, Nurit said she realized that time had stood still for her
mother and that the past was totally alive in her present world. Nurit’s
denial of her mother’s accusation was to no avail. Mother began recount-
ing Nurit’s sins, beginning with her childhood. The list was interminable:
When she was four years old and mother took her to a department store,
Nurit said that she wanted a mannequin she saw there to be her mother,
which her mother took as evidence that already at that fragile age, Nurit
wanted to exchange her for a different mother. At age twelve, Nurit said
she hated her mother’s handwriting. Afterward, she wrote a note and
apol-ogized for that, but the note got lost. Mother went on and on in this
vein, ruminating about Nurit’s offenses.
Trying to bring her back to reality and to connect her to some feelings
of love, Nurit said to her mother, ‘‘I am forty-six years old and I am your
daughter. Can it be possible that this is all you remember? Don’t you
have any good memories of me?’’
In spite of her efforts, Nurit claimed her mother could not be swayed.
Firmly entrenched in feelings of hatred and persecution, her mother con-
tinued, ‘‘You threw me out of your house!’’ Nurit was stunned.
‘‘What!’’ she said. ‘‘When did this happen?’’ Mother mentioned an
incident when she had come to Nurit’s house in Israel to visit Nurit’s
father, who had been hospitalized there at the time. ‘‘I put my things
away, but you told
me not to make such a mess. You threw me out of your house.’’

Mother’s logic could not be disputed. ‘‘During that same visit,’’ she said,
‘‘I slept in your double bed. You always grabbed the blanket away from
me during the night. I could have died of cold. And I never had lunch
when I visited your father at the hospital—you never asked me if I had
eaten. I could have died of hunger and you wouldn’t have cared.’’
Nurit recounted the enormous effort she made to interrupt her moth-
er’s tirade: ‘‘What a pity that this is all you remember after forty-six
years! Mother, I do not agree with your accusations. I want to remember
the good things we had together, the things I learned from you. I am
leaving and taking those memories with me. I wish I could leave the
others be-hind. Thank you for your nice presents.’’ Nurit kissed her
mother on both cheeks and walked out.
In analysis, Nurit tried to work through the feelings caused by this
painful encounter: At first she was dumbfounded; her adolescence, and
indeed, her life with her mother, were revivified in her mind. Nurit told
me she now realized that her mother was living in a totally different real-
ity, where Nurit was her Nazi persecutor. ‘‘This time Mother actually ex-
plained to me why she hated me,’’ said Nurit. ‘‘Not only did I grow up
turning into Father’s daughter, but I also made her feel homeless and de-
prived her of heat and food. I denied her the most basic necessities of life
and was so cruel that I didn’t even care.’’
I pointed out to Nurit that she felt persecuted by her mother no less
than her mother felt persecuted by her. Nurit agreed that each of them
had projected the Nazi aggressor upon the other.
Nurit claimed that the way she now perceived her mother brought her a
measure of relief and strengthened her belief in her perception of reality.
Expressing her gratitude to me, she said, ‘‘When I listened to Mother, I
thought about my treatment. I now see things in a totally different light. It
was worth every penny I’ve spent on analysis,’’ she added.
Phase 3: Finding Hidden Truths

During this third stage, we both, analyst and patient, attempted to un-
cover the truth of Nurit’s internal representation of her father and to work
through her complex relationship with him. Until recently, Nurit had
greatly idealized him. He was not only clever and successful, but had
140 CHAPTER 7
shown her much love throughout her childhood. They used to enjoy
walk-ing and talking together; her father had always been proud of her.
Nurit’s oedipal attraction to her father, her love and admiration for him,
stood in sharp contrast to her attitude toward her mother. In analy-sis, we
worked through her oedipal conflicts at length. I will now describe an
episode from the patient’s adolescence that illustrates her unconscious
attraction to her father and the place she wanted to have in his life.
Nurit related that when she was around seventeen years old, Father
confessed to an affair with his secretary during his travels abroad. Nurit
believed that this confession had been forced upon her father, as her
mother had confronted him with a letter to his secretary that she had
found which implicated him, followed by information she had obtained
from a private detective whom she had employed for this purpose. Father
acknowledged his guilt, but claimed that the relationship was over and
promised to be loyal to his wife from then on. Mother had raved madly
about father’s betrayal and had even considered the possibility of
divorce. To her mother’s great surprise, Nurit took her mother’s side and
sup-ported the idea of divorce, pointing out that she did not want her
parents to stay together on her behalf.
Nurit remembered being very involved in the story of her father’s be-
trayal. One day, she walked into his office and asked him if he had had
only one lover or many. Father, totally surprised by the question, claimed
that he had had only one relationship, which was finished. Nurit walked
out of her father’s office, satisfied with his answer.
In analysis, we tried to discover and work through Nurit’s unconscious
wishes and fantasies. She remembered feeling hurt by her father, as if she
herself had been the woman who was betrayed. We understood that by
favoring the idea of divorce and attempting to find out intimate details of
his love life, Nurit had unconsciously wished to become his fantasized
partner. Much psychic work was needed for Nurit to realize the impact
that her oedipal attraction toward her father had had on her clashes with
her mother, as well as on her defenses. Only later did we understand that
her emotional detachment in analysis stemmed not only from the protec-
tive shield she had developed against being hurt by her mother, but also
from her identification with her father.
Nurit was able to acknowledge some of her negative feelings toward her
father, such as the fact that, even though he was loving and admiring of
her, he had been of no help to her during her difficult adolescence. She
claimed that he had preferred to ignore his wife’s emotional state—her
unexpected outbursts of anger and her cruel ways of handling Nurit. She
remembered that, when she had initially found herself at the mercy of her
aggressive, persecutory mother, she had turned to him for help and sup-
port. But father never took her side, in spite of seeing how upset and
help-less she was. Nurit quickly learned that she was on her own in her
fight for survival. Aware of her plight, father would sometimes softly
utter, ‘‘It isn’t really so terrible!’’ But he never actually dared to comfort
her or to argue on her behalf with his bitter, spiteful wife. His repeated
comment to Nurit was, ‘‘You have to understand your mother—she has
been through so much suffering!’’
In analysis, we tried to work through Nurit’s feelings of anger and frus-
tration at what she experienced as her father’s emotional abandonment,
feelings that until now she had denied. Attempting to understand his be-
havior, she expressed the belief that his guilt feelings—not only regarding
his lover, but also over his former family—were at the core of it. He had fled
to Russia during the war, leaving his father, wife, and child behind, and they
had all perished in his absence. Nurit never saw him exhibit any feelings of
mourning or guilt over the loss of his family. Father always kept his feelings
under control. Nurit now believed that his life had been dedicated to her
mother’s well-being, which helped him make reparation for his lost family.
She came to the conclusion that he had sacrificed her, Nurit, as part of a
‘‘peace treaty’’ with his wife. The patient believed that by never interfering
with his wife’s ‘‘methods of education’’ and leaving Nurit to her mercy, her
father had gained the freedom to do as he pleased in his profession, his
hobbies, and even in his relationships with members of his family whom his
wife did not accept. When he did quarrel with his wife, she would express
her anger by shouting and accusing him of being inconsiderate, egoistic, and
lacking in feelings. She would then move on to Nurit, accusing her of being
his daughter, resembling him and his fam-ily: hard, cold, and egocentric.
The following incident caused Nurit to realize her ambivalent feelings

toward her father. When she opened the door to leave the room at the end
of the painful encounter with her mother described earlier, her father
passed by on the way to his room and closed his door. Although he had
just seen the two women together in an unusual situation and had proba-
142 CHAPTER 7
bly observed the flustered expression on his daughter’s face, he did not
pause to ask about it. ‘‘That’s what he always used to do. I remember
now,’’ said Nurit. ‘‘I once thought that he loved me. I clung to him and
had to believe in his love even if it wasn’t true. I know now that he was
never there for me when I needed him. He sacrificed me for his own
well-being.’’
In connection with this episode I remembered that Nurit had re-proached
me, as well, for never asking her enough questions. Was it possi-ble, I asked
myself, that she felt that I, too, had abandoned her to carry her pain and
suffering alone? I did not dare bring up this idea, feeling that she would
immediately reject it. I later realized that at this stage, Nurit had projected
onto me the role of her father, and I had identified with it.
The elaboration of her disappointment in her father highlighted the oe-
dipal rivalry and envy that existed between Nurit and her mother. Nurit
felt that her mother envied her everything she had ever achieved. I tried
to point out to Nurit the extent to which she envied her mother for the
love bestowed upon her by her father. Nurit acknowledged that for a long
time she had felt that this love was given to her mother at her own ex-
pense.
Realizing how much she was affected by her parents’ past, Nurit said,
‘‘I used to think that my parents’ stories belonged to their past and I
didn’t want to know about them. Now I know that my parents’ stories are
my own stories. I am struggling to know, to understand. I am struggling
to live.’’
Phase 4: Confronting Her Own Wrath

During this stage of the analysis, Nurit’s mother, who was eighty-four
years old, developed breast cancer, underwent an operation, and lived for
another eighteen months. I will not describe this phase in detail; suffice it
to say that at the start, her mother refused treatment, apparently conceal-
ing her illness for about two years.
Nurit reacted strongly to mother’s behavior: ‘‘That’s suicidal! If she
had sought treatment from the start, she would still have a good chance
of living. Mother told me on the phone that there was nothing to be sad
about; at her age, this is normal. I separated from my real mother a long
time ago. I can only pity this woman and hope that she suffers as little as
possible. If that’s what she wants, that’s what she’ll get!’’
I pointed out to Nurit how angry she was at her mother. Nurit readily
agreed: ‘‘Mother couldn’t save her daughter, so she had to pay for it by
suffering. This is her way of appeasing her feelings of guilt.’’
Nurit continued to settle her account with her mother. She claimed that by
not seeking treatment for breast cancer, her mother was trying to destroy her
breast, the symbol of motherhood. From her last discussion with her, she
deduced that her mother had erased Nurit’s happy child-hood from her
memory. ‘‘She lost her first child and erased the memories of the second,’’
said Nurit. ‘‘She doesn’t need a breast anymore.’’ Was this really so, I asked
myself, or was it Nurit’s anger resurfacing at the moment of separation from
her mother that made her see the tragic event from this perspective? Had her
mother erased all memories from her mind or had Nurit erased her loving
mother, the one who held happy memories? And if so, was it not because
Nurit wanted to protect herself against the feelings of loss and pain that
would be incurred by her mother’s death? This hypothesis was confirmed by
the events that followed.
Despite her opposition to receiving treatment, the doctors convinced
Nurit’s mother to undergo an operation. Nurit and her family visited her
and sat for hours at her bedside. Nurit recounted that her mother recov-
ered quickly from the operation and behaved very lovingly toward her
husband and grandchildren. Nurit felt that it was only toward her that her
mother acted coldly. Though hurt, she expressed some relief, confirming
my hypothesis as to the defensive quality of her anger. ‘‘I was afraid she
was going to bestow a lot of love and affection on me. I separated from a
loving mother once before in my life. If she had shown me affection, I
would have had to go through another painful separation.’’
I asked Nurit if it were possible that she had already separated from
her loving mother, but not yet from her persecutory one. Nurit
acknowledged the truth in this. When confronted with situations where
she felt a lack of self-confidence, she would hear mother’s voice inside
her, undermining her trust in her senses. Evidently, this voice was now
part of her. It was apparent to me that reparation of the split mother
figure should be one of the objectives of analysis.
Nurit’s mother died a year and a half after the operation. I now describe
how, at long last, we revealed and worked through Nurit’s aggressive feel-
ings toward me (her mother) in the transference. For this purpose, I use
material taken from two consecutive sessions in the fifth year of analysis.
144 CHAPTER 7
Session 1. Two years after her mother’s death, Nurit’s persecution at the
hands of her mother still remained a topic that constantly preoccupied us.
There seemed to be no room in Nurit’s mind for anything else. The
image of the critical, persecutory mother accompanied us through entire
ses-sions. I felt as if we were never alone in the room, but always in the
pres-ence of a threatening third figure. I was flooded by Nurit’s obsessive
thinking, angry and helpless to stop it. Feeling impotent and frustrated I
said:
I: Your mother is always here with us; she never leaves us alone.
Lately, I feel that she is persecuting both of us.
Silence. What was it, I asked myself, that I could no longer tolerate?
Nurit’s never-ending obsession with her persecutory, present-though-
absent mother was unbearable. Was it possibly connected to how,
throughout her life, she had experienced the presence of her absent
sister? Was this connected to my feelings about my own mother or about
myself as an analyst? Or did it represent Nurit’s sadistic, aggressive
aspect, which I had never succeeded in working through in the
transference? Nurit’s en-suing remark and my reaction to it made me
realize how angry she was with me.
N: Well, lately, I’ve seen you looking exhausted, especially toward the
end of the week. I thought, ‘‘She looks so tired—what can I
possibly expect of her!’’
I was astonished and ashamed, as if caught doing something wrong. True,

I had lately been suffering from a state of physical exhaustion, which
fortunately had been diagnosed and was being treated successfully. I was
making an extreme effort to overcome it, hoping my patients would not be
affected by it. The blow of Nurit’s aggressive words left me speechless. I felt
impotent, humiliated, vulnerable, afraid that my weak state had been
exposed, that I had become totally useless to my patients. Her anger is so
bitter, I thought to myself. With great effort, I addressed Nurit:
I: If you felt I wasn’t doing you any good, you must have been ex-
tremely disappointed and angry with me.
N: Only for a short while. [This was stated in an unperturbed manner.]
I silently observed that in the previously-described situation Nurit no

longer asked me whether her perception of me was correct. I neither con-
firmed nor denied it. Nurit no longer needed that from me.
Session 2.
N: I wanted to tell you something I’m very proud of—the way I han-
dled a difficult situation. My beloved cat, Kotul, 1 went outside and
hunted down a little bird. He came back into the house, holding the
bird firmly in his teeth. I was so upset at seeing the captive little
bird. I thought that if I shouted at him, he would only hold the bird
even more tightly in his teeth. So I decided to speak to him softly.
Then I gently put my hands around his neck and squeezed; the
pressure made him open his mouth for air and the bird was freed.
I: You’re saying that you had to strangle the fierce, attacking cat to
free the little bird?
N: [She laughed.] Actually, I love Kotul very much, but it was the
only way to free the bird. I didn’t want Kotul to feel that I was
angry with him; I handled him with love.
There was a silence. My thoughts revolved around the ferocious cat

and the vulnerable little bird as the Nazi-persecutor and Jewish-victim
images, which were always lurking in the background of the analysis and
which represented aspects of Nurit’s self. But immediately, a question
crossed my mind: Am I still so afraid of my patient that instead of
interpreting the experience in the transference, I have to go back to
Holocaust history and intellectualize?
N: My mother held me in her clutches, the way my cat clutched the

poor bird brutally in his mouth. For a long time, I felt that Mother
was my Nazi persecutor, even though she felt it was the other way
around. She always accused me of being the cause of her unhappi-
ness. When her accusations first began, I was furious, mad with
rage; I tried to argue with her. Later on, feeling there was no point
in ar-guing, I stopped displaying any emotion whatsoever. I was
like a smooth wall—just try and climb it! I gave my mother nothing
to hold on to.
146 CHAPTER 7
I: Here, too, you were like a smooth wall for a long time, not allowing
me to get hold of your feelings. It made me feel that I was a weak,
ineffective therapist who couldn’t give you the necessary foothold. I
became the inoffensive little bird and you hated my ineffectiveness. It
was only when you opened your mouth and expressed your anger that
you set me free. But perhaps you felt that I was putting pressure on you
so that you would open up and express your anger toward me, and this
eventually helped you to release the bird, the tender,
loving part of your being. You finally felt that you had to open your
mouth—actually, your heart—and express emotions.
N: Remember that long talk I had with Mother? I wish I could have
told her that I didn’t really hate her, but that I was terribly angry
with her for so many years! Actually, all that time, all I wanted was
her love.
I: You are telling me how much you needed my love in spite of being
angry with me for sometimes appearing weak and ineffective.
N: True. I sometimes asked myself whether we touched on everything
we could touch on, conscious and unconscious, if we asked every
possible question. But the relationship with you was always very
im-portant to me—your understanding and acceptance, your
sympathy. The fact that you looked at the reality I experienced
through my eyes gave me a lot of strength. [There was a silence,
after which she con-tinued.] I always loved my mother; I always
needed her love. I can now appreciate the positive things about her:
her sense of humor, her ability to enjoy the small joys of life. She
loved me, too, I know, but as the years passed, the relationship
became complicated, diffi-cult. I often miss the good things she
could have given me—simple, direct support and understanding.
But now that I understand her suffering better and realize that I
wasn’t its only cause, I feel less angry than I used to be. The anger
and pain are less acute. I see her in a different light.
Through the elaboration of these feelings, the obsessive quality of the

sessions revolving around her mother’s persecution decreased. Nurit began
to recount a succession of memories of the doting, loving mother of her
childhood. She began to realize that she had inherited some of mother’s
better qualities, such as an appreciation of good food and of run-
ning a fine home. She even began to wear the beautiful jewelry she had
inherited from her mother, something that she had previously been un-
able to do.
As a result of the analytic process, Nurit began writing short stories
with a passion that overshadowed everything else. Her stories often
resem-bled still-life pictures, moments frozen in time. This creative
activity helped her free herself from her internal persecutory mother, and
her ob-sessive symptoms diminished greatly. Below is an excerpt from
one of her stories, which describes her mother’s life in Germany after the
war, before she moved elsewhere in Europe—and, in Nurit’s opinion, on
to a different stage in life.
‘‘Regina Schuhe’’2
Her life is easy, comfortable, filled with things she likes to do, people who
like and respect her. She belongs to an elite group of outsiders enjoying a
spe-cial status, and she also speaks the local language. She now has more
than she ever did, and she enjoys it all with a wonderful lust for life. She
mentions the recent past: the deprivation, the hunger, the dirt, the
promiscuity, the con-stant struggle to remain decent and civilized, the bonds
of friendship, of soli-darity, and the sudden emergence of natural leaders:
‘‘wise ones,’’ comedians. She never speaks of her murdered daughter, and
never acts as though she could be meeting the men who killed her child. She
is very normal, very ade-quate, well adapted to her new situation. She
should perhaps never have moved on.
The analytic process facilitated the sublimation of Nurit’s obsessive symp-

toms into genuine creativity (Chasseguet-Smirgel 1971). The creative
process, in turn, facilitated recovery, helping Nurit achieve a better differ-
entiation between herself and her mother, between her present life and her
mother’s past experiences, between reality and fantasy. Creative activ-ity
also reinforced Nurit’s sense of self-worth and self-confidence, strengthening
her perception of reality. At this stage in the analysis, we both felt that we
were heading toward the end of our analytic journey.
DISCUSSION
I wish to examine this case from two different aspects. I shall first explore
the patient’s emotional and cognitive development in light of her parents’
Holocaust experiences, with particular focus on the impact of the moth-
148 CHAPTER 7
er’s traumatization and unresolved mourning on the mother-child rela-

tionship and on the character structure of the child. I will then discuss
some of the transference and countertransference problems encountered,
particularly the unique countertransference challenges resulting from the
analyst’s sharing a similar traumatic experience, as well as from the fact
that the patient and analyst belonged to the same traumatized large group.
The Impact of the Mother’s Traumatization on the Child

The patient came to therapy at the same developmental stage in life at
which her mother had experienced her own trauma, and upon undergoing
an experience akin to that of her mother’s: the separation from and poor
relationship with her adolescent daughter. It is possible that the inability
of the mother to work through her horrific loss did not allow for a normal
separation between mother and daughter, and this reverberated in the
next generation in the relationship of the patient to her own adolescent
daughter. Afraid of reenacting her own traumatic experiences vis-a`-vis
her daughter, the patient decided to undergo treatment and open up the
wounds of the past, the pain of which continued to haunt her present-day
life.
I wish to speculate about certain aspects of the mother-child relation-
ship that preoccupied me throughout this treatment. First, how can we
explain the transformation of the ‘‘good-enough mother’’ (Winnicott
1965) of the patient’s childhood into a persecutory figure so many years
after the trauma of having lost her first child? The patient remembered
her childhood years as joyful ones, with her mother apparently happy,
loving, forgiving, full of joie de vivre, knowing how to enjoy the simple
things in life. The change that the daughter experienced in the mother’s
personality and behavior was singularly incomprehensible to her.
Lorenzer (1968) writes that pseudo- or super-normality, based on a
split in the ego, may explain the phenomena of symptom-free intervals
and may provide an explanation for the late decompensations or depres-
sions resulting from extreme emotional traumatization, after a prolonged
intermediate phase of apparent health. Such a split in the mother’s ego
could account for her ability, after her traumatic loss, to muster sufficient
strength to find a new love, divorce her first husband, remarry, and have
another child.
I wish to suggest that the mother found a compromise solution that
enabled the healthy part of her ego to function. On the one hand, she
denied the death of her beloved child, as it was simply unacceptable; on
the other hand, denying the loss entirely would have caused her to lose
touch with reality and to become psychotic. Her solution—that of living
in a world where her first child was not really dead, having been resur-
rected by the second child—was, in my view, what has been termed a
‘‘manic defense’’ (Klein 1935; Winnicott 1935). However, the normal
process of her adolescent daughter’s separation may have been experi-
enced as traumatic by the damaged mother (Freyberg 1980), causing the
mother’s bitter, depressed aspect to surface.
As for the daughter, I believe that the trauma of the Holocaust, which
affected both her parents, intertwined with her own developmental prob-
lems, had an impact on her relationship with her mother, as well as on the
relationship with her own daughter. In analysis, the patient and I dealt
extensively with her oedipal conflicts, but I will not expand on this topic
here. My goal is to deal primarily with one particular aspect of the analy-
sis: that of growing up as a replacement child to parents who were Holo-
caust survivors.
In considering how the mother’s traumatization affected the psychic
make up and defenses of the child, we might note that the intermingling
of former parental nurturing with current aggression can give rise to con-
fusion in a child, who may then begin to doubt his or her sense of reality
(Auerhahn and Prelinger 1983). Hence, the persecution that the patient
experienced at the hands of her formerly loving and nurturing mother left
her totally baffled; it had a disorganizing effect on her life that even influ-
enced her perception of reality. Furthermore, the patient was torn be-
tween the fears of losing her mother and losing touch with reality, leading
to terrible internal conflict (Olagner 1975).
The patient developed obsessive-compulsive symptoms in performing
her chores, which she endeavored to accomplish with utmost perfection
in order to appease her mother. Auerhahn and Prelinger (1983) state that
a child who has been confronted with a vision of a world gone out of
control may have an intense need to keep matters under total control,
both in the environment and in the self, and to defend against feelings of
helplessness or aggression. Thus, the patient’s obsessive-compulsive be-
havior may have served to keep difficult emotions at bay.
The daughter’s obsessive-compulsive behavior can be understood from
150 CHAPTER 7
yet another angle. She had internalized the image of the persecutory mother,
and the mother’s voice followed her throughout her everyday adult life. The
moments of confusion about reality, in which the patient heard her mother’s
voice in her present life, could be regarded as mo-ments in which separation
had not yet occurred. The daughter may have tried to preserve the
relationship with her persecutory mother even at the cost of her own health.
Guntrip writes eloquently about this problem: ‘‘Why do human beings
maintain an internal object-relations world at all, especially if it is a bad one?
What greater danger is being avoided in elect-ing to face the dangers of
internal bad objects experience?’’ (1968, p. 207). Apparently, losing oneself
in a vacuum of experience would be even more frightening (Fairbairn 1943;
Green 1974; Guntrip 1968). The patient’s in-ability to differentiate between
her inner world and external reality, be-tween past and present, between her
mother and herself, came to the fore at these moments of confusion. Her
compulsive behavior grew out of an attempt to master this confusion and to
reaffirm her grasp of reality. The years of being regarded as totally
untrustworthy, of being accused of terri-ble deeds that she could not possibly
have committed, had left her feeling that anything at all was possible. She
could not trust her own perception of reality, nor could she be a reliable
relayer of information.
In reconstructing her mother’s story and attempting to understand her,
Nurit speculated upon the possibility that during the Holocaust, the per-
fect performance of everyday tasks might have been of vital importance
for her helpless, lonely mother. Her mother must have believed that these
compulsive rituals would protect her from the terrible events occurring
around her. The daughter came to the realization that, by imposing this
form of behavior on her, her mother was actually trying to save her, an
act belonging to the reality of the Holocaust.
Thus, her mother, who had accused her of not being capable of
perceiv-ing reality correctly, may herself have been living in a chaotic
world, one in which past and present were confused. As a result, the
daughter often felt transposed into an unknown, persecutory world as
well—this, too, af-fecting her perception of reality.
But what might have been the source of the mother’s confusion? The
mother never actually knew how her first child had been lost. We can spec-
ulate that this fact shook her belief in herself and in her perception of reality
(she never totally believed that the child was lost), causing terrible
feelings of guilt. The crisis of her daughter’s adolescence as well as later

on her husband’s betrayal must have reinforced her confusion. In an
attempt to master her depression and guilt, she may have projected her
insecurity and confusion into the daughter, who—through ‘‘primitive
identifica-tion’’—identified with it (Freyberg 1980; Grubrich-Simitis
1984; Kogan 1995, 1996, 1998a, 1998b, 2000, 2001a, 2001b, 2002,
2005). The daughter, too, may have borne feelings of insecurity, which
often felt ego-alien to her, primarily because they belonged to her mother
and not to herself. In this way, the child probably became a container of
pain that could not be encompassed intrapsychically within the mother’s
personality structure (Bion 1959), and this, in my opinion, was vital to
her mother’s psychic survival.
The moments of confusion in the patient’s present reality, when the
voice of the mother shook her trust in her senses, were moments of self-
imposed terror. The punishment inherent in this situation may have been
related to the patient’s unconscious feelings of guilt. I wish to examine
some of the sources of these guilt feelings.
Nurit, born after two children who had perished, was a replacement
child for both her parents. Blum (1983) describes the so-called
replacement-child syndrome: What is deposited by the parents in the new
child’s self-representation is not only the image of the lost child but the
image cou-pled with the unconscious fantasy that this will repair the
parent’s grief. Thus, failing in this regard, Nurit may have been
tormented by feelings of guilt and, as punishment, unconsciously brought
upon herself the critical voice of her mother.
Freyberg (1980) writes that the offspring of Holocaust survivors tend
to experience their individuation as destructive toward their bereaved par-
ents, who cannot sustain any further ‘‘losses’’ in their lives. Thus, it is
pos-sible that the patient, who on a conscious level rebelled against the
role she had been assigned, on an unconscious level felt guilty for
becoming an individual and building a life of her own.
From a different angle, the patient felt guilty over wishing to erase the
memory of her sibling from her mother’s mind. Failing in the competition
with her mother’s dead, beloved child, she was overcome by anger and death
wishes toward her deprived mother. The mother, unable to contain her
daughter’s angry feelings because of her own traumatization, accused her of
‘‘terrible deeds’’ and assigned her the role of the Nazi aggressor.
152 CHAPTER 7
She thus confirmed the daughter’s murderous fantasies and enhanced her
guilt.
Special Transference and Countertransference Problems

In the case of Nurit, special transference and countertransference prob-
lems were encountered. Many of the countertransference problems were
linked to the fact that analyst and analysand shared a common traumatic
historical experience on a personal level, as well as belonging to the same
large group whose parents were affected, either directly or indirectly, by
the Holocaust.
Roth (1993) and Moses (1993) list the barriers to making conscious
what has been unconscious among Jewish patients who have been
through the Holocaust. These include, inter alia, a sense of shame and
difficulty in taming aggression. In the transference, I encountered Nurit’s
powerful resistance to becoming aware of her unacceptable feelings of
guilt and shame. These feelings were linked to her unconscious
aggressive, murder-ous wishes toward her sister and her mother. As she
was ashamed of these feelings, she used massive defenses that were
designed to avoid any emo-tional understanding of her unconscious
wishes. Only after becoming aware, through her emotional experience in
analysis, that her aggression would not kill me, could the patient become
aware of her aggression toward the primary objects in her life, and as a
result, achieve better inte-gration of self- and object-representations.
As for the countertransference, it, too, was problematic. It was clear to
me that my feelings, perceptions, and attitudes with regard to the patient
were, in part, displacements from my own early-life situations (memories
about my relationship to my mother) onto the patient. My own personal
history demonstrates this quite clearly. My father, upon completing his
studies in pediatric medicine in Vienna, returned to Eastern Europe,
where he married my mother. When war broke out, my paternal grand-
parents and two of my father’s siblings, along with their families, were
taken to concentration camps. My grandfather, as well as my aunt’s fam-
ily, perished there. In the meantime, my mother contracted tuberculosis,
which at the time was regarded as a fatal disease.
Because of the war, as well as due to my mother’s illness, my parents
decided not to have children for thirteen years. It was an oft-repeated
comment at home that ‘‘Nobody should be born during such times.’’ I
was born at the end of the war, when my parents were in their mid-
thirties. The story I grew up with was that I was the only one of my
moth-er’s thirteen fetuses that she did not abort or miscarry. My mother
disre-garded the doctors’ warnings that she would be endangering her life
by having me.
Throughout her life, my mother mourned the first child she had aborted, a
boy. This absent child was always present in her life—as well as in mine.
And, as with my patient, I never fully succeeded in competing with my
mother’s idealized, beloved son. On a conscious level, my mother gave me
the love she had for twelve additional unborn children, but on an
unconscious level, I always felt that she was never totally satisfied with me.
Although she was proud of my success and achievements in life, I felt I
never succeeded in resurrecting and replacing her lost son.
It was this difficult lifelong experience that was evoked in the analysis
with Nurit. When the patient obsessed about her mother, this brought my
own mother and my complex and painful relationship with her into the
room. Although elaborated upon over long years of my own analysis, it
nevertheless had an impact on my countertransference feelings, and, as a
result, on the patient’s transference and the enactments created by both of
us.
In addition, in this case, I believe my countertransference feelings
were also the result of the fact that both the patient and I belonged to the
same traumatized large group (Blum 1985; Volkan, Ast, and Greer 2002),
whose unconscious fantasies included imagery of the Holocaust.
Although I was, of course, very much aware of the difference between a
live child mur-dered by the Nazis during the Holocaust and a fetus
aborted by a mother because of her fear of the Nazis, the images,
identifications, and uncon-scious fantasies involved in being a
replacement child of parents trauma-tized by the Holocaust affected me
to such an extent that for a period of time, I completely identified with
Nurit and fell under the spell of her internal world. The trauma of the
Holocaust, the havoc and destruction it wreaked upon the lives of our
parents, affected both of us, patient and analyst alike.
This may be the reason why, in spite of my awareness of the patient’s
massive defenses against aggression and guilt, I found myself temporarily
powerless in the face of her efforts to control my feelings as well as her own.
Afraid to arouse her anger, I became the helpless, frightened little
154 CHAPTER 7
Jewish girl, while the patient became the omnipotent Nazi persecutor
whose murderous rage I did not dare arouse. At the same time, I was
afraid that by interpreting her unconscious aggressive wishes in the trans-
ference, I would become the Nazi perpetrator and inflict further shame
and humiliation upon her (Oliner 1996). Only after working through my
feelings, which led me to the realization that my apprehension was
perme-ating the therapeutic relationship and hindering the patient’s
progress, did I disidentify myself from the Jewish-victim/Nazi-
perpetrator images, re-cover my analytic function, and help the patient
get in contact with her unconscious aggressive wishes and anxieties.
In spite of the fact that, for a period of time, out of my countertransfer-
ence feelings, I had colluded with the patient in keeping the threatening
material out of analysis, I believe that my regression during this period
was actually a ‘‘regression in the service of the other’’ (Olinick 1969).
The fact that for some time I had accepted Nurit’s view of reality as
objective helped strengthen her belief in her perception of reality and her
psychic sanity. This cemented our therapeutic relationship, which became
the background against which we could later attempt to make the uncon-
scious conscious.
I feel that the moment in analysis when I experienced Nurit’s direct
aggression toward me constituted a ‘‘crucial juncture’’ (Klein 1929), in
which her love and hatred toward me converged. The patient’s aggressive
attack expressed itself through her encroachment into my ‘‘perimeter of
safety’’ (McLaughlin 1995). Unlike in other situations, where ‘‘getting
real in analysis’’ (Renik 1998) had not posed such a problem for me, in
this case I felt crushed by the violence of her attack. The fact that I
survived her assault without retaliation (Winnicott 1971) turned me into a
good object for the patient, enabling her to finally release the bad object
from her unconscious (Fairbairn 1943, p. 336; Guntrip 1968, p. 345).
This also helped her accept the ordinariness of her aggression, which
then became dissociated from the Jewish-victim and Nazi-perpetrator
images that were tormenting her. Working through this experience in the
transference, the patient was then better able to integrate self- and object-
representations and associated polarized affects. It helped her mend the
split in the inter-nal maternal figure, as well as the rupture in herself.
Other important achievements that resulted from the analysis were the
patient’s experience of an easier separation from her adolescent daughter
and an improved relationship with her. In addition, the patient’s anal

struggles for control were transformed into creative activity (Chasseguet-
Smirgel 1971). Through her creativity, the patient attempted a double
rep-aration: to repair her mother—the object whose retaliation was feared
(Klein 1929)—and to achieve self-reparation by mending what her ego
had done to itself in fantasy.
NOTES
1. The word hatul in Hebrew means cat. In Polish, Nurit’s mother tongue, the
word kot means cat. Apparently, the name Kotul was a combination of the Hebrew
and Polish words for cat. In addition, the root katol in Hebrew means murder,
destruction; thus, the name Kotul has the connotation of a ferocious animal.
2. The name of the story is also the name of a store where the patient’s mother
bought shoes.
3.
III
OBSTACLES TO
MOURNING IN AN
AGE OF TERROR
Introduction
In this section I will explore defenses against mourning during the Holo-
caust (chapter 8) and during current episodes of terror in Israel (chapters
9 and 10).
Chapter 8 examines massive defenses, including the erasing of one’s
history, the denial of reality, and the absence of mourning in extreme
life-threatening situations. These defenses are illustrated through a
psychoana-lytic examination of the life of Solomon (‘‘Solly’’) Perel—the
hero of the movie Europa, Europa. Solly is a Jewish adolescent who,
during World War II, attended a Hitler Youth School, and this saved his
life. Solly’s mecha-nisms of repression and denial of mourning helped
him survive physically, but at the cost of an enormous emotional price—
the disintegration of his identity.
In recent years, Israel has continued to experience times of terror.
Chapters 9 and 10 refer to the intifada, the Palestinian guerrilla war
against Israel. When it broke out, most of us were in a state of shock. We
were so close to peace, or so it had seemed to us. The intifada brought
with it continuous gunfire in Jerusalem, murder on the roads, suicide
bombers blowing themselves up in public places, terrible destruction, and
the death of children and youth, adults and the elderly, sometimes even
of entire families.
When acts of terror become part and parcel of our everyday life, and the
threat to the security of each and every one of us increases, traces of the
Holocaust may be reactivated in the unconscious of those who have been
directly or indirectly affected by it. The reactivation of the traumatic past
may have an impact on the defenses of both patient and analyst alike.
Chapters 9 and 10 present cases in which manic defenses were reinforced
159
160 INTRODUCTION
(Klein 1935; Winnicott 1935) as a result of the encounter with external

traumatic reality, and analysis became difficult under the shadow of ter-
ror. Theoretical issues such as the relationship between external and
inter-nal reality in a situation of terror and the goal of analysis during
such times are discussed in chapter 9 but apply to chapter 10 as well.
Both chapters illustrate the reactivation of the Holocaust trauma in the
unconscious. Chapter 9 deals with the problem of the analyst’s role during
times of chronic crises and the impact of a shared life-threatening situa-tion
on the defenses of both members of the analytic couple. Chapter 10 focuses
on the impact of external traumatic stimuli on the perception of reality and
on the defenses of Holocaust survivors’ offspring.
8
Who Am I? Trauma
and Identity
So, we turned to the victims, the survivors. They were
asked to bare themselves, to delve into the innermost
recesses of their being, and tell, and tell again, to the point
of exhaustion and beyond: to the delirium that follows.
How it had been. . . . And you, how did you manage to
survive? Had you known the art of survival from before?
And how were you able to keep your sanity?
—Elie Wiesel, 1972
INTRODUCTION
Up to this point, the different chapters of the book have related to de-
fenses against mourning in the context of a normal external reality. This
chapter, by contrast, explores the survival value of repression and denial
of mourning during the traumatic reality of the Holocaust and their im-
pact on identity. In the case described in this chapter, mourning and guilt
would have been a liability and could have interfered with survival.
How-ever, maintaining these defenses extracted a heavy emotional price
—the destruction of integrity and self-identity.
The Holocaust was a cataclysmic event that changed the shape of
human history forever. It was an unprecedented, systematic attempt to
achieve racial purity through the extermination of innocent people. Re-
duced in the eyes of their persecutors to the lowest form of life, Jews, as
well as homosexuals and those suffering from physical and mental abnor-
malities, were regarded as a threat to the Aryan race. As invaders of the
Aryan body, they were to be totally and completely annihilated in order
161
162 CHAPTER 8
to purge the German genetic pool of their alleged taint. Even as late as the
spring of 1944, when the tide had already turned against the German war
effort, the official party line put forth by Joseph Goebbels and the German
Ministry of Propaganda was still being broadcast: ‘‘In the case of the Jews,
there are not merely a few criminals (as in other people), but all Jewry rose
from criminal roots and in its very nature it is criminal. The Jews are no
people like any other people, but a pseudo people welded together by
hereditary criminality. . . . The annihilation of Jewry is no loss to humanity
but just as useful as capital punishment or protective custody against other
criminals’’ (Hilberg 1985, p.1021; quoted in Brenner 2004, p.117).
The Holocaust left its impact in endless ways. To illustrate my theme,
I examine the remarkable life of Solomon (‘‘Solly’’) Perel—the hero of
the movie Europa, Europa—from a psychoanalytic perspective. Solly is
a Jew-ish adolescent who, during World War II, found himself attending
a Hitler Youth School, thereby saving his life. I will briefly summarize
the movie for the readers who did not have a chance to see it.
Set between 1938 and 1945, the movie (directed by Agneshka Holland),
which is based on the autobiography of Solomon Perel (1994), tells the story
of Solly, the son of a Polish-Jewish shopkeeper living in Peine, Ger-many.
Nazi persecution of Jews is already well under way when Solly’s sister is
killed in a pogrom. After this traumatic event, the Perels deter-mine to save
themselves and their two remaining children (Solly and his older brother,
Isaac) by moving from Peine to Lodz, Poland. As the Nazi threat grows
worse, Solly’s parents insist that he and his brother, Isaac, save themselves
by fleeing east. At the beginning of his journey east, Solly clings to his older
brother, but the siblings are soon separated. This new, traumatic separation
leaves Solly to fend for himself, alone in a world full of danger. Solly arrives
at a Russian camp and is sent to a Soviet orphanage in Grodno, east Poland.
From there, Solly corresponds with his parents, who inform him that they are
being transferred to the local ghetto. The daily routine at the orphanage is
devoted mostly to Communist instruc-tion. Solly adapts easily to his new
sociocultural environment and be-comes an enthusiastic Komsomol youth.
With the collapse of the nonaggression pact between Hitler and Stalin, the
orphanage is bombed, and the teacher and children flee. The teacher stops a
truck, the children climb aboard, and Solly, who turns his attention elsewhere
for a moment, is suddenly left behind. Again, Solly finds himself on his own.
WHO AM I? TRAUMA AND IDENTITY 163
Adrift once more, this time Solly lands in the hands of Nazi soldiers.
With his fluent German, he passes himself off as an Aryan; he is now
Jupp, an East German. Strange providence intervenes again. Solly finds
himself in the midst of a battle after which he is mistakenly celebrated as
a hero and greatly honored by being sent to a Hitler Youth School. In this
new environment, Solly is soon ready to shed both his Jewish identity as
well as the Communist one. However, his Jewish identity is branded on
his flesh by circumcision. Falling in love with Leni, a girl attending the
same school, only adds to his plight, as he cannot give in to their desire
for sex without endangering his life. Solly unsuccessfully attempts to
erase the mark of his Jewish identity that is imprinted on his flesh. He
tries to dis-guise his circumcision by pulling down the remaining
foreskin and sewing it back in place. Leni, however, hurt by what she
experiences as Solly’s rejection, turns her attention to his best friend as a
partner for giving the Fuhrer the gift of a child.
The movie shows Solly shifting identities under extreme life-
threatening situations in the service of survival. Only at the end of the
war does Solly decide to return to his roots and search for his early
Jewish identity. He is saved by finding his brother among the
concentration camp inmates who wish to kill him because they
mistakenly consider him a German officer, and together they make their
way to Israel. Solly has a family of his own, and states that he is prepared
to circumcise his sons, thus bringing the story full circle.
To return to my theme—the survival value of defenses against pain
and mourning during life-threatening situations and their impact on
identity, I first briefly review some of the psychoanalytic views on
identity. I will relate to the developmental aspects, focusing on the seeds
of identity that exist before birth and in early childhood, and then
proceed to the vicissi-tudes of identity that occur during adolescence.
Each is discussed in light of the hero’s life story.
IDENTITY IN EARLY CHILDHOOD

The term identity was introduced into the psychoanalytic literature in 1919.
Tausk described how the child discovers his or her self, and asserted that
throughout life one must constantly find and experience one’s self anew.
Freud used the term identity only once (Guttman et al. 1980), in his address
to B’nai Brith, where he spoke of his ‘‘inner identity’’ (Freud
164 CHAPTER 8
1926a, p. 274) as a Jew. However, a number of his ideas are of great sig-
nificance to the concept of identity. Freud coined the term das ich (the ego)
and used it in two different ways: as an executive agency of the mind, and as
a ‘‘person’s self as a whole’’ (Strachey et al. 1923, p. 7). The latter
conceptualization of the ego seems to correspond to what is today termed
identity. With regard to this conceptualization, Freud states: ‘‘In the proc-ess
of a child’s development into a mature adult there is a more and more
extensive integration of his personality’’ (1921, p. 18). This integration of
personality may be damaged by traumatic separations from protective ob-
jects, such as by forced migration from one sociocultural environment to
another, as we shall see in the movie under discussion.
As mentioned, a child’s identity can be traced back not only to earliest
infancy but even to before his or her birth. Two factors lay the ground for
what will be the child’s basic core (Weil 1970; Akhtar 1999): his genetic
blueprint and the parental expectations of the yet unborn baby.
The story of Solly begins at the most logical, primal point—his
circum-cision. The circumcision ceremony is a physical manifestation of
Jewish identity that has been passed on from generation to generation
since the very beginning of Jewish history. Solly’s circumcision is
pregnant with meaning, reflecting his parents’ wish that their child carry
the Jewish iden-tity. The ceremony is also a metaphorical event, a
branding, and the blood from the wound of the circumcision reverberates
throughout the film— the Nazi ideology of spilling Jewish blood.
Solly claims to remember his circumcision. This memory is an early
introjection, or, in Kernberg’s terms, ‘‘an organized cluster of memory
traces’’ (1976, p. 26), which forms his Jewish identity. Other childhood
memories, including the celebration of Jewish holidays such as Passover
and the Feast of Tabernacles (Sukkot), reinforce this identity (Passover,
in commemoration of the liberation of the Jewish people from Egypt,
after which they wandered in the desert for forty years; Sukkot in
commemora-tion of the booths in which the wandering Jews lived in the
desert, after their delivery from Egypt). His memory of these two
holidays exposes Sol-ly’s longing for the Jewish atmosphere of his
parents’ home. Solly may have remembered these two particular
holidays, which recall the Jewish people’s fate as migrants and
wanderers, as they were symbols of his own forced migration from one
ideological framework to another during his adolescence.
DISRUPTION OF IDENTITY IN LATER CHILDHOOD

With the shifting of the scene from his circumcision, we now see Solly at
age thirteen soaking in the bathtub on the eve of his bar mitzvah (an im-
portant ceremonial event in the life of a young Jewish boy, who at age
thirteen becomes an adult and takes on the responsibilities that are part of
belonging to the Jewish people). The Nazi persecution of the Jews is
already well underway, and as Solly bathes, a brick flies through the win-
dow and soldiers swarm into the family’s apartment. To escape, Solly
jumps naked out the widow and hides in a barrel. After several hours, he
plucks up enough courage to ask a waitress friend to bring him some
clothes; all she can find is a black leather coat with a Nazi insignia on the
sleeve. But eager to return home, he slips into it. This is Solly’s first dis-
guise, and it is also prophetic of his future disguise as a Nazi. Arriving
back home, Solly discovers that his family has been the victim of a
pogrom and that his sister has been killed. This traumatic event has a
great impact on Solly’s psychic life.
Greenacre (1967) maintains that in situations in which actual
traumatic experiences are associated with an underlying fantasy
stemming from dif-ficult experiences, the impact of the actual trauma is
more intense, and the tendency to fixation is greater than in instances
where life experiences are bland and incidental. In the same vein, Anna
Freud writes: ‘‘External traumas are turned into internal ones if they
touch on, coincide with, or symbolize the fulfillment of either deep-
seated anxieties or wish fantasies’’ (1967, p. 24). The horrific murder of
Solly’s sister, which occurred against a background of normal sibling
rivalry, may have greatly intensified Solly’s survival guilt.
Soon after their daughter’s murder, the Perels decide to save themselves
and their two remaining children by moving from Peine to Lodz, Poland.
Here we observe Solly’s adjustment to his new surroundings and the
awakening of his libidinal urges. In the short interim before he begins his
painful, lonely exile, we are shown Solly’s penchant for the cinema and his
dreaming of being an actor like Clark Gable. It was perhaps this theatrical
urge, combined with his inner resourcefulness, which equipped him with a
special ability to adapt to his surroundings.
At the movie house, Solly becomes friendly with the cashier, a Polish
woman and hunchback. Solly’s oedipal attraction to older women (also
to his young teacher in the Communist school, later on in the movie) was
166 CHAPTER 8
part of his developing gender identity. From the metaphorical prism, the
hunchback woman may be regarded as a symbol of Solly’s new mother-
land, Poland, the country that he began to like but which was already car-
rying the Nazi war machine on its back.
With the Nazi threat intensifying, Solly’s parents decide that he and
his brother, Isaac, must save themselves by fleeing east. The boys refuse
to go, but the father orders them to flee, thus conveying to them the
message that they must survive at all costs. The movie shows the two
boys making their way east. But let us pause for a moment and try to
analyze the impact of this traumatic event on Solly’s psychic life.
In spite of the fact that Solly’s parents forced him to flee in order to
save his life, Solly may have unconsciously experienced this as a
rejection and expulsion from his family. Although this most likely caused
him frus-tration and anger, he was not in touch with these feelings.
Moreover, the image of a strong father who should have been able to
protect the family from danger and destruction is shattered. Thus, Solly’s
feelings of aban-donment, anger, and frustration caused by the traumatic
separation from his parents at this early age may have contributed to his
relatively easy disengagement from his Jewish identity later on in life.
The massive trauma caused by this rupture from his family wrought
havoc upon his identity, his sense of security, and all of his basic
assumptions about the future (Elsass 1997; Kestenberg and Brenner
1996; Krystal 1968; Brenner 2004).
Freud has stated that ‘‘the character of the ego is a precipitate of aban-
doned object-cathexes and . . . it contains the history of those object
choices’’ (1923, p. 29). When Solly encounters other sociocultural envi-
ronments that provided him with a new ‘‘family’’ and idealized new pa-
rental figures, Solly is ready to shed his Jewish identity, his identification
with primary objects and their/his own history, and become part of these
new cultures.
Solly and his brother find themselves fleeing from destruction to a
world full of danger and animosity. Solly has to deny his guilt feelings
for leaving his parents behind to perish. Guilt feelings would have carried
with them the potential for demoralization and would have distracted him
from the task at hand—of surviving one more day (Lifton 1968; Hass
1996). Even though Solly experiences overwhelming loss and is under
enormous stress, causing feelings of intolerable anger and fear, he has to
block out painful feelings such as guilt and mourning, which would pre-
vent him from adapting to a changing, hostile environment.
THE ENCOUNTER WITH OTHER

SOCIOCULTURAL ENVIRONMENTS AND THE
ADOPTING OF NEW IDENTITIES
The Communist Camp and Orphanage

At the beginning of his journey east, Solly clings to his older brother, his
substitute father, but the siblings are soon separated. This new trau-matic
separation leaves Solly to fend for himself, alone in a world full of danger.
Solly finds himself in a Russian camp and is transferred to a Soviet
orphanage in Grodno, in eastern Poland. The daily routine at the orphan-age
is devoted mostly to Communist instruction. Partly out of his wish to find a
new ego-ideal in the form of a powerful father figure (Stalin), partly out of a
crush he has on a mother figure (a pretty young teacher who takes him under
her wing), Solly adapts easily to the training and becomes an ideal student, a
member of the Komsomol youth, renouncing his Jewish identity as easily as
he slipped into the Nazi overcoat. Eagerly adopting the Communist ideology,
the movie shows him avidly reading a strident pro-Stalinist article that
denounces religion as the ‘‘opiate of the masses,’’ with which he now
identifies. In spite of the fact that his identity as a Jew is reasonably safe
because of its irrelevance, his coexistence with his Chris-tian classmates is
not devoid of tension. A Polish boy attempts to bully him for belonging to
those who killed Jesus, the father of all Christians. This theme recurs later
on, when Solly’s girlfriend Leni informs him that the Jews, the enemies of
the Fuhrer, killed her father in battle.
After the nonaggression pact between Hitler and Stalin collapses, the
orphanage is bombed and Solly is left behind. The new idealized father
(the great Stalin) was unable to protect him, and his new beloved mother
of whom he was enamored (the young teacher) was unable to save him.
The new ego-ideals are broken and Solly is once again separated from his
newly acquired ‘‘family.’’
The Nazi Ideology
Solly is again adrift, and this time lands in the hands of Nazi soldiers.
With his fluent German, he passes himself off as an Aryan; he is now Jupp,
168 CHAPTER 8
an Ost-Deutche. The soldiers treat him royally, partly because of his

rosy, wide-eyed good looks, and partly because of his usefulness as a
Russian translator.
Strange providence intervenes again. Solly finds himself involved in a
battle between the Germans and the Russians and is afterwards
mistakenly crowned a hero. The ultimate irony occurs when Solly (who
shares the same birth date as Hitler) is sent in triumph to a Hitler Youth
School. There he is presented with his personal copy of Mein Kampf.
Regarded as a hero at the front and winning a swimming competition in a
swastika-decorated pool while wearing his army helmet and carrying his
rifle, Solly eventually becomes a respected member of the Hitler Youth.
In classroom lectures on how to identify Jews on sight, Solly is selected
as an example of a true East German Aryan.
In comparison with the earlier communities to which he belonged, which
were unable to protect him and which had rejected and abandoned him, this
new community appears strong and promising. His fellow stu-dents are
qualified to become the elite and are meant to have a distinct self-awareness
of their own elevated, elitist status. Solly experiences his fu-sion with this
elite peer group as a source of strength. This fusion symbol-izes a larger
fusion with the German Volk (the mother figure) and the Fu¨hrer (the father
figure), which makes his identification with the group vitally important to
him. Solly is soon ready to shed both his Jewish iden-tity as well as his
Communist identity. His Jewish identity, however, is branded on his flesh
through circumcision. The physical evidence of his circumcised state, which
is the only link to his Jewish heritage, gravely endangers his survival. The
movie shows Solly’s efforts to hide his true identity by avoiding being seen
in the shower or in the bathroom; letting down his guard even slightly would
result in certain death. Solly has to be forever on guard; even a casual pause
to relieve himself in the woods is fraught with danger, for no matter how
deeply he immerses himself in his new role, the evidence of his identity is
always there to betray him.
Solly becomes confused over the meaning of being Jewish, as he is loved
and admired by the officers who, he knows, would kill him were they to
know his true identity. One officer falls in love with him; another, the
company’s commanding officer, wants to adopt him. He is constantly ex-
posed to talk about the Jews, of how they are the ‘‘real enemy.’’ The Fu¨hrer
has a solution to the Jewish problem, Solly is told, and he naively accepts
the lie he is fed that the solution is to gather the Jews and ship them off
somewhere, ‘‘to Madagascar or Siberia,’’ where they would no longer
pose a threat to the German way of life. Solly is thus in a situation of
‘‘knowing and not knowing psychic trauma’’ (Laub and Auerhahn 1993),
a two-sided state in which conscious ignorance of the Holocaust forms
one side of the coin, while unconscious knowledge of it forms the other.
This ‘‘not knowing,’’ which is actually a denial of reality, also serves as
a survival mechanism.
Another aspect of Solly’s identity that is worth exploring is his gender
identity that, at this stage, includes both homosexual and heterosexual
tendencies. The German officer who became enamored with Solly finds
out the boy’s secret, and, in spite of the danger that this love relationship
poses for the officer, he keeps the secret and thus saves Solly’s life. This
man forgives Solly his biggest flaw—the fact that he is Jewish—which
leads Solly to perceive this older member of the institution as a substitute
father or substitute brother. His love for Solly brings him in touch with
his humane aspects, and he even recalls that once, in a different world
than the one they are living in, he had been an actor and part of a cultured
society. This ‘‘good’’ German is killed in a Russian attack, and with him
the love and protection bestowed on Solly vanish, along with the humane
aspect of Germany that he possibly represents. The death of the only man
in this environment who loved him for what he was and who had been
the container of his secret is a grave loss for Solly; and superimposed
upon his former traumatic separations from beloved objects, it intensifies
his feelings of loss and abandonment.
In regard to Solly’s bisexual gender identity during his adolescence, I
wish to refer to Freud who states that ‘‘all human individuals, as a result of
their bisexual disposition and of cross-inheritance, combine in them-selves
both masculine and feminine characteristics’’ (1925, p. 258). Gen-der
identity is a complex psychological process that has its roots in the
experiences of early childhood and the identification with both parents
(McDougall 1989). Although Solly’s core gender identity is already formed
when he joins the Hitler Youth School, the constraints on his heterosexual
behavior (which would endanger his life), in addition to the well-known
injunction that adolescents had to keep themselves ‘‘pure’’ until they were
ready to give a child as a gift to the Fu¨hrer, cause him to regress to the
preadolescent phase in which the need for a father figure is greater (Kogan
170 CHAPTER 8
and Schneider 2002). This may explain Solly’s homosexual leanings,

which stem mainly from his need to acquire protection from an older
member of the institution. The need for a father figure, which may have
been intensified by his disappointment in his own father, is another factor
in Solly’s feelings toward the homosexual German officer who falls in
love with him.
The need for a father is mentioned by Freud, who declares that he ‘‘cannot
think of any need in childhood as strong as the need for a father’s
protection’’ (1930, p. 72). In a series of essays spanning two decades, Blos
(1962, 1965, 1967, 1974, 1985) demonstrates that the early, pre-oedipal son-
father relationship has a crucial effect on the son’s self and world view for a
lifetime. The little boy seeks the father’s approval and praise, and if these are
found, a deep and lasting bond is established between them. The father’s
approval instills in the son ‘‘a modicum of self-possession and self-assertion
—distilled, as it were, out of mutual sameness or shared maleness—which
renders the wider world not only manageable and con-querable, but infinitely
alluring’’ (Blos 1985, p. 11). But what kind of maleness could the
traumatized and broken Jewish father instill in his son? And could the world
of the Nazi Holocaust be at all manageable and con-querable? To counter his
inner representation of a weak father, Solly wishes to fuse with idealized,
omnipotent figures. This wish is actually typ-ical of adolescence, because of
the normal process of devaluation of the parents that occurs during this phase
of development. In the case of Solly, the fantasized protective figures are
Stalin and Hitler, and in real life, the protective figure is the homosexual
German officer, and, in his great con-fusion, he attempts to replace his father
with them.
Solly’s heterosexual tendency is expressed through his attraction to
Leni, a fresh-faced German girl who attends the Hitler Youth School and
who admires Solly as a German hero. Leni’s father was killed in battle,
and she strongly believes that Jews killed him. Leni regards the Jews as
the ene-mies of the Fu¨hrer, the idealized father figure, and therefore
have to be destroyed. ‘‘If I ever catch a Jew, I’ll cut his throat,’’ she
eventually tells Solly in an offhand manner that nonetheless offends and
angers him, and he impulsively slaps her face.
Solly does not dare sleep with Leni in spite of his very intense desire for
her. Unable to fulfill his sexual needs because they endanger his life, Solly
attempts to erase the scar that his Jewish identity has branded upon his
flesh. He tries to disguise his circumcision by pulling down the

remaining foreskin and sewing it back in place.
An individual’s existence is deeply anchored in the sense of his or her
corporeal existence. Freud’s (1923) declaration that ‘‘the ego is first and
foremost a bodily ego’’ speaks to this very point. Twelve years after Freud’s
statement, Schilder (1935) defined the concept of body image as the psy-chic
representation of the body. Solly’s psychic representation of his body is that
of a castrated, wounded body that bears the traces of belonging to an inferior
race. Thus, thinking in a way typical of adolescence, Solly seeks a concrete
solution for ‘‘repairing’’ his ‘‘damaged’’ body. This concrete style of
thinking usually undergoes transformations and is mediated by changes in
ego functions; these changes depend on the structural-cogni-tive
development that takes place in this phase of development (Ehrlich 1978). In
Solly’s case, these changes most likely did not take place because of the
traumatic circumstances under which he lived. Solly’s solution is not only
concrete, but also self-destructive. This is one of the few times in Solly’s life
that death forces take over: By trying to rid himself of his Jewish identity he
develops a very serious infection that is life-endangering. It is only due to his
tremendous resilience that he survives this self-affliction.
It is intriguing to explore the Joseph (‘‘Jupp’’) Peters persona that
Solly adopted among the German soldiers on the battlefront. This identity
is reinforced in the Hitler Youth School. Perhaps this is an example of
how humanity-as-civilized and humanity-as-beast are separated by a
tissue-thin veil. In a sense, Solly does become Jupp the Nazi. He is
thrilled when the radio announces that the Germans have won another
victory, and is saddened when Stalingrad falls and is heartbroken along
with his German schoolmates. The experience of living in close quarters
with German sol-diers on the Eastern Front, along with the Nazi
indoctrination in school, with its music and military drill, consolidate his
Hitler Youth identity; but even if his spirit allows it, his body does not.
He cannot be one of them, nor can he be himself; he can only wander
between the two, an actor trapped—and saved—by his role.
Wheelis (1958) defines identity as a coherent sense of self. In the case of
Solly, trauma breaks this coherence and the alternation between his var-ious
identities implies such grossly contradictory ideologies and values that he
cannot be regarded as a whole human being. There is a major difference,
however, between adopting different identities in external life-
172 CHAPTER 8
threatening situations and the phenomenon of multiple personalities

(DID), which is described by Brenner (2004) as being at the extreme end
of character pathology, ‘‘a lower level dissociative character’’ (1996a,
1996b). In Solly’s case, adopting different identities was purely a mecha-
nism for survival, which did not have pathological roots.
The confusion and conflicts accompanying the various roles that Solly
adopts cause him great psychic suffering. This suffering is illustrated in
the episode in which Solly discloses his true identity to a German
woman, Leni’s mother. He attempts to find Leni, who has disappeared
from his life, and is told by her mother that Leni is pregnant. Fed up with
his refusal to have sex with her, she chose his close friend as a partner for
giving the Fu¨hrer the gift of a child. Leni preferred to surrender to the
Fu¨hrer, the idealized father figure, rather than continue her relationship
with the am-bivalent Solly.
At this point Solly breaks down. His narcissistic hurt over Leni’s
aban-donment is stronger than his life-preserving instincts and compels
him to explain to Leni’s mother his real motive for abstaining from sex
with Leni. Aware of his suffering, Leni’s mother takes him in her arms.
Apparently she belongs to a generation that did not grow up with Nazi
ideology and did not succumb to the Fu¨hrer’s ‘‘charm.’’ But her warmth
towards him cannot change anything, because he is still living in a world
fraught with peril and danger.
The issue of a consolidated identity has been amply explored in the
psychoanalytic literature. Erikson claims that a consolidated identity pro-
vides individuals with the intrapsychic experience of self-sameness. In the
diverse social situations existing in a normal reality, these individuals act and
feel in a manner that is true to themselves. They experience them-selves as
essentially one personality and maintain similar preferences across various
external circumstances (Erikson 1950a, 1950b, 1956, 1958, 1962;
Lichtenstein 1963). When interacting with different age groups or with
individuals with whom they are on various levels of intimacy, they can
modulate their behavior without losing a core of inner sameness and
demonstrate consistent attitudes and behaviors. They display a stable in-
vestment in personal values and ideologies, and possess a repertoire of be-
haviors that presume congruous and predictable parameters. The desire to act
in ways that deviate too widely from the prevailing sense of self are
repressed or consciously inhibited and discouraged, thus maintaining a

sense of internal consistency (Akhtar 1999).
Under normal life circumstances, an essential characteristic of individ-
uals with a consolidated identity is this capacity to maintain personal con-
tinuity amid change and with the passing of time. Stern’s concept of ‘‘self-
history,’’ that is, a sense of enduring and of a continuation with one’s own
subjective past, refers to this specific capacity. Individuals who possess it
retain genuine ties with their past, can comfortably locate themselves in their
current realities, and can envision their future (Stern 1985).
But how could Solly establish a sense of identity and express
consistent attitudes and behaviors while constantly living under life-
threatening situ-ations? How could he develop a sense of personal
continuity and of self-history? Was it at all possible for him to develop a
sense of generational continuity (Chasseguet-Smirgel 1984) in a situation
where to continue to be Jewish meant death and destruction? How could
he belong to a histori-cal community (Volkan 1988) if the ethnic identity
of the group to which he belonged was life-endangering?
The story of Solly illustrates how trauma broke the coherence of the
self. In defining trauma, Freud (1920, 1926b) emphasizes how the mind,
like the body, can be pierced and wounded by events. For Solly, the
stress of living in a constant state of peril overcame the protective
barriers of his mind and damaged the integrity of his personality. Even at
the very end of the war, the identity that saved him also almost caused
his death, as rocked on the stormy waves of fate, he is almost executed
by the Russians who are convinced he is a Nazi in disguise.
Watching the movie, we are aware time and again of Solly’s great
resil-ience in the face of adversity. Solly’s objective was survival and
survive he did. His resilience was due to his good looks, his intelligence,
and a special talent for adapting to his surroundings. His shape-shifting,
his ability to change identities, which were the result of his immense
resourcefulness, and his ability to block off pain and mourning, were also
elements of this resilience.
Rutter (1987) maintains that resilience is not a fixed attribute, but rather
hinges on a balance between the mechanisms and processes of pro-tection
and vulnerability. Solly had the ability to protect his vulnerability by denying
and repressing the cluster of cognitions, emotions, and mean-ings
inconsistent with his survival (Kogan 1995, 2004). Solly survived be-
174 CHAPTER 8
cause he was endowed with the wish to live life, to create it, to live and
hope even in the face of adversity, as well as because his parents gave
him the message that he must survive, all of which were important
elements of his resilience. Love of life itself, stamina, courage, and inner
resourceful-ness when confronted with life-threatening situations
contributed to his resilience.
‘‘Who am I?’’ or ‘‘Which group do I belong to?’’ were central and
most painful issues in Solly’s psychic life. Towards the end of the war,
Solly trav-els from his school to Poland to visit the Jewish ghetto near his
childhood home. From inside a closed tram he observes the dreadful
suffering of the ghetto’s inhabitants and realizes that something terrible
must have be-fallen his parents. This visit is his first attempt to rebuild
his sense of conti-nuity and broken identity.
I would like to quote what Perel writes about this visit in his autobiog-
raphy, upon which the movie is based. Perel describes the guilt feelings
that this visit evoked in him at the time: ‘‘I did not know about the de-
struction, its forms and methods. . . . In the cocoon of my school I studied
theories, but my brain refused to acknowledge the fact that these theories
were being put into practice in the different death camps. A deep pain is
lodged inside me: How did I not understand when I traveled through the
Lodz Ghetto that these people would not be there long, that they would
be sent to the death camps? Looking back I remember that I saw only
grown-ups on the ghetto streets, and no children at all. How did I not ask
myself the meaning of this? I am greatly disturbed by the barrenness of
thinking that encompassed me. I failed to break through the fog that
enve-loped me, that prevented me from seeing the screaming writing on
the wall. The war I was caught up in sharpened my senses, but also
blunted them’’ (1994, p. 192).
At the end of the war, Solly becomes aware that he has paid a terrible
price for surviving and is overcome by depression. He feels lost, belongs
nowhere; he is neither Jewish nor German. ‘‘The faces of those who
were liberated radiate happiness. They know that in a few weeks they
will return to their country, their homes and families, renew their normal
way of life. For me there is no place to return to. . . . I fear that I am
losing my sanity. I do not know who I am and what I am’’ (p. 149).
Only after he becomes aware of his pain is Solly able to reflect and
begin the work of mourning. ‘‘I now wish to give some thought to my
emotional belonging. . . . It is strange and perhaps not understandable,

but I can say for certain that at times I forgot my past. It was an amazing
ability not to remember things, as if they never existed. Sometimes entire
weeks passed, and even months, and nothing bothered me. I even erased
the memory of father and mother. Except in times of extreme danger or
attacks of anxiety about my future, my life went on as usual. I do not
understand it, but that is how it was’’ (pp. 173–74).
Solly’s partial erasing of history had definite survival value on a
physical level. Although this defense was invaluable at the time and
contributed to Solly’s resilience, it led to the disintegration of his
identity. As Laub and Lee (2003) maintain, erasing one’s history also
contains an element of de-struction and death.
After the war, Solly underwent a long period of working through his
mourning, as a result of which he decides to return to his roots and to his
previous Jewish identity. He moves to Israel and raises a family. The movie,
which began with Solly’s circumcision and caused him endless sur-vival
problems, ends with Solly’s readiness to nonetheless circumcise his own
sons, thus openly affirming his Jewishness. This brings the movie full circle
and demonstrates Solly’s better-consolidated identity, which could only have
been achieved by working through his mourning for his lost parents, and thus
getting in touch with the lost parts of his own self.
9
The Role of the Analyst in

the Analytic Cure during
Times of Chronic Crises
INTRODUCTION
At a time when war and destruction are part of everyday life and our
safety is increasingly threatened, one of the questions we Israeli analysts
ask our-selves is, what is the place of psychoanalysis in such a world?
Can we in good faith propose to practice psychoanalysis in situations of
chronic cri-ses,1 and can we, in the face of the effect of terrorism, hold on
to our identities as psychoanalysts?
My first attempt to deal with this issue is described in my book The
Cry of Mute Children (Kogan 1995), in the chapter ‘‘In the Same Boat:
Psychoanalysis during the Gulf War.’’ There I examined the curative ele-
ments of psychoanalysis during a period of acute stress in which analyst
and patient found themselves in a shared life-threatening situation. The
relationship between external and internal realities in a situation of
chronic life-threatening crisis provides a natural laboratory in which to
reexamine fundamental questions regarding the practice, as well as the
theory, of psychoanalysis.
In this chapter, situated at the boundary of external and internal
reality, and at the boundary of the personal and the professional, I
examine the role of the analyst in psychoanalytic treatment in such
situations. For this purpose I use clinical material from two case studies.
177
178 CHAPTER 9
CASE ILLUSTRATION: SUSAN

Susan, a forty-one-year-old accountant, sought professional help for pho-
bic symptoms and anxiety attacks that affected the quality of her life.
Susan was married and the mother of three boys—a fifteen-year-old and
twins age thirteen. Susan complained of feeling insecure, irritable, easily
hurt, and isolated in her social environment. Although she felt her hus-
band was loyal and a good provider, he was not a source of emotional
support. When her twin boys were born, he became very depressed and
underwent analytic treatment, which facilitated his recovery. The
husband supported the idea that Susan also undergo analysis.
Susan grew up in Western Europe, the oldest of three children. Her
mother was a child survivor who had lost both parents in the Holocaust and
had spent the Holocaust years between her tenth and fourteenth birthdays in
hiding. Her father had been drafted into the Russian army two years before
the war and later disappeared in a concentration camp. Her mother hid for
some time with her own mother (Susan’s grand-mother) until they were
discovered; the grandmother was taken to Ausch-witz, where she perished.
Susan’s mother ran away into the woods, where she almost died of hunger.
More than once she came face to face with death when, disguised as a
peasant girl, she encountered German soldiers.
Susan’s mother was sent on a Kindertransport to England where she
met Susan’s father. He became a successful businessman, and the family
was well off. Susan’s mother was a psychotic person who suffered
episodes of decompensation. She had seen psychiatrists at various stages
during her life and had been treated with medication. Susan remembered
that throughout her childhood her mother had often talked to herself and
be-haved strangely. Her mother often spoiled the family fun by stopping
them from going on outings at the last moment, claiming she was not
feeling well. She discouraged any connection with other family members
or friends, thus isolating their family from everyone else.
Susan’s relationship with her mother was complicated and painful. She
felt that her mother was never satisfied with the way she looked or with her
achievements. The mother especially disliked Susan’s boyfriend, who
eventually became her husband. She tried to convince Susan to break up with
him, and when he came to visit, would totally ignore him.
Ten days before the wedding, the mother tried to commit suicide and
was hospitalized in a mental institution. The wedding took place despite
THE ROLE OF THE ANALYST IN THE ANALYTIC CURE 179
this, as in the Jewish religion weddings are not postponed under any cir-
cumstances. Susan’s father always tried to camouflage the incident by
say-ing that his wife had mistakenly overdosed on tranquilizers.
After the wedding, the couple immigrated to Israel, where their chil-
dren were born. Susan’s mother came to visit only once, after the birth of
the twins. This was a difficult time for Susan, who had no help from her
depressed husband and had to care for a two-year-old and two infants,
her mother all the while complaining that Susan was not paying her
enough attention.
Five years before Susan came to me, her mother stopped taking medi-
cation, and as a result, her situation deteriorated. She no longer left the
house and would not allow visitors. When Susan last saw her, she was
shocked by her mother’s neglected appearance—her torn, dirty clothes,
her unkempt hair, her missing teeth. Susan feared that this deterioration
in her mother’s psychic and physical condition would eventually lead to
her death. Her father, preoccupied with his own affairs, continued to
deny that his wife was mentally ill. The parents never allowed anyone to
inter-fere in their lives. Susan believed that, in spite of her father’s
resistance, she should have sought psychiatric help to possibly save her
mother. That she did not have the strength for this struggle with her
parents put an even greater burden of guilt on her shoulders.
During the first two years of analysis, we attempted to work through
Susan’s complicated relationship with her primary objects. The elabora-tion
on her feelings of anger and guilt led to a lessening of her depression, and
her phobic symptoms subsided. She derived greater satisfaction from her
work and became more self-assured in her role as wife and mother.
The terror of the current situation in Israel (a situation which we dealt
with in the third year of analysis) evoked great fear in Susan, upsetting
her emotional stability. In analysis it became clear that this fear was
connected to Susan’s greatest anxiety, which revolved around the
possibility of loss of control and decompensation. Susan was afraid of
becoming ill like her mother.
I will now illustrate Susan’s reaction to the external reality, and my
un-derstanding of that reaction, with verbatim material followed by an
enact-ment. The following two consecutive sessions are from the third
year of analysis.
180 CHAPTER 9
Session 1.
Susan: Do you remember the two little children from Tekoa (a place
in Israel) who had wandered off and were murdered? I felt I had to
go help their families. I take each day as it comes, and at the end of
the day I say, Thank God. It’s like Russian roulette. It can happen
to anyone, anywhere. That’s why I want my family to know where
I am.
She’s so right, I thought to myself. We all feel the same, we’re all
afraid of death and destruction. But another thought immediately crossed
my mind: Was it possible that, in addition to Susan’s fear of external
reality, she was expressing her fear of psychic death and fragmentation?
If so, did she expect me, in the role of a family member, to know about it,
so that I could watch over her more closely?
S: Last week a mortar shell fell on my brother-in-law’s house. It

landed on the couch in the living room, where we had all sat a few
days before. From the couch it fell to the floor. My sister-in-law
came in and touched it with her foot, and nothing happened.
Soldiers came and removed it, and then they called and told her that
they should be grateful for being alive. A week ago I was in
Jerusalem. I was there several days after a terrorist attack. I don’t
know what can happen in the future. I live from day to day. I worry
about the children and hope we’ll remain alive. My older son is
fifteen, the twins are thir-teen. They will be in the army at the same
time. I don’t like thinking about it.
We remained silent for a while. My thoughts revolved around my own

feelings of impotence in this situation, and my fear for my own sons.
This is not projective identification, I thought to myself; this is our
blood-stained reality!
I: We are all vulnerable, we are all afraid of death and destruction.

S: I see people leaving Israel. I know somebody from Jerusalem whose
son was supposed to enter the army. They left. I don’t know. On the
one hand, I’m proud of our children in the army, but on the other
hand, am I doing the right thing by living here and letting them serve
in the army? It might be life-saving to leave. I told my husband that
those who ran away during the Holocaust saved their lives. My
husband, who is the more stable of the two of us, says that if there is
no place for us here, there is no place for us anywhere in the world.
I: Maybe these are the two voices inside yourself. On the one hand
you identify with your mother, who saved herself by running into
the woods, but on the other hand you feel that you have to stay here
and have a place of your own.
S: Right. I want my children to live a normal life. I don’t want them to
feel my fear.
I wondered silently to myself whether Susan was expressing her

ambiv-alent attitude toward analysis: her wish to run away from it, and
her si-multaneous wish to continue her struggle with the dark forces
inside herself.
Session 2.
Susan arrived crying and in between sobs stated that perhaps she
should stop analysis. I asked her why she was so upset. She answered my
question with the following story: Two days earlier she had taken her son
to Jerusalem for a doctor’s appointment. They first went to the
‘‘triangle’’ to do some shopping. (The ‘‘triangle’’ is an area where three
main streets in the center of the city form a triangle; most people refer to
it as ‘‘down-town.’’)
Susan and her son did not find what they needed in the store. The
shopkeeper ordered it for them and they had to come back later to pick it
up. They then took a bus and went to the doctor, after which Susan’s son
went to school. Just then Susan heard that a suicide bomber had blown
himself up right next to the store they had shopped in. She immediately
called the shopkeeper, asked if everyone was all right, and if she could
come and pick up her order. The man said that the people working in the
store were all alive, though the windows were broken and the police were
everywhere, but she could come if she wanted to. Susan went back to the
store. The place was deserted, with only policemen roaming around. She
picked up her order and returned home.
The next day after work, she felt a terrible urge to go to the triangle
182 CHAPTER 9
again. She strolled the empty streets and bought some things. She told me
between sobs that she did not know why she had acted in this way. She
was very upset.
To understand Susan’s behavior, which I felt contained unconscious
symbolic meanings, I asked her to tell me more about her feelings
regard-ing the episode. Bursting into tears, she told me that she felt guilty
about not helping her depressed, mentally ill mother. She had purchased
things in order to help the people in the store feel that life goes on.
My first thought was that throughout this episode Susan was attempt-
ing to enact the story of her mother in her own life (Kogan 2002). Like
her mother running through the woods, who came face to face with death,
Susan had to come close to death in order to overcome it. Viewed from
this angle, her return to the site of the explosion was an attempt to
achieve active mastery over the passive trauma.
I wondered though, what symbolic meaning the word triangle might
have in this context. Was Susan returning to the oedipal triangle, and did
the man in the store whom she had tried to help represent her father,
whom she had often tried to help after her mother’s psychotic outbreaks?
Or was her need to see with her own eyes what had happened at the scene
of the explosion an unconscious fantasy about the primal scene? Could
the destruction in the triangle represent the pubic triangle of her mentally
ill mother, who contained the life source but also destructive forces of
psy-chic death and fragmentation?
Thinking about all of these possibilities, I said to Susan, ‘‘You asked
me at the beginning of the session whether you should stop analysis. I
think you might be afraid of an explosion within you, of being in touch
with something that might destroy your sanity. But you are unable to run
away from the dangerous triangle within yourself. You went back to it in
order to make sure that you are alive and sane. I think that you want me
to reassure you that I will not let you go there alone, but that I will
accom-pany you on this journey.’’ Susan sighed with relief and said, ‘‘I
think you are right. I was unaware of it.’’
After this session, I left my office and met my cleaning lady, who had
just come into the apartment. She appeared agitated, looked at me anx-
iously and said, ‘‘Did you hear what happened in Jerusalem? Another
sui-cide bomber, in the same place as two days ago!’’
I looked at her in surprise and shock. ‘‘What?’’ I said. ‘‘It can’t be true!’’
I had just been immersed during the last session in seeking the symbolic
meanings of this terrible event, searching for the innermost personal meaning
that my patient was attaching to it, and now reality struck me in the face. I
had the uncanny feeling of reality and fantasy intermingling. True, my
cleaning woman did not refer to the place as the triangle, and she was not
flirting with death, as my patient was. But was it possible, I asked myself,
that by thinking of the metaphorical meaning of the trian-gle—the oedipal
constellation, the primal scene—I was actually trying to protect myself
against our cruel shared reality? On the other hand, if I only took into
account my patient’s conscious attitude toward external reality, wouldn’t I be
missing the basic unconscious fear that made her want to stop analysis?
What was my responsibility as an analyst in such times?
CASE ILLUSTRATION: JACOB

Jacob is a forty-year-old scientist who works in a research institute. He is
married for the second time, has two children, five and seven years old,
and a six-month-old baby. Jacob sought analysis for what he perceived as
his social inhibitions, and has been in analysis with me for the last five
years.
Jacob is a Jew of Bulgarian origin, his family originally from Sophia.
His father started from nothing as a car salesman and built up a
successful business there.
Jacob, whose name was Jacko until he immigrated to Israel from Bul-
garia, described himself as ‘‘wild’’ and unruly as a child. Hyperactive
and suffering from problems of concentration, he did poorly in school
and was considered stupid by family and friends. His behavior when
playing with friends was often ‘‘wild’’—he tore his clothes, caused
damage, and sometimes injured himself and other children. He was very
attached to his mother, who was dissatisfied with his poor scholastic
achievement and irritated by his wild behavior.
Jacko, the ‘‘wild’’ child, turned into a stormy adolescent, rebelling
against his family’s materialistic values and those of the society in which he
grew up. He developed an interest in antigovernment activities and be-came
an active member of a dissident organization. His parents, worried about his
safety, as well as their own, were greatly relieved when at the age of
seventeen he emigrated to Israel. Upon his arrival, Jacko changed his name
to Jacob and completely changed his lifestyle and behavior. Dis-
184 CHAPTER 9
covering his intellectual ability, he applied himself with great passion to

the study of Slavic languages. He fell in love with a young woman, a
fellow student, and married her. During this time, his mother developed
cancer and died after terrible suffering. His father remarried shortly after
her death.
Jacob and his wife worked hard at menial jobs in order to finance their
studies. Jacob’s father, meanwhile, was frittering away his wealth, and his
health began to fail. During this time, Jacob became bored with his choice of
profession, his marriage, and his life. Weary of being poor and feeling the
urge to ‘‘make it big,’’ he divorced his wife, left everything behind, and
went to Europe to make a fresh start. There, Jacob changed his name, once
again becoming Jacko. He began working as a car salesman (his father’s
occupation), and changed his lifestyle, once intellectual, restricted, and
puritanical, to one dominated by appetites and drives. He discovered the joys
of sex and enjoyed great sexual freedom; he looked for ways to make easy
money on the stock market and drove ‘‘wildly.’’ Although his father was ill,
he never visited him, as he could not face the humiliation he felt over his
father’s poverty and ill health. Jacko was on his way to becoming a
successful businessman when his father, after losing all of his property,
including the house he lived in, died of a heart attack.
An important figure in Jacob’s life was Shlomo, his father’s best
friend from Bulgaria. Jacob greatly admired Shlomo, whom he regarded
as a suc-cessful businessman with a charismatic personality, a great deal
of money, and power over the lives of others. As an adolescent, far from
his parents and alone in Israel, he had often been invited to Shlomo’s
home, where he had been treated like a son. Having only daughters,
Shlomo ‘‘adopted’’ him and spoiled him with expensive presents.
During a visit to his prote´ge´ in Europe, Shlomo introduced Jacob, now
Jacko, to the world of financial speculation and gambling. Shlomo, who
enjoyed an extravagant lifestyle, bedazzled Jacko with luxurious hotels and
expensive restaurants. Little did Jacko know that his father’s friend was a
swindler who was now deeply in debt and on the run from creditors. Jacko
put him in charge of all his money. It came as a shock when he discovered
that Shlomo was in fact bankrupt. Jacko, learning he was just another
‘‘sucker’’ supporting his mentor’s swindling and extravagant lifestyle, felt
deeply betrayed by the man he had most loved and admired. As a result of
this painful experience, Jacko gave up his newly acquired identity as a
budding businessman, his dreams of easy money, and his new lifestyle.
He returned to Israel, where he again reverted to Jacob, a science student
working hard to make a living.
I will not describe our long and complex analytic journey. For our pur-
poses here, suffice it to say that Jacob, the young man who sought
analytic treatment, was a highly intelligent, serious, and hard-working
scientist. He had remarried and was now the father of three small
children. Jacob hoped to be granted tenure at the research institute where
he worked. Lately, however, he had been troubled by the responsibility
of another child and the burden of work he had taken on.
In analysis we understood that Jacob’s attempt to become Jacko, a
suc-cessful car salesman, stemmed from his inability to accept his
father’s downfall. His ego ideal was destroyed when the omnipotent,
powerful father figure of his childhood deteriorated into a poor and
miserable man. Unable to mourn his paternal representation, he himself
tried to become the successful businessman his father had once been. He
then modeled his ego ideal on his father’s friend, his substitute father,
with whom he wanted to identify. The discovery of this man’s deceit
destroyed his ego ideal once again and caused him deep narcissistic hurt.
Much psychic work was needed to help Jacob work through his feelings
of admiration, love, and hate toward the split paternal representation.
After working through the split father figure, we tried to elaborate the
split in Jacob’s self-representation. I helped Jacob realize that he envied
Jacko, the young man who lived the easy life and loved soccer, money,
and luxury. Jacko, with his lenient superego, with few aggressive and
libidinal inhibitions, appeared to have vanished into thin air. He was
replaced by Jacob, a shy, hard-working, periodically depressed young
man who came to analysis because of his inhibitions, but who was
terribly afraid of getting rid of them, lest Jacko take over again.
One of the objectives of analysis was to stitch together the conflicting
aspects of Jacko and Jacob into a better-integrated self.
I will now present some verbatim material from a session that took
place in the fourth year of analysis, during the intifada, that illustrates
both my patient’s perception of the reality of life here in Israel and my
inability to stay with his fears, which were also my own.
Jacob: What can I say about the current situation in our country! It’s a
catastrophe! The fact that I can be here with you is a great luxury.
186 CHAPTER 9
In my lab I work alone. During my lunch break I sometimes listen to

music or read. Yesterday I had quite an experience. I went back to
work at four o’clock, and heard there had been another terrorist attack.
As a scientist I work in another world, but when I leave that world,
reality hits me. I feel that in therapy we are dealing with petty things. I
know that this is the human condition, but analytic therapy deals with a
world in which the notion of good exists. As a scientist I want to give
people a better world to live in, but when such terrible things are
occurring, it becomes irrelevant. (He reflected for a mo-ment and then
continued.) Am I using what is happening here now to avoid doing all
the things I took upon myself, like work and a family? But actually I
feel good doing what I’m now doing.
I wondered to myself whether I should be focusing on the defensive

way Jacob was using external reality. Was he showing me that analysis
was irrelevant to him during such frightening times?
J: (continuing) I usually come home at eight o’clock. I find my wife

watching a stupid movie. She avoids watching the news. There is
al-ways tension when I want to watch the news. She’s pregnant and
bothered by the idea of raising children in this insane country. (This
was before their third child was born.) The situation in the country
is so hostile and unpleasant. My Israeli-born wife wants to leave the
country and live a quiet, comfortable life someplace where she
doesn’t have to worry about her children’s safety when they go to
nursery school.
I: The situation is indeed difficult for all of us; we are all afraid. But
in describing your wife’s desire to leave the country, might you not
ac-tually be expressing your own desire to run away from your
family, your profession, from analysis?
J: Yes, I am. I do have such a fantasy. But I am not acting upon it.
And there are also great advantages to living here—it’s our own
country, we belong here. I’m slowly beginning to understand how
complex the political situation is. A miracle would be needed to
solve this conflict!
Jacob agreed with my interpretation of his wishes stemming from his

internal world. From our work over the years I knew how compliant he
was on the surface. But he immediately switched back to external reality.

What should I do now? I thought. Isn’t it my role as analyst to point out
to him the unconscious meaning of the conflict he is referring to, which
in my view represents the conflict between two polarized aspects of his
personality, and not deal with the external reality?
J: (continuing) I believe that the political conflict between Israel and the
Palestinians cannot be solved. It won’t destroy the country, but life will
become such a nightmare that people will leave of their own
free will.
I: I think you’re telling me something about the way you feel now
about analysis, that perhaps you wish to leave it behind and not
face your own conflicts and fantasies [again I bring the subject
back to internal reality].
J: Out there things are on fire, and we are sitting here discussing the
fine nuances of feelings. It’s such an indulgence! It’s like placing
my-self inside a bubble, so that I can be left alone and have a decent
life. It’s sociopathic, egocentric! But first we have to stay alive. It’s
like Russian roulette. People are being murdered every day. Now,
in my army reserve duty, I accompany soldiers to the front, to
dangerous places. There’s a new song by a famous singer, ‘‘Who
will be next in line, who will be in the next line?’’ The way I
understand politics, I feel that in the future, living in the shadow of
fear, people will carry guns in the street, violence will increase,
terrorism will increase, there will be economic problems, this
country will become a Third World country.
Listening to Jacob, I was aware of being terrified by his grim

prediction of the future. Unable to remain silent, I asked, ‘‘And where do
you fit in all of this?’’
J: I wonder if everything I’m saying is showing that what I really want

is to cop out of my present life. But I’m going to continue doing
everything I’m doing. I’m confused. My wife recently changed
from being a lefty to being an extreme right-winger. I think we
need a sane voice in order to unite the people, so that they won’t
follow fanatics on either side.
188 CHAPTER 9
I: I think that in describing our difficult external reality, you are actu-ally
also telling me something about the problems you are encoun-tering in
your inner reality. Perhaps you are telling me that, on the one hand,
you took upon yourself the responsibility of a family, work, and the
pressure of career advancement, but, on the other hand, you really want
to run away from it all and leave everything behind, as you did in the
past. And perhaps you are asking me here, in analysis, to be the sane
voice that will help you unite the polarized aspects of your own
personality, so that you can feel more whole.
As can be seen from this material, I finally became aware in this

session that Jacob’s perception of the frightening external reality was my
percep-tion of the situation as well, a realization that made me feel
passive and helpless. And what about my analytic role? Could I give it up
and ‘‘just’’ stay with my patient’s fears, and my own? I was trying to
hold on to my own identity as an analyst, and whenever he reverted to
external reality, I found myself time and again striving to go back to
internal reality. I found that I had to interpret the unconscious meaning
behind his perception of external reality. His perception of external
reality was not simply a reflec-tion of conflicting wishes and fantasies
that stemmed from his inner real-ity; he was using it also to repeat a
defensive form of behavior that he had used several times previously. I
could have considered his behavior to be an adaptation to real danger, but
instead I clung to what made me feel safe—analyzing his defenses and
working them through with him. And, indeed, following this lengthy
process, Jacob became less ambivalent about his decision to stay with his
family, in Israel, in his profession, and in analysis.
However, in my countertransference feelings, I suddenly found doubt
sneaking up on me regarding Jacob’s decision. If something were to hap-pen
to Jacob during his reserve army service, I would feel guilty, I thought to
myself. I reminded myself that my duty was to point out to Jacob his
unconscious wishes and fantasies, that he was a mature person, capable of
making his own decisions, that he alone was responsible for his life. But
what impact was the external reality having on me? I asked myself. Had the
dangerous situation increased my omnipotence to such an extent that I
thought I could save my patient’s life by letting him run away from dan-ger?
Was I myself feeling threatened by the daily confrontation with my
own and my family’s possible destruction? Yet, how could I let this diffi-
cult situation destroy my analytic ability! Wasn’t being able to continue
functioning as an analyst a hope for the continuation of life?
One Year Later

An episode one year later, which occurred during the threat of a possi-
ble biological or chemical attack on Israel from Iraq, put me more closely
in touch with my own defenses when confronted with the possibility of
death and destruction. During the past two years, faced with the intifada,
Jacob mentioned several times that he wished to immigrate to another
country. Lately he claimed that his wife was completely panicked; she
wanted all of them to go to Bulgaria for a couple of months and stay with
his brother until the threat of war passed. His wife loathed her sister-in-
law and felt that life in Bulgaria was poor and miserable. But she was so
anxious that she saw this as the only possible solution.
I told Jacob that his wife probably represented a voice inside himself,
the voice of his own fear. I added that going away with his family now
might diminish this fear, but would also give him the opportunity of flee-
ing from his conflicting wishes and the fantasies we were dealing with in
analysis.
Jacob answered by trying to describe how difficult it was for him to
leave the country, now that we might be faced with a terrible war. And
what would happen to the people whose work he supervised, or his stu-
dents? How would they feel if he, their boss, left in order to save himself
and his children? But, he wondered immediately, what was more impor-
tant, his own children or other people? During the Holocaust, those who
fled from dangerous places were the ones who survived.
I was wondering to myself whether Jacob was afraid I might go away
and take care of myself and my family, abandoning him here alone, in
the midst of danger and destruction.
As if hearing my unspoken thoughts, Jacob said, ‘‘I fantasized that
you would leave the country. I know how prominent you are in your
field. You’d get the red-carpet treatment anywhere in the world; you
would be very welcome, you have friends everywhere. Perhaps you
would take a break and call it going on sabbatical.’’
Smiling to myself, I said, ‘‘I am often aware of the fact that you want
to run away from me, from analysis. But now you are sending me away;
190 CHAPTER 9
you are arranging for me to have friends abroad and to get the red-carpet
treatment. All you have to do is to bring me the tickets next session.’’
Jacob did not find this funny. He said, ‘‘Maybe this is only my fear
that you are going to leave me? If you had to choose between a quiet,
peaceful life or a life full of terror, maybe it wouldn’t be so difficult to
disappoint a few patients!’’
My thoughts revolved around the transference reflected in his remarks
about my going way. Jacob was indeed frightened that I would leave him.
But I also felt that in the transference Jacob was now placing me in the role
of Shlomo, his father’s friend, the man he had once greatly admired and
loved. I had become the charismatic con man who had power over people’s
lives, and who always saved his own skin by disappointing those close to
him. Jacob bestowed those qualities on me, while at the same time
identifying with me and thus attributing them to himself. Apparently, the red
carpet was Jacob’s own wish, which he projected onto me.
A Turning Point
I will now present an important event from my personal life that in-
creased my awareness of the extent to which I had been denying external
reality. I mention this event only because it constituted a turning point for
me in the analysis and caused me to work through my own fears of death
and destruction, as well as the threat to my identity as an analyst. This
event, during this tense period in which a chemical or biological attack
was looming high on the horizon, was the birth of my first grandchild.
Babies were now being discharged from the hospital with a little plastic
tent, for use in the eventuality of war, which would completely insulate them
and keep them safe in the case of a chemical or biological attack. I envisaged
what could happen during such an attack: the young parents (my son and his
wife, in particular) wearing gas masks, and frantically attempting to put the
screaming baby into this device, and then being un-able to touch and calm
her. This image made me aware that I was not coping with the situation.
What I really wished was that the parents and the baby would stay abroad
through this threatening period, with its un-certain outcome. They could stay
with my daughter-in-law’s family in France, just for a few weeks. Only now
did the possibility occur to me that my interpretation of fleeing from analysis,
though connected to Jacob’s
way of dealing with life, may also have been a projection of a fantasy of
mine that was intruding on the analysis.
When Jacob came for his next session and again talked about going
away with his family to Bulgaria, I was very quiet. The only thing I could
say was, ‘‘It is indeed very frightening to be here with little children
during such times.’’ Now, at last, I was acknowledging external reality.
Jacob was silent. Then he said, ‘‘Thank you for being with me during
these difficult times.’’ Jacob must have sensed that my attitude had
changed. As I ac-cepted his fears of external reality, instead of just
focusing on his internal reality, Jacob felt supported. This gave him the
courage, as the analysis progressed, to deal with his internal and external
conflicts in a different way. Until now, Jacob had perceived me as
representing a persecutory in-ternal reality that seemed to him irrelevant
in a period of danger. He therefore kept focusing the analysis on external
reality only. Now he could relate to me more as an ally in his struggle
with his own self in our shared life-threatening situation.
DISCUSSION
My work as a psychoanalyst during a period of chronic crises, and espe-
cially the change in my patient’s fears that I experienced during the war
with Iraq, led me to explore the following issues: (1) the impact of the
person of the analyst on the analytic cure in a shared life-threatening situ-
ation; (2) the relation between external and internal reality in a situation
of terror; and (3) the goal of psychoanalysis in an age of terror.
The Impact of the Person of the Analyst on the

Analytic Cure in a Shared Life-Threatening Situation
This issue preoccupied me for some time and made me ask myself
sev-eral questions. Is it possible that for a while I was unable to contain
my patient’s fear because I was denying my own? What made me adhere
so blindly to the ordinary rules of psychoanalysis during such frightening
times? Was my fear of losing my analytic function so great that I lost
sight of reality?
On the issue of containing the patient, I wish to quote Bion, who so
eloquently stated: ‘‘When the patient strove to rid himself of fears of death
which were felt to be too powerful for his personality to contain he split off
his fears and put them into me, the idea apparently being that if they
192 CHAPTER 9
were allowed to repose there long enough they would undergo modifica-
tion by my psyche and could then be safely reintrojected’’ (1959, p. 103).
Are we able to contain and modify the fears of our patients while we
find ourselves confronted with death and destruction? Isn’t our psyche,
the inner space in which these fears are to repose, constricted by such a
situation? Regarding this issue Abend has remarked that ‘‘the impact of
daily events, inner as well as outer, plays upon our psychic integration
and produces those fluctuations of mood, thought, and behavior which
are part of our so-called normal personalities. Since our receptivity and
reac-tivity to our analysands depends upon our psychic balance, how can
we imagine that this ‘analyzing instrument,’ as Isakower liked to call it, is
un-affected by its constantly shifting dynamism?’’ (1986, p. 565).
In the shared life-threatening situation we are living under in Israel, I
have found that our ‘‘analyzing instrument’’ is indeed affected by current
events. The turning point for me in the treatment of Jacob was when I
realized that my countertransference feelings were not induced only by
the typical patient’s transference and actions toward me (Boyer 1983,
1999; Giovacchini 2000; Kernberg 1984; Volkan 1987; Volkan and Ast
1992, 1994); they were also the result of my own defense mechanisms in
con-frontation with death and destruction. These defenses had a deep
impact on the analytic encounter and therefore deserve to be scrutinized
just as closely as reactions normally regarded as countertransferential.
Perhaps I was denying my own wishes of fleeing with my family to
safety, since these wishes ran directly counter to my ideological reasons
for living in Israel. I found it easier to struggle with Jacob’s wishes to run
away (which could come under the ‘‘normal’’ heading of resistance) than
to accept his fears as well as my own. Thus, ‘‘denial in the service of
nor-mality’’ was most likely my way of living in a life-threatening
situation. In this case, denial of external reality made me, to a certain
extent, unem-pathic toward my patient’s fears and restricted my ability to
contain and modify them so that he would feel supported. This hindered
the analytic work, and the patient rightly felt that analysis had become
irrelevant to his most pressing needs (‘‘Out there things are on fire, and
we are sitting here discussing the fine nuances of feelings. It’s such an
indulgence! . . . It’s sociopathic, egocentric!’’).
I have found Carpy’s words about the normal development of the in-fant
very useful. ‘‘The normal infant needs . . . an experience of being fed
by a mother in whom he can sense the panic, but who is nevertheless able
to give him milk. This is what makes pain tolerable’’ (1989, p. 293). Pa-
tients who fear external reality need this experience—of a ‘‘holding envi-
ronment’’ (Modell 1976) or ‘‘mutative support’’ (De Jonghe, Rijnierse,
and Janssen 1992) no less than when they are afraid of projections
coming from their internal world. It was only when I could be in touch
with my own panic that I was able to give my patient the containment
that he needed.
A great difficulty for me in the case of Jacob was that fleeing from a
dangerous reality could be considered a realistic solution to real danger,
as well as a ‘‘manic defense’’ (Klein et al. 1952; Winnicott 1935) that he
had employed several times previously in order to flee from his internal
conflicting wishes. My feelings of omnipotence and guilt, which were
greatly increased by the fact that I was experiencing external reality as a
threat, made it difficult for me to take both of these perspectives into con-
sideration.
Regarding Susan, it was easier to feel empathy with her plight. I was
aware of the possibility that external reality facilitated the omnipotent en-
actment of traumatic fantasized past events connected to her mother’s
Holocaust history, in order to lessen or undo their impact. From another
angle, we explored the current traumatic reality that enhanced Susan’s
feelings of guilt in relation to her ill mother. This helped Susan
understand that she tried to mitigate her self-blame by helping others
who found themselves in a difficult situation. Finally, because I was
better able to con-tain our shared fears evoked by external reality, I
succeeded in helping her realize that her enactment had an unconscious
meaning related to her fears and anxieties over losing her sanity (which
arose from her inner re-ality).
The threat to my identity as an analyst symbolized for me the possible
destruction of my own and my patient’s psychic life. The current situation
reminded me of the Holocaust history of our parents and grandparents and of
the damage to metaphorical thinking that has been demonstrated in studies of
Holocaust survivors (Grubrich-Simitis 1984; Herzog 1982; Krystal 1985;
Oliner 1983). This fear of a return of the past made me expe-rience the
current situation as no less a threat to our psychic life than it is to our
physical existence. The damage to metaphorization has been attrib-uted to
the deadening of inner life as the result of an overwhelming reality.
194 CHAPTER 9
I felt that the current reality was threatening to erase inner reality by di-
minishing the place of symbolism in analysis. To counteract this, I pur-
posely focused on inner reality. I did this in order to create a sense of
safety, to confirm the continuity of normal life, and to ensure the survival
of both psychic and physical reality. But by doing so, I sometimes paid a
high price, as I have discussed.
The Relation between External and Internal Reality in a

Situation of Terror
In the current wave of violence that is overwhelming us, we can
observe the disintegration of the normal fabric of life and the destruction
of a sense of safety.
The sense of safety is described by Sandler (1960) as a feeling that is
so much a part of us that we take it for granted as a background to our
every-day experiences. It is a feeling that bears the same relation to
anxiety as the positive bodily states of satiation and contentment bear to
instinctual tension. It is a feeling of well-being. The need to maintain a
sense of safety is of greatest importance in learning and development, and
is therefore one of the fundamental components of the therapeutic
situation. In treat-ment we often deal with the internal anxieties and
conflicting wishes that underlie our patients’ reactions to external reality.
As analysts we try to provide an environment that is safe and protected,
that will enable the therapeutic regression to unfold, 2 and that will
facilitate the search into the internal world of the individual.
But what happens to this ‘‘safe haven’’ when external conditions are
filled with terror and violence? Should we, as analysts, try to preserve the
safety of the setting? Can this be done by clinging to the ordinary notions
of ‘‘classical analysis,’’ by encouraging the exploration of inner conflicts
and anxieties and denying the dangers outside?
There is an ongoing controversy over the impact of external reality on
our inner life. This controversy has been reviewed in depth by Oliner
(1996). I will bring only a few illustrations of the polarized attitude of
psychoanalysts toward the place of traumatic external reality in our inner
world.
A classic example is Melanie Klein’s famous analysis (1961) of Richard,
a ten-year-old boy brought to London for her to treat during World War II.
The analysis focused solely on the psychic reality of the boy, while the
outside reality of the Blitz under which he lived was totally ignored. At
the other pole we find the work of Melitta Schmideberg (1942), Melanie
Klein’s daughter, who, in conducting analysis during wartime acknowl-
edged the traumatic external reality, as well as the common fears of
patient and analyst sharing a life-threatening situation.
A most important figure with regard to traumatic reality in psychoana-
lytic history is Winnicott. In a meeting of the British Psychoanalytical So-
ciety that took place during World War II, he pointed out the existence of
external reality to a group that preferred to ignore it. In his bibliography of
Winnicott, Phillips describes the incident: ‘‘Margaret Little, one of
Winnicott’s analysands, recalls that in the first Scientific Meetings of the
British Society that she attended, there were bombs dropping every few
minutes and people ducking as each crash came. In the middle of the dis-
cussion, someone I later came to know as D.W. stood up and said ‘I should
like to point out that there is an air-raid going on’, and sat down. No-one paid
any notice, and the meeting continued!’’ (1988, p. 61).
The controversy over the impact of traumatic external reality on psy-
chic reality continues to this day. Therapists treating victims of known
abuse claim that classical psychoanalysis pays too little attention to real
events in a person’s life to be of use to traumatized patients. Shevrin dis-
agrees with this assumption. In his contribution to an issue of JAPA de-
voted to trauma, he noted that ‘‘psychoanalysis came in at the fault line
between presumed sexual seduction at an early age as a cause of neurosis,
and the role of fantasy’’ (1994, pp. 991–92). His conclusion is that
classical psychoanalysis considers external traumatic reality and its effect
on psy-chic life to be a most important element in neurotic conflict.
Normally there is a mutual influence of elements from the external and
the internal worlds, each modifying the other. According to Arlow,
‘‘There is a constant mutual interaction between the individual’s mental
set, as dictated by his persistent unconscious fantasies, and the events of
his daily conscious experience’’ (1991, p. 60).
The reciprocal relation between external reality and unconscious fan-tasy
in normal life situations has been studied in depth by Winnicott. He felt that
reality is useful for setting limits to fantasy, thus having a reassur-ing effect.
Referring to Freud (1923), who views reality as that which frus-trates the
individual, Winnicott writes, ‘‘The point is that in fantasy things work by
magic: there are no brakes on fantasy, and love and hate cause
196 CHAPTER 9
alarming effects. External reality has brakes on it, and can be studied and
known and, in fact, fantasy is only tolerable at full blast when objective
reality is appreciated well’’ (1964, p. 153).
I wish to raise the hypothesis that external reality of a traumatic nature
differs from reality under normal life conditions in that the former cannot
modify fantasy and thus contribute to the internal world by serving as a
reassuring entity.3 Unable to establish factual limits to aggressive and
destructive wishes, it cannot mitigate omnipotence and feelings of guilt.
This hypothesis, which I will discuss in greater depth in the epilogue, is
relevant to the effect of the traumatic external reality on the entire
popula-tion in Israel.
The Goal of Psychoanalysis in an Age of Terror

It would seem that in an age of terror, we cannot claim that the aim of
psychoanalysis is to continue to ‘‘verbalise the nascent conscious in
terms of the transference’’ (Winnicott 1962, p. 169); instead we must
think about the death anxieties of the patient evoked by the life-
threatening situ-ation.
Modell (1996) has referred to the problem of the analyst’s perception
of the patient’s mind by stating that interpretation not only reestablishes
the frame of the psychoanalysis, but also introduces the analyst’s
construc-tion of reality. This leads to the question, Is the content of the
interpreta-tion entirely the analyst’s construction or does it also reflect
the patient’s mind?
As analysts, our subjective experience of a shared life-threatening
situa-tion may facilitate interpretations that reflect our patients’
construction of reality, as well as our own. This subjective experience is
the only alley through which we may become the repository of our
patients’ need to contain the intense death anxiety occasioned by the
traumatic reality; this paradoxically provides a hopeful investment in the
future. It thus becomes part of our function as analysts to recognize our
own reactions to external reality and to acknowledge them. In the cases I
have described, this oc-curred when I came in touch with my own fears in
reaction to the threat-ening reality I experienced along with my patients.
As a result of the long and painful working through of my own defenses
and conflicts in reaction to psychoanalytic work in a shared life-threaten-ing
situation, I have become aware of the need to respect external reality
even as I try, together with my patient, to explore the inner universe that
processes and handles this reality in unique and idiosyncratic ways. As Eis-
sler has so pointedly stated, ‘‘No individual can divorce himself from the
historical period in which he is living, any more than he can put himself
beyond time and space’’ (1953, p. 107). We should respect the historical
period in which we are living and adjust the analytic tool accordingly.
NOTES
1. The recurrence of crisis in Israel during the last three-and-a-half years of

the intifada, the guerrilla war, and the threat of a U.S. war with Iraq and its
possible repercussions for Israel, induced me to use the paradoxical term chronic
crises to describe the current situation.
2. As Treurniet has noted, ‘‘Regression may be therapeutic in analysis,
because it gives the subject an opportunity to become acquainted with himself
through experiences. This is conditioned upon the setting and the analyst’s
attitude in pro-viding sufficient security’’ (1993, p. 879).
3. Wallerstein draws attention to the problem of reality and its place in our
psychological scheme of things. ‘‘[B]eyond what I have stated of the contempo-
rary breakdown in consensus about reality, and of our having to self-consciously
face and discriminate amongst a profusion of competing views of reality, there is
the frightfully real question, in this day of nuclear power and environmental
despoliation, of what kind of future does our or any reality have’’ (1973, p. 7).
4.
10
Working with Sons and

Daughters of Holocaust
Survivors in the
Shadow of Terror
INTRODUCTION
As I have shown in earlier chapters, the trauma of the Holocaust is often
transmitted to and absorbed by the children of survivors. The psychoana-
lytic literature on the offspring of Holocaust survivors states that the Ho-
locaust is transmitted to them through early, unconscious identifications
that carry in their wake the parents’ perception of an everlasting, life-
threatening inner and outer reality (Axelrod et al. 1978; Barocas and
Baro-cas 1973; Kestenberg 1972; Klein 1971; Laufer 1973; Lipkowitz
1973; Ra-koff 1966; Sonnenberg 1974). These children, whose minds
have been impregnated with mental representations of the atrocities of the
Holo-caust deposited by their parents, carry within themselves powerful
feelings of loss and humiliation, guilt and aggression.
Volkan coined the concept of ‘‘deposited representations’’ (1987, p. 73),
emphasizing the role of the parent, who unconsciously, and some-times even
consciously, forces aspects of himself onto the child. By doing so, the parent
affects the child’s sense of identity and gives the child certain specific tasks
to perform. In these cases, the children become the reservoirs for deposited
images connected to the trauma, which often initiate uncon-scious fantasies
linked to it. The children are compelled to deal with the
199
200 CHAPTER 10
shame, rage, helplessness, and guilt that the parents have been unable to
work through for themselves (Volkan et al. 2002).
The question I wish to address here is what happens when children
whose Holocaust-survivor parents have undergone victimization, actual
abuse and humiliation, encounter traumatic reality in the present? What is
the impact of this external reality on their inner life, their perception of
reality, and their defenses?
I show that life-threatening reality does not reactivate only a simple
recollection of traumatic events, but it also reactivates in the children the
mental representation of the Holocaust that they share with their parents.
These include real events of a traumatic nature, conscious and uncon-
scious fantasies regarding these events, intense feelings of mourning and
guilt, and defenses against unacceptable feelings such as shame, guilt, or
aggression (Roth 1993; Moses 1993; Kogan and Schneider 2003). For
this purpose I will use clinical vignettes from two cases in which the life-
threat-ening situation of the intifada in Israel reactivated mental
representations of the Holocaust and had an impact on their perception of
reality, rein-forcing their manic defenses.
THE CASE OF DAPHNA

Daphna, a forty-six-year-old high-school teacher, married and mother of
a sixteen-year-old boy, was a member of a small group of extreme leftists
who strongly advocated the pro-Palestinian position. Not only did she
participate in the big peace demonstrations organized by Israel’s left-
wing parties, but she also stood at crossroads together with several other
women, holding up signs that promoted their pro-Palestinian views.
These signs often evoked furious reactions from passersby, many of
whom responded by shouting angrily at the demonstrators. These angry
reac-tions never deterred Daphna from what she was doing. On the
contrary, they increased her emotional excitement and the importance of
these demonstrations for her.
Daphna was the daughter of a Holocaust survivor father and a mother
who arrived in Israel with her parents before World War II. Her father’s
parents and siblings were taken to Auschwitz where they were gassed and
their bodies cremated in the ovens. Daphna’s mother had suffered from
depression throughout her life, which worsened with age. Her psychic sit-
uation deteriorated after the birth of Daphna, the younger of two children.
SONS AND DAUGHTERS OF HOLOCAUST SURVIVORS 201
Daphna remembered her mother as a sad, passive, very silent woman,

who could not cope with the simple chores of life. ‘‘I grew up with a
shadow,’’ was how Daphna described the mother of her childhood.
Daphna’s parents lived in a little village. From the time she was a baby,
Daphna lived in a children’s home, together with the other children. She was
told that after her birth her mother had become so depressed that she would
sometimes forget to feed her. When this was discovered, she was put in a
children’s home, and there they took charge of her.
When Daphna was nine years old, the family moved to the United States
for a period of three years. Her mother had a very bad reaction to leaving
Israel, where she had led a sheltered life and where her children had been
cared for. Daphna remembered that during this period her mother would lie
in bed for days on end, unable to buy food or cook for her family, never
responding to teachers’ requests to discuss the problems the child was having
in school. Father took care of these matters, and Daphna learned to live with
a depressed, psychically dead mother.
Upon their return to Israel, Daphna was placed in a boarding school
where she began to thrive. She was a good student, had many friends,
and led the life of a normal adolescent.
When Daphna was twelve, her mother committed suicide. Father was
the one who found her burnt corpse near the oven, and an empty bottle of
pills which she had apparently swallowed before putting her head inside
the oven (it was an old-fashioned gas oven with an open flame). It was
never clear whether the mother had died from gas inhalation or from the
flames that consumed her body after she had poured gasoline over
herself. Daphna was shocked and horrified by this terrible event. Nobody
talked with Daphna about what happened; the father never mourned his
wife. Daphna knew that the shocking death of her mother must have
reminded him of his lost relatives who died in the gas chambers. After
about two years, he was hospitalized because of a psychotic depression.
Daphna vis-ited him regularly in the hospital and was terribly ashamed of
the way he looked and behaved.
After the initial shock, Daphna made a conscious decision to get on with
her life. She studied and worked, and married a man she did not love, out of
fear that she would remain an old maid. She gave birth to her first child, a
boy. Throughout her life, Daphna was plagued by pseuriasis and periodic
depressions. She encountered great difficulties in raising her son,
202 CHAPTER 10
and in spite of giving him love and care, she sometimes lost her temper
and became violent, a fact which tormented her deeply and aroused feel-
ings of guilt. Daphna was in therapy for a period of ten years, at the end
of which her therapist developed a terminal illness.
Daphna sought analysis two years ago, when her older brother, at the
age of fifty-one, became ill and was hospitalized in a mental institution
because of a mental breakdown. Concerned that she, like her older
brother, might suffer a psychotic breakdown at the fatal age of fifty-one
(the age at which her mother had committed suicide), Daphna decided to
seek analytic treatment.
I will not describe our painful analytic journey over the last three
years. Instead, I will examine Daphna’s reaction to the life-threatening
situation in Israel over the last few years as revealed in analysis. I will
illustrate this with a vignette from one of our sessions.
D: There are so many terrorist attacks. I am so angry about it. I feel

like another Holocaust is descending on us.
We were silent for some moments.
D: (continuing): There is a story about a frog. A frog is insensitive to

differences in temperature. So, if you slowly warm up water to boil the
frog, it will not jump out of it, because it does not feel the dan-ger.
This happened to the Jewish people in the past. Those who did not run
away from the Holocaust, look what happened to them, they all got
cooked in the oven. It’s the same with us now. We don’t pay attention
to what’s going on until the situation gets really bad.
I was frightened by Daphna’s words. Perhaps she is right, I thought to

myself. Nobody knows what the future will bring upon us. Then, my
thoughts turned to Daphna’s tragic mother who had put her head in an
oven, possibly choosing to concretely follow the fate of her relatives who
had been gassed and cremated in Auschwitz. Was the mother the ‘‘frog
who was insensitive to pain,’’ I asked myself, or was her psychic pain so
overwhelming that she destroyed herself in order to get rid of it?
Further on we delved into Daphna’s fantasies regarding the political
demonstrations that she participated in at crossroads. We discovered that
Daphna was not reacting to external reality only out of political

conviction and striving for peace, but she was also reacting to an internal
world full of fear and feelings of guilt.
D: You know, yesterday I was demonstrating together with other women

against the occupation of the territories. When I took part in these
demonstrations in the past, people threw tomatoes at us or cursed us. I
heard that women who demonstrated were beaten and needed
hospitalization. I thought, with the level of violence being so high,
there are people who might shoot us. I feel like the Jews at the
beginning of the Nazi era, when they were persecuted in the streets.
What a mixture of past and present, I thought to myself. Apparently,

Daphna felt that she lived back at the beginning of the Nazi era and that
her persecutors were after her.
D: (after some moments of silence) I feel I do not have the right to live
a life of my own, that I have to be punished. Like religious people,
I also say to God: ‘‘I am paying my dues, I demonstrate against the
war every Friday at noon, every Saturday night, you should have
mercy on me.’’
I: What do you feel you should be punished for?
D: I don’t know. It has to do with my mother. How could I never have
noticed what was going to happen to her? I was so preoccupied
with the stupid things of adolescence. I wasn’t really concerned
with her well-being. You know, when I came home for visits from
the board-ing school before she killed herself, she always wanted to
hug me and kiss me. I didn’t want her to do that, I rejected her. I
wasn’t a baby anymore, and she never did that when I was a child.
Suddenly she wanted to hug me all the time; is it possible that she
needed my embrace and I wasn’t aware of it? And what about my
father? I knew that all his relatives perished in the ovens, and now
[my] mother perished in the same way. He could not survive that. I
knew it, but I could not save him. How can I allow myself to live a
normal life in Israel when life is so crazy!
From this short vignette we can see that by participating in demonstra-

tions, Daphna on a conscious level was fighting for pacifist ideas, while
204 CHAPTER 10
unconsciously she was trying to mitigate the tremendous burden of guilt

she felt toward her parents.
Daphna transferred the guilt-ridden relationship with her mother and
father to her son, and this relationship became another source of torment
for her. Daphna perceived herself as a hungry, needy person who de-
stroyed all those who became close to her—her parents, her son, her for-
mer therapist, as well as myself in analysis. I illustrate this with the
following excerpt from a session:
D: Sometimes I think I don’t want Benny to go to the army. I am forty-

eight and he is eighteen; it is the end of my life. Sometimes I think
about my ambivalence toward him, maybe I want him to die. When he
was little, I was sometimes so aggressive toward him, almost vio-lent.
I went to work once a week, and then my husband gave him a bottle.
Benny hated it. I felt I was forcing him to do something he didn’t want
to do, that I was traumatizing him. I know that my
mother was very depressed after my birth and that she sometimes
forgot to feed me. When this was discovered, neighbors came in
and fed me the bottle.
I: Perhaps you are afraid that in the relationship with your son you
were unconsciously repeating some of your own experiences with
your mother.
D: Yes, definitely. I feel terribly destructive, especially toward people
who are close to me. I have very powerful needs.
I: Are you perhaps afraid that you will destroy me with your powerful
needs and that I will break down like your mother, or become ill like
your former therapist, and will not be able to give you the caring
and support you need from me in analysis?
D: Exactly so. I’m afraid that nobody can really withstand my own
needy self, nobody can survive my needs and my destructiveness.
And I am also afraid that Israel is a short episode in the history of
the Jewish people, this intifada can become our next Holocaust.
This material illustrates how the shadow of the Holocaust affected

Daphna’s life. Daphna identified with her mother’s victim/aggressor as-
pects. In the role of victim, she was the baby of a persecutory mother who
could have murdered her by starving her to death. In the role of aggressor,
not only did she feel guilty for not saving her mother (and indirectly also
her father) from death and destruction, but she also accused herself of
destroying her mother because of her needy, ravenous self. This
polarized attitude, in which love and hatred were split apart, was
projected onto her son, and she felt that she was simultaneously his
potential savior and his murderer.
THE CASE OF ISAAC

Isaac, a thirty-year-old scientist, married and father of a three-year-old
child, sought analysis because of uncontrolled outbursts of anger toward
his family and his subsequent feelings of guilt and unhappiness.
Isaac came to analysis during a time of crisis in his life: his father,
aged seventy-two, had committed suicide several weeks previously. The
father had suffered from pain in his testicles for over a year before being
diag-nosed with prostate cancer. He underwent an operation and
radiation therapy, after which tests showed that the cancerous cells had
completely disappeared. Only the pain persisted, increasingly affecting
his psychic state.
Isaac’s father was a simple man who had worked as a technician his
entire life, devoting most of his free time to sports and athletics.
Recently, these activities were greatly hindered by the constant pain that
had begun tormenting him, and which gradually led to overwhelming
depression. Despite his recovery and the good prognosis, despite all the
love and sup-port he received from his family, Father decided to end his
life. It was Isaac’s mother who found his body dangling from a rope in
the shower. Father left a note for his family: ‘‘My dear family, please
forgive me, I cannot stand it anymore.’’
Isaac came to me during the first month after his father’s death. His
appearance was striking: he had delicate features and long hair, which
gave him a feminine appearance. He observed the Jewish custom of not
shaving during the period of mourning, and the beard adorning his face
lent him a most bizarre look. He had great difficulty talking and stuttered
terribly during the first session. His strange appearance and fragmented
speech made me regard him as more emotionally ill than he really was, a
fact that I realized later on in analysis.
During this stage of treatment we reconstructed his parents’ story. Isaac
was the son of a Holocaust survivor father and a mother whose family
206 CHAPTER 10
had been living in Israel for several generations. His father had been in a
concentration camp between the ages of fourteen and nineteen. Isaac
knew very little of his father’s life during that period, except for the fact
that only his father and his father’s brother had survived.
Isaac’s own history revealed a very intelligent and talented young
man. During high school he was already taking courses at university, and
at the age of twenty he had completed a first degree in science. He was
then drafted into the army, working there in his field of expertise, and at
the same time was sent by the army to study for a Ph.D. Now, at the age
of thirty, he had a family whom he loved, he had close friends, and was
con-ducting research at a prominent scientific institute.
Isaac complained that in spite of all this, he would sometimes feel de-
pressed. During these periods, he had little energy for work. Nowadays,
he was especially upset by his angry outbursts toward his wife and child.
Isaac described the atmosphere in his parents’ home as coercive. He
was the only son of a couple who had been childless for many years, and
was very much loved and overprotected by his mother. The relationship
with his father was more complex and ambivalent. Though proud of the
boy’s intellectual achievements, the father was never ever satisfied with
him. In contrast to his mother, who spoiled him, his father wanted him to
be totally independent, physically and emotionally. The sensitive young
boy learned that he had to ‘‘become a man.’’ He was urged to look out
for himself and to engage in sports in order to develop his body. He was
ex-pected to learn a profession that would earn him a great deal of
money, with no regard for his real interests.
The boy found himself under great pressure to fulfill his father’s ego-
ideal, but also felt very antagonistic about it. He felt a great deal of anger
toward his father, but afraid to hurt him, he learned to keep his feelings in
check and behaved in a passive-aggressive manner. In my view, he
adopted the mechanism of turning his aggressive feelings against
himself, which caused him to become periodically depressed.
Certain changes occurred in Isaac’s appearance and behavior during
therapy. He stopped stuttering, and his speech became clearer. At the end
of the first month after his father’s death, he shaved off his beard. His
long hair still adorned his feminine features, but without the beard, he no
longer looked so bizarre.
Inquiring about his hair, I discovered that Isaac had not always worn
his hair long. (Hair length has symbolic value. The unconscious meaning
of hair length in children of Nazi persecutors has been the subject of re-
search [Kogan and Schneider 2002a].) There was a period in school and
during his army service when he said that he had looked like a ‘‘normal’’
guy. In the attempt to understand how he defined ‘‘normal’’ or ‘‘abnor-
mal,’’ Isaac mentioned a homosexual encounter that almost occurred at
the age of nineteen, during his army service. Immediately after breaking
up with a girlfriend, he became very close to a young man several years
older. He and this man were supposed to meet and spend the night to-
gether, but at the last moment Isaac got cold feet and didn’t turn up. The
man was very offended and the relationship ended.
In analysis, we tried to understand this episode in light of information
about his father’s life that was revealed to Isaac during the first month after
his father’s death. A cousin told Isaac about some of the dreadful events in
his father’s life during the Holocaust. One terrible episode was about his
father and the uncle who had survived peeping through a fence and seeing
their mother and sister being marched off to the gas chambers. Another
terrifying story was that Father, who was a handsome boy at the time, had
been sexually exploited by men in the concentration camps. The cousin
remembered one of the things Father had said: ‘‘Men were always after me,
the younger ones during the day, the older ones at night.’’ Isaac remembered
his father warning him in this regard: ‘‘You are such a hand-some boy, you
are the type for men, they will be after you!’’
We tried to understand Isaac’s behavior in light of his father’s
powerful message to ‘‘behave like a man.’’ Isaac now realized that
having long hair and looking feminine was the most rebellious action he
could have taken against his father. Consciously, Isaac was rebelling
against the masculinity that he felt was expected of him. Unconsciously,
Isaac almost repeated his father’s fate when he came close to a
homosexual encounter, but fled from it at the last moment.
After elaborating this episode in analysis, Isaac cut his hair. Having to
a certain extent worked through his love and anger toward his father, this
rebellion was no longer necessary.
Describing his feelings about the life-threatening situation in Israel, Isaac
revealed that he had years ago acquired a revolver, which he kept in a locked
drawer. He said, ‘‘I have to have a revolver; it can be very useful in case we
are attacked by terrorists; in case they break into my house, I
208 CHAPTER 10
will not be completely impotent.’’ After further inquiry, Isaac connected

his feelings of impotence to the past sexual exploitation of his father by
the Nazis.
Working through his father’s suicide, we connected the father’s trau-
matic history to his illness and its outcome. Apparently the illness, the
surgery and the radiation therapy had left his father impotent. The un-
bearable pain he complained of might have been an unbearable combina-
tion of physical as well as psychic pain. This trauma, superimposed upon
his father’s earlier trauma, possibly led to his final act of self-destruction.
The life-threatening situation in Israel reactivated in Isaac traces of his
father’s concern over his masculinity, which he had transmitted to Isaac
in ways that went beyond words. In acquiring the revolver, Isaac was at-
tempting to defend not only himself and his family from Palestinian ter-
rorists, but he was also trying to ensure that his manhood would not be
damaged, living his father’s past in his own present life.
DISCUSSION
I will now discuss the impact of traumatic external reality on the percep-
tion of reality and on the defenses of Holocaust survivors’ offspring, as
shown by the previous cases.
In the two cases described earlier, the patients’ psychic realities were
in large part structured by unconscious fantasies and guilt feelings related
to their parents’ traumatic past. Life-threatening external reality and
terror reinforced their internal fears and made it more difficult for them
to dif-ferentiate between internal and external reality, and this had an
impact on their defenses. It caused them to react to their external world
with behav-ior dominated by fantasies and unconscious fears evoked by
their parents’ Holocaust past. The reality of the Holocaust often
penetrated the current reality through real or imagined enactments
(Bergmann 1982; Kogan and Schneider 2002b).
In the case of Daphna, the threatening external situation increased her
feelings of omnipotence, leading her to recreate, through her pro-Palestin-ian
demonstrations, a past world in which she was exposed to death and
destruction. She experienced these demonstrations as life-threatening sit-
uations that ‘‘transposed’’ (Kestenberg 1972) her into the Holocaust past of
her father. The tragic repetition of the Holocaust trauma by her mother
reinforced the mental representations of the Holocaust. This brought a
distortion of reality and she regarded the angry Jews as her Nazi persecu-
tors. In addition, by demonstrating for peace and exposing herself to an
imagined danger, she fulfilled her conscious wish of acting as a savior to
Jews (by omnipotently trying to prevent another Holocaust) as well as to
Palestinians (by helping the underdog). On an unconscious level, Daphna
was attempting to alleviate the guilt stemming from the trauma of her
mother’s suicide, followed by her father’s illness and death, while at the
same time coming close to death in order to overcome it.
In the case of Isaac, external reality was experienced not only as an
exis-tential threat, but also as a potential threat to his manhood. Fearing
his father’s fate, Isaac acquired a revolver to defend himself against a
possible attack on his manhood, which had been his father’s misfortune.
Perhaps in his unconscious fantasies, Isaac perceived the Palestinian
terrorists who might break into his house as Nazi aggressors raping his
body. The threat-ening external reality reactivated the lack of
differentiation between Isaac and his father, causing him to relive his
father’s traumatic past in his own present. In this mixed reality, the
revolver represented the phallus (thus fulfilling his father’s message to
become a man) as well as the weapon that enabled Isaac to defend his
manhood against those who wished to destroy it.
Both cases are marked by great confusion between past and present,
fantasy and reality, internal and external. External life-threatening situa-
tions reinforced the patients’ manic defenses, leading to a distorted per-
ception of reality in each case.
I wish to conclude by saying that we can conceive of Daphna’s and
Isaac’s parents as typical of many Jewish mothers and fathers who were
damaged by the Holocaust. Therefore these patients represent a large
group of individuals for whom the encounter with a life-threatening
situa-tion reinforced their manic defenses, leading to a distorted
perception of reality.
Epilogue
Mourning was first defined as a process that occurs in reaction to the loss
of an object. The work of mourning thus included a massive psychic
effort to recover a link with reality and to detach oneself from the
persecutory aspects of the lost object by assimilating its positive and
kindly aspects. Viewing it from this perspective, Burch regarded
mourning as ‘‘a kind of final act of love’’ (Burch 1989, p. 622).
After examining the mourning process for nearly two decades, Pollock
(1978) arrived at a different conclusion, namely that the mourning proc-ess is
not linked absolutely to object loss. Instead, it is ‘‘a universal adapta-tional
series of intrapsychic operations occurring in sequential successive stages
involved in the reestablishment of a new level of internal and related external
equilibrium’’ (p. 262). These series of operations are caused by different
stages of change that occur throughout a person’s development and that can
be interpreted as threats to one’s integrity and self-identity, forcing the
individual to suffer deep, painful affects.
Similarly to Pollock, Grinberg (1992) maintained that mourning is not
linked exclusively to object loss, but also to growth and to the passage
from one stage of life to another. This process involves the loss of certain
attitudes, ways of life, and relationships, which, even though replaced by
other, more developed ones, nonetheless evoke pain and mourning. Liv-
ing therefore necessarily requires that an individual go through a succes-
sion of mourning processes that are not always successfully completed.
When we pass from one stage of life to another, as well as when we are
confronted with loss and bereavement, trauma, and stress, reality is often
distorted or denied. In some cases, neither time nor therapy, perhaps nothing,
may completely change this. What is required for recovery is not
211
212 EPILOGUE
retribution and triumph, not just the relief of rage, not even simply for-
giveness, but an emotional awareness of the loss, genuinely experienced,
however painful1 it is. This means acceptance of one’s perpetual vulnera-
bility to loss and betrayal, as well as the vulnerability caused by one’s
own limitations and by the finality of life.
In the various chapters of this book we have found detailed
descriptions of the journey from the absence of conscious grieving—a
form of patho-logical mourning (Bowlby 1980)—to emotional awareness
of the pain evoked by loss and its elaboration. The work of mourning
includes the painful toll on the individual, whether in everyday life or in
analysis, as he confronts his losses. By means of the mourning process,
the individual strives to accept loss, overcome pathological defenses, and
readapt the ego to reality in situations of object loss and in a variety of
other situations which cause the individual to suffer painful feelings.
The work of mourning may be impeded by depressive anxiety, pain,
and ‘‘persecutory guilt’’ (Grinberg 1992). 2 These feelings can flood the
ego, which attempts to counteract them by reverting to primitive defenses
(e.g., denial and manic defenses). The struggle of the ego may result in
nonreceptivity to loss and, in varying degrees, a splitting and denial of
reality. The struggle against pain and mourning may have adaptive and/
or pathological aspects, as demonstrated in the various chapters of this
book. The individual’s strategies against mourning prevent the despair
that often accompanies emotional awareness, thus helping him survive
physically as well as psychically, but leaving him emotionally depleted.
The book deals with the individual’s and society’s use of defenses
against emotional awareness of pain and mourning in situations of inter-
nal and external stress. On the individual level, it deals with manic de-
fenses against pain and loss in cases of individuals who are threatened by
fragmentation and psychic death. On the societal level, it explores enact-
ment as a substitute-for-mourning mechanism among Holocaust survi-
vors’ offspring, a specific population group scattered to the four corners
of the earth, who carry the burden of pain and guilt transmitted to them
by their traumatized parents. The book also examines the impact of life-
threatening situations in Israel on the perception of reality and on the de-
fenses of Holocaust survivors’ offspring and on Israeli society as a whole.
In the first section of the book I described individuals who, threatened
by fragmentation, mobilized manic defenses against emotional awareness
EPILOGUE 213
of loss. These patients suffered psychic wounds that could not be com-
pletely healed by therapy. Nonetheless, their emotional experience in
anal-ysis enabled them to discover their original attachment and its
betrayal, and helped them bear the torment of mourning, guilt, and
persecution without fear of being flooded by it. Consequently, their
internal world was less denied and the compulsive need to erase it by
various types of defenses diminished. The patients’ growing ability to
mourn increased their capac-ity to love and to mitigate hate, in spite of
the manic mechanisms that still persisted for the most part.
In the second and third sections of the book I examined the impact of
unresolved mourning on the individual and society. The struggle against
mourning shapes one’s perception of reality, fantasy world, relationships,
decision making, and actions, thus leaving an impact both on the individ-
ual and on society.
The second section deals primarily with the way in which Holocaust
survivors’ offspring contend with the unresolved mourning transmitted to
them by their parents. Holocaust survivors’ offspring suffer from a long-
ing and nostalgia that is akin to a depressive state (Shoshan 1989). In
spite of significant achievements in their professional lives, wealth,
substantial personal acclaim, or social status, they have no full sense of
living in the present and are left with a void and mourning for a past they
do not know (Auerhahn and Prelinger 1983; Fresco 1984; Auerhahn and
Laub 1998). These individuals employ various defenses, such as
enactment, obsessive-compulsive symptoms, splitting, denial, and so on
to avoid the pain and grief transmitted to them by their parents. In this
section, I focused pri-marily on the mechanism of enactment, which
includes split off, frag-mented behaviors, cognition, and affect. Holocaust
survivors’ offspring have no cognitive understanding of the trauma that is
enacted, no emo-tional awareness of the painful feelings connected to the
enactment. The mourning of the second generation is often
decontextualized and there-fore no longer meaningful. It is only by
understanding that it belongs to their parents’ past, by putting it into the
context of the Holocaust, that it acquires meaning and ceases to be
irrational, thus strengthening their life-forces. As Victor Frankl (1963)
stated: ‘‘The search for meaning is the pri-mary source of life.’’
The chapters that dealt with Holocaust survivors’ offspring illustrate
their discovery of the ‘‘unknown’’ story of their parents and the lifting of
214 EPILOGUE
the repression. It is followed by the process of working through, which

transforms the phenomenon of enactment into an ‘‘affective understand-
ing’’ (Freud 1915). This understanding links thoughts and feelings, which
have often been severed by the parents’ repression of the trauma and by
traces of the repression in the child. The resulting integration of cognition
and emotions greatly diminishes the offspring’s need to repeatedly enact
the parents’ stories in his or her current life, a need that is often reacti-
vated by a current life-threatening reality.
In this section I examined the difficult experience of the survivors’ off-
spring in learning details about the parents’ traumatic past. Here I would
add that the missing pieces of the parents’ history may often be connected
to the offspring’s own feelings of shame and guilt. The realization that
the traumatic past is persecuting him up to the present and has an impact
on the way he perceives reality may be experienced as a narcissistic hurt
for the offspring, thus mobilizing his manic defenses. Much psychic work
is needed for working through feelings of guilt and shame connected to
the parents’ Holocaust past. As demonstrated by the various clinical
illustra-tions, the overcoming of defenses against pain, and the
subsequent work of mourning in the further stages of analysis, enables
these offspring to proceed with their lives in the face of the
overwhelming evil that was part of their parents’ experiences and
therefore part of the offspring them-selves.
In the last section of the book, I explored the impact of external trau-
matic reality in Israel on Israeli society as a whole. In writing about the
reaction to the Gulf War among second-generation Holocaust survivors
living in Israel, I observed that ‘‘a large segment of the Israeli population
linked the threat of the Gulf War to the Holocaust history of the Jewish
people. It is therefore possible that the collective memory of past
traumas, in a certain sense, turned us all into the second generation’’
(Kogan 1995, p. 145). Thus, I would dare say that the current ongoing
threatening and terrifying situation in Israel has reactivated the traumatic
Holocaust past, with all its devastating affects and implications, not only
among those who were directly affected by it (Moses 1993; Volkan et al.
2002; Brenner 2002) and their offspring, but among an entire population.
Living in a life-threatening situation presents us with the question of
how present trauma affects the memory of the past. According to Freud
(1915), there is no time in the unconscious. Past and present merge there,
EPILOGUE 215
so that meanings that were still are, and the meanings that are affect and
change those that were (Schaeffer 1980; Loftus and Loftus 1980). There
is an unconscious component in fearing the repetition of the past, which
is found particularly among Holocaust survivors (Moses 1993), even
though it is not based on reality. This fear does not belong only to the
large group of Holocaust survivors and their offspring. For all of us in
Israel who share the collective memory of the Holocaust, the possibility
of a destructive attack reactivates the trauma of our parents’ past.
We can understand this reactivation by means of the psychoanalytic
model of trauma, which posits two events: a later event that revivifies an
original event, which only then becomes traumatic (Laplanche and Pon-
talis 1967). As it is linked to past horrors, the present terror takes on the
quality of childhood fears and nightmares. This threatens to destroy the
boundary between inside and outside, between reality and fantasy (Auer-
hahn and Prelinger 1983). These ‘‘unfortunate encounters’’ (Green 1973)
between fantasy and traumatic events in reality can be terrifying because
the communication from inside to outside is damaged to the point that
inner spaces are no longer able to contain the inner world (Janin 1996).
The subject can no longer tell whether excitation is of internal or external
origin, and so is overwhelmed by feelings of helplessness and fear—the
famous hilflosigkeit described by Freud (1917). Traumatic external
reality becomes the embodiment of the worst fantasies of inner reality,
over-whelming the subject with the realization of his or her own potential
de-structiveness. The life-threatening external reality in Israel may lead to
a perception of reality based on past scripts and may reinforce the
imprints of the past, which insidiously spill into and permeate the present.
To be free of the burden of the past, we must learn from history, both
on the individual level and on the societal level. Learning from history
means becoming acquainted with elements of the present by understand-
ing what entered the present from the past. The memory of past events,
both as ideas and feelings, should ideally constitute a means for avoiding
the repetition of past errors or perseverating unsuccessful patterns of per-
formance. Or, more informally, learning from the past means ‘‘learning
from experience’’ (Novey 1968).
As I illustrated in various chapters of the book, history is never properly
over. That is, the past is never dead; it lives in the mind, never to perish. The
intermeshed nature of past and present has been eloquently expressed
216 EPILOGUE
by Turner (1938): ‘‘For the present is simply the undeveloped past, the
past is the undeveloped present.’’
This connection between past and present derives from the difference
between the ‘‘facts’’ of history, and the meaning and significance that we
attribute to these facts. The initial fact has many ramifications and is not a
thing unto itself with sharp and clear outlines. Becker (1955) posed three
questions about historical fact: the what, the where, and the when of it.
Regarding the what, Becker states that historical fact is not the past event,
but a symbol that enables us to recreate it imaginatively. As to the where,
Becker places it in the mind and insists that a historical fact is—not was.
While the actual past event is gone forever, it is remembered and it is the
persistence of records and memories, rather than the ephemeral event, that
makes a difference to us now. He then addresses himself to the when of
historical fact as follows: ‘‘If the historical fact is present, imaginatively, in
someone’s mind, then it is now a part of the present.’’
This mutual impact of present terror on past terror and vice versa raises
some crucial questions: Is there a way to break the unending cycle of ha-tred
and violence that is passed on from one generation to another? Can
psychoanalysis help us uncover traumatizations that wars and catastro-phes
have left within us or our parents? Can it help us work through the mourning
connected to them? Can the elaboration of mourning reinforce life forces on
the societal level and replace destructiveness with creativity?
I do not presume to have answers to these questions. In an exchange with
Albert Einstein, Freud (1933) stated clearly that mankind is capable of
destroying itself, a fact that leads to a race for time between civilization and
our potential for destruction (p. 214). Freud regarded the experience of
World War I as a witness to the breakdown of the ideals of our civiliza-tion
and the hopes linked to them. It was evident that people were ready to kill
each other, to destroy lives and property in the name of exalted ideas such as
‘‘fatherland,’’ ‘‘brotherhood,’’ and so on. In this context, Freud also
regarded Christianity as a failure. He scrutinized man’s de-structive forces
and raised fundamental questions about civilization in his great works of the
late 1920s: ‘‘The future of an illusion’’ (1927) and ‘‘Civ-ilization and its
discontents’’ (1930). For Freud, the only hope was the voice of reason: ‘‘Die
Stimme des Intellekts ist leise . . .’’ (‘‘The voice of the intellect is a soft one .
. .’’ (Freud 1927, p. 53).
Various disciplines have claimed primacy in understanding the ‘‘voice
EPILOGUE 217
of reason’’ as an effective tool against human destructiveness. Kant and

other Enlightenment philosophers claimed that reason, a mental faculty
with which every individual is endowed, has an impact on history. For
Kant, only reason can indicate how to reshape the present into a better
future.
In contrast to Kant, Hegel stated that reason—the ability to think—is
indelibly shaped by time and culture. Reason, for Hegel, is not an abstract
human faculty that all human beings come equipped with and can affirm
on autonomous grounds; rather, it grows out of the way in which the indi-
vidual understands himself as part of a community. Reason, thus, is his-
tory-dependent, and, in his view, history is the only science that is able to
reveal human nature and its place in the world.
In our modern world, various sciences claim to be the most effective
tool against global terrorism, the opening trauma of the new millennium.
The specter of global terrorism wounds our present and haunts our sense
of the future. In all its horror, September 11, 2001, has left us waiting for
the worst. The violence of the attacks against the Twin Towers in New
York City and the Pentagon in Virginia has revealed an abyss of terror
that is going to haunt our existence and thinking for years and perhaps
decades to come.
In the realm of modern philosophy, Borradori conducted dialogues
with Habermas and Derrida, two representatives of modern philosophy,
in an attempt to understand the complexity underlying terrorism and ter-
ror. Claiming the supremacy of philosophy in this realm, she states:
‘‘Phi-losophy knows better than any science how to reorient itself, even
as the familiar points of reference seem to have been pulverized, as it is
in the case with both the elusive concept of terrorism and the experience
of ter-ror that radiates from it’’ (Borradori 2003, p. 2).
In the same vein, Bollas, in an interview with Vincenzo Bonaminio at the
EPF Conference in Athens, regards psychoanalysis as the only effective tool
for dealing with social violence: ‘‘I think that the Freudian moment arrived
just after the discovery of mass armaments that could kill thou-sands of
people. The twentieth century is a precursive warning. Either we understand
ourselves and others, either we find a way to think about our conflicts with
one another, to analyze destructive processes, or we shall cease to exist. I
think that psychoanalysis is the arrival of the only means to think about
destructive processes’’ (Bollas 2006, pp. 134–35).
218 EPILOGUE
And indeed, as we and psychoanalysis face the emergence of new forms

of mass destruction, we must strive to learn about, comprehend, and ana-lyze
the states of mind that are conducive to such acts. The recent psycho-analytic
literature reflects some of the important attempts that have been made to
understand the terrorist’s mind (Stein 2002; Akhtar 2003; Awad 2003;
Bohleber 2003; Erlich 2003; Berke 2006). Yet much remains to be learned
about the psychodynamic issues involved in terror attacks such as those of
September 11, 2001, and the bombings in Madrid and London, which caused
horrible suffering and grief to masses of people. But, since war and social
violence are ‘‘a matter of life and death for civilization’’ (Einstein 1932), I
believe, in contrast to the various approaches mentioned earlier, that a
multidisciplinary effort must be made to confront this issue.
Psychoanalysis has made important strides over the years, and such
concepts as working through mourning and reconciliation, which were
not part of the psychoanalytic discourse, now play a prominent role in
dealing with trauma on the individual as well as on the societal level
(Wangh 1993; Bohleber 1997, 1998; Parens 2004). Though a painful
one, the journey from absence of mourning to an emotional awareness of
pain and loss, and the process involved in working them through, is
essential so that loss may be converted into gain for society as a whole.
NOTES
1. Puzzled by the pain of mourning, Freud (1917) stated: ‘‘Why this process
of carrying out the behest of reality bit by bit, which is in the nature of a compro-
mise, should be so extraordinarily painful is not at all easy to explain in terms of
mental economics’’ (p.154).
2. This type of guilt includes anxiety and persecution caused by loss and frus-
tration and it appears in the most regressive states. Grinberg links ‘‘persecutory
guilt’’ to the mechanism of the schizoid-paranoid phase, as described by Melanie
Klein.
References
INTRODUCTION (Part I)
Bowlby, J. (1960). Grief and mourning in infancy. The Psychoanalytic Study of

the Child 15: 9–52.
Brenner, I. (2002a). Foreword. In The Third Reich in the Unconscious—
Transgenerational Transmission and Its Consequences, ed. Vamik D.
Volkan, Ga-brielle Ast, and William F. Greer, Jr. New York and London:
Brunner-Routledge, pp. xi–xvii.
———. (2002b). Reflections on the aftermath of September 11. The
Philadelphia Interpreter—The Newsletter of the Psychoanalytic Center of
Philadelphia, February 2002, p. 4.
Grinberg, L. (1992). Guilt and Depression. London and New York: Karnac Books.
Freud, A. (1960). Discussion of Dr. John Bowlby’s paper. In Psychoanalytic Study
of the Child, 15: 52–62.
Freud, S. (1913 [1912–1913]). Totem and Taboo. Standard Edition 13: 1–162.
Kogan, I. (1995). The Cry of Mute Children—A Psychoanalytic Perspective of the
Second Generation of the Holocaust. London and New York: Free
Association Books.
Moses, R., ed. (1993). Persistent Shadows of the Holocaust: The Meaning to Those
Not Directly Affected. Madison, CT: International Universities Press.
Parens, H. (2001). We all mourn: C’est la condition humane. In Three Faces of
Mourning—Melancholia, Manic Defense and Moving On, ed. Salman Akhtar.
Northvale, NJ: Jason Aronson, pp. 1–13.
Poland, W. (2006). Remarks for awards meeting. Washington, DC, 2006. Schafer, R.
(1973). Termination. International Journal of Psychoanalytic Psycho-
therapy 2: 135–48.
Volkan, V. D. (1998). Chosen trauma: Unresolved mourning. In Blood Lines.
Boulder, CO: Westview Press, pp. 36–50.
219
220 REFERENCES
Volkan, V. D., Gabrielle Ast, and William Greer Jr. (2002). The Third Reich in
the Unconscious—Transgenerational Transmission and Its Consequences.
New York and London: Brunner-Routledge.
CHAPTER 1
Abend, S. M., and M. S. Porder. (1986). Identification in the neurosis. Interna-

tional Journal of Psychoanalysis 67: 201–8.
Abraham, K. (1924). A short study of the development of the libido viewed in
the light of mental disorders. In Selected Papers on Psychoanalysis. London:
Ho-garth Press, 1948; reprinted London: Karnac Books, 1979.
Akhtar, S. (2000). From mental pain through manic defense to mourning. In
Three Faces of Mourning—Melancholy, Manic Defense and Moving On, ed.
Sal-man Akhtar. Northvale, NJ: Jason Aronson.
———. (2001). Mental pain and the cultural ointment of poetry. International
Journal of Psychoanalysis 81: 229–45.
Auerhahn, N. C., and E. Prelinger. (1983). Repetition in the concentration camp
survivor and her child. International Review of Psychoanalysis 10: 31–45.
Bergmann, M. V. (1982). Thoughts on super-ego pathology of survivors and
their children. In Generations of the Holocaust, ed. M. S. Bergmann and M.
E. Ju-covy. New York: Basic Books, pp. 287–311.
Bowlby, J. (1961). Processes of mourning. International Journal of
Psychoanalysis 42: 317–40.
Burch, B. (1989). Mourning and failure to mourn—An object-relations view.
Contemporary Psychoanalysis 25: 608–23.
Chasseguet-Smirgel, J. (1984). Thoughts on the concept of reparation and the hi-
erarchy of creative arts. International Review of Psychoanalysis 11: 399–406.
Cooper, A. (1988). The narcissistic-masochistic character. In Masochism: Current
Psychoanalytic Perspectives, ed. R. A. Glick and D. I. Meyers. Hillsdale, NJ:
Ana-lytic Press, pp. 117–38.
Dorpat, T. L. (1977). Depressive Affect. Psychoanalytic Study of the Child 32: 3–27.
———. (1979). Is splitting a defense? International Review of Psychoanalysis 6:
105–13.
———. (1987). A new look at denial and defense. Annual of Psychoanalysis 15:
23–47.
Fingarette, H. (1969). Self-Deception. New York: Routledge and Kegan Paul.
Freeman-Sharpe, E. (1935). Similar and divergent unconscious determinants un-
derlying the sublimations of pure art and pure science. International Journal
of Psychoanalysis 16: 186–202.
Freud, A. (1936). The Ego and the Mechanisms of Defense. New York:
International University Press, 1966.
REFERENCES 221
Freud, S. (1908). ‘‘Civilized’’ sexual morality and modern nervous illness. Stan-
dard Edition 9.
———. (1916). Some character-types met with in analytic work: III. Criminals
from a sense of guilt. Standard Edition 14.
———. (1917). Mourning and melancholia. Standard Edition 14.
———. (1923). The infantile genital organization. Standard Edition 19.
———. (1926). Inhibitions, symptoms and anxiety. Standard Edition 20.
———. (1940). Splitting of the ego in the processes of defense. Standard
Edition 23.
———. (1950 [1985]). Project for a scientific psychology. Standard Edition 1:
281–388.
Freyberg, S. (1980). Difficulties in separation-individuation, as experienced by
off-spring of Nazi-Holocaust survivors. American Journal of Orthopsychiatry
5: 87–95.
Grinberg, L. (1964). Two kinds of guilt—their relations with normal and patho-
logical aspects of mourning. International Journal of Psychoanalysis 45: 366–71.
———. (1992). Guilt and Depression. London and New York: Karnac Books.
Grubrich-Simitis, I. (1984). From concretism to metaphor. Psychoanalytic Study
of the Child 39: 301–19.
Hamilton, J. (1969). Object loss, dreaming and creativity: The poetry of John
Keats. Psychoanalytic Study of the Child 24: 488–31.
———. (1976). Early trauma, dreaming and creativity. Works of Eugene
O’Neil. International Review of Psychoanalysis 3: 341–64.
———. (1979). Transitional phenomena and the early writings of Eugene
O’Neil. International Review of Psychoanalysis 6: 49–60.
Hartmann, H. (1964). Essays on Ego Psychology. New York: International
Univer-sity Press.
Hilgard, E. R. (1949). Human motives and the concept of the self. American
Psy-chologist 4: 374–82.
Hinshelwood, R. D. (1991). A Dictionary of Kleinian Thought. London: Free
Asso-ciation Books.
Jacobson, E. (1959). Denial and repression. Journal of American Psychoanalytic
As-sociation 7: 581–609.
Joffee, W. G., and J. Sandler. (1965). Pain, depression and individuation. In
From Safety to Superego, ed. J. Sandler. New York: Guilford, pp. 154–79.
Joseph, B. (1981). Towards the experiencing of psychic pain. In Psychic Equilib-
rium and Psychic Change, ed. M. Feldman and E. B. Spillius. London:
Routledge, 1989, pp. 88–97.
Kahn, M. M. (1979). From masochism to psychic pain. In Alienation in Perver-
sions. New York: International University Press, pp. 210–18.
222 REFERENCES
Klein, M. (1920). Inhibitions and difficulties at puberty. Works of Melanie Klein

1, pp. 54–58.
———. (1927). Criminal tendencies in normal children. British Journal of
Medical Psychology 7: 177–92.
———. (1929). Infantile anxiety-situations reflected in a work of art and in the
creative impulse. Works of Melanie Klein 1, pp. 210–18.
———. (1935). A contribution to the psychogenesis of manic-depressive states.
International Journal of Psychoanalysis 16: 145–74.
———. (1946). Notes on some schizoid mechanisms. International Journal of
Psy-choanalysis 27: 99–110. Republished (1952) in Developments in
Psychoanalysis, ed. Melanie Klein, Paula Heimann, Susan Isaacs, and Joan
Riviere. London: Hogarth Press, pp. 292–320.
Klein, H., and I. Kogan. (1989). Some observations on denial and avoidance in
Jewish Holocaust and post-Holocaust experience. In Denial—A Clarification
of Concepts and Research, ed. E. L. Edelstein, Donald L. Nathanson, and
Andrew M. Stone. New York and London: Plenum Press, pp. 299–309.
Kogan, I. (1990). A journey to pain. International Journal of Psychoanalysis 71:
629–40. Reprinted in Libro Annual de Psicoanalisis, 1991. Also in Zeitschrift
fur Psychoanalytische Theorie und Praxis, Jahrgang VI (1), 1991, pp. 62–79.
———. (1995). The Cry of Mute Children—A Psychoanalytic Perspective of the Sec-
ond Generation of the Holocaust. London and New York: Free Association
Books. In German: (1998). Der Stumme Schrei der Kinder—Die Zweite Genera-
tion der Holocaust—Opfer. Frankfurt/Main: S. Fischer Verlag. In French:
(2001). Le Cri des Enfants sans Voix—L’Holocauste et la Deuxieme
Generation: Une Perspective Analytique. Paris and Suisse: Delachaux et
Niestle. In Roma-nian: (2001). Strigatul Copiilor Muti. Psihanaliza si
Holocaust: O Perspectiva Asupra Celei de-a Doua Generatii a
Holocaustului. Bucharest: Editura Trei. In Croatian: (2004). Nijemi Krik—
Druga generacija zrtava Holokausta. Zagreb: O. B. izdanja antiBarbarus.
———. (1998). The black hole of dread: The psychic reality of children of Holo-
caust survivors. In Even Paranoids Have Enemies—A New Perspective on Perse-
cution and Paranoia, ed. Joseph H. Berke, Stella Pierides, Andrea Sabbadini, and
Stanley Schneider. London and New York: Routledge, pp. 47–59.
Laub, D., and N. C. Auerhahn. (1993). Knowing and not knowing psychic
trauma. Forms of traumatic memory. International Journal of Psychoanalysis
74: 287– 302.
Lewin, B. (1950). The Psychoanalysis of Elation. New York: Norton.
Metcalf, A. (1977). Childhood: from process to structure. In Hysterical Personality,
ed. M. J. Horowitz. New York: Jason Aronson, pp. 273–81.
REFERENCES 223
Ogden, T. (1986). The Matrix of the Mind. New York: Jason Aronson.
Person, E. S. (1988). Review of Creativy and Perversion by Janine Chasseguet-
Sm-irgel. New York: Norton, 1984.
Pollock, G. (1975). On mourning, immortality and utopia. Journal of American
Psychoanalytic Association 23: 334–62.
———. (1977). The mourning process and creative organizational change. Jour-
nal of American Psychoanalytic Association 25: 3–34.
Pontalis, J. B. (1981). Frontiers in Psychoanalysis: Between the Dream and Psychic
Reality. New York: International University Press.
Renik, O. (1990). Comments on the clinical analysis of anxiety and depressive
affect. Psychoanalytic Quarterly 59: 226–48.
Rosenfeld, H. (1983). Primitive object relations and mechanisms. International
———. (1987). Impasse and Interpretation. London and New York: Tavistock.
Schafer, R. (1968). The mechanisms of defense. International Journal of Psycho-
analysis 49: 49–62.
———. (1976). A New Language for Psychoanalysis. New Haven and London:
Yale University Press.
Segal, H. (1983). Some clinical implications of Melanie Klein’s work.
Volkan, V. D. (1981). Linking Objects and Linking Phenomena: Study of the
Forms, Symptoms, Metapsychology and Therapy of Complicated Mourning.
New York: International University Press.
Waelder, R. (1951). The structure of paranoid ideas. International Journal of
Psy-choanalysis 32: 167–77.
Weisman, A. D. (1972). On denying and denying. A psychiatric study of terminality.
New York: Behavioral Publications, Inc.
Weiss, E. (1934). Bodily pain and mental pain. International Journal of
Psychoanal-ysis 15: 1–13.
Winnicott, D. W. (1935). The manic defense. In Through Pediatrics to Psychoanal-
ysis: Collected Papers. New York: Brunner/Mazel, 1992, pp. 129.
CHAPTER 2
Akhtar, S. (2001). From mental pain through manic defense to mourning. In

Three Faces of Mourning—Melancholia, Manic Defense and Moving On, ed.
S. Akhtar. Northvale, NJ: Jason Aronson, pp. 95–115.
Arlow, J. A. (1970). Some problems in current psychoanalytic thought. In The
World Biennial of Psychiatry & Psychotherapy, vol. 1, ed. S. Arieti. New
York: Basic Books, pp. 34–54.
224 REFERENCES
Balkoura, A. (Reporter) (1974). Panel: The fate of the transference neurosis after
analysis. Journal of the American Psychoanalytic Association 22: 875–903.
de Berenstein, S. P., and S. S. de Fondevila. (1989). Termination in analysis in
the light of the evolution of a link. International Review of Psychoanalysis
16: 385–89.
Blum, H. P. (1989). The concept of termination and the evolution of psychoana-lytic
thought. Journal of the American Psychoanalytic Association 37: 275–95.
Cooper, A. M. (1985). The termination of the training analysis: process, expecta-
tions, achievement. International Psychoanalytic Association Monograph
Series 5: 1–17.
Deutsch, H. (1933). Motherhood and sexuality. Psychoanalytic Quarterly 2:
476–88.
Dewald, P. (1982). The clinical importance of the termination phase. Psychoana-
lytic Inquiry 2: 441–61.
Fast, I. (1979). Developments in gender identity: gender differentiation in girls.
Firestein, S. K. (Reporter) (1969). Panel. Problems of termination in the analysis
of adults. Journal of the American Psychoanalytic Association 17: 222–37.
———. (1982). Termination of psychoanalysis: theoretical, clinical and
pedagogic considerations. Psychoanalytic Inquiry 2: 473–97.
Freud, S. (1915). Thoughts on war and death. Standard Edition 14: 273–303.
———. (1937). Analysis terminable and interminable. Standard Edition 23:
209–55.
Greenson, R. R. (1967). The Technique and Practice of Psychoanalysis. New York:
International University Press, 1971.
Grinberg, L. (1980). The closing phase of the psychoanalytic treatment of adults
and the goals of psychoanalysis: ‘‘The search for truth about one’s self.’’
Inter-national Journal of Psychoanalysis 61: 25–37.
Hoffer, W. (1950). Three psychological criteria for the termination of treatment.
Hurn, H. (Reporter) (1973). Panel: On the fate of transference after the termina-
tion of analysis. Journal of the American Psychoanalytic Association 21: 182–92.
Jaques, E. (1965). Death and the middle life crisis. International Journal of
Psycho-analysis 46: 458–72.
Kantrowitz, J. L. et al. (1990). Follow-up of psychoanalysis five to ten years
after termination. II. Development of the self-analytic function. Journal of the
Amer-ican Psychoanalytic Association 38: 637–54.
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive
states. In Love, Guilt and Reparation and Other Works 1921–1945. New
York: Free Press, 1992, pp. 262–89.
REFERENCES 225
Kramer, M. K. (1959). On the continuation of the analytic process after psycho-

analysis (a self-observation). International Journal of Psychoanalysis 40: 17–25.
Novick, J. (1982). Termination: themes and issues. Psychoanalytic Inquiry 2:
329–65.
Pfeffer, A. (1963). The meaning of the analyst after analysis—a contribution to
the theory of therapeutic results. Journal of the American Psychoanalytic
Associ-ation 11: 229–44.
Pines, D. (1993). The relevance of early psychic development to pregnancy and
abortion. In A Woman’s Unconscious Use of Her Body. London: Virago
Press, pp. 97–116.
Rangell, L. (1982). Some thoughts on termination. Psychoanalytic Inquiry 2:
367–92.
Robbins, W. (Reporter) (1975). Panel: Termination: problems and techniques.
Journal of the American Psychoanalytic Association 23: 166–76.
Schachter, J. (1992). Concepts of termination and post-termination. Patient-ana-
lyst contact. International Journal of Psychoanalysis 73: 137–54.
Schafer, R. (1973). Termination. International Journal of Psychoanalytic
Psycho-therapy 2: 135–48.
Schlessinger, N., and F. P. Robbins. (1983). A Developmental View of the
Psychoan-alytic Process: Follow-up Studies and their Consequences.
Madison, CT: Interna-tional Universities Press.
Siegel, B. L. (1982). Some thoughts on ‘‘Some thoughts on termination’’ by Leo
Rangell. Psychoanalytic Inquiry 2: 393–98.
Symposium. (1937). The theory of the therapeutic results of psychoanalysis.
Inter-national Journal of Psychoanalysis 18:125–88.
———. (1948). On the evaluation of therapeutic results. International Journal
of Psychoanalysis 29: 7–33.
———. (1950). On the criteria for the termination of an analysis. International
Journal of Psychoanalysis 31: 78–80, 179–205.
Ticho, E. E. (1972). Termination of psychoanalysis: treatment goals, life goals. Psy-
choanalytic Quarterly 41: 315–33.
Weigert, E. (1952). Contribution to the problem of terminating psychoanalysis.
Psychoanalytic Quarterly 21: 465–80.
Winnicott, D.W. (1935). The manic defense. In Through Pediatrics to Psycho-
Anal-ysis: Collected Papers, pp. 129–44. New York: Brunner/Mazel, 1992.
CHAPTER 3
Anzieu, D. (1986). Un Peau Pour Les Pensees. Entretiens avec Gilbert Tarab. Paris:
Clancier-Guenod.
226 REFERENCES
Bacal, H. (1985). Optimal responsiveness and the therapeutic process. In

Progress in Self-Psychology, vol. 1, ed. A. Goldberg. New York: Guilford
Press, pp. 202–27.
Balint, M. (1952). Primary Love and Psychoanalytic Technique. London: Tavistock.
———. (1968). The Basic Fault. London and New York: Tavistock.
Bion, W. R. (1989). Learning from Experience. London: Karnac Books; original
work published 1962.
Bollas, C. (1992). Cruising in the homosexual arena. In Being a Character—
Psychoanalysis and Self-Experience. London: Routledge, p. 147.
Breckenridge, K. (2000). Physical touch in psychoanalysis: A closet phenomenon?
Psychoanalytic Inquiry 20: 2–21.
Casement, P. (1982). Some pressures on the analyst for physical contact during
the reliving of an early trauma. International Review of Psychoanalysis 9:
279–86.
Chasseguet-Smirgel, J. (1984). Creativity and Perversion. New York: Norton.
Chused, S. F. (1990). Neutrality in the analysis of action-prone adolescents. Jour-
nal of American Psychoanalytic Association 38: 679–704.
Ferenczi, S. (1953). The Theory and Technique of Psychoanalysis. New York:
Basic Books.
Fosshage, J. L. (2000). The meaning of touch in psychoanalysis: A time for reas-
sessment. Psychoanalytic Inquiry 20: 21–44.
Freud, S. (1915). The unconscious. Standard Edition 15: 205–18.
———. (1927). Fetishism. Standard Edition 21: 147–57.
Fromm-Reichmann, F. (1950). Principles of Intensive Psychotherapy. Chicago:
Uni-versity of Chicago Press.
Gedo, J. E. (1944). Analytic interventions: The question of form. In The
Spectrum of Psychoanalysis—Essays in Honor of Martin S. Bergmann, eds.
A. Kramer Richards and A. D. Richards. Madison, CT: International
Universities Press, pp. 111–29.
Goethe, J. W. (1984). Faust I and II. In Goethe: The Collected Works (vol. 2), ed.
and trans. S. Atkins. Princeton, NJ: Princeton University Press. (Original
work published 1808.)
Green, A. (1986). The dead mother. In On Private Madness. London: Hogarth
Press, pp. 142–73.
Greenberg, J. (1991). Countertransference and reality. Psychoanalytic Dialogues 1:
52–73.
Grunes, M. (1984). The therapeutic object relationship. Psychoanalytic Review 71:
123–43.
Jones, E. (1955). The Life and Work of Sigmund Freud, vol. 2. New York: Basic
Books.
REFERENCES 227
Kahn, M. M. R. (1979). Alienation in Perversion. New York: International

Univer-sity Press.
Kernberg, O. (1975). Borderline Conditions and Pathological Narcissism. New York:
Jason Aronson.
Kernberg, O. F. (1992). Psychoanalytic psychotherapy with borderline patients.
Paper presented at University College, London, Psychoanalysis Unit.
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive states.
Klein, M., P. Heimann, S. Isaacs, and J. Riviere. (1952). Developments in
Psycho-analysis. London: Hogarth Press.
Kohut, H. (1971). A clinical contribution to the analysis of a perversion. Interna-
———. (1977). The Restoration of the Self. New York: International University
Press.
———. (1981). Lecture presented at the annual conference on self-psychology,
Berkeley, CA, October.
Lecourt, E. (1990). The musical envelope. In Psychic Envelopes, ed. D. Anzieu.
London: Karnac Books, pp. 211–37.
Little, M. (1966). Transference in borderline states. International Journal of Psy-
choanalysis 47: 135–54.
———. (1990). Psychotic Anxieties and Containment. Northvale, NJ: Jason
Aro-nson.
Loewald, H. W. (1960). On the therapeutic action of psychoanalysis.
Maroda, K. J. (1999). Therapeutic necessity or malpractice? Physical contact re-
considered. In Seduction, Surrender and Transformation: Emotional Engagement
in the Analytic Process. Hillsdale, NJ: Analytic Press, pp. 141–59.
McDougall, J. (1978). The primal scene and the perverse scenario. In Plea for a
Measure of Abnormality. New York: International University Press, 1980, pp.
53–86.
———. (1986). Identifications, neoneeds and neosexualities. International
McLaughlin, J. (1995). Touching limits in the analytic dyad. Psychoanalytic
Quar-terly 64: 433–65.
Meltzer, D. (1973). Sexual States of Mind. Pertshire, Scotland: Clunie Press.
Mintz, E. (1969). Touch and the psychoanalytic tradition. Psychoanalytic Review
56: 365–76.
Modell, A. (1990). Other Times, Other Realities. Cambridge, MA: Harvard
Univer-sity Press.
228 REFERENCES
Ogden, T. (1994). The concept of interpretive action. In Subjects of Analysis.

Nor-thvale, NJ: Jason Aronson, pp. 107–37.
———. (1996). The perverse subject of analysis. Journal of American
Psychoana-lytic Association 44: 1121–46.
———. (1999). Reverie and Interpretation—Sensing Something Human.
London: Karnac Books.
Pedder, J. R. (1986). Attachment and new beginning: Some links between the
work of Michael Balint and John Bowlby. In The British School of
Psychoanaly-sis—The Independent Tradition, ed. G. Kohon. London: Free
Association Books, pp. 295–309.
Rechy, J. (1967). Numbers. New York: Grove, 1981.
Renik, O. (1995). The ideal of the anonymous analyst and the problem of self-
disclosure. Psychoanalytic Quarterly 64: 466–95.
Reppen, J. (1999). Discussion of I. Kogan’s paper, Physical contact and affect in
the analytic situation. Presented at the IPA Congress, Santiago de Chile, Au-
gust.
Rilke, R. M. (1904). Letters. In Rilke on Love and Other Difficulties, trans. J. J. L.
Mood. New York: Norton, 1975, p. 27.
Riviere, J. (1929). Womanliness as a masquerade. International Journal of
Rycroft, C. (1986). An enquiry into the function of words in the psychoanalytical
situation. In The British School of Psychoanalysis—The Independent
Tradition, ed. G. Kohon. London: Free Association Books, pp. 237–53.
Schlesinger, H. J., and A. H. Appelbaum. (2000). When words are not enough.
Psychoanalytic Inquiry 20: 124–44.
Searles, H. (1965). Collected Papers on Schizophrenia. New York: International
University Press.
Shapiro, S. (1992). The discrediting of Ferenczi and the taboo on touch.
Presented at the APA Division 39 spring meeting, Philadelphia, PA, April.
Singer, E. (1977). The fiction of analytic anonymity. In The Human Dimension
in Psychoanalysis, ed. K. A. Frank. New York: Grune & Stratton, pp. 181–92.
Stern, D. N. et al. (1998). Non-interpretive mechanisms in psychoanalytic
psycho-therapy. International Journal of Psychoanalysis 79: 903–23.
Stoller, R. (1975). Perversion. New York: Pantheon.
Winnicott, D. W. (1965). The Maturational process and the facilitating environ-
ment. Studies in the Theory of Emotional Development. New York:
International University Press.
———. (1992). The manic defence. In Through pediatrics to psychoanalysis:
Col-lected papers. New York: Brunner/Mazel, pp. 129–44; original work
published in 1935.
REFERENCES 229
Zetzel, E. (1968). The so-called good hysteric. In The Capacity for Emotional
Growth. New York: International University Press; reprinted 1972, London:
Hogarth.
INTRODUCTION (PART II)
Barocas, H. A., and Barocas, C. B. (1979). Wounds of the fathers’: The next gener-
ation of Holocaust victims. International Review of Psychoanalysis 6: 331–40.
Bion, W. R. (1959). Experiences in Groups. New York: Basic Books.
Brenner, I. (2002). Foreword. In The Third Reich in the Unconscious, ed. V. D.
Volkan. New York and London: Bruner-Routledge, pp. xi–xvii.
Freud, S. (1921). Group psychology and the analysis of the ego. Standard
Edition 18: 16–143.
Volkan, V. D. (1991). On chosen trauma. Mind and Human Interaction 4: 3–19.
———. (1992). Ethnonationalistic rituals. An introduction. Mind and Human
In-teraction 4: 3–19.
———. (1997). Bloodlines: From ethnic pride to ethnic terrorism. New York:
Farrar, Straus and Giroux.
———. (1999). Psychoanalysis and diplomacy. Part 1 Individual and large
group identity. Journal of Applied Psychoanalytic Studies 1: 29–55.
———. (2002). The Third Reich in the Unconscious. New York and London:
Bruner-Routledge.
Volkan, V. D., and N. Itzkowitz. (1994). Turks and Greeks: Neighbors in Conflict.
Cambridgeshire, England: Eothen Press.
CHAPTER 4
Akhtar, S. (1999). Immigration and Identity—Turmoil, Treatment and

Transforma-tion. Northvale, NJ: Jason Aronson.
Akhtar, S., and A. Smolar. (1998). Visiting the father’s grave. Psychoanalytic
Amati-Mehler, J., S. Argentieri, and J. Canestri. (1993). The Babel of the Uncon-
scious: Mother Tongue and Foreign Languages in the Psychoanalytic Dimension,
trans. J. Whitelaw-Cucco. Madison, CT: International Universities Press.
Anzieu, D. (1976). L’envelope sonore du Soi. Nouvelle Revue de Psychanalyse 13:
161–79.
Cioran, E. M. (1982). Storia e Utopia. Milan: Adelphi.
Erikson, E. H. (1950). Growth and crises of the healthy personality. In Identity and
the Life Cycle. New York: International University Press, 1959, pp. 50–100.
230 REFERENCES
———. (1956). The problem of ego identity. Journal of American

Psychoanalytic Association 4: 56–121.
Freud, S. (1913). Totem and Taboo. Standard Edition 13: 1–162.
———. (1917). Mourning and melancholia. Standard Edition 14: 237–59.
———. (1926). Inhibitions, symptoms and anxiety. Standard Edition 20: 77–174.
Garza-Guerrero, A. C. (1974). Culture shock: Its mourning and the vicissitudes
of identity. Journal of American Psychoanalytic Association 22: 408–29.
Grinberg, L. (1964). Two kinds of guilt—their relations with normal and patho-
logical aspects of mourning. International Journal of Psychoanalysis 45: 366–71.
Grinberg, L. and R. Grinberg. (1989). Psychoanalytic Perspectives on Migration
and Exile. Translated by Nancy Festinger. New Haven, CT, and London: Yale
Uni-versity Press. Originally published as Psicoanalisis de la migracio´n y
del exilio, 1984, Alianza Editorial.
Joffe, W. G., and J. Sandler. (1965). Pain, depression and individuation. In From
Safety to Superego, ed. Joseph Sandler. London: Karnac (1987).
Kahn, C. (1997). Emigration without leaving home. In Immigrant Experiences—
Personal Narrative and Psychological Analysis, ed. Paul H. Elovitz and
Charlotte Kahn. Madison: Teaneck.
Kogan, I. (1995). The Cry of Mute Children—A Psychoanalytic Perspective of
the Second Generation of the Holocaust. London and New York: Free
Association Books.
———. (1996). Die Suche nach Geschichte in den Analysen der Nachkommen
von Holocaust-Uberlebenden: Rekonstruktion des ‘‘seelischen Lochs.’’ In
Psy-choanalyse Heute Und Vor 70 Jahren, eds. Heinz Weiss and Hermann
Lang. Tubingen: edition diskord, pp. 201–308. Also in: Traumatisierung in
Kindheit und Jugend, eds. Manfred Endres and Gerd Biermann. Munchen and
Basel: Ernst Reinhardt Verlag (1998b) p. 83–98.
———. (1998). The black hole of dread: the psychic reality of children of Holo-caust
survivors. In Even Paranoids Have Enemies—New Perspectives on Para-noia
and Persecution, ed. Joseph H. Berke, Stella Pierides, Andrea Sabbadini, and
———. (2000). Breaking the cycle of trauma—from the individual to society. In
Mind & Human Interaction 11: 2–10.
———. (2002). ‘‘Enactment’’ in lives and treatment of Holocaust survivors’ off-
spring. Psychoanalytic Quarterly 71: 251–73.
Pfeiffer, E. (1974). Borderline states. Disorders of the Nervous System. 35: 212–19.
Sandler, J., A. Holder, and D. Meers. (1987). Ego-ideal and ideal self. In From
Safety to Superego, ed. Joseph Sandler. London: Karnac, pp. 73–90.
Stern, D. (1985). The Interpersonal World of the Infant. New York: Basic Books.
REFERENCES 231
Urdang, L., ed. (1968). The Random House Dictionary of the English Language.
New York: Random.
Volkan, V. (1998). Totem and Taboo in Romania: The internalization of a
‘‘dead’’ leader and re-stabilization of an ethnic tent. In Blood Lines. Boulder,
CO: West-view Press, pp. 181–202.
Zac de Filc. (1992). Psychic change in the analyst. International Journal of
CHAPTER 5
Auerhahn, N. C., and D. Laub. (1998). Intergenerational memory of the Holo-

caust. In International Handbook of Multigenerational Legacies of Trauma,
ed. Yael Danieli. New York and London: Plenum, pp. 21–43.
Axelrod, S., O. L. Schnipper, and J. H. Rau. (1978). Hospitalized offspring of
Ho-locaust survivors: problems and dynamics. Bulletin: Menninger Clinic 44
(1980): 1–14.
Barocas, H. A., and C. B. Barocas. (1973). Manifestations of concentration camp
effects on the second generation. American Journal of Psychiatry 30: 820–21.
Bion, W. R. (1962). Learning from Experience. London: Heinemann.
———. (1970). Attention and Interpretation. London: Tavistock.
Boesky, D. (1982). Acting out: a reconsideration of the concept. International
Brenner, I. (2000). Transmission of trauma in children of survivors: a review of
cases. Paper presented at the American Psychoanalytic Association Holocaust
Discussion Group, New York, December.
———. (2002). Foreword. In The Third Reich in the Unconscious, by V. D.
Volkan. New York: Brunner-Routledge, pp. xi–xvii.
Chused, J. (1991). The evocative power of enactments. Journal of American
Psy-choanalytic Association 39: 615–38.
Eshel, O. (1998a). Meeting acting out, acting in and enacting or going into the
eye of the storm. Sihot-Dialogue, Israel Journal of Psychotherapy 13: 4–16.
———. (1998b). ‘‘Black holes,’’ deadness and existing analytically.
Etchegoyen, R. H. (1991). The Fundamentals of Psychoanalytic Technique. London:
Karnac.
232 REFERENCES
Fenichel, O. (1945). Neurotic acting out. In Collected Papers, ed. Hanna

Fenichel and David Rapaport. New York: Davis Lewis, 1953.
Fresco, N. O. (1984). Remembering the unknown. International Review of
Freud, S. (1905). Fragment of an analysis of a case of Hysteria. Standard Edition
7: 3–125.
———. (1914). Remembering, repeating and working through. Standard
Edition 12: 145–57.
———. (1915). The unconscious. Standard Edition 14: 159–215.
———. (1917). Mourning and melancholia. Standard Edition 14: 239–58.
———. (1920). Beyond the pleasure principle. Standard Edition 18:7–64.
———. (1940). An outline of psycho-analysis. Standard Edition 23: 141–95.
Freyberg, S. (1980). Difficulties in separation-individuation, as experienced by off-
spring of Nazi Holocaust survivors. American Journal of Orthopsychiatry 5:
87–95.
Gampel, Y. (1982). A daughter of silence. In Generations of the Holocaust, ed.
M. S. Bergmann and M. E. Jucovy. New York: Basic Books, pp. 120–36.
Garland, C. (1991). External disasters and the internal world: an approach to psy-
chotherapeutic understanding of survivors. In Textbook of Psychotherapy in
Psychiatric Practice, ed. J. Holmes. London: Churchill Livingstone, (chapter
22).
———. (2002). Thinking about trauma. In Understanding Trauma—A Psychoan-
alytical Approach, ed. J. Holmes. London and New York: Karnac, pp. 9–31.
Green, A. (1986). The dead mother. In On Private Madness. London: Hogarth, pp.
142–73.
Greenacre, P. (1950). General problems of acting out. Psychoanalytic Quarterly
19: 445–67. Also in Trauma, Growth and Personality. London: Maresfield
Library, 1953, pp. 208–19.
———. (1963). Problems of acting out in the transference relationship. In A De-
velopmental Approach to the Problem of Acting Out, ed. E. W. Rexford. New
York: International University Press, pp. 215–34.
Gribbin, J. (1992). In Search of the Edge of Time: Black Holes, White Holes, Worm
Holes. London: Penguin.
Grinberg, L., and R. Grinberg. (1974). The problem of identity and the psychoan-
alytical process. International Journal of Psychoanalysis 1: 499–507.
Grotstein, J. S. (1986). The psychology of powerlessness; disorders of self-
regula-tion as a newer paradigm for psychopathology. Psychoanalytic Inquiry
6: 93– 118.
———. (1989). A revised psychoanalytic conception of schizophrenia: an inter-
disciplinary update. Psychoanalytic Psychology 6: 253–75.
REFERENCES 233
———. (1990a). ‘‘Black hole’’ as the basic psychotic experience: Some newer
psy-choanalytic and neuroscience perspectives on psychosis. Journal of
American Academic Psychoanalysis 18: 29–46.
———. (1990b). Nothingness, meaninglessness, chaos and ‘‘black hole.’’ I: The
importance of nothingness, meaninglessness and chaos in psychoanalysis.
Con-temporary Psychoanalysis 26: 257–91.
———. (1990c). Nothingness, meaninglessness, chaos and ‘‘black hole.’’ II:
The black hole. Contemporary Psychoanalysis 26: 377–407.
———. (1993). Boundary difficulties in borderline patients. In Master
Clinicians on Treating the Regressed Patient, vol. 2, ed. L. B. Boyer and P. L.
Giovacchini. Northvale, NJ: Jason Aronson, pp. 107–42.
Hinshelwood, R. D. (1989). Acting in. In A Dictionary of Kleinian Thought.
Lon-don: Free Association Books, pp. 213–14.
Jacobs, T. J. (1986). On countertransference enactments. Journal of American
———. (1991). On countertransference enactments. In The Use of the Self:
Coun-tertransference and Communication in the Analytic Situation. Madison,
CT: In-ternational Universities Press, pp. 139–56.
———. (2000). Unbewusste Kommunikation und verdeckte Enactments in ana-
lytischen Setting. In Errinern, Agieren und Inszenieren, ed. Ulrich Streeck.
Got-tingen: Vanderhoeck & Ruprecht, pp. 97–27.
Kestenberg, J. S. (1972). How children remember and parents forget.
International Journal of Psychoanalytic Psychotherapy 1–2: 103–23.
———. (1982). A metapsychological assessment based on an analysis of a
survi-vor’s child. In Generations of the Holocaust, eds. M. S. Bergmann and
M. E. Jucovy. New York: Basic Books, pp. 137–58.
Kinston, W., and J. Cohen. (1986). Primal repression: clinical and theoretical as-
pects. International Journal of Psychoanalysis 67: 337–55.
Klein, H. (1971). Families of Holocaust survivors in the kibbutz: Psychological
studies. In Psychic Traumatization: After-effects in Individuals and Communities,
ed. H. Krystal and W. G. Niederland. Boston: Little & Brown.
Klein, H., and I. Kogan. (1986). Identification and denial in the shadow of Na-
zism. International Journal of Psychoanalysis 67: 45–52. Also in
Psychoanalyse im Exil—Texte Verfolgter Analytiker, ed. Stephen Brose and
Gerda Pagel. Wurz-burg: Konigshausen & Neumann (1987), pp. 128–37.
Kogan, I. (1987). The second skin. International Review of Psychoanalysis 15: 251–
61. Also in The Cry of Mute Children. London and New York: Free
Association Books (1995), pp. 46–69.
234 REFERENCES
———. (1989). The search for self. International Journal of Psychoanalysis 70:
661–71. Also in The Cry of Mute Children. London and New York: Free
Associ-ation Books (1995), pp. 29–46.
———. (1993). Curative factors in the psychoanalyses of Holocaust survivors’
offspring before and during the Gulf War. International Journal of
Psychoanaly-sis 74: 803–815. Also in The Cry of Mute Children. London and
New York: Free Association Books (1995), pp. 133–48.
———. (1995). The Cry of Mute Children—A Psychoanalytic Perspective of the
Sec-ond Generation of the Holocaust. London and New York: Free
Association Books.
von Holocaust Uberlebenden; Rekonstruktion des ‘seelischen Lochs.’ In Psy-
choanalyse Heute Und Vor 70 Jahren, ed. Heinz Weiss and Hermann Lang,
Tub-ingen: edition diskord, pp. 291–308. Also in Traumatisierung in
Kindheit und Jugend., ed. Manfred Endres and Gerd Biermann, Basel: E.
Reinhardt (1998), pp. 83–98. Also in Das Ende der Sprachlosigkeit? Ed.
Liliane Opher-Cohn, Jo-hannes Pfafflin, Bernd Sonntag, Bernd Klose, Peter
Pogany-Wnendt. Giessen: Psychosozial-Verlag (2000), pp. 163–83.
———. (2000). Die Suche nach Gevissheit: Enactments traumatischer
Vegangen-heit. In Errinem, Agieren und Inszenieren: Enactments und
szenische Darstel-lungen im therapeutishen Prozess, ed. Ulrich Streeck,
Gottingen: Vandehoeck & Rupricht, pp. 127–43.
———. (2002). ‘‘Enactment’’ in lives and treatment of Holocaust survivors’ off-
spring. Psychoanalytic Quarterly 71: 251–73.
Krell, R. (1979). Holocaust families: The survivors and their children. Comprehen-
sive Psychiatry 20(6): 560–67.
Laplanche, J., and J. B. Pontalis. (1973). The Language of Psychoanalysis. London:
Hogarth, pp. 4–6.
Laub, D., and N. C. Auerhahn. (1984). Reverberations of genocide: Its
expression in the conscious and unconscious of post-Holocaust generations.
In Psychoan-alytic Reflections of the Holocaust: Selected Essays, ed. S. A.
Luel and P. Marcus. Denver: Ktav Publishing House, pp. 151–67.
———. (1993). Knowing and not knowing psychic trauma: Forms of traumatic
memory. International Journal of Psychoanalysis 74: 287–302.
Laub, D., and D. Podell. (1995). Art and trauma. International Journal of
REFERENCES 235
Laufer, M. (1973). The analysis of a child of survivors. In The Child in His

Family: The Impact of Disease and Death, ed. E. J. Anthony and C.
Koupernik. New York: John Wiley, vol. 2: 363–73.
Lipkowitz, M. H. (1973). The child of two survivors: the report of an unsuccessful
therapy. Israeli Annals of Psychiatry and Related Disciplines 11: 2.
Marty, P., and M. de M’Uzan. (1963). La pensee operatoire. Revue Francaise de
Psychanalyse 27: 345–56.
McLaughlin, J. (1992). Nonverbal behavior in the analytic situation: The search
for meaning in nonverbal cues. In When the Body Speaks: Psychological
Mean-ings in Kinetic Cues, ed. S. Kramer and S. Akhtar. Northvale, NJ:
Jason Aron-son, pp. 131–61.
Meltzer, D. (1967). The Psychoanalytic Process. London: Heinemann.
Micheels, L. J. (1985). Bearer of the secret. Psychoanalytic Inquiry 5: 21–30.
Ogden, T. (1994). The concept of interpretive action. Psychoanalytic Quarterly 63:
219–45.
Phillips, R. (1978). Impact of Nazi Holocaust on children of survivors. American
Journal of Psychotherapy 32: 370–77.
Quinodoz, D. (1996). An adopted analysand transference of a ‘‘hole-object.’’ In-
ternational Journal of Psychoanalysis 77: 323–36.
Rakoff, V. (1966). Long-term effects of the concentration camp experience,
View-points 1: 17–21.
Renik, O. (1993). Analytic interactions. Conceptualizing technique in light of the
analyst’s irreducible subjectivity. Psychoanalytic Quarterly 562: 553–71.
Rosenfeld, H. A. (1965). An investigation into need of neurotic and psychotic
pa-tients to act out during analysis. In Psychotic States. London: Hogarth, pp.
200–17.
Sandler, J., and A. M. Sandler. (1978). On the development of object-relations
and affects. International Journal of Psychoanalysis 59: 285–93.
Schafer, R. (1982). Retelling a Life. New York: Basic Books.
Sonnenberg, S. M. (1974). Children of survivors: workshop report. Journal of
American Psychoanalytic Association 22: 200–4.
Tustin, F. (1972). Autism and Childhood Psychosis. London: Hogarth.
———. (1986). Autistic Barriers in Neurotic Patients. London: Tavistock.
———. (1990). The Protective Shell in Children and Adults. London: Karnac.
———. (1992). Autistic States in Children. London: Routledge.
CHAPTER 6
Anthony, E. J. (1974). The syndrome of the psychologically invulnerable child.

In The Child in His Family: Children at Psychiatric Risk, ed. E. J. Anthony
and C. Koupernik. New York: Wiley.
236 REFERENCES

ed. Yael Danieli. New York and London: Plenum Press.
Barocas, H., and H. Barocas. (1973). Manifestations of concentration camp effects on
the second generation. American Journal of Psychiatry 130: 820–21.
Bion, W. (1959). Experience in Groups. London: Routledge, 1989.
———. (1962). A theory of thinking. International Journal of Psychoanalysis,
43: 306: 10; republished (1967) in W. R. Bion, Second Thoughts, pp. 110–19.
Brenner, I. (1988). Multisensory bridges in response to object loss during the
Ho-locaust. Psychoanalytic Review 75: 573–78.
———. (2002). Foreword. In The Third Reich in the Unconscious—
Transgenerational Transmission and its Consequences, ed. Vamik D. Volkan,
Ga-brielle Ast, and William F. Greer Jr. New York & London: Brunner-
Routledge, pp. xi–xvii.
Cyrulnik, B. (1993). Les Nourritures Affectives. Paris: Editions Odile Jacob, 2000.
———. (1997). L’Ensorcellement du Monde. Paris: Editions Odile Jacob, 2001.
———. (1999). Un Merveilleux Malheur. Paris: Editions Odile Jacob, 2002.
———. (2001). Les Vilains Petits Canards. Paris: Editions Odile Jacob, 2004.
———. (2003). Le Murmure des Fantomes. Paris: Editions Odile Jacob, 2003.
———. (2004). Parler D’amour au Bord du Gouffre. Paris: Editions Odile Jacob.
Danieli, Yael, ed. (1998). Introduction. In Intergenerational Handbook of Multigen-
erational Legacies of Trauma. New York and London: Plenum Press, pp. 1–21.
Eitinger, L. (1964). Concentration Camp Survivors in Norway and Israel. London:
Allen & Unwin.
Flach, F. (1988). Resilience—Discovering a New Strength at Times of Stress.
New York: Fawcett Columbine.
Frankl, V. E. (1963). Man’s Search for Meaning: An Introduction to
Logotherapy. New York: Washington Square (121).
Freud, A. (1936). The Ego and the Mechanisms of Defense. New York:
International University Press (1960).
Freud, A., and S. Dann. (1951). An Experiment in Group Upbringing.
Psychoana-lytic Study of the Child 6: 127–68.
Freud, S. (1897). Draft N. Standard Edition 1: 254–57.
———. (1908). Creative writers and daydreaming. Standard Edition 9: 143–53.
———. (1913 [1912–1913]). Totem and Taboo. Standard Edition 13: 1–162.
———. (1916). Introductory lectures in Psychoanalysis. Standard Edition 15–
16: 9–463.
REFERENCES 237
Freyberg, S. (1980). Difficulties in separation-individuation as experienced by

off-spring of Nazi Holocaust survivors. American Journal of Orthopsychiatry
5: 87–95.
Grinberg, L. (1992). Analysis of guilt feelings and mourning in artistic creation.
In Guilt and Depression. London and New York: Karnac Books, pp. 231–45.
Hass, A. (1996). The Aftermath—Living With The Holocaust. Cambridge: Cam-
bridge University Press.
Hogman, F. (1983). Displaced Jewish children during World War II: How they
coped. Journal of Humanistic Psychology 23: 51–66.
Kestenberg, J. S. (1972). Psychoanalytic contributions to the problem of
survivors from Nazi persecution. Israel Annals of Psychiatry and Related
Disciplines 10: 311–25.
Kestenberg, J. S., and Brenner, I. (1986) Children who survived the Holocaust—
The role of rules and routines in the development of the superego. Interna-
tional Journal of Psycho-Analysis 67: 309–16.
Klein, H. (1981). Yale Symposium of the Holocaust. Proceedings, September
1981. New Haven.
Klein, H., and I. Kogan. (1986). Identification and denial in the shadow of Na-
zism. International Journal of Psychoanalysis 67: 45–52.
Klein, M. (1930). The importance of symbol formation in the development of the
ego. In Love, Guilt And Reparation and Other Works 1921–1945. London:
Vi-rago Press (1988), pp. 219–32.
Association Books.
———. (2002). ‘‘Enactment’’ in the lives and treatment of Holocaust survivors’
offspring. Psychoanalytic Quarterly 71: 251–73.
Kris, E. (1952). Psychoanalytic Exploration in Art. New York: International
Univer-sity Press.
Krystal, H. (1968). Patterns of psychological damage. In Massive Psychic Trauma,
ed. Henry Krystal. New York: International University Press, pp.1–8.
Laub, D., and N. C. Auerhahn. (1993). Knowing and not knowing massive
psychic trauma: Forms of traumatic memory. International Journal of
Psychoanalysis 74: 287–302.
238 REFERENCES
Laub, D., and S. Lee. (2003). Thanatos and massive psychic trauma: The impact
of the death instinct on remembering and forgetting. Journal of American
Psy-choanalytic Association 51(2): 433–64.
Laub, D., and D. Podell. (1995). Art and trauma. International Journal of
Psycho-Analysis 76: 995–1005.
Lee, B. S. (1988). Holocaust survivors and internal strengths. Journal of
Humanis-tic Psychology 28: 67–96.
Lifton, R. J. (1968). Survivors of Hiroshima and Nazi persecution. In Massive
Psy-chic Trauma, ed. Henry Krystal. New York: International University
Press, pp. 168–89.
———. (1978). Witnessing Survival. Transactions (March 1978): 40–44.
McLaughlin, J. (1995). Touching limits in the analytic dyad. Psychoanalytic Quar-
terly 64: 433–65.
Moskovitz, S. (1983). Love Despite Hate. New York: Schocken Books.
Niederland, W. C. (1964). Psychiatric disorders among persecution victims: A
contribution to the understanding of the concentration camp pathology and its
after effects. Journal of Nervous and Mental Diseases 139: 458–74.
Parsons, M. (2000). Creativity, psychoanalytic and artistic. In The Dove that Re-
turns, The Dove that Vanishes. London and Philadelphia: Routledge, pp. 146–
71.
Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American
Journal Orthopsychiatry 57: 316–31.
———. (1993). Resilience: Some conceptual considerations. Journal of
Adolescent Health 14: 626–31.
Segal, H. (1952). A psychoanalytic approach to aesthetics. In The Work of
Hanna Segal. New York: Jason Aronson (1981), pp. 101–9.
———. (1991). Imagination, play and art. In Dream, Fantasy and Art. London
and New York: Tavistock/Routledge.
Trossman, B. (1968). Adolescent children of concentration camp survivors.
Cana-dian Psychiatric Association Journal 12: 121–23.
Valent, P. (1988). Resilience in child survivors of the Holocaust. The
Psychoana-lytic Review 85: 517–35.
Winnicott, D. W. (1964). Correspondence: Love or skill? In The Spontaneous
Ges-ture: Selected Letters of D. W. Winnicott, ed. F. Robert Rodman.
London: Kar-nac Books, 1999, pp. 140–42.
———. (1971a). Transitional objects and transitional phenomena. In Playing
and Reality. London: Tavistock, pp. 1–31.
———. (1971b). Creativity and its origins. In Playing and Reality. London:
Tavis-tock, pp. 76–100.
REFERENCES 239
CHAPTER 7
Auerhahn, N. C., and E. Prelinger, E. (1983). Repetition in the concentration camp

Bion, W. (1959). Experience in Groups. London: Routledge, 1989.
Blum, H. (1983). Adoptive parents: generative conflict and generational continu-
ity. Psychoanalytic Study of the Child 38: 141–63.
———. (1985). Superego formation, adolescent transformation and the adult
neurosis. Journal of American Psychoanalytic Association 4: 887–909.
Brenner, I. (2001). Personal communication.
Chasseguet-Smirgel, J. (1971). Pour une Psychanalyse de l’Art et de la Creativite.
Paris: Payot.
Fairbairn, W. R. D. (1943). The repression and the return of bad objects. In Psy-
choanalytic Studies of the Personality. London: Tavistock, 1952, pp. 59–81.
Freyberg, S. (1980). Difficulties in separation-individuation as experienced by
off-spring of Nazi Holocaust survivors. American Journal of Orthopsychiatry
5: 87–95.
Green, A. (1974). L’analyste, la symbolisation et l’absence. Nouvelle Revue de
Psy-chanalyse 10: 225–52.
Kestenberg, J. S. (1982). The experience of survivor-parents. In Generations of

the Holocaust, ed. M. S. Bergmann and M. E. Jucovy. New York: Basic
Books, pp. 46–62.
Kierkegaard, S. (1941). Repetition: An Essay in Experimental Psychology. New York:
Harper & Row, 1964.
Klein, M. (1929). Infantile anxiety situations reflected in a work of art and the
creative impulse. In The Writings of Melanie Klein. London: Hogarth, 1975.
Also in Love, Guilt And Reparation. London: Virago Press, pp. 210–19.
———. (1935). A contribution to the psychogenesis of manic-depressive states.
Association Books.
240 REFERENCES
von Holocaust-Uberlebenden: Rekonstruktion des ‘‘seelischen Lochs.’’ In
Psy-choanalyse Heute Und Vor 70 Jahren, ed. H. Weiss and H. Lang.
Tu¨bingen, Ger-many: Edition Diskord.
———. (1998b). The black hole of dread: the psychic reality of children of
Holo-caust survivors. In Even Paranoids Have Enemies—New Perspectives
on Para-noia and Persecution, ed. J. H. Berke, S. Pierides, A. Sabbadini, and
S. Schneider. London/New York: Routledge, pp. 47–58.
———. (2000). Breaking the cycle of trauma—from the individual to society. In
Mind & Human Interaction 11: 2–10.
Lorenzer, A. (1968). Some observations on the latency of symptoms in patients
suffering from persecution sequelae. International Journal of Psychoanalysis
49: 316–18.
McLaughlin, J. (1995). Touching limits in the analytic dyad. Psychoanalytic
Olagner, P. (1975). La Violence de L’Interpretation. Paris: Presse Universitere
de France.
Oliner, M. M. (1996). External reality: the elusive dimension of psychoanalysis.
Psychoanalytic Quarterly 65: 267–300.
Olinick, S. (1969). On empathy and regression in the service of the other. British
Journal of Medical Psychology 42: 41–49.
Renik, O. (1998). Getting real in analysis. Psychoanalytic Quarterly 67: 566–93.
Roth, S. (1993). The shadow of the Holocaust. In Persistent Shadows of the Holo-
caust: The Meaning to Those Not Directly Affected, ed. R. Moses. Madison, CT:
International Universities Press, pp. 37–79.
Volkan, V. D. (1987). Six Steps in the Treatment of Borderline Personality
Organiza-tion. Northvale, NJ: Jason Aronson.
Volkan, V. D., G. Ast, and W. F. Greer. (2002). The Third Reich in the Unconscious.
New York and London: Bruner-Routledge.
Winnicott, D. W. (1935). The manic defence. In Through Paediatrics to Psycho-
Analysis: Collected Papers. New York: Bruner/Mazel, 1992, pp. 129–44.
———. (1965). The Maturational Processes and the Facilitating Environment.
Lon-don: Hogarth.
———. (1971). The use of an object and relating through identification. In Play-
ing and Reality. London: Tavistock, pp. 101–12.
REFERENCES 241
INTRODUCTION (PART III)
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive states.

International Journal of Psychoanalysis 16: 145–74. Also in Love, Guilt and Rep-
aration and Other Works 1921–1945. New York: Free Press, 1992, pp. 262–89.
Winnicott, D. W. (1935). The manic defence. In Through Paediatrics to Psycho-
Analysis: Collected Papers. New York: Bruner/Mazel, 1992, pp. 129–44.
CHAPTER 8
Akhtar, S. (1999). Immigration and Identity—Turmoil, Treatment and

Transforma-tion. Northvale, NJ: Jason Aronson.
Blos, P. (1962). On Adolescence. New York: Free Press.
———. (1965). The initial stage of male adolescence. Psychoanalytic Study of
the Child 20: 145–64. New York: International University Press.
———. (1967). The second individuation process of adolescence. Psychoanalytic
Study of the Child 22: 162–86. New York: International University Press.
———. (1974). The genealogy of the ego ideal. Psychoanalytic Study of the
Child 29: 43–88. New Haven, CT: Yale University Press.
———. (1984). Father and son. Journal of American Psychoanalytic
Association 32: 301–24.
———. (1985). Son and fathers: Before and beyond the Oedipus Complex. New
York: Free Press.
Brenner, I. (1996a). On trauma, perversion, and multiple personality. Journal of
———. (1996b). The characterological basis of ‘‘multiple personality.’’
American Journal of Psychotherapy 50:154–66.
———. (2004). Psychic Trauma—Dynamics, Symptoms and Treatment. Oxford,
UK: Jason Aronson.
Chasseguet-Smirgel, J. (1984). Creativity and Perversion. New York: Norton.
Ehrlich, S. (1978). Adolescent suicide-maternal longing and cognitive develop-
ment. Psychoanalytic Study of the Child 33: 261–77.
Elsass, P. (1997). Treating Victims of Torture and Violence. New York: New
York University Press.
Erikson, E. H. (1950a). Growth and crises of the healthy personality. In Identity
and the Life Cycle, pp. 50–100. New York: International University Press, 1959.
———. (1950b). Childhood and Society. New York: Norton.
———. (1956). The problem of ego identity. In Identity and the Life Cycle, pp.
104–64. New York: International University Press, 1959.
———. (1958). Young Man Luther: A Study in Psychoanalysis and History.
New York: Norton.
242 REFERENCES
———. (1962). Identity: Youth and Crisis. New York: Norton.

Freud, A. (1967). Comments on trauma. In S. Furst, ed., Psychic Trauma. New
York: Basic Books.
Freud, S. (1920). Beyond the pleasure principle. Standard Edition, 18: 7–68.
———. (1921). Group psychology and the analysis of the ego. Standard Edition,
18: 67–144.
———. (1923). The ego and the id. Standard Edition, 19: 12–68.
———. (1925). Some psychical consequences of anatomical distinction between
the sexes. Standard Edition, 19: 243–58.
———. (1926a). Address to the society of B’nai Brith. Standard Edition, 20:
271–74.
———. (1926b). Inhibitions, symptoms and anxiety. Standard Edition, 20: 1–260.
———. (1930). Civilization and its discontents. Standard Edition, 21: 64–145.
Greenacre, P. (1967). The influence of infantile traume on genetic patterns. In
Psychic Trauma ed. S. S. Furst, pp. 260–99. New York and London: Basic
Books.
Guttman, S. A., R. L. Jones, and S. M. Parrish. (1980). The Concordance to the
Standard Edition of the Complete Psychological Works of Sigmund Freud,
vol. 1. Boston: G. K. Hall.
Hass, A. (1996). The Aftermath—Living With The Holocaust. Cambridge: Cam-
bridge University Press.
Hilberg, R. (1985). The Destruction of the European Jews, revised edition, vol.
3. New York: Holmes & Meier.
Kernberg, O. F. (1976). Object Relations Theory and Clinical Psychoanalysis.
New York: Jason Aronson.
Kestenberg, J., and I. Brenner. (1996). The Last Witness. Washington, DC:
Ameri-can Psychiatric Press.
Association Books.
———. (2004). Trauma, Resistenz und Kreativita¨t—Beobachtungen aus Analy-
sen von Kindern Holocaustu¨berlebenden. In Margrit Fro¨hlich, Yariv Lapid,
and Christian Schneider, eds., Representationen des Holocaust im
Geda¨chtnis der Generationen. Frankfurt: Brandes & Apsel, pp. 90–112.
Kogan, I. and C. Schneider. (2002). The Nazi heritage and gender identity.
Journal of Applied Psychoanalytic Studies 4 (1): 49–63.
Krystal, H. (1968). Patterns of psychological damage. In Henry Krystal, ed.
Mas-sive Psychic Trauma. New York: International University Press.
Laub, D., and N. C. Auerhahn. (1993). Knowing and not knowing massive psychic
REFERENCES 243
trauma: Forms of traumatic memory. International Journal of Psychoanalysis

74: 287–302.
Laub, D., N. C. Auerhahn, and S. Lee. (2003). Thanatos and massive psychic
trauma: The impact of the death instinct on remembering and forgetting.
Jour-nal of American Psychoanalytic Association 51 (2): 433–64.
Lichtenstein, H. (1963). The dilemma of human identity: Notes on self transfor-
mation, self-objectivation and metamorphosis. Journal of the American
Psycho-analytic Association 11: 173–223.
Lifton, R. J. (1968). Survivors of Hiroshima and Nazi persecution. In Henry Krys-tal,
ed., Massive Psychic Trauma. New York: International University Press.
McDougall, J. (1989). The dead father. International Journal of Psychoanalysis 2:
205–21.
Perel, S. (2004). Europa, Europa. Tel-Aviv: Miskal. First published 1994,
Yediot Achronot Vesifrei Hemed.
Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American
Journal of Orthopsychiatry 57: 316–31.
Schilder, P. (1935). The Image and Appearance of the Human Body. New York:
International University Press.
Stern, D. N. (1985). The Interpersonal World of the Infant. New York: Basic Books.
Strachey J., A. Freud, A. Strachey, and A. Tyson. (1923). Editor’s introduction, pp.
3–11. In The Ego and the Id, S. Freud. Standard Edition 19: 1–66.
Tausk, V. (1919). Uber die enstehung des beeinflussungapparates in der schizo-
phrenie. International Journal of Psychoanalysis, 5: 1–33.
Volkan, V. D. (1988). The Need to Have Enemies and Allies. Northvale, NJ:
Jason Aronson.
Weil, A. (1970). The basic core. Psychoanalytic Study of the Child 25: 442–60. New
York: International University Press.
Wheelis, A. (1958). The Quest for Identity. New York: Norton.
Wiesel, Elie. (1972). One Generation After. New York: Avon Books.
CHAPTER 9
Abend, S. (1986). Countertransference, empathy, and the analytic ideal: the im-
pact of life stresses on analytic capability. Psychoanalytic Quarterly 55: 563–75.
Arlow, J. A. (1991). Derivative manifestations of perversions. In Perversions
and Near-Perversions in Clinical Practice: New Psychoanalytic Perspectives,
ed. G. I. Fogel and W. A. Mye. New Haven and London: Yale University
Press, pp. 59–74.
Bion, W. (1959). Attacks on linking. In Second Thoughts—Selected Papers on
Psy-choanalysis. London: Heinemann, 1967. Reprinted London: Karnac
Books, 1984, pp. 93–109.
244 REFERENCES
Boyer, C. B. (1983). The Regressed Patient. New York: Jason Aronson.

———. (1999). Countertransference and Regression. Northvale, NJ: Jason Aro-
nson.
Carpy, D. V. (1989). Tolerating the countertransference: a mutative process. Inter-
national Journal of Psychoanalysis 70: 287–94.
De Jonghe, F., P. Rijnierse, and R. Janssen, R. (1992). The role of support in Psy-
choanalysis. Journal of the American Psychoanalytic Association 40: 475–99.
Eissler, K. R. (1953). The effect of the structure of the ego on psychoanalytic
tech-nique. Journal of the American Psychoanalytic Association 1: 104–43.
Freud, S. (1923). The ego and the id. Standard Edition 13: 1–60.
Giovacchini, P. I. (2000). Impact of Narcissism: The Errant Therapist as a Chaotic
Quest. Northvale, NJ: Jason Aronson.
Grubrich-Simitis, I. (1984) From concretism to metaphor. Psychoanalytic Study
Herzog, J. (1982). World beyond metaphor: Thoughts on the transmission of
trauma. In Generations of the Holocaust, ed. M. S. Bergmann and M. E.
Jucovy. New York: Basic Books, pp. 103–19.
Kernberg, O. F. (1984). Severe Personality Disorders: Psychotherapeutic Strategies.
New Haven: Yale University Press.
Klein, M. (1961). Narrative of a Child Analysis—The Conduct of the
Psychoanalysis of Children as seen in the Treatment of a Ten-Year-Old Boy.
London: Hogarth Press (1975).
———. (1935). A contribution to the psychogenesis of manic depressive states.
In Love, Guilt and Reparation and Other Works 1921–1945, pp. 262–89.
New York: Free Press, 1992.
Klein, M., P. Heimann, S. Isaacs, and J. Riviere. (1952). Developments in
Psycho-analysis. London: Hogarth Press.
Association Books.
———. (2002). ‘‘Enactment’’ in the lives and treatment of Holocaust survivors
Krystal, H. (1985). Trauma and stimulus barrier. Psychoanalytic Inquiry 5: 131–61.
Loftus, E. F., and G. R. Loftus. (1980). On the permanence of stored information
on the human brain. American Psychologist 5: 405–20.
Modell, A. H. (1976). ‘‘The holding environment’’ and the therapeutic action of
psychoanalysis. Journal of the American Psychoanalytic Association 24: 285–307.
–——. (1996). Other times, other realities. Cambridge, MA: Harvard University
Press.
REFERENCES 245
Moses, R. (1993). Persistent Shadows of the Holocaust—The Meaning to Those

Not Directly Affected. New York: International University Press.
Oliner, N. M. (1983). Cultivating Freud’s Garden in France. Northvale, NJ, and
London: Jason Aronson.
———. (1996). External reality: The elusive dimension of psychoanalysis.
Psycho-analytic Quarterly 65: 267–300.
Phillips, A. (1988). Winnicott. Cambridge, MA: Harvard University Press.
Sandler, J. (1960). The background of safety. In From Safety to Superego. London:
Karnac Books, 1987, pp. 1–9.
Schaeffer, S. F. (1980). The unreality of realism. Critical Inquiry 6: 727–38.
Schmideberg, M. (1942). Some observations on individual reactions to air raids.
Shevrin, H. (1994). The uses and abuses of memory. Journal of the American
Treurniet, N. (1993). What is psychoanalysis now? International Journal of
Organisa-tion. Northvale, NJ: Jason Aronson.
Volkan, V. D. and G. Ast. (1992). Ein Borderline Therapie: Strukturelle und
Objekt-beziehungskonflikte in der Psychoanalyse der Borderline-
Personlichkeitsorganisa-tion. Gottingen: Vanderhoeck & Ruprecht.
———. (1994). Spektrum des Narzismuss: Ein klinishce studie des gesunden
Narzis-smus, des narzisstische-masochistischen charakters, der
narzisstischen Personlich-keits-organisation, des malign Narzissmus und des
erfolgreichen Narzissmus. Gottingen: Vanderhoeck & Ruprecht.
Wallerstein, R. S. (1973). Psychoanalytic Perspectives on the Problem of Reality.
Journal of the American Psychoanalytic Association 21: 5–33.
Winnicott, D. W. (1935). The manic defense. In Collected Papers. New York:
Basic Books, 1958, pp. 129–44.
———. (1962). Ego integration and child development. In The Maturational Process
and the Facilitating Environment. London: Hogarth, 1965, pp. 56–64.
———. (1964). Group influences and the maladjusted child. In The Family and
Individual Development. London: Tavistock, pp. 146–54.
CHAPTER 10
Axelrod, S., O. L. Schnipper, and J. H. Rau. (1978). Hospitalized offspring of

Ho-locaust survivors: problems and dynamics. Bulletin: Menninger Clinic 44
(1980): 1–14.
Barocas, H. A., and C. B. Barocas. (1973). Manifestations of concentration camp
effects on the second generation. American Journal of Psychiatry 30: 820–21.
246 REFERENCES
Bergmann, M. V. (1982). Thoughts on superego pathology of survivors and their

children. In Generations of the Holocaust, ed. M. S. Bergmann and M. E. Ju-
covy. New York: Basic Books, pp. 287–311.
Kestenberg, J. S. (1972). How children remember and parents forget.
International Journal of Psychoanalytic Psychotherapy 1–2: 103–23.
Klein, H. (1971). Families of Holocaust survivors in the kibbutz: Psychological
studies. In Psychic Traumatization: After-effects in Individuals and Communities,
Boston: Little & Brown.
Association Books.
———. (2003). On being a dead, beloved child. Psychoanalytic Quarterly 72:
727–67.
Kogan, I. and C. Schneider. (2002a). The Nazi heritage and gender identity.
Jour-nal of Applied Psychoanalytic Studies 4: 49–63.
Laufer, M. (1973). The analysis of a child of survivors. In The Child in His
Family: The Impact of Disease and Death, ed. E. J. Anthony and C.
Koupernik. New York: John Wiley, 2: 363–73.
Lipkowitz, M. H. (1973). The child of two survivors: the report of an unsuccessful
therapy. Israeli Annals of Psychiatry and Related Disciplines 11: 2.
Moses, R. (1993). Persistent Shadows of the Holocaust—The Meaning to Those
Rakoff, V. (1966). Long-term effects of the concentration camp experience.
View-points 1: 17–21.
Roth, S. (1993). The shadow of the Holocaust. In Persistent Shadows of the
Holo-caust: The Meaning to Those Not Directly Affected, ed. R. Moses.
Madison, CT: International Universities Press, pp. 37–79.
Sonnenberg, S. M. (1974). Children of survivors: workshop report. Journal of
Organisa-tion. Northvale, NJ: Jason Aronson.
New York & London: Bruner-Routledge.
EPILOGUE
Akhtar, S. (2003). Dehumanization, origins, manifestations, and remedies. In Vio-

lence or Dialogue? Psychoanalytic Insights on Terror and Terrorism, ed. Sverre
REFERENCES 247
Varvin and Vamik Volkan. London: International Psychoanalytical Associa-

tion, pp. 131–46.
ed. Yael Danieli. New York and London: Plenum Press.
Awad, G. A. (2003). The minds and perception of ‘‘the others.’’ In Violence or
Dialogue? Psychoanalytic Insights on Terror and Terrorism, ed. Sverre
Varvin and Vamik Volkan. London: International Psychoanalytical
Association, pp. 153–79.
Becker, C. L. (1955). What are historical facts? Western Political Quarterly 8 (3).
pp. 327–40.
Berke, J. H. (2006). The psychology of Muslim terrorism. In Malice Through the
Looking Glass. London: Teva Publications, pp. 333–55.
Bohleber, W. (1997). Trauma, Identifizierung und historischer Kontext. In
Psyche 51: 958–95.
———. (1998). Traumata und deren Bearbeitung in der Psychoanalyse. BIOS
Jg. (1998). Heft 2, Verlag Leske & Budrich GmBH.
———. (2003). Collective Phantasms, destructiveness, and terrorism. In
Violence or Dialogue? Psychoanalytic Insights on Terror and Terrorism, ed.
Sverre Varvin and Vamik Volkan. London: International Psychoanalytical
Association, pp. 111–31.
Bollas, C. (2006). Transformations wrought by the unconscious. Creativities of
the unconscious. Vincenzo Bonaminio interviewing Christopher Bollas. Psy-
choanalysis in Europe, Bulletin 60, pp. 133–61.
Borradori, G. (2003). Philosophy in a Time of Terror—Dialogues with Jurgen
Ha-bermas and Jacques Derrida. Chicago and London: The University of
Chicago Press.
Bowlby, J. (1980). Attachment and Loss. Volume 3: Loss. New York: Basic Books.
Brenner, I. (2002). Foreword. The Third Reich in the Unconscious. New York and
London: Bruner-Routledge, pp. xi–xvii.
Burch, B. (1989). Mourning and failure to mourn—An object relations view.
Con-temporary Psychoanalysis 25: 608–23.
Einstein, A. (1932). Why war? In Standard Edition, 22: 199–203.
Erlich, H. S. (2003). Reflections on the terrorist’s mind. In Violence or Dialogue?
Psychoanalytic Insights on Terror and Terrorism, ed. Sverre Varvin and Vamik
Volkan. London: International Psychoanalytical Association, pp. 146–53.
Frankl, V. E. (1963). Man’s Search for Meaning: An Introduction to Logotherapy.
New York: Washington Square, 121.
248 REFERENCES
Fresco, N. O. (1984). Remembering the unknown. International Review of

———. (1917). A metapsychological supplement to the theory of dreams. Stan-
dard Edition 14: 222–35.
———. (1927). The future of an illusion. Standard Edition 21: 1–56.
———. (1930). Civilisation and its discontents. Standard Edition 21: 57–145.
———. (1933). Why war? Standard Edition 22: 203–19.
Green, A. (1973). Le Discours Vivant. La Conception Psychanalytique de L’affect.
Paris: P.U.F.
Grinberg, L. (1978). The ‘‘Razor’s Edge’’ in depression and mourning. Interna-
———. (1992). Guilt and Depression. London and New York: Karnac Books.
Janin, C. (1996). Figures et Destins du Traumatisme. Paris: P.U.F.
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive
states. International Journal of Psychoanalysis 16: 145–74.
Association Books.
———. (1996). Die suche nach Geschichte in den Analysen der Nachkommen
von Holocaust Uberlebenden: Rekonstruktion des seelischen Lochs. In Heinz
Weiss and Hermann Lang (Hg.), Psychoanalyse Heute Und Vor 70 Jahren.
Tub-ingen: edition diskord.
———. (1998). The black hole of dread: the psychic reality of children of Holo-
caust survivors. In Even Paranoids have Enemies—New Perspectives on
Paranoia and Persecution, ed. Joseph H. Berke, Stella Pierides, Andrea
Sabbadini, and Stanley Schneider. London and New York: Routledge.
Laplanche, J., and J. P. Pontalis. (1967). The Language of Psychoanalysis, trans. D.
Nicholson-Smith. New York: Norton, 1973.
Loftus, E. F., and G. R. Loftus. (1980). On the permanence of stored information
on the human brain. American Psychologist 5: 405–20.
Novey, S. (1968). The Second Look—The Reconstruction of Personal History in
Psy-chiatry and Psychoanalysis. Baltimore: The Johns Hopkins Press.
Parens, H. (2004). Renewal of Life—Healing from the Holocaust. Rockville, MD:
Schreiber Publishing.
Pollock, G. H. (1978). Process and affect: Mourning and grief. International Jour-
nal of Psychoanalysis 59: 255–76.
REFERENCES 249
Schaeffer, S. F. (1980). The unreality of realism. Critical Inquiry 6: 727–38.

Shoshan, T. (1989). Mourning and longing from generation to generation.
Ameri-
can Journal of Psychotherapy 43 (2): 193–207.
Stein, R. (2002). Evil as love and liberation. Psychoanalytic Dialogues 12: 393–420.
Turner, F. J. (1891). The significance of history. In The Early Writings of Frederick
Jackson Turner, ed. Everett E. Edwards. Madison: University of Wisconsin
Press, 1938, pp. xi, 316.
New York and London: Bruner-Routledge.
Wangh, M. (1993). The working through of the Nazi experience in the German
Psychoanalytical Community. In The Trauma of the Past—Remembering and
Working Through, ed. Hella Ehlers and Joyce Crick. London: Goethe Institut.
Winnicott, D. W. (1935). The manic defence. In Collected Papers. New York:
Basic Books, 1958.
Index
abortion, 153 diminishing place of, 194; threat to,

Abraham, K., 9 193; during wartime, 195
abstinence, rule of, 48 analysis, termination of, 5, 42; Arlow on,
acting in, 89, 91; negative connotations 45; criterion for, 42; fantasies/
of, 91; problems with, 91 conflicts involved in, 45; Freud, Sig-
acting out, 89; Boesky on, 90; Cohen mund, on, 43; Greenson on, 42;
on, 91; Etchegoyen on, 90; as ex- Grinberg on, 42–43; Novick on, 42;
pression of resistance, 90; Fenichel Rangell on, 42; satisfactory aspects
on, 91; Freud, Sigmund, on, 90; of, 43; Schachter on, 44; Siegel on,
Kinston on, 91; primary repression 42, 44; Ticho on, 44; Weigert on, 42
and, 91; trauma and, 91; as way of analyst: anonymity of, 63; perception
remembering, 90 of patient’s mind by, 198; responsi-
actualization, 91, 93; wish-fulfilling bility of, 2
as-pects of, 93 analyzing instrument, 192
‘‘addiction to treatment,’’ 35 anger, defensive, 143
‘‘affective understanding,’’ 60, 98, annihilation anxiety, 107
102–3, 214 anorexia, 96
age, limitations of, 33, 34, 40 Anzieu, D., 64
‘‘Airplanes that take you away from Arlow, J. A., 195; on termination
me,’’ 114 of analysis, 45
Akhtar, S.: on identity, 84; on art. See creative activity
psychic pain, 11 artificial insemination, 30, 34,
alter ego, 130 36 Auerhahn, N. C., 149
analysis: classical, 194; of deviant sexu- Auschwitz, 129–30
ality, 67; Dewald on limitations of,
44; fleeing from, 189, 190; in foreign Barocas, H., 72, 111
languages, 75; ‘‘getting real in,’’ 154; Becker, C. L., 216
lovemaking and, 31; symbolism in, bereavement, 9
251
252 INDEX
Bergmann, M. V., 16 childbirth, relinquishing, 41

‘‘betweenness,’’ 121 childhood: molestation in, 56; repeat-
binding: as defensive operation re- ing trauma from, 60
stricting free-flowing excitation, children: genetic blueprint of, 164;
104n4; Freud, Sigmund, on, identity in, 163–64, 199; identity
104n4; literature on, recent, 105n4 in, tracing, 164; loss of separate
Bion, W. R.: on black hole, 94; on sense of self in, 94; needy, 24–26;
con-taining patient, 191–92 omnipo-tence in, 13, 33–34;
black hole: in astrophysics, 94; Bion parental expec-tations of, 164;
on, 94; Eshel on, 94, 95; Grotstein psychogenic autism of, 94;
on, 94; in psychoanalysis, 94; reconstructing traumatic wounds in,
Tustin on, 94 104; sexual seduction of, 195;
blankness, 95 street, 82; Tausk on, 163. See also
Blum, H., 151 Holocaust survivors, children of
B’nai Brith, 163 children, dead beloved: competition
body image, 171 with, 151, 153; denial of, 149; re-
Boesky, D., 90 sentment of, 136; resurrecting, 136
Bollas, Christopher, 217 children, replacement, 136, 149; antag-
Bonaminio, Vincenzo, onism of, 124; anxiety over being,
217 Borradori, Giovanna,
133; Auerhahn on, 149; Blum on,
217 Bowlby, J., 1
151; as cause for unhappiness, 136–
breast: cancer, 142, 143; as symbol
37; defenses of, 149, 153; guilt over
of motherhood, 143
being, 133; internalization of
Breckenridge, K., 49
persecutory mother by, 150; manic
Brenner, I., 109; on multiple
defense and, 149; Nazi oppressor role
personali-ties, 172
of, 124, 139, 151, 154; Prelinger on,
British Psychoanalytical Society,
149; psychic make-up of, 149;
195 Burch, B., 211
resentment of dead sibling from, 136;
cancer: breast, 142, 143; prostate, 205 resistance to awareness of guilt of,
Carpy, D. V., 192 152; restitution role of, 124; self-
Casement, P., 48 perception of, 124; unconscious guilt
‘‘The castrated child,’’ 117 of, 151
castration, denial of, 65 ‘‘The child’s head—a pot filled with
Ceausescu, Nicolae, 80; death of, 86; earth and a tree growing out of it,’’
as father figure, 71, 73; influence 114
of, 74; nostalgia for, 87; unresolved Christianity, failure of,
mourning for, 86; Volkan on, 86 216 Cioran, E. M., 73
Chasseguet-Smirgel, J.: on creativity, circumcision, 79; Jewish identity and,
18–19; on homosexuality, 65 163; Perel and, 164, 165, 168, 171,
INDEX 253
175; as physical manifestation culture-shock, 84

of Jewish identity, 164 Cyrulnik, Boris, 108
‘‘Civilization and its
discontents’’ (Freud, S.), 216 ‘‘The damaged child,’’
Cohen, J., 91, 95 114 Danieli, Yael, 109
concretization, 89; Bergmann on, 16 Dann, Sophie, 110 dead
‘‘containing the patient’’: Abend on, mother, 66, 95
192; Bion on, 191 death: denial of, 26–29, 149; fear of, 24,
control struggles, 155 43, 180; Freud, Sigmund, on,
creative activity, 6, 108, 123; anal strug- 42; psychic, 61, 180, 182, 212
gles transformed into, 155; as at- decompensation, 178, 179 de-
tempt to repair object/self, 18–19; idealization: Joffee on, 11–12; as re-
Chasseguet-Smirgel on, 18–19; chil- sponse to pain, 11–12; Sandler on,
dren of Holocaust survivors and, 72; 11–12
as defense, 18, 120; development denial, 10, 13, 17–18, 213; adaptive
and, 120; evolution of, 122; Freud, value of, 17; of castration, 65; of
Sigmund, on, 120; Grinberg on, 18; death, 26–29; of death of beloved
healing of traumatic memory child, 149; Dorpat on, 17; enact-
through, 122; hidden truths discov- ment and, 92; of external reality,
ered through, 108, 112; Klein on, 18; 190, 192; Freud, Anna, on, 17;
life/death instincts expressed through, Freud, Sigmund, on, 17; of gender
121; movement repre-sented through, differences, 65; of inner reality, 14,
121; obsessive symptoms sublimated 32–33; ‘‘in the service of normal-
into, 147; playful element introduced ity,’’ 192; Klein on, 17; of
through, 121; as quest for mastery/ mourning, 111; of reality, 159, 169,
redemption, 122; recovery through, 212; of sex-ual differences, 65
147; regression through, control-ling, deposited representations, 199
121; as reparative activity, 120; depressive anxiety, 212
reparative impulse and, 121; resil- depressive feelings, reversal of, 14
ience facilitated through, 112; in derealization, 97
search of internal anguish source, 19; Derrida, Jacques, 217
Segal on, 120; self-confidence re- desire: inner deadness and, 52; perse-
inforced through, 147; self-worth cutory fears and, 52–54
reinforced through, 147; in therapy, Dewald, P., 44
72; Winnicott on, 112, 121 disavowal. See denial
displaced persons (DP), 137
crises, chronic, 177 displacement mechanisms, 92
‘‘crucial juncture,’’ 154 disturbed hysteric, 61
The Cry of Mute Children (Kogan), 2, Dorpat, T. L., 17
81, 177 DP. See displaced persons
254 INDEX
‘‘education, methods of,’’ 141 ity and, 195, 208; murderous,

ego: alter, 130; as executive agency of 152; Winnicott on, 195, 196
mind, 164; Freud, Sigmund, on, father figure: Ceausescu as, 71, 73;
164, 166, 171; identity and, 164; as de-terioration of, 185; Perel and,
‘‘person’s self as a whole,’’ 164; re- 168; split, 185
organization of, 2; splitting of, 65, Faust (Goethe), 64
148; struggle of, 212 fear: of death, 24, 43, 180; desire and
Einstein, Albert, 216 persecutory, 52–54; of external real-
Eissler, K. R., 197 ity, 180, 191; of fragmentation, 180;
Eitinger, I., 109 of incontinence, 102; of psychic pain,
emigrate, 73 40–42; of return of past, 193
emotional abandonment, 141 Feast of Tabernacles, 164
emptiness, problem of, 95 enactment, feelings, language of, 129
6, 10, 15–17, 212; behav- Fenichel, O., 91
ioral, 48; children of Holocaust sur- Ferenczi, S., 48
vivors and, 72; defining, 89–92; financial speculation, 184
Eshel on, 90; expression of, 92; ex- ‘‘fracture of the psyche,’’ 85
ternalizing conflict through, 15; in fragmentation, 61, 182, 212; fear of,
fantasy, 16; Holocaust and, 91; Ja- 180
cobs on, 91; manic defense and, 92; Frankl, Victor, 213
to mental representation, 102–4; free associations, 134
origins of, 89; of parents’ traumatic Freud, Anna, 1, 110; on denial, 17; on
experiences, 93; in reality, 16; external traumas, 165; on outcome
Renik on, 15; role of, 92–93; of mourning, 1
source of, 93–96; transforming into Freud, Sigmund: on abstinence, 48; on
cognitive mode, 102; unconscious acting out, 90; on binding, 104n4;
meaning of, 97 ‘‘Civilization and its discontents’’ by,
EPF Conference in Athens, 216; on creative activity, 120; on
217 Erikson, E. H., 84, 172 death, 42; definition of mourning by,
erotic love, 54 9; on denial, 17; on ego, 164, 166,
Eshel, O.: on black hole, 94, 95; on 171; on external reality, 195; on
en-actment, 90 failure of Christianity, 216; ‘‘The fu-
Etchegoyen, R. H., 90 ture of an illusion’’ by, 216; on gen-
Europa, Europa, 4, 159; der identity, 169; ‘‘Groups
psychoanalytic review of, 6, 162; psychology and the analysis of the
summary of, 162–63 ego’’ by, 72n1; on hilflosigkeit, 215;
on homosexuality, 65; on identity,
fame, 55 163; on individual v. group psychol-
fantasy: enactment in, 16; external real- ogy, 72n1; ‘‘Inhibitions, symptoms,
INDEX 255
and anxiety’’ by, 10; on manic de- Grotstein, J. S., 94

fense, 12; on melancholia, 12; on ‘‘Groups psychology and the analysis
mourning, 86; ‘‘Mourning and mel- of the ego’’ (Freud, S.), 72n1
ancholia’’ by, 10; on need for father, Grunes, M., 64
170; on outcome of mourning, 1; on Gulf War, 214
pathological mourning, 94; on Guntrip, H., 150
primitive identification, 16–17;
primitive man by, psychoanalytic Habermas, Ju¨rgen, 217
understanding of, 86; ‘‘Project for a hair length, 207
scientific psychology’’ by, 10; on ‘‘healthy neurotic,’’ 49
projection, 15; on psychic pain, 10; hearing, touch and, 62
on reason, 216–17; on Seelen- Hegel, Georg Wilhelm Friedrich, 217
schmerz, 10; on talking cure, 90; on hilflosigkeit, 215
termination of analysis, 43; on time, historical fact, 216
214–15; on trauma, 173; trauma by, history, erasing of, 159, 175; Laub on,
metapsychological explanation of, 175; Lee on, 175; by Perel, 175
104n4; World War I and, 216 Hitler, Adolph, 162, 167, 168, 170
Freyberg, S., 151 Fromm- Hitler Youth School, 162, 163, 168,
Reichmann, F., 48 169, 170
‘‘The future of an illusion’’ (Freud, holding environment, 48, 193
S.), 216 holding interpretations, 103
holding relationship, 85
Gable, Clark, 165 ‘‘hole-object,’’ 95 Holland,
gambling, 184 Agneshka, 162
gender: denying differences in, 65; Holocaust: as attempt to achieve racial
identity, 166, 169; limitations of, 33 purity, 161; destruction of integrity
generational continuity, 173 by, 161; enactment and, 91; Gulf
German Ministry of Propaganda, 162 War and, 214; intifada
Gestalt exercise, 56 Goebbels, representing, 200, 204; reinforced
Joseph, 162 mental repre-sentations of, 208;
Goethe, Johann Wolfgang von, trauma transmis-sion of, 3;
64 Goldberger, Alice, 110 unconscious fantasies of, 153
Greenacre, P., 165 Greenson, R. Holocaust Remembrance Day, 57
R., 42 Holocaust survivors: apathy of, 109;
grief, 9 damage to metaphorical thinking
Grinberg, L.: on creativity, 18; on demonstrated in, 193; difficulty ‘‘re-
manic defense, 14; on maturity, 41; investing in life’’ of, 109; seclusion
on mourning, 211; on persecutory of, 109; social withdrawal of, 109;
guilt, 218n2; on psychic pain, 11; trauma studies on, 109; victimiza-tion
on termination of analysis, 42–43 of, 200; vulnerability of, 109
256 INDEX
Holocaust survivors, children of: Baro- identity, gender, 166, 169; early child-
cas on, 72, 111; cognitive develop- hood experiences and, 169; Freud,
ment of, 147; creative activity and, Sigmund, on, 169; identification
72; denial of mourning and, 111; with parents and, 169; of Perel,
destructive individuation of, 151; 166, 169
emotional development of, 147; en- immigrate, 73
actment and, 72; Freyberg on, 151; incest, 33
memory prohibition of, 112; nostal- incontinence, fear of, 102
gia in, 213; psychic hole and, 95; re- indignation: Joffee on, 11–12; as re-
enactment and, 112; resilience of, sponse to pain, 11; Sandler on,
111–20; transmission of trauma to, 11–12
72, 199, 208; understanding/treat- individuation, enhanced: Joffee on,
ment of, 81; unresolved mourning of, 11–12; as response to pain, 11;
148; vulnerability of, 111–20 San-dler on, 11–12
homosexuality: Chasseguet-Smirgel on, infant, development of, 192 infantile
65; converting infantile trauma into traumata, 61 information, quest for,
adult triumph through, 66; creation of 103 ‘‘Inhibitions, symptoms, and
self through, 66; denying gender/ anxiety’’
sexual differences through, 65; de- (Freud, S.), 10
nying inner reality through, 65; inner deadness, 52
Freud, Sigmund, on, 65; Kahn on, International Observatory of Resil-
65–66; Kohut on, 66; as manic de- ience, 108
fense, 47, 66–67; Perel and, 170 ‘‘interpretive action,’’ 62;
humanity-as-beast, 171 intervention as, 61–62; Ogden on,
humanity-as-civilized, 171 61; Reppen on, 61
intervention: as interpretive action,
61–62; as ‘‘moment of meeting,’’
idealization, 13; of dead, 92; enactment
62; self-revealing aspect of, 62–63
and, 92; Rosenfeld on, 13
intifada, 159, 185, 189, 197n1; Holo-
identity: adoption of new, 167–75; Ak-
caust representations and, 200, 204
htar on, 84; in children, 199; chil-
introjection, 164
dren’s, tracing, 164; circumcision as
invulnerability, 107
manifestation of Jewish, 164; as co-
Isakower, Otto, 192
herent sense of self, 171; destabiliza-
Israel: impact of life-threatening situa-
tion of, 84; discontinuity of, 86; ego
tions in, 212, 215; Palestinians and,
and, 164; emigration and, 83; eth-nic,
conflict between, 187; political
173; Freud, Sigmund, on, 163; dem-onstrations in, 202–3, 208;
problem with, 75; Wheelis on, 171 recur-rence of crisis in, 197n1;
identity, consolidated: Erikson on, terrorism in, 202; terror of current
84, 172; internal consistency and, situation in, 179
173
INDEX 257
Jacobs, T. J., 91 on, 12; Grinberg on, 14; homosexu-

JAPA, 195 ality as, 47, 66–67; Klein on, 12;
Jesus, 76 mourning from, journey to, 5, 40; as
Joffee, W. G.: on de-idealization, 11– normal development, 15; Ogden on,
12; on enhanced individuation, 15; parthenogenesis as, 24; purpose
11–12; on indignation, 11–12; on of, 65–66; reinforcement of, 7, 200,
psychic pain, 11 209; replacement child and, 149; as
retreat from depression, 12; Winni-
Kahn, M. M. R., 65–66 cott on, 12, 14
Kant, Immanuel, 217 Maroda, K. J., 49
Kernberg, O. F.: on introjection, masculinity: father’s concern over,
164; on Oedipus complex, 65 208; rebellion against, 207
Kestenberg, J. S., 109 maternal object, internal, 27
Kindertransport, 178 maturity, 40; Grinberg on, 41
Kinston, W., 91, 95 McLaughlin, J., 49
Klein, M., 194; on creativity, 18; on Mein Kampf (Hitler), 168
de-nial, 17; on manic defense, 12; melancholia, 12
on projection, 15; on reparation, Mengele experiments, 101
18; on schizoid-paranoid phase,
mid-life crisis, 41
218n2
migration: delayed mourning due to,
Kogan, Ilany, 2, 81, 177
73; external reality from,
Kohut, H.: on homosexuality, 66; on
alteration of, 84; identity and, 83;
touching, 49
mourning and, 83
miscarriage, 153
Laub, D., 175
Modell, A. H., 196
‘‘learning from experience,’’
monosexual destiny, accepting, 30–32
215 Le Bon, Gustave, 72n1
Lee, S., 175 Moses, R., 152
libidinal needs, 59 Moskovitz, Sarah, 110
life goals, 46n1 mother: ‘‘good enough,’’ 148; as Nazi
Little, Margaret, 48, 195 persecutor, 145; Perel and, 168; per-
Loewald, H. W., 63–64 secutory, 144; psychically dead, 201;
Lorenzer, A., 148 replacement child internalizing image
Love Despite Hate (Moskovitz), of persecutory, 150; separa-tion from,
110 lovemaking, analysis and, 31 29; trauma from, 148–52
‘‘Mother, child and the demon,’’
‘‘malignant narcissism,’’ 61 manic 116 mother tongue, 74
defense, 10, 12–15, 42–45; mourning, 211; Abraham on, 9; ab-
change/growth, against, 40; compo- sence of, 159; adaptive aspects of,
nents of, 14; constituents of, 12; en- 212; Bowlby on, 1; Burch on, 211;
actment and, 92; Freud, Sigmund,
258 INDEX
collective, 71; defense configura- nightmares, 215

tions to avoid, 10; defenses against, The Night Porter, 98
11–19; denial of, 111; elaboration of, Novick, J.: on termination of
2; as ‘‘final act of love,’’ 211; Freud, analysis, 42
Anna, on, 1; Freud, Sig-mund, on, 1, ‘‘now moment,’’ 62
9, 86; Grinberg on, 211; growth and, NSF. See National Salvation Front
211; impedance to, 212; manic
defense to, journey from, 5, 40; ‘‘objective interpretation,’’ 63 object-
migration delaying, 73, 83; normal relationships: dangers of, 150;
and pathological, dis-tinction establishment of new, 64; Grunes
between, 9; as obligatory on, 64; Guntrip on, 150; Loewald
psychobiological process, 86; out- on, 63–64; psychic pain and, 11
come of, 1; ‘‘passage of one stage of obsessive-compulsive disorder,
life to another’’ and, 211; Perel and, 149, 213
174, 175; Pollock on, 211; separa- oedipal triangle, 182, 183
tion from mother and, 29; substitu- Oedipus complex, 56, 140; conflicts
tion mechanisms for, 89; survival in, 149; Kernberg on, 65; of Perel,
value of defenses against, 163; unre- 165; rivalry and, 142
solved, 5, 6, 148, 213; unresolved, Ogden, T.: on interpretive action, 61;
Romanian society’s, 73–87 on manic defense, 15
‘‘Mourning and melancholia’’ omnipotence, 12–13, 208; child’s
(Freud, S.), 10 feel-ings of, 13, 33–34; enactment
and, 92
mourning, group, 71; avoiding, 71–72;
individual and, link between, 71 outsider, 77
mourning, pathological, 86, 117, 212;
pacifist ideas, 203
Freud, Sigmund, on, 94; for old
val-ues, 82 pain: adaptive aspects of, 212; defense
configurations to avoid, 10, 214;
multiple personalities, 172
de-fenses against, 11–19; de-
murderous fantasies, 152
idealiza-tion as response to, 11–12;
‘‘mutative support,’’ 193
emotional awareness of, 212; en-
Mythos of Survival, 121
hanced individuation as response
to, 11–12; facing mental, 85; indig-
narcissistic injury, 44, 216; in nation as response to, 11–12; indi-
Romania, 83 vidual defenses against, 212;
narrative, construction of unbroken, managing emotional, 108; patho-
104 logical aspects of, 212; societal de-
National Salvation Front (NSF), fenses against, 212; survival value
86 ‘‘need-relationship,’’ 115 of defenses against, 163
Niederland, W. C., 109 pain, psychic, 9, 10–11; Akhtar on, 11;
INDEX 259
avoidance of, 92; fear of, 40–42; Jewish identity by, 167, 168;
Freud, Sigmund, on, 10; Grinberg survival guilt of, 165
on, 11; Joffee on, 11; object-loss ‘‘perimeter of safety,’’ 115;
and, 11; physical pain and, 11; Pon- encroach-ment into, 154
talis on, 11; psychological deadness persecutory fears: desire and, 52–
to avoid, 64; Sandler on, 11; Weiss 54; exploration of, 53
on, 11 persecutory guilt, 212; Grinberg on,
Palestinians/Israel, conflict 218n2; schizoid-paranoid phase
between, 187 and, 218n2
Parens, Henri, 1 Phillips, A., 195
parent: as Nazi aggressor, 124, 139; physical contact. See touching
as persecuted victim, 124 poetry, 18
parthenogenesis, 23, 34; as manic de- pogrom, 165
fense, 24; as psychotic obsession, 40 Pollock, G. H., 211
Passover, 164 Pontalis, J. B., 11
past/present, confusion between, 150 post-traumatic stress disorder (PTSD),
Pedder, J. R., 49 71, 107
pensee operatoire, 92 ‘‘potential space,’’ 112
Perel, Solomon (Solly), 159, 162; bar Prelinger, E., 149
mitzvah of, 165; circumcision of, ‘‘present moment,’’ 62
164, 165, 168, 171, 175; continuity present/past, confusion between, 150
of, rebuilding sense of, 174; denial of ‘‘primary love,’’ 64
guilt by, 166; denial of reality by, ‘‘primary repression,’’ 91
169; depression of, 174; fantasized primitive identification, 16, 94, 95,
protective figures of, 170; father 117, 151; Freud, Sigmund, on, 16–17
figure and, 168; first disguise of, 165; primitive man, psychoanalytic under-
gender identity of, 166, 169; standing of, 86
generational continuity of, 173; on ‘‘Project for a scientific
guilt, 174; as hero, 168; heterosexual psychology’’ (Freud, S.), 10
tendency of, 170; Hitler Youth iden- projection, 15
tity of, 171; homosexual tendency of, projective identification,
170; ‘‘knowing and not knowing 100 prostate cancer, 205
psychic trauma’’ and, 169; as Kom- protective shield, 128
somol youth, 167; mother figure and, pseuriasis, 201
168; mourning of, 174, 175; Nazi psychic hole, 94, 95; as absence of psy-
ideology and, 167–75; Oedipus chic structure, 95; as ‘‘empty circle,’’
complex of, 165; partial erasing of 95; filling, 101; forming of, 95; Ho-
history by, 175; psychic representa- locaust survivor’s children and, 95
tion of body, 171; renouncement of ‘‘psychic numbing,’’ 109
260 INDEX
psychic pain. See pain, psychic ‘‘Regina Schuhe,’’ 147

Psychoanalytic Inquiry, 48 regression: creative activity and, 121;
psychodynamic psychotherapy, 125 ‘‘for recognition,’’ 64; ‘‘in the ser-
Psychotherapy Center for the Treat- vice of the ego,’’ 121; ‘‘in the
ment of the Child and Adolescent service of the other,’’ 154;
in Bucharest, 81 Treurniet on, 197n2
psychotic, infantile catastrophe of, 94 ‘‘religion as the opiate of the
PTSD. See post-traumatic stress dis- masses,’’ 167
order Renik, O., 15–16
reparative defense, 10; Klein on, 18
Rangell, L., 42 replacement-child syndrome. See chil-
reality: confusion in present, 151; de- dren, replacement
nial of, 159, 169, 212; life-threaten- Reppen, J., 61
ing, 200; splitting of, 212; resilience, 107–9; creative activity and,
traumatic, 195; Wallerstein on 112; Cyrulnik on, 108; Danieli on,
problem of, 197n3 109; intrapsychic structure and, 108;
reality, external: alteration from migra- psychosocial, 107; Rutter on, 173
tion, 84; controversy of impact of, reverie, state of, 63
194; denial of, 190, 192; Eissler on,
Riedesser, Peter, 82
197; fear of, 180, 191; Freud, Sig-
Rilke, Rainer Maria, 59
mund, on, 195; as frustrating, 195;
Riviere, J., 66
internal reality and, inability to dif-
Romania Mare, 87
ferentiate between, 150, 208; inter-
Romanian Communist Party, 86
nal reality and, relationship of, 160,
Romanian nationalists, 87
177, 191; internal reality to, flight
Romanian society: Communist regime
from, 14; mastering historical, 121;
respect for, 196–97; unconscious
in, 83; as emotionally immigrants,
fantasy and, 195, 208; unconscious
85; mourning of, 71;
meaning behind perception of, 188 ‘‘purifying,’’ 87; turmoil in, 83;
unresolved mourning of, 73–87;
reality, inner: denial of, 14, 32–33; ex-
Westerniza-tion of, 82
ternal reality and, inability to
Rosenfeld, H., 13
differ-entiate between, 150, 208;
external reality and, relationship of, Roth, S., 152
160, 177, 191; external reality Rutter, M., 173
from, flight to, 14; homosexuality
to deny, using, 65 safety, sense of, 194
reason: Freud, Sigmund, on, 216; Sandler, J.: on de-realization, 11–12;
Hegel on, 217; impact on history on enhanced individuation, 11–12;
of, 217; Kant on, 217; as tool on indignation, 11–12; on psychic
against human destruction, 217 pain, 11; on safety, 194
INDEX 261
Sandor, Vera, 81 ‘‘Terror and birth,’’ 118

Schachter, R., 44 terrorism: complexity underlying,
Schilder, P., 171 217; in Israel, 202; in London,
schizophrenia, 51 218; in Madrid, 218; September
Schmideberg, Melitta, 195 11, 2001, 217, 218
Scientific Meetings of the British Soci- therapy: creative activity in, 72;
ety, 195 limita-tions of, 3; sex, 50, 55
‘‘search for self through family Ticho, E. E., 40; on termination of
secrets,’’ 101 analysis, 44; on treatment
Searles, H., 48 goals, 46n1
Seelenschmerz, 10 time, 214–15
Segal, H., 120 self- touching, 48; Anzieu on, 64; avoiding
confidence, 147 self- feelings through, 59; Breckenridge
deception. See denial on, 49; Casement on, 48; disturbed/
self-destructiveness, 114 deeply regressed patients and, 49;
‘‘self-history,’’ 84, 173 Ferenczi on, 48; Fromm-
self-worth, 147 Reichmann on, 48; hearing and,
separation, 26–29; from mother, 29 association be-tween, 62; Kohut on,
sex therapy, 50, 55 49; Maroda on, 49; McLaughlin on,
sexuality, deviant, 67 49; Pedder on, 49; Searles on, 48;
Shakespeare, William, 1 verbal inter-action as, 49–50, 61,
Sharpe, Ella Freeman, 18 63–64; Winni-cott on, 48
‘‘Shelly with the ropes,’’ ‘‘tranquil quiet sense of well-being,’’
114 Shevrin, H., 195 49 transferential incidents, 130–31
Siegel, B. L., 42, 44 treatment goals, 46n1
‘‘sonorous bath,’’ 62 Trei, Editura, 81 Treurniet,
‘‘sonorous wrapping,’’ 85 N., 197n2 Tudor, Corneliu
Stalin, Josef, 162, 167, 170 Vadim, 87 Tustin, F., 94
Stern, D. N.: on ‘‘now moment,’’
62; on ‘‘self-history,’’ 84, 173
sublimation, 18, 41 suicide, 53, unconscious conscious, making,
178–79 suicide bomber, 181– 133; barriers to, 152; Moses on,
82 surrogate, 54; emotional, 152; Roth on, 152
63–64 suspended animation,
13, 14 symbol formation, 112 Volkan, V.: on Ceausescu, 86; on col-
lective mourning, 71; on deposited
representations, 199
Tausk, V., 163 vulnerability, 108; acceptance of per-
‘‘Termination of psychoanalysis: treat- petual, 212; Danieli on, 109; Ei-
ment goals, life goals’’ (Ticho), 40 tinger on, 109; Niederland on, 109
262 INDEX
Wallerstein, R. S., 195 on ‘‘potential space,’’ 112; on

197n3 Weigert, E., 42 touching, 48; traumatic reality and,
Weiss, E., 11 195
Wheelis, A., 171 ‘‘Womanliness as a masquerade’’
Wiesel, Elie, 161 (Rivi-ere), 66
Winnicott, D. W.: on aim of psycho- ‘‘Woman with two faces, one superim-
analysis, 196; on creativity, 121; on posed upon the other,’’ 116
external reality v. unconscious fan- World War I, 216
tasy, 195; on fantasy, 195, 196; on
manic defense, 12, 14; Phillips on, Zetzel, E., 61
About the Author
Ilany Kogan serves as training analyst of the Israel Psychoanalytic

Society and chief supervisor of the Psychotherapy Center for the
Treatment of the Child and Adolescent, Bucharest, Romania. She is a
member of the scien-tific advisory board of the Fritz Bauer Institute for
Holocaust Studies in Frankfurt, Germany.
For many years, she worked extensively with Holocaust survivors’
off-spring and was awarded the Elise M. Hayman Award for the Study of
the Holocaust and Genocide at the IPA Congress, Rio de Janeiro (2005)
for the work in the realm of the second generation of the Holocaust.
She has published many papers and her books include The Cry of
Mute Children—A Psychoanalytic Perspective of the Second Generation
of the Ho-locaust (1995), which has been published in German,
Romanian, French, and Croatian in addition to English, and Escape from
Selfhood—Breaking Boundaries and Craving for Oneness (2007).
263

The Struggle Against Mourning

Uploaded by

Copyright:

Available Formats

The Struggle Against Mourning

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Struggle Against Mourning

Uploaded by

Copyright:

Available Formats

The Struggle

Published in the United States of America

A wholly owned subsidiary of

Copyright 2007 by Jason Aronson

All rights reserved. No part of this publication may be reproduced,

British Library Cataloguing in Publication Information Available

Library of Congress Cataloging-in-Publication Data

Printed in the United States of America

1 Revisiting Defenses against Pain and Mourning 9

PART I: Obstacles to Individual Mourning 21

3 Lust for Love 47

PART II: Unresolved Mourning and Its Bearing on Society 69

4 Romania and Its Unresolved Mourning 73

5 From Enactment to Mental Representation 89

6 Trauma, Resilience, and Creative Activity 107

7 On Being a Dead, Beloved Child 123

PART III: Obstacles to Mourning in an Age of Terror 157

8 Who Am I? Trauma and Identity 161

9 The Role of the Analyst in the Analytic Cure during Times of

10 Working with Sons and Daughters of Holocaust Survivors in

Finally, I am grateful to my patients who allowed me to accompany

Chapter 2. Presented at the Thirty-eighth Congress of the IPA, Amster-

Chapter 3. Presented at the Fortieth Congress of the IPA, Santiago de Chile,

Chapter 4. Presented at the Conference on Migration, Bressanone, Italy, July

Chapter 5. Presented at the Conference on Remembering, Acting and En-

Chapter 6. Presented at the IPA Congress, Rio, 2005. Published (shorter

Chapter 7. Presented at the German Psychoanalytic Society (DPG),

Chapter 8. Presented at the Conference on Trauma and Youth Culture,

International Journal of Psychoanalysis (2004) under the title ‘‘Working

‘‘We all mourn: C’est la condition humane,’’ eloquently states the

The elaboration of mourning eventually leads to a better

through my therapeutic narcissism, redefine my analytic goals, and

transmitted to them by their parents. The mechanisms of ‘‘enactment,’’

Mourning is a concept that originally appeared in papers dealing with de-

inherent in mourning, and then explore various defense configurations

Weiss continued this line of thinking. ‘‘Love objects become, as we

DEFENSES AGAINST PAIN AND MOURNING

among the healthy responses to pain, and an attitude of hopelessness and

to the paranoid-schizoid position, and that form a powerful, integrated

its relinquishment of unobtainable goals with eventual formulation of

mourning avoids working through the loss by maintaining a fantasy that

The elaboration of this defense, as illustrated in the various chapters,

there are two categories of reparation, which are expressed through

The Omnipotent Needy Child

Phase I: Struggling with Denial of Death and Separation

dered whether Dina might have experienced my reactions to her in analy-

Phase II: Accepting Her Monosexual Destiny

Phase III: Discovering a Part of the Denied Inner Reality

Phase IV: Accepting the Limitations of Age and Gender

In order to illustrate Dina’s manic defenses against the limitations of age

to save him.’’ In the transference, I referred to Dina’s feelings of being

merge with me narcissistically, while harboring the murderous wish of

dimension into the transference relationship, through which we were able

Fear of Psychic Pain

wasn’t Dina’s struggle to postpone aging and death a universal one?

my unvoiced questions, said: ‘‘I am all right, you know. I am working as

Lust for Love

The First Encounter—Desire and Fear

Desire and Inner Deadness

Desire and Persecutory Fears