The American Journal of Psychoanalysis, 2008, 68, (177–188)

© 2008 Association for the Advancement of Psychoanalysis 0002-9548/08 $30.00

www.palgrave-journals.com/ajp

ALLERGIC TO PEOPLE: BUILDING BRIDGES

IN A RIPPED PSYCHIC-SOMA

Stefanie Teitelbaum

An exploration of the use mind/body metaphors in a woman whose physical, environmental

and psychoneurotic trauma culminated in an irreversible colostomy. She lived in a world of
concrete symbols, her primary process damaged such that she could not create generative
symbols to process her trauma. She regressed to a state of infantile megalomania, recoiling
from the external reality of subjective others. Her introjective disorder mirrored her digestive
disorder as she could absorb neither good objects nor good nutrients. The analytic situation
has been an auxiliary fecal container and we work to bridge her mind body split with
mind/body metaphors. As she reclaims lost development mastery, she displays a symbolized
sphincter. As her capacity to form symbols grows, she rages and mourns for the loss of her
fantasized ideal parents and her ideal body.

KEY WORDS: colostomy; digestive disorders; psychosomatics; mourning; symbolization.

Doi:10.1057/ajp.2008.9

This essay explores the clinical use of mind/body metaphors as healing

agents in Margot’s psychoanalysis; a woman ravaged by environmental,
physical and psychoneurotic trauma at just about every theoretical cross
cut of development. She regressed to an intermediate stage of reality, in
between Freud’s sharp bifurcation of pleasure and reality principles (Freud,
1911) to a state dominated by infantile megalomania (Ferenczi, 1913). Her
fixation is regressive; she had developed a nascent, nasty, persecutory
superego whose demands that she submit to the existence of subjective
others evoke floods of rage and shame. When the shock of the unimagined
impinges upon her reveries, her recoil is catastrophic (Eigen, 1973). She
flails like a small child knocked off her feet firing an enormous rifle. She
names her annihilation anxiety as guilt, endless as her craving to connect.

Stefanie Teitelbaum, MSW, LCSW, NCPsyA, Member, Training Analyst, Supervisor, National
Psychological Association for Psychoanalysis (NPAP). Member, Faculty, Training Analyst,
Supervisor, Institute for Expressive Analysis (IEA).
Address correspondence to Stefanie Teitelbaum, MSW, LCSW, NCPsyA, 156 Fifth Ave, Suite
1208, New York, NY 10010; e-mail: stef.teitelbaum@gmail.com
Paper presented at the Clinical Sándor Ferenczi Conference, August 2–6, 2006,
Baden-Baden, Germany.
178 TEITELBAUM

She suffers as one who dearly loves cats but whose hyper-vigilant
auto immune system makes contact with her pets life-threatening. She is
allergic to people.
Psychic anorexia (Freud, 1895) has also been a critical central metaphor
in her treatment. Anorexic and depressive starvations are different. The
anorexic is eternally hungry and is endlessly thinking of food: the depres-
sive has neither appetite nor fantasy. The first is an effort to master eternal
disappointment, the latter capitulates to hopelessness. Margot knows both
states well, and often feels both at the same time. She prefers depression;
anorexic hope is too painful. She hopes in opposition to herself. Her starved
psychic-soma, cataclysmically split, is at war with itself, a ghastly self civil
war. Neither army is strong enough to carry out the sadistic super-ego’s
marching orders fight to the death. The psychic hemorrhage, a material
experience of floods of violent feelings (Freud, 1895; Bion, 1953) is an
affect with a physical double she knows well. Margot has high blood
pressure and fears her panic attacks will bring on a stroke like the one
that left her mother brain damaged, a living dead. She absorbed this dead
mother, the massive decathexsis of a living imago (Green, 1983). She is
allergic to excitement. Excitement = Death. Passion, she believes, brought
on the ulcerative colitis that made childhood a living hell. Passion, she
was told, made her an impossible child, made her mother wish she had
never had children. Poetry needs passion. Margot has stopped writing
poetry. Her self-image as a poet has been the only part of herself that
Margot can love.
Metaphor, allegory, analogy, simile, etc., are not symbols. Symbols are
psychically determined, be that determination phylogenic or ontogenetic
(Ferenczi, 1912).
..metaphor can only evolve in language or in the arts when bodily orifices can be
controlled. Then only can the angers, pleasures, desires of the infantile life find
metaphorical expression and the immaterial express itself in terms of the material.
(Sharpe, 1940)

Margot’s rectum was disabled when she was 16, removed at 21 to save
her life. We needed to find an alternate route for language to express
instinctual life (Freud, 1915). These pre-symbolic bits work as an auxiliary
primary processor, jumper cables to reanimate her shocked psychic life
(Eigen, 1995a). Her symbolizing capacity exists; its vestiges are seen in the
now silent voice of her early poetry, and the screaming voice of her somatic
symptoms. The absence is not one of developmental arrest, but one of
traumatic regression. She found resonance in a Helen Keller analogy; Helen
had achieved the gift of signification before catastrophic illness drove to
the abject horror of primal repression. Instead of the face of her idealized
 BUILDING BRIDGES IN A RIPPED PSYCHIC-SOMA 179

self, when Margot looks into the mirror of Narcissus’ river, she sees an
ostomy pouch. Her self-representation is cast off by her ego, and left as a
relentless object of loathing by her superego (Kristeva, 1982). Helen’s and
Margot’s prognosis might have been quite different had not these critical
milestones been achieved before the disaster. The body metaphors opened
diplomatic relations between Margot’s warring, split selves. The negotiations
are painful, like psychic frostbite, the pain of fresh blood reaching the
thawing extremity. Margot remembers her intact self, body and soul. The
memory binds her, but is excruciating. Nostalgia is an agony every bit as
torturous as torture itself (Levi, 1995).
Psychoanalytic sessions have been like allergy shots. Now in the 13th
year of analysis, we have built up some tolerance to the other’s dander.
Session/shots have been reduced to twice weekly with a rare phone call
between sessions. A symbolized sphincter control has developed; she can
hold the “shitty” feelings between sessions. Nascent anal mastery revives
the trauma of autonomy. Her autoimmune system rejected autonomy, which
signaled the loss of the object’s love (Freud, 1926):
Memory: I was so ill and a cousin offered to help my mother and took me to stay
with her. I was desperately homesick and called my mother, weeping, begging to
come home. I was ecstatic when she arrived. She said, “I came because you were
miserable. You’re happy, why did I have to come?”

Margot’s is a raging, ravenous psyche that fears the indictment of greed

above all. Her reaction formation character was marked by an exquisite,
uncomfortable sensitivity to courtesy and squeaky-clean language (Freud,
1908). At her most developed, Margot lived in a hell of the paranoid-
schizoid position, endlessly repeating projection, identification and intro-
jection without symbolic processing, unable to taste the liberating reality
of the half-angels and half-devils of the depressive position (Klein, 1946).
Ferenczi (1912) equated the pleasure principle with a projection phase
and the reality principle with an introjection phase. Klein’s paranoid-schizoid
position includes rudimentary identifications, and Margot’s identification
capabilities were savagely compromised. She sang “I love my father, I hate
my mother” from the time she was 7, on the precious post-divorce Sundays
that she spent with her father. She had to choose between her father’s love
and the identification with her mother necessary to end the Oedipal conflict
(Freud, 1924). The traumatic relationship with her father forced her to freeze
her object world in good/bad split parts. When the Thanatos-laden splitting
became too much to bear, she regressed to an earlier emerging reality and
could no longer use developmental projective identification to grow.
Margot is both aware and ashamed of the omnipresent passivity that keeps
her at the mercy of others, yet taking active steps towards self-protection and
180 TEITELBAUM

self-satisfaction seem impossible to her. Over-determined, catastrophic

identifications can cause an utterly passive personality, similar to that seen
in parasitic organisms utterly and hopelessly dependent on the host
organism. This type of character develops from physical memory traces of
the feeding infant; “Through memory traces of alimentary experiences, the
infant introjects the good feeding mother = the good self, and the bad-frus-
trating mother = the bad-frustrated (hungry, painful) self” (Grinker, 1956).
The psychobiological paradigm adds to the Kleinian fantasy. Margot was a
colicky infant, and the pediatrician’s advice to her mother was to let Margot
“cry it out.” While Klein seems to come to life in being with Margot, I recoil
at understanding her self-assaults as death drive derivatives. She has good reason
to reject both maternal and paternal introjection. She fights for life by screening
out psychic toxins. Eros wears a demonic costume in her, like the ostomy
pouch—the macabre life saver she loathes—that clings to her body.
Yet a classical, biologically based death drive screams out in Margot’s
persona. Catabolic, destructive metabolism, taking simple food and simple
tasks and breaking them down so as to produce an explosion of negative
energy leaving nothing of value for the psychic-soma to absorb. The “simple”
task of leaving a message on an answering machine leaves Margot depleted
after the passionate torture of trying to get it right, hounded by her sadistic
superego introjects (Freud, 1923).
A trim, fit, pretty, sullen Margot, looking more like a teenager than a
32-year-old woman, brought a dream to the first session:
“My girlfriend was nursing at my breast like a baby and she was draining the
life from me.”
Me: There’s only enough life for one.

The teen imago told a story. Margo lived her teen years as a virtual shut-
in. She looked like an 8-year-old at 16, recalled painful memories of shame
when she tried to do grown-up things and was perceived as a child and
scolded by strangers. She missed the adolescent’s opportunity to redo some
of the damaged psycho-sexual developmental steps (Blos, 1966), living as
a self-described freak as a curious, sexual teen encased in a little girl’s
body. She felt safe only in her room, in the fantasy life she and her
dolls created, comforted by the knowledge that her preoccupied mother
was somewhere in the house, the mother that might have preferred dolls
to the living subjectivity of her children (Stoller, 1979).
Winnicott (1964, 1969) called somatic expression of psychotic anxiety a
body madness, and used the metaphor of “a picture without a frame.” I too
rely on the somatic alternate route of expression and I got used to our two
frameless pictures co-mingling. I feel the life draining from me and have
stopped fighting sleep to let projective identifications become conscious as
 BUILDING BRIDGES IN A RIPPED PSYCHIC-SOMA 181

hypnagogic hallucinations. These body communiqués of the two-person

unconscious are powerfully intimate. I have felt ravenous hunger and jaw
clenching rage. Sudden, volcanic urges to move my bowels left me close
to experiencing the accidents that ruined her childhood. My chronic sinusitis
has erupted in her sessions. I cannot control my coughing and am shamed
by my nasal incontinence. Perhaps the drip cough is displaced crying, the
choked back tears we know so well. We have recreated the infant’s fusion
fantasy of the mother/baby dyad with a single skin, as the rash on my legs
flares in harmony with a fungus whose pale object shadow falls upon
Margot’s skin ego (Freud, 1917; Bick, 1964; Anzieu, 1985).
Dream: “I was in your house. You were puffy, bloated. Your skin looked like some
strange, pale, blown- up parchment. I was ashamed to be there looking at you.”

She is in my psyche. The bizarre skin, the single skin our fused selves
share (Bick, 1964) is the ostomy pouch I want to see. Two shamed voyeurs,
we are a shit bag. Eye trauma = I trauma (Ferenczi, 1912). Had she noticed
I had gained weight (my somatic shame emblem, evidence of my greed)?
Me: What would have happened if you told me you noticed I gained weight?
Margot: (whisper) You wouldn’t let me be your patient any more.

The confusion of tongues (Ferenczi, 1933) was omnipresent and she

learned to hold her tongue.
Memory: “My father and I were skipping down the street together, holding hands.
Bliss. I smiled at him, he said: ‘You only think that I’m happy.’”

She was coerced under threat of loss of love, loss of the object and
ultimately the threat of mind and body annihilation (Freud, 1917), to destroy
the reality of her common senses (Bion, 1959), to be consigned to an
endless hell of epistemology and reversal (Eigen, 1984) to maintain ideal
selves for her parents to see in the mirror of her gaze. A seductive, depressed
father and uninvolved mother, a divorce when Margot was seven left the
Oedipal phase in chaos as the possibility of Oedipal victory loomed with
father and daughter, bonding in their hatred of the mother who lived in a
fantasy of romance and stardom, irritated at the intrusion of her two chil-
dren’s demands, bored and contemptuous father a generation older than
his, beautiful, unfaithful and ultimately abandoning wife, still melancholic
over the loss of his own mother at age seven, demanded the twinship of
chronic depravation from his favorite child.
“I live for Sunday,” wrote the precocious poet, about her day with
her father. She had no hope of variation, of a mid-week feeding. Did
she see him in those ghastly years she was bed-ridden? She doesn’t
remember. Margot’s rigid character is a pseudo-frame, a frame without a
182 TEITELBAUM

picture, a negative psycho-somatosis. The anal phase of superego formation

with its development of sphincter morality (Ferenczi, 1925) was compromised
when her anal sphincter was removed. Her character is bound by a ubiqui-
tous, deadening, often nasty moral violence (Eigen, 1995b). The sphincter,
the dam of the great reservoir of libido was gone, leaving a reservoir of liqui-
fied feces. For Margot, both id and ego have been wiped out in a shit flood,
leaving a punitive, horrific superego, a horrific overcompensation for the loss
of the piece of soma that holds the bedrock of civilization (Freud, 1923).
Margot created her own civilization dam at the cost of her happiness.
Anal castration saved her life and murdered her soul. “Probably no male
human being is spared the horror of castration at the sight of the female geni-
tals” (Freud, 1927). The fetish replaces the horror of the sight of the mother’s
amputated penis. The ostomy she so despises is fetishized, eroticized:
Dream: “My clitoris was elongated and black, like the pedal of a clam. I suppose
YOU (sneering) think that’s about penis envy.”

I thought of the black pedal as the piece of stoma protruding from the
slit of her abdomen.
Me: What’s the sneer about? (my sneer not quite excised, my people allergy flaring.)
Margot: (anxious) I can’t imagine what else it could be.
Me: Are the experiences of the world limited to your imagination?
Margot: (relief) When I was sick, imagination was all I had.

One doesn’t need a body to imagine. The sneer was the expression of
annihilation anxiety, a threat to the safety of infantile megalomania in both
of us. We scared each other to death and then discussed both our inter-
pretations of her dream. Next session:
Dream: “There was a magical alien creature, the size of a cat. Its fur was neon pas-
tel colors and a different texture than fur. An older woman, (that must be you) said
‘she’s a very special creature and doesn’t use the litter box like the other cats.’”

The rectal amputation is the greater trauma than the inescapable ostomy
apparatus. A male lover wants to worship her asshole. Disclosing the ostomy
was relatively painless. Not having the anus he wishes to worship is devas-
tating. The anus is neither male nor female. Her fetishistic effort to soothe
castration trauma transcends the preoedipal trauma of gender identification,
perhaps the root of her bisexuality.
I love you but because, inexplicably I love in you something more than you—the
objet petit a—I mutilate you. (Lacan, 1973)

Margot loves something more than herself in herself; a delusional, excre-

mental object of desire that will open the magical door of jouissance. She
turns against herself, mutilating her self-esteem, pleasure in work and ability
 BUILDING BRIDGES IN A RIPPED PSYCHIC-SOMA 183

to write poetry (Freud, 1915). She is allergic to herself. Jocasta begs Oedipus
to look no further, do not seek lest you find the horror. Margot decimates
her goodness so that nothing is left but horror. She is bereft of the comfort
of negative hallucination (Freud, 1911).
After the initial self-state dreams, Margot’s dreams were prolific, detailed,
flooding, evacuating intolerable affect, providing momentary relief, but the
structural change brought about by the structuring work of the primary process
didn’t happen. Her dreams neither protected her sleep nor created symbols,
dramatizations or poems with which she could comfort herself (Freud, 1933).
She feared self-comfort. Her only hope for love rested in arousing sympathy
from a lover-parent figure, male or female. Getting that sympathy, she feels
guilty about feeling sorry for herself, her only dependable comfort. Comfort = -
Loneliness, Contact = Pain. The psychotic superego would wake up, endlessly
repeating its impossible double-bind like a great sleeping snake eating its own
tail, getting smaller and smaller until the tiny dot on the horizon disappears
into a complete emotional shut down of psychic death (Eigen, 1984). Concrete
symbols and beta elements took over her dream work, leaving her dependent
on the analytic sessions and phone contact between sessions for comfort.
I have wanted to write about Margot for years, but find my primary process
breaking down into bibliographical diarrhea. I see bits of her in everything I
have read; titles and footnotes run through me unprocessed, waste to be flushed
like the undigested food that ran through her ulcerated intestines leaving only
the fecal no-think thoughts of damaged primary process.
My Dream: “I’m in a small room, my feces are all over the floor, pouring out of me.
I am horrified, not only at the mess, but that I can’t feel the evacuation, can’t identify
the orifice from which my feces spew, and I didn’t know it was happening. Horror.”

In the realm of external reality, I can’t really know what it feels like to
be her, but perhaps I can know in inner reality. Which is real, which is the
facsimilie? Margot would argue the primacy of external reality; I’ll keep
my preference for The Real (Lacan, 1973) to myself for the time being.
If dreams are the royal road to the unconscious (Freud, 1900) the hyster-
ical somatic expressions we share are off-road treks to the same destination,
more so than the bowel movement dreams (Ferenczi, 1919, Rangell, 1958,
Segal, 1981). I have thought about psycho-somatosis as a body expression
of beta elements, but today they seem like encapsulated alpha elements,
like images in a dream within a dream, symbols, interpretable, but needing
to be freed to be absorbed and processed by the dream work:
Dream: “There is a turtle inside a double glass bowl, like a terrarium. There is green
leafy food inside the first and second glass layer. I try to feed the turtle, but it will
only eat the greens in the glass.”
Me: Like the way I try to feed you, but you’ll only eat your own food.
184 TEITELBAUM

Her cheeks flushed with relief. Good blood, good flush. She is under-
stood and understands. The turtle cannot get to the greens through the glass.
The image of self-sufficiency was a megalomaniacal delusion. The turtle,
unknown to itself, was starving and needed coaxing to come to the banquet
table of alpha function structuring. Margot eats sparingly of Eros’ meal.
The recovering physical anorexic is at risk for cardiac arrest and needs
to be careful when she starts to eat again. Identifying with me, a therapeutic
alliance, positive transference, attachment, irritated her allergy to me.
Once she spoke of ending treatment, when her feelings for me crept into
a dream:
Dream: “My mother and I were together, on a plane to San Francisco. I was
in heaven. Then I realized I would miss you.”
Me: (touched) I think you like me more than you would like either of us to know.
Margot: (exasperated) Well, why else would I still be here?

The derivatives of Eros need to be kept secret. In recent years she has
let me see her wild sense of humor, know about the pleasure she takes in
eating good food. She has even confessed to a piece of mastery; she is a
good cook. Yet she demands recognition of her inner reality, the experience
of endless deprivation and chronic loss of agency. Cooking is not creative.
Only creativity in the fine arts could make her life meaningful. She rejects
psychoanalysis as an act of creativity. We are bound in the twinship of
deprivation, the only intimacy she has ever known.
If the psyche seen in analysis shows us the baby-self, never was there a
baby more in need of demand feeding. Extra sessions, schedule and
frequency changes and phone calls between sessions were like extra
feedings. I never thought of her as being able to use traditional analytic
work until reading her journals and poetry in the second and third
years of therapy, when a devastating disappointment left her silent for
weeks. I was able to peek at her symbolizing self. She was capable of and
needed deeper work to transfuse her anemic primary process with some
red blood cells.
A recent mind/body allegory failed. She panics as she leaves her passive
safety, risking anger and/or abandonment to protect herself with her lover,
friends, family, colleagues and me. I likened the feelings to the aches of
stretching her fitness proficiency, a kind of psychic growing pains. No
resonance for her. Aloud, I wondered if she was so fit as to be perfectly
toned; silently I wondered how much she is in her body. The Gnostics
believed that the soul has to be enticed into the tomb of the womb. The
mental ego observes and informs the body ego until self-hatred shrinks
the former into oblivion (Federn, 1926). Winnicott’s (1988) pediatric
observations saw self in body as a developmental milestone. All point to a
 BUILDING BRIDGES IN A RIPPED PSYCHIC-SOMA 185

primordial, originary out of body consciousness. I have wondered how she

was able to stay in her body those years that she was bedridden, neglected,
wasting away, weighing 45 pounds at age 16, sometimes lying in her own
excrement, needing extraordinary care from a mother who struggled to give
the minimum.
Recent Dream: “There is an ostrich outside my window with beautiful long white
feathers. It is stumbling as if it were drunk. I feel sorry for her, but I’m glad she’s
outside.”

Glass can keep out toxins and well as nutrients. The boundaries of
Eros.
My hypnagogic hallucination from years ago: A beautiful bright pink flamingo
slowly cranes its neck through its spindly legs and shoves its beak up its ass.

Perhaps her primary process is starting to work on a transformation of

that super-ego snake. Perhaps the loss of her anal sphincter helped prevent
the regression to a complete personality collapse, oral/anal fusion, a florid
psychosis.
Me: You’re used to talking to the ass-end of strange birds with heads buried in the
sand who can’t hear you.

Feathers are nasty irritants to an allergic soul; her allergies are lessening
as this toxin enters her dream work. I am a strange bird to her, with my
new white hair, not always hearing her as she needs to be heard. Over the
years, she has spent a fair amount of time talking to my ass end as well as
her own. We’re getting used to each other’s absences (Green, 1975).
Fairy tales can be a way for parents to project their own intermediate
reality onto their children (Ferenczi, 1913). Such was Margot’s experience,
a perversion of transitional play (Winnicott, 1953). She speaks of her mother
living in a fairy tale world. Snow White has been important in Margot’s
analysis, an archetype of her initial dream of the two women battling for
a single life. To be sexually attractive to men is proof of life in a life not
experienced as alive. Clumsy, limited psychoanalysis has dropped Snow
White’s glass schizoid coffin many times, cracking (if not yet shattering) it,
dislodging the poisoned apple neither absorbed nor evacuated. Margot
grieves at waking up middle-aged having missed so much of life, particu-
larly the chance to have children. My snow blonde hair is a last gasp of
transitional play as I prepare to leave middle-age, each of us uncertain
about our identity as sexually attractive women as time marches on.
Hysteria, with all its somatic expressions, is a trauma of position in the
world as well as one of identity (Mitchell, 2000; Winnicott, 1964, 1969).
Margot and I have moved beyond dependence on pre-symbols and use
186 TEITELBAUM

transitional play more and more in analysis. She sometimes used the “people
allergy” metaphor as a transition object outside our sessions to calm
herself so that she can use the reality principle in life’s daily travails. Perhaps
that last mind/body metaphor in session failed because she has outgrown
them and I used that metaphor to project my childlike self into her and
keep her my dependent baby. Now we can play. She said I could have
Paul Newman; he’s too old for her. I gave Tom Cruise to her; he doesn’t
turn me on, he’s too young for me. If there are enough men for both of us,
maybe there is also enough air for us both to breathe. After his attacks
on psychoanalysis Margot may not want Tom Cruise any more. She first
identified with my love and respect for psychoanalysis before considering
me as an introjectable subject. We might, however, have to fight it out
over Johnny Depp. Cat fight scratches sting, but maybe we can both
survive.
Margot happily and generously gave permission to write and present her
story and asked to read the paper. We had not spoken of the paper for
some months as the submission deadline approached for the Clinical
Ferenczi Conference. My performance anxiety flared and I thought about
withdrawing from the conference. With not a trace of her characteristic
passivity, she asked with seeming ease and confidence, “By the way, have
you written that paper yet?” I wrote it. Margot’s allergy to excitement is
waning, but she still cannot tolerate the thrill of writing poetry. She helped
me get this essay written and perhaps analysis will help her poetry. Maybe
we can both write, too. I wonder what not yet imagined bits of life, plen-
tiful enough for two, are possible for us.

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