Doidge - Diagnosing The English Patient - Schizoid Fantasies of Being Skinless and of Being Buried Alive

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Doidge, N. (2001). Diagnosing the English Patient: Schizoid Fantasies of being Skinl... J. Amer. Psychoanal. Assn., 49:279-309.
(2001). Journal of the American Psychoanalytic Association, 49:279-309
Diagnosing the English Patient: Schizoid Fantasies of being Skinless and of

being Buried Alive
Norman Doidge
The psychological world of The English Patient is explored to deepen the understanding of schizoid states. The
protagonist, Almásy, is a remote desert explorer whose triangular sadomasochistic affair with the married Katharine
destroys them all. His damaged skin is understood as a symbolic representation of his psychological condition. For
the schizoid, love consumes and leads to obliteration of the self, represented by the loss of identifying features, and
to traumatic permeability (i.e., the loss of boundaries between self and other, and between the ego and repressed
desires). Other schizoid themes are the animation of the inanimate, as in the depiction of the desert as a woman;
hidden or buried identities; the digital and destructive experience of emotion represented by the conundrum of the
bomb defuser; the sense that everything good is imaginary and might suddenly explode; and the moral unevenness
of the characters. Almásy collaborates with the Nazis so he can retrieve Katharine's three-year-old corpse, with
which he has necrophilic contact in a cave. Fantasies of the lost object buried within the self, of being buried alive,
and of being skinned alive are related to the schizoid condition. Hyperpermeability is proposed as a core schizoid
state, underlying schizoid withdrawal.
One would have had to have lived in a cave in the desert for many months in 1997 not to have heard of The English Patient, the
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Training and Supervising Analyst, Canadian Psychoanalytic Society, Toronto Branch; Head, Long-term Psychotherapy, University of Toronto,
Department of Psychiatry; faculty, Columbia University Center for Psychoanalytic Training and Research.
This essay received the American Psychoanalytic Association's CORST Essay Prize In Psychoanalysis and Culture in December 1998 and the
Canadian Psychoanalytic Association's Miguel Prados Essay Prize in June 1999. It was delivered as a keynote address to the Royal Australian
and New Zealand College of Psychiatrists, in Perth, and was broadcast on Life Matters, in Sydney. Renée Cosgrove alerted the author to French
research on intrapsychic tombs. Submitted for publication September 14, 1998.
WARNING! This text is printed for the personal use of the PEPWeb subscriber and is copyright to the Journal in which it originally appeared. It is
illegal to copy, distribute or circulate it in any form.
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novel by the Canadian writer Michael Ondaatje, which won the Booker Prize and became the basis for director Anthony Minghella's
film, the winner of nine Academy Awards including Best Picture that year. The film recalls Lawrence of Arabia, with its central
character a refined and classically educated Westerner exploring and attempting to redeem the nomadic heritage of the desert; it
equally recalls Casablanca in its use of a romantic North African setting on the edge of the encroaching Second World War to
demonstrate how war interferes with private lives and affects an evolving love triangle. Set in the 1930s and 1940s, this seductive story
about an adulterous affair, with two attractive leads unencumbered by the obligations of children, sporting Ralph Lauren–type khaki
desert wear and a haute eco-sensitivity to the desert, has resonated with many current fashions, intellectual and otherwise.
And yet there are those for whom the characters and landscapes are merely beautiful surfaces that are hollow inside. These
detractors report leaving the theaters having felt seduced in the sense of having been tricked, because it dawns on them that the story's
climax involves a most unbeautiful act—putting thousands of innocent people under Hitler's control when the “hero” turns crucial
British maps over to the Nazis. These maps enable the German forces to successfully attack Tobruk and almost win the war in North
Africa. And why does the hero do this? To retrieve the three-year-old corpse of his dead lover. Further, he is without remorse—“I
made a promise. The rest meant nothing to me” (Minghella 1996, p. 147)—and successfully convinces the other characters of the
forgivability if not nobility of his act. He seems to persuade them that both sides are equally wrong in the war. When confronted by the
fact that had the Nazis not been foiled thousands of people might have died because of what he did, he answers, “Thousands of people
did die, just different people” (p. 147). This neutralizing calculation appears to tally for the other characters, and in the end the English
patient seems to compel their sympathy, pity, and admiration. Indeed, it has been pointed out that the real Almásy was not an
accidental collaborator but a Nazi spy, and Ondaatje has been criticized for misrepresenting this (see Salett 1996).
I shall for the most part bypass that important controversy—the historical-revisionist attempt to level differences between the Axis
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powers and the Allies—and instead attempt to understand the psychological world of The English Patient. I shall make reference to
both the film version and the novel (Ondaatje 1992), using the latter as the
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principal text, except where indicated. Minghella wrote the screenplay in close collaboration with Ondaatje, who has stated that the
film powerfully evokes his novel and characters (Ondaatje 1996a, p. xviii). Though the film is better known, the novel more fully
elaborates the internal lives of the characters. It also contains important disturbing elements that have been airbrushed from the film.
I will pursue two goals here, equally important. The first involves applied analysis. I shall try to explain many apparently
unrelated things, such as why the patient was a burn victim who fell from the sky, the conditions of his loving (including why he
makes love to a corpse), the meaning of the Gyges story, the role of the desert expanse, and why all the characters forgive the English
patient. This requires not only “diagnosing” the English patient as though he were a real person, but, more important, diagnosing The
English Patient as a work of art to show how it achieves its mood and power by evoking a particular set of fantasies. I argue that these
fantasies are related to schizoid states. My second goal is to deepen our understanding of schizoid fantasy life by showing how the
images of skinlessness and of being buried alive are clues to understanding two distinct schizoid states: hyper-permeability and
withdrawal. These two states, though not confined to schizoid conditions, are particularly prominent in them. I will first briefly
summarize the plot of the film, review some key works on schizoid conditions, propose some new concepts, and then examine the
novel's characters and plot in depth. Finally, having benefited from an immersion in the work, I shall explain the relationship between
hyper-permeability and withdrawal, and the primary place of permeability.
The Plot
The film begins as follows. We see a plane flying languidly over the desert. It comes under enemy fire and is blown out of the
sky. The pilot turns into a human fireball and is found completely burned in the wreckage by Bedouins. He is turned over to the British
and taken to Italy for nursing. His real name is Count Almásy, but he hides his identity from the British, claiming amnesia. A nurse,
Hana, originally from Canada, leaves her colleagues and patients to nurse him, and him alone, as he dies. She finds, overlooking the
beautiful hills of Tuscany, an abandoned Italian villa in which to care for him. There they are visited by two figures, the first a
Canadian thief turned spy, named
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Caravaggio. He has come, we learn, to kill the English patient, who he suspects to be the man whose betrayals led to his capture,
torture, and permanent disfigurement by the Nazis. We learn also that the villa has been mined by the retreating Nazis. The second
figure is a Sikh sapper—a defuser of bombs—who joins the group and falls in love with Hana, only then to leave. As time goes on, the
English patient seems more willing to speak, partly because he is dying and wants to speak, partly because he is being drugged by
Caravaggio.
The patient reveals that he was a Hungarian explorer who worked in the desert during the 1930s with men from different
countries, hoping to find lost cities, lakes, and caves. During their work, young Geoffrey Clifton and his wife Katharine join them.
Geoffrey is secretly working for British Intelligence, photographing North Africa in preparation for the looming Nazi invasion. At first
Almásy resents Katharine's joining the previously all male group, claiming the desert is no place for a woman. But soon he starts to fall
for her, follows her, and they begin an affair. They spend their first night together, and fall in love, while being buried alive in a jeep
during a sandstorm. Subsequently, they make imperfect attempts to hide their affair. Almásy, however, is wary of love and writes that
the heart is an organ of fire, that burns. He does not feel guilty about hurting his friend Geoffrey. When the latter can no longer
tolerate the affair, he attempts, in a rather operatic way, to kill Almásy in a suicidal plane crash. But only Geoffrey is killed. Katharine
is gravely injured, and Almásy escapes unharmed, dragging Katharine off to a cave. She tells him that should she die she wants to be
buried back in the garden of her childhood home in England. Almásy then treks through the desert in search of medical help. Finding
two junior British officers, he demands deliriously that they give him a truck to rescue Katharine, who he says is his wife. But a war is
on, and since he has no identification papers and is Austro-Hungarian, he is suspect. Making a scene, he is incarcerated. Eventually he
escapes, and to get safe passage back to the cave where he has left Katharine, he helps one of Rommel's spies cross the desert to get to
Cairo. He also turns over Geoffrey's reconnaissance maps to the Nazis, which allows them to take Tobruk. Almásy then retrieves
Katharine's body, and puts it in his plane to take to England. It is at this point that he is shot down over the desert and turned into a
human fireball. Burned to the point of being unrecognizable, he is in Hana's eyes “a man with no face. An ebony pool. All
identification consumed in a fire” (p. 48).
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Upon hearing this story, Caravaggio reveals himself to the patient as one of his victims, for when the Nazis invaded Tobruk they
captured and tortured him, amputating his thumbs. He tells Almásy he had come to kill him. But now he will not. The love story has
somehow justified Almásy's treachery. “It is about forgiveness, how people come out of a war,” Ondaatje has said (1996b).
I have, by italicizing the bit about the heart being an organ of fire, that burns, intimated my hypothesis that the English patient's
physical condition, in which “all identification [has been] consumed in a fire,” is a symbolic representation of his psychological
condition. He is burned because he has been consumed by love. Indeed, Almásy, Geoffrey, and Katharine all die as a consequence of
their love triangle; all are consumed by it. But the image of a man without a protective skin may also symbolize a fear of losing the
external boundary between self and other and the internal boundary between the ego and its warded-off desires.
Before giving a detailed analysis of the characters, I wish to propose the general hypothesis that this film and the novel on which
it is based depict the world of schizoid object relations. Perhaps this hypothesis sounds jarring, for is this not the story of a passionate
love relationship, and don't we think of schizoids as people who are withdrawn and incapable of expressing feeling? I will argue
nonetheless that all the main characters—including even the desert that in a way plays the starring role—represent aspects of the
complex schizoid world of which Almásy presents the most obvious example. Each of the main characters may be seen as a
hypertrophied aspect of Almásy; they are expressive foils who “reflect and qualify” him (Ondaatje 1996b). I first began to see this
story as a depiction of the schizoid world when I sensed that the burned, skinless state of the English patient was best understood
symbolically; it reminded me of the dreams of charred, skinless creatures reported by one of my patients, dreams on which I had long
reflected. My patient had been traumatically overstimulated in childhood and presented with schizoid states and sadomasochistic
object relations. As a child he was terrified of being buried alive. Once I made this connection, the novel began to disclose a variety of
other schizoid themes: the hidden or submerged identities of the characters, three of them spies; an obsessive interest in the inanimate
world; a longing for isolation; the experience of emotion as either turned off or explosively present in Almásy and Kip, the bomb
defuser; the moral unevenness of all the characters; the inability of Katharine and Almásy to commit to
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each other or break it off; the romanticization of death; and the single-minded preference for the private life as opposed to the greater
good. All of this occurs against the traumatic backdrop of the war.
The Schizoid World

I use the term schizoid as it was first used by British object relations theorists, who called certain people schizoid because of
“schisms” in the personality.1 Because the disorder often involves skilled role play at ordinary social relations, clinicians often
misdiagnose these patients as obsessional or higher-level narcissistic characters. Akhtar (1992) has observed that these “schisms” are
based not only on the conscious versus unconscious opposition, but also on overt and covert descriptive features (p. 139). Thus, the
schizoid may be “‘overtly’ detached, self-sufficient, absentminded, uninteresting, asexual, and idiosyncratically moral, while
‘covertly’ exquisitely sensitive, emotionally needy, acutely vigilant, creative, often perverse, and vulnerable to corruption” (p. 141).
Such patients display a “moral unevenness”; they are “occasionally strikingly amoral and vulnerable to odd crimes, at other times
altruistically self-sacrificing” (p. 140). Guntrip (1969) argued that the key schizoid characteristics are introversion, withdrawnness,
narcissism, self-sufficiency, a sense of superiority, loss of affect, loneliness, depersonalization, and regression.
Affects. Schizoids are often thought to lack affect. Yet, though their affect is constricted, they are not without affective
investments. One schizoid patient, who seemed Spock-like talking to people, had a passionate fascination with machines. His
experience of emotions when dealing with people was almost digital: he was on or off, without the
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1 The significant problems with the current DSM-IV schizoid diagnoses are dealt with elsewhere (Akhtar 1992, p. 139; Gabbard 1994, p. 431).
DSM-III described two classes of individuals who are withdrawn from others. People with Avoidant Personality Disorders long for social
contact but anxiously anticipate rejection and so avoid people. Those with Schizoid Personality Disorders simply have limited interest in
relationships. These categories were meant to be mutually exclusive by definition. But empirical studies now show that many patients qualify
as both Avoidant and Schizoid personalities. Unfortunately, the DSM-III innovations took schizoid detachment at face value (Kernberg 1984),
ignoring the complex, if not byzantine, importance of human relationships for the schizoid person. Avoidant behavior is highly comorbid with
other personality disorders because avoidant behavior, or withdrawal, is a defense, or tactic, that many can use in times of interpersonal duress.
The character I will speak of would tend to qualify for Avoidant, Schizoid, and Narcissistic features according to DSM-IV.
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analogical crescendos and diminuendos of passion. For schizoid people, the smallest surge of emotion is like a bomb going off. This
state of affairs finds its objective correlative in the mined villa and in Kip, the bomb defuser who must turn off all his fear.
Reasons for seeking treatment. Schizoid individuals tend to alternate between two painful and complex states, a dependent one
and a detached one: “there is a consuming need for object dependence but attachment threatens the schizoid with the loss of self”
(Seinfeld 1991, p. 1). Schizoid persons can function well as long as they can successfully repress their intense dependence (p. 3); to
avoid losing themselves in relationships they protect themselves by withdrawal and affective isolation. But without meaningful
relationships, with affect shut down, they feel enervated, futile, and lifeless (Guntrip 1969). This chronic sense of futility,
meaninglessness, and deadness is easily misdiagnosed as dysthymia, depression, or existential anxiety.
Typical development and dynamics. The schizoid condition was first described by Fairbairn (1940, 1952), who believed that his
patients had withdrawn from parents, especially mothers, who were overtly rejecting, deserting, or unable to convince their child by
spontaneous and genuine expressions of affection that the child was loved as a person. “Both possessive mothers and indifferent
mothers fall under this category” (1940, p. 13). Akhtar (1992), in an extensive review, has shown that rejection, traumatic
overstimulation, and neglect in the first two years of life are common in the history of schizoids. Fairbairn noted that schizoids
preferred to withdraw into, and live in, a rich imaginary world.2
The core belief that love, rather than hatred, is the problem. Fairbairn observed that children with a rejecting or disappointing
parent develop an internalized image of a tantalizing but rejecting parent—the antilibidinal object—to which they are desperately
attached. Such parents are often incapable of loving, or are preoccupied
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2 The ability to create a vivid inner world in one's head gives a schizoid person some advantages at writing fiction. The downside is that the
schizoid's sense of other people is impoverished. Samuel Beckett, who was analyzed by Wilfred Bion, is often admired by schizoid people. He
articulates many schizoid themes, including the futility of everyday life, our isolation, and the limits of human communication. His characters
also attack ideals and meaning. Beckett, incidentally, often insisted that he had never been born, a fantasy that may relate to what I describe
below as the schizoid's sense that there is a baby buried alive within, or that personhood has not been achieved (see Simon 1988, esp. p. 231,
for a formidable analysis of the schizoid elements in Beckett; see also Knowlson 1996, pp. 169-175).
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with their own needs. The child is rewarded when not demanding, and is devalued or ridiculed as needy when for expressing
dependent longings. Thus, the child's picture of “good” behavior is distorted. The child learns never to nag or even yearn for love,
because it makes the parent more distant and censorious. The child may then cover over the resulting loneliness, emptiness, and sense
of ineptness with a fantasy (often unconscious) of self-sufficiency. Love and anger get hopelessly intertwined. Fairbairn argued that
the tragedy of schizoid children is that their conscience has been warped: they believe it is their love, rather than their hatred, that is the
destructive force within. Love consumes. Hence the schizoid child's chief mental operation is to repress the normal wish to be loved.
Being smitten. In my experience, when schizoid individuals fall in love with someone who reminds them—consciously or not—of
a rejecting parent, they will often describe themselves as “smitten” or some such equivalent; smitten is the past participle of to smite,
and to be smitten is to be disastrously and deeply affected as one falls in love, as though one has sustained a severe blow. (The British
upper classes frequently describe falling in love this way, and I suspect this is related to their sending children off to boarding schools.)
Pickinesss and prickliness. However, when a more nurturing person comes along, schizoids will often dream, guiltily, that they
are being disloyal to the parent imago, betraying a pact. This intense internal backlash derives from a pathological superego, which
unlike that of a loved child is antilibidinal because based on an internalization of the antilibidinal parental imago. Schizoid children
have a conscience that has made self-sufficiency an ideal and love a crime. Conscience always incites us to pour scrupulously over
events and see them in a moral light; the schizoid's conscience demands that he or she focus on the new love interest in an active,
picky, prosecutorial, and faultfinding way. Love becomes about as pleasant as litigation, for both parties. To avoid feeling picky,
schizoid individuals may try to withdraw or simply enter a defensive, turned-off state, finding the potential lover “boring” or “a turn-
off.” They go into total affect shutdown. Alternatively, they may become prickly and chronically irritable, so that others know not to
approach.
Under the skin, the wish for merger or fusion. Should the love object “get under their skin,” schizoid people feel taken over. This
is pleasant, insofar as it undoes their isolation and terror of separateness.
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But being smitten also releases the pent-up wish to merge and cling that, though appropriate in early childhood, was never satisfied at
that time; yet this longing gives rise to a fear of losing the external boundary between oneself and the exciting love object. In such
situations, schizoids feel as if the love object is possessing them, as in spirit possession.
Reversal of the values of life and death; preoccupation with the living dead, and with the dead in the living. While schizoid
patients may on the surface hold the conventional attitude that life is good, their fantasy life, so suffused with antilibidinal themes,
often displays a reversal of the values of life and death, and an emphasis on the futility of life that is so frequently expressed in
Beckett. For instance, many of us fear that death is futile, and goes on for an unrelieved eternity; Beckett depicts not death but life as
futile and as going on and on without meaning. Thus, there is in schizoids a strong tendency toward nihilism and withdrawal that must
be struggled against.
Being buried alive. Schizoid withdrawal is not only interpersonal; that is, it is not simply withdrawal from real people. There is
also a kind of intrapsychic withdrawal, based in fantasy. As treatment progresses, it is not uncommon for schizoid patients to reveal
fantasies of having buried their self within them—where it lies waiting until it is safe to be exposed (Guntrip 1969, pp. 22, 40). This
fantasy may represent an archaic wish to return to the safety of the womb. (In some cases this wish may be triggered by the child's
seeing the mother pregnant, with another being inside her.) The fantasy that the self is buried also explains a dread of many schizoids,
the fear of being buried alive.3 One patient dreamed, “There was a baby, it was buried alive. It was horrible and no one knew.” Images
of being frozen, put in suspended animation, paralyzed and unable to communicate, forced hibernation, and solitary confinement are
versions of being buried alive. The fantasy of being buried alive is probably related to the notion of encapsulation as a defense against
annihilation (Hopper 1991), and related imagery includes tortoises, crustaceans, encased insects, foxes in holes, armor, safety deposit
boxes, laminated objects, and items related to latex and leather perversions. Related to the fantasy of being buried
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3Throughout the nineteenth century in Britain and the U.S., coffins with flags, whistles, or bells attached were patented, to be used by people
who feared being buried alive to signal their sorry state. An Italian company recently marketed an electronic version. Sometimes the wish to
withdraw is so frightening that the patient may have nightmares of becoming lost in a black hole, isolated like an astronaut lost in space (see
Guntrip 1969).
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alive is imagery that fuses living states and dead ones. Imagery of the “living dead” and the “dead come back to life” are especially
common in gothic horror stories.4
Defensive Techniques Against Falling in Love

Ascetic ideals, the fantasy that the object is a temptress and desires are insatiable. To squelch this hunger for love the schizoid
may idealize asceticism. But like the ascetic who retreats to the desert to avoid human contact and temptation, the schizoid soon begins
to see the temptress—in wet dreams, sanctuary drawings, and religious stories—in a tantalizing return of the repressed. Mistakenly, the
schizoid concludes that desire is a bottomless pit; promiscuity and celibacy may alternate, both as attempts to deal with this perceived
insatiability. Related to this is a wish to be inanimate. Such patients may describe a wish to be passionless, to become bone, or rock, an
ice queen, sphinx-like. One, who cycled through periods of celibacy and promiscuity, was so tortured by peremptory desires that he
dreamed of a dead person, all bone and no flesh. In his associations he said, “This is how I wish to be, this would be happiness, to be
dry as bone, with no desire, or need, or longing.”5
Role playing. Another antilibidinal technique used by schizoids to preserve the pact with the bad parent is to appear to be involved
with others by role playing, and by being involved in a limited way. Fairbairn (1940, p. 16) showed that the schizoid can
unconsciously disown the social role even while playing it. A patient of mine who appeared cooperative and involved in sessions
disclosed, only well into treatment, that he always had the omnipotent fantasy that he was controlling everything I said.
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4 The state of being buried alive is similar, in ways, to the pathological organization that Steiner (1993) has described as “psychic retreats.”
Psychic retreats occur in patients who dread contact, and who have had exceptional difficulty in the paranoid-schizoid position, and typically
appear “as a house, a castle, a fortress, a desert island, or a similar location which is seen as an area of relative safety” (p. 2). Psychic retreats
can also be represented in a semipersonified way, as an organized gang, a totalitarian regime, or the Mafia, all of which provide “protection,”
but at a cost.
5
5One thinks of T. S. Eliot's “The Hollow Men” or the lyric by Simon and Garfunkel, “I am a rock, I am an island,” in which “a rock can feel no
pain.” St. Anthony fled desire, isolating himself in the desert, where he was repeatedly tempted. Flaubert's Temptation of St. Anthony closes
with the saint wishing to turn into inert matter.
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The in and out program. A related distancing technique has been described by Guntrip (1969) as the in and out program. It
involves “always breaking away from what one is at the same time holding on to” (p. 36). This may involve “rushing in and out of one
marriage after another,” or always emphasizing to one's partner that one could get along without him or her, or always fantasizing
about taking a job away from the partner while staying with the partner. Such patients are “unable to commit themselves to any one
relationship in a stable and permanent way” (p. 37). They are always negotiating the optimal distance between themselves and others,
saying things like “I need my space.” But not infinite space, for the repressed hungry self is rarely completely obliterated, and it draws
them back into the optimal orbit of others (Akhtar 1992). Often they prefer that much of the relationship take place “in their head.”
Sadomasochistic object relations. The belief that love consumes or destroys one's identity makes sadomasochistic object relations
with a rejecting parent substitute highly likely. Sadomasochistic hurts help keep the object at a distance, which suits the schizoid's in
and out program. Given the history of rejection or desertion, the schizoid, when smitten, is drawn to depriving, attached, or unavailable
mates like a moth to a flame. Untreated schizoid states preclude resolution of the oedipus complex; repetitive and self-injurious sexual
triangles are extremely common. Schizoid people may be drawn to philosophies, sensibilities, and ideologies that ridicule tender love
as a vain illusion. Yet such “liberated” thoughts actually appease the antilibidinal conscience.
Attitudes toward children. There are no children in The English Patient. In my experience, the classic schizoid, though ambivalent
about the “idea” of having children, may be surprised at how attached he or she may become to them should they come along. In sicker
schizoids the parental instincts often turn to pets, to collecting things, or to the environment, which becomes animated.
Hypersensitivity and Hyperpermeability: Psychogenic and Biological Causes

I suggest that hypersensitivity and hyperpermeability are primary schizoid states, and that detachment and withdrawal defend
against them. The schizoid type I am describing is hypersensitive to rejection,
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or emotionally “thin-skinned,” for several reasons. Such patients are always being deserted in their internal fantasy world (Guntrip
1969). They always project a rejecting but exciting object onto others. Finally, they experience their infantile neediness for a real
object as threatening them with a perceived loss of self and boundaries (Seinfeld 1991), so that if the other leaves they will lose their
self as well.
A number of patients I have treated, who presented with schizoid states, also had an acute nervous hypersensitivity to stimuli,
including smells, sounds, light, temperature, and motion, as though they lacked a filter or stimulus barrier. In short, they were thin-
skinned, and described having been so going back to childhood. Such hypersen-sitivities are seen also in a number of other conditions
(Bergman and Escalona 1949), including autism (Tustin 1981; Ratey and Johnson 1997); in bipolar children (Papolos and
Papolos 1999); and in some right-brained individuals, who are visual learners, and some children with Attention Deficit Disorder
(Freed and Parsons 1997). Edgar Allan Poe's description of Roderick Usher in “The Fall of the House of Usher” captures this
nervous hypersensitivity: “He suffered much from a morbid acuteness of the senses; the most insipid food was alone endurable; he
could wear only garments of certain texture; the odours of all flowers were oppressive; his eyes were tortured by even a faint light …”
(1986, p. 143). Incidentally, in that story, which takes place in a Gothic setting, the hypersensitive Usher accidentally kills his twin
sister, burying her alive, a connection I will explore below.
Injured skin imagery and hypersensitivity to stimuli. In some patients this hypersensitivity seems almost a constitutional given,
and schizoid withdrawal an attempt to turn off the overstimulation. In others, however, it seems more like a posttraumatic
hypersensitivity (in the form of nervousness, jumpiness, agitation) that decreases as the trauma is worked through. Hyperpermeable
states may be represented by images of skin envelopes that have been penetrated. Anzieu (1980, 1989) has systematically shown how
Freud's statement that the ego is first and foremost a body ego applies to the skin, or skin ego. The skin is the first border, as well as
first place of contact between baby and mother. Torn animal skins or envelopes, open mouths, orifices, doors, liquids escaping,
decomposing bodies, skin diseases, invasive germs, porous bodies, and flaying imagery can also represent insults to the skin ego.
Often these injuries are symbolically healed by skin contact (e.g., the laying on of
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hands). Anzieu (1980) describes Dalton Trumbo's Johnny Got His Gun, and the film that was made from it, which in many ways
parallel The English Patient. Trumbo's novel is about a wounded soldier who has lost sight, hearing, and all four limbs, who is cared
for by a nurse who establishes contact with him by writing letters with her fingers on his damaged skin and who masturbates him.
Incidentally, this soldier, blind, mute, deaf, and immobile, is in effect buried in his own body.
Second skins: rhythmic sensations to counter fears of unboundedness, falling, spilling, dissolving. As schizoids turn away from
people, they often turn to things, which they animate. This tendency parallels a phenomenon observed in some autistic children who,
out of extreme hypersensitivity, seem unable to turn toward others. Tustin (1981, 1986), based both on accounts of children who as a
result of treatment emerged from autistic states and on work with neurotic patients with autistic barriers, showed that autistic
individuals are often terrified of dissolving and falling into dreaded bottomless pits, black holes, or chasms. This fear seemed to be
based on presymbolic, preverbal terrors, involving loss of contiguity with the caregiver and occurring in an immature state of psychic
organization. To block this terrifying, unbuffered awareness of bodily separateness, these individuals took to moving ob-jects
rhythmically in order to create a protective envelope of contiguous sensations. But when these rhythmic sensations were interfered
with, the individuals experienced their skin as a sieve, and themselves as falling into unbounded space or terrifying black holes. The
film The English Patient begins with an unforgettable sequence of buffering sensations: the sonorous rhythms of the whirring airplane
motor passing over the highly regular, almost stroboscopic shadows created by the riblike waves of desert dunes. Then beautiful yet
menacing music rises, and the English patient is shot. Dissolved by fire, he loses his skin, becomes permeable (i.e., hypersensitive),
and falls out of the sky, in one fell swoop.
Hyperpermeability and petrification fears. Schizoid individuals are often aware that their sense of self is a fragile fortress built on
a fantasy. Several of my schizoid patients had the ongoing fear that this imaginary fantasy world, in which they were withdrawn and
protected, could all blow up at a moment's notice. Thus, while the schizoid person's surface may be nondescript, decorous, and
emotionless, underneath he or she is terrified of experiencing the self as permeable—of being “seen through” or revealed as human
and full of hunger. Seinfeld (1991) has noted that the schizoid person fears being turned into rock if caught in
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another's glance, as was Medusa. (In classical mythology, Medusa was petrified when she saw herself as others did, in all her fantastic,
composite ugliness, filled with unruly sexual and aggressive desires. Medusa is not only frozen but, by being turned into stone, is
buried alive in her own statue.) This fear of petrification may in fact cover a powerful wish to be inanimate.
The Intrapsychic Tomb

The phenomenon of intrapsychic tombs was first described by the French psychoanalysts Abraham and Torok (1994). Though
their experience was not specifically with schizoid patients, the phenomenon will be particularly important when we analyze the cave
scene and Almásy's grief in response to Katharine's death. Torok (1968) began formulating this concept by following up a lead offered
by Karl Abraham, who wrote to Freud of patients who seemed to show manic denial and an upsurge of libido, as opposed to
melancholia, after the death of a loved one. Torok noticed that a number of her patients related stories of sexual acts and needs right
after a death. She saw this as a desperate and final attempt to sustain the relationship by enacting, with a substitute object, a fantasy of
incorporation (concretely taking a person's body inside them). In these cases grief could not proceed because of a shameful secret in
relation to the lost object (e.g., an incestuous link). Torok described these patients as having a fantasy of the lost object as an “exquisite
corpse,” entombed somewhere inside them, which they hoped to revive. The sense of exquisiteness attached to the exquisite pain of
the outburst and was also a cover for the exquisite pleasure involved. “I committed a terrible crime,” one patient dreamed; “I ate
someone and then buried them.… For this reason I have to spend the rest of my life in prison” (Torok 1968, p. 122). Abraham and
Torok brilliantly observed that in many cases of complicated grief the anguished pining felt by the bereaved is not their own longing
for the love object, but rather their unconsious fantasy of how the deceased is pining for them. Insofar as we deny that the beloved has
died, our fantasy of our beloved as alive, and as seeking us, persists. This crucial fantasy is overlooked because it is unconscious, and
because we are preoccupied with our conscious longing for the lost object. Fantasized incorporation of the deceased—eating the object
(which parallels, in ways, the Eucharistic imagery of consuming the
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body of Christ)—stifles mourning. “When, in the form of imaginary or real nourishment, we ingest the love object we miss, … we
refuse to mourn …” (Abraham and Torok 1972, p. 127). In a related phenomenon, children can form a “dead mother” identification
with a mother who, though not literally dead, seems dead because depressed and distant (Green 1972).
The Characters in the English Patient

Hana and hidden, traumatized selves and identities. This theme is more apparent in the novel, which begins with page upon page
describing an unnamed character. Finally, on page 32, we learn that her name is Hana, the twenty-year-old nurse. As is common in the
schizoid world, there is a loving presentation of inanimate detail. In the opening paragraphs, Ondaatje employs a modified version of
the impersonal technique developed by Alain Robbe-Grillet, originator of the “antipsychological novel.” The nameless Hana seems
selfless, just a series of devoted actions. She seems selfless in more than one sense. Indeed, there is something strangely evocative in
watching this woman without a name, without a past, performing her nursing tasks on this dying man with no apparent physical or
historical identity. These hidden or buried identities evoke the fact that in the schizoid world the self is deeply buried beneath a
nondescript surface.
Eventually we learn that Hana's beloved father has been killed recently in the war and that this has broken her; her single-minded
devotion to her patient helps her deal with his death. She is in shell shock. Her lover too has just been killed in the war, but not before
having impregnated her. On page 83 we learn that she has had an abortion and feels she has destroyed the child. Everyone she loves
dies—her love consumes. She longs to perform acts of reparation by nursing the English patient, who is described as the ghost she is
caring for (p. 28). In the villa she cuts off all her hair, and discards her femininity, in grief.
As the main Allied forces move up the ankle of Italy, the Germans are in retreat. In the abandoned Villa San Gorilamo she cares
for the skinless man who now needn't suffer by being jostled about by others. Through charred lips her nameless patient begins to
speak. He tells first of his accident, which arouses our sympathy for him as a victim. He then describes himself as an idealistic explorer
who had sought to document
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the desert and find a lost ancient city, near where there had once been a lake in the midst of what is now desert.
Hana too has something to hide: herself. “There was something about him she wanted to learn, grow into, and hide in, where she
could turn away from being an adult” (p. 52). The villa seems at first to be a respite from the war. Hana is nomadic in it, half-adult and
half-child (p. 14). She is there not only to nurse, but because she is fed up with war. “She would not be ordered again or carry out
duties for the greater good.” But the Nazis are not yet defeated, and one cannot but think that this wish to close her eyes and make the
war go away is childlike. The only catch is that in fact she is not safe in the villa, for it, like the English patient's story, is mined.
Shorn, Hana will need a complementary helpmate, someone who is her opposite, who will keep his eyes open and turn off his
emotions, to defuse the villa—the longhaired Kip. Hana is terrified of her destructiveness; Kip spends his life defusing it.
The breakdown of psychological boundaries between self and other. A real, largely nonverbal intimacy builds up between Hana
and her patient. Imagine how isolated he must feel! In this private place her nursing is not bound by stifling convention. When he is
cold at night, she lies in bed beside him (p. 5). Next we hear a description of his almost ceremonial treatment by the Bedouins, who
applied layers of salves to cover his injured flesh. Like many of his descriptions, though, this one is numb. The terror of losing one's
skin, of losing the natural boundary or barrier between oneself and the world, is never described. Yet it is evoked throughout the novel
in images of permeability. Images of water deepen our sense of a state without boundaries. As the English patient listens to Hana, he is
“swallowing her words like water” (p. 5). Numerous beautiful metaphors of the breakdown of boundaries are presented, of the passing
of fluid between boundaries. When he is in the desert, a Bedouin feeds him by chewing and softening a date, which is then passed
from his mouth to the English patient's. He remembers “the taste of saliva that enters him along with the date” (p. 6). Hana takes the
skin off plums that grow in the garden, and passes them into his mouth. What Almásy says he likes about the desert is the lack of any
kind of physical boundary—it is more like a sea: “In the desert it is easy to lose a sense of demarcation. When I came out of the air and
crashed into the desert, into those troughs of yellow, all I kept thinking was, I must build a raft.… And here, though I was in the
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dry sand, I know I was among water people” (p. 18). The Cave of Swimmers—the most important of Almásy's discoveries—was a
cave in the midst of the desert with prehistoric drawings of figures swimming. This proved to Almásy that in Tassali, six thousand
years ago, there had been a lake where now there is dryness. The desert is turned by him, in his imagination, into a plentiful sea. This
is what a schizoid child does in the midst of deprivation.

The desert becomes a woman. When Katharine Clifton first arrives with her husband, Almásy is noticeably standoffish, picky and
prickly, because he feels that women don't belong in the desert. Yet he often describes the desert as if it were itself a woman. In the
film, the desert is adoringly photographed, as though it were a lover's body, with lean ribs, thickening plateaus, spread dunes, hidden
recesses and caves hiding water. In the book we read that the desert has been “raped by war” (p. 257). To find the legendary lost lake,
Almásy is told to find a place where the mountains form the shape of a woman's back. When Almásy describes “the deserts of Libya,”
he says, “Remove politics, and it is the loveliest phrase I know. Libya. A sexual, drawn-out word, a coaxed well” (p. 257).
The English patient. Our first impression of the English patient is that he is, by virtue of being a patient, in the very dependent
position so feared by schizoid individuals. But he seems to be impressively stoical, almost inhumanly so, never feeling sorry for
himself. This is because he is detached, with the schizoid gift for living in his own internal world. We are told of his life before his
accident and he seems, at first glance, to represent reason, refinement, knowledge, and universality. Indeed, he seems to know about
everything, from jazz to Plato. As a learned explorer he takes one book with him, his precious Herodotus, and attached to its pages are
all his drawings, notes, discoveries, and letters. But, though he knows so much, we hear absolutely nothing about his family history.
His past is a blank. Katharine and Almásy are opposites in this respect: “For her there was a line back to her ancestors that was tactile,
whereas he had erased the path he had emerged from. He was amazed she had loved him in spite of such [a] quality of anonymity …
“(p. 170). This anonymity suggests a reluctance to be revealed. Though Hungarian, he lacks a “parochial” national identity. About the
war he takes a superior attitude—both sides are wrong. He thinks of himself as an idealist who has transcended the love of one's own
that is the heart of familial and political ties, and that gives rise to
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feelings of loyalty. Yet, for all his declared openness to others, he has few friends and no loves. This openness to others is an openness
more to people who have erased themselves as he has. In the desert, where there are no boundaries, he says:
There were rivers of desert tribes, the most beautiful humans I've met in my life. We were German, English, Hungarian,
African—all of us insignificant to them. Gradually we became nationless. I came to hate nations. We are deformed by
nation-states.… The desert could not be claimed or owned.… All of … us wished to remove the clothing of our
countries.… Erase the family name! Erase nations! I was taught such things by the desert.… By the time the war
arrived, after ten years in the desert, it was easy for me to slip across borders, not to belong to anyone, any nation [p.
138].
A great leveling operation is performed by Almásy: all nations are blurred together. The regimes of these nations—be they Nazi,
totalitarian, monarchic, democratic—all become morally equivalent. So what can he pledge himself to? If he sees no good in nations,
he see no bad in tribes; but to do so he must depict tribes without tribalism. He praises the “openness” the desert teaches; but such
openness is a desire for people who have no identity based on family or historical roots. Is this really openness?
Katharine Clifton. When Katharine Clifton arrives, it seems Almásy has never fallen in love before. Airbrushed from the movie is
the fact that Katharine is a generation younger than Almásy. Seeing the Cliftons for the first time, he says, “They were youth, felt like
our children” (p. 142). As Almásy emphasizes, “She was a willow … an innocent…. I was forgetting she was younger than I” (p. 144).
Later he says that her “openness is like a wound, whose youth is not mortal yet” (p. 157). Her youth is a remedy for Almásy's sense of
his own mortality. Katharine begins a very 1960s-bohemian piece of dialogue just before the two make love:
“If you make love to me I won't lie about it. If I make love to you I won't lie about it.” She moves the cushion against
her heart, as if she would suffocate that part of herself which has broken free.
“What do you hate most?” he asks.
“A lie. And you?”
“Ownership,” he says. “When you leave me, forget me.”
Her fist swings towards him and hits hard in the bone just below his eye. She dresses and leaves” [p. 152].
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Katharine has just had the first of what are to be many encounters with Almásy's tendency to blot her out, to erect a cold wall
between them (p. 155). Katharine notes he never reveals his real self to her, and tells him that he acts “as if the greatest betrayal of
yourself would be to reveal one more inch of your character” (p. 174). She is describing what it is like to be with a schizoid person
terrified he will be consumed in closeness and so retreats; someone who fears that in revealing himself he will lose himself and be
engulfed, petrified, overexposed. She says of his tendency to disappear, “You have become inhuman.… I don't think you care.… You
slide past everything with your fear and hate of ownership, of owning, of being owned, of being named. You think this is a virtue” (p.
238). But Almásy is experiencing his “old desire for self-sufficiency” (p. 238).
Love consumes. Yet he falls in love, and his “in and out program” is no longer working: “Nothing can keep him from her” (p.
153). The man who has never felt alone in the desert is now desperately lonely, and begins to stalk her. “The minute she turns away
from him … after he greets her, he is insane” (p 156). In the diary entry of July 1936, Almásy writes that to love is to be consumed, to
lose the inner self, and that the heart is an organ of fire: “There are betrayals in war that are childlike compared with our human
betrayals during peace. The new lover enters the habits of the other. Things are smashed, revealed in new light. This is done with
nervous or tender sentences, although the heart is an organ of fire. A love story is not about those who lose their heart but about those
who find that sullen inhabitant.… It is a consuming of oneself and the past” (p. 97).
In other words, when a schizoid person falls in love, a sullen hidden aspect of the self, not previously seen, emerges and consumes
one or threatens one's identity. This passage anticipates and rationalizes Almásy's turning over the maps to the Nazis: it is not as bad as
the betrayals of peacetime, which Almásy doesn't fret about too much in the case of Geoffrey. He will betray thousands so that he can
tell himself he did not betray his lover's dying wish. Yet this absolute preference for the private sphere of love over the public sphere is
articulated by a man who is no unambivalent champion of love. This passage demonstrates his moral unevenness, and anticipates the
combination of hypersensitive, idiosyncratic sacrifice and hyposensitive depravity that we shall see in his rescue of Katharine's corpse.
In truth, the English patient is at home neither in the public world of nations nor in the private sphere of love.
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The sadomasochistic relationship with Katharine. When love, by definition, burns, sadomasochistic object relations cannot be far
behind. Shortly after meeting Almásy, Katharine has a sadomasochistic sexual dream about the two of them, set in her marital
bedroom: Katharine and Almásy “had been bent over like animals, and he had yoked her neck back so she had been unable to breathe
within her arousal” (p. 149). This sadomasochistic theme is expressed not only in dreams. “She had always had the desire to slap him,
and she realized even that was sexual” (p. 150). In a section beginning “A list of wounds” we learn that Katharine once stuck a fork
into his back, has thrown countless objects at him, and that he has frequently appeared in public with welts or “with bruises or a
bandaged head” (p. 154). Katharine suffers with “a terrible conscience” and asks, “How can I be your lover?” Geoffrey, she says, “will
go mad” (p. 153). Yet she betrays her husband many times. As for Almásy, he suffers no remorse toward his cuckolded friend and
rival. Why should he? If love never means possession, then love triangles are nothing to be fussed over. If no one belongs to anyone,
adultery is no sin; rather, it is fidelity, the keeping of what does not belong to one, that merits our disapproval.
Jealousy. Yet things change. Once love has broken down his defenses, Almásy begins to feel out of control. “He has been
disassembled by her” (p. 155). The possessiveness he once scorned now comes back with a vengeance as jealousy. Almásy “slides his
open palm along the sweat of her shoulder. This is my shoulder, he thinks, not her husband's, this is my shoulder” (p. 156). In a jealous
fit, he follows for two days a man she has innocently touched. We can understand this jealousy from the point of view of the schizoid
state: Katharine made him feel alive with love; how can he, now alive, imagine living without her? This jealousy is one of the first
signs that Almásy might really be able to attach to a person, and his possessiveness signals an almost infantile terror of separation from
her. But there is more to it. As Freud pointed out, pathological jealousy has many roots; in some cases this includes a warded-off
homosexual attraction to one's same-sex rival. Indeed there are at least hints of homoerotic longings in Almásy, which are revealed in
the book in a powerfully sensual homoerotic description of a dancing, teasing, desert boy: on waking from his wounds, at a campfire,
Almásy sees “a boy dancing, who in this light is the most desirable thing he has seen. His thin shoulders white as papyrus, light from
the fire reflecting sweat on his stomach, nakedness glimpsed
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through openings in the blue linen he wears a lure from neck to ankle, revealing himself as a line of brown lightning.… a boy arousing
himself, his genitals against the color of fire” (p. 22). Possibly these longings inform Almásy's wish to keep women out of the desert.
(Apparently the real Count was homosexual.) Then, halfway into the novel, it is stated, explicitly, that Almásy had loved Geoffrey
Clifton. Just before the death scene, Geoffrey is described as “the husband they had both loved until they began to love each other” (p.
174). But what does Ondaatje mean by “love” here?
The relationship of Almásy, Geoffrey, and Katharine. To understand this love, we must enlarge our view of it, into the full-blown
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oedipal love triangle it is. It touches the most elemental passions and leads to the death of all three. It begins strangely. Almost
immediately upon arriving at the campsite, Geoffrey, acting as if unaware that others might take a sexual interest in his wife, “shared
his adoration of her constantly” (p. 229). “Clifton celebrated the beauty of her arms, the thin lines of her ankles, he described
witnessing her swim.” Initially, Almásy thinks “the words of her husband in praise of her meant nothing” (p. 231). But Clifton behaves
as if on a campaign to interest Almásy in his wife. He leaves Katharine for long periods with other men and with Almásy, alone in the
desert. One begins to wonder if Geoffrey extols Katharine to support his own vanity. It is at this point that Katharine reads the famous
story of Gyges from Herodotus, aloud to her husband, Almásy, and friends. It is a story of a love triangle that Almásy says he always
skims past (p. 223). This story within a story, like a dream within a dream, contains important warded-off elements. Indeed, it is right
after hearing this story that Almásy says, “I fell in love” (p. 234). In the eerie scene, with an embarrassing directness that makes the
observer want to turn away in that strange shame one feels when one sees too much, Katharine tells Geoffrey, by allusion, that he is
setting up a triangle in which Almásy will sleep with her. “Are you listening Geoffrey?” she says emphatically, as she begins to read
the story:
This Candaules [the king] had become passionately in love with his own wife; and having become so, he deemed that
his wife was fairer by far than all other women. To Gyges … (for he of all his spearmen was the most pleasing to him)
he used to describe the beauty of his wife, praising it above all measure.… He said to Gyges: “Gyges, I think that you
do not believe me when I tell you of the beauty of my wife.… Contrive therefore means by which you may look upon
her naked” [p. 232].
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Gyges, like Almásy, puts up some initial resistance, entreating the king not to ask him to look, but the king insists, and hides Gyges in
the bedroom, saying “there is a seat near the entrance of the room and on this she lays her garments as she takes them off one by one;
and so you will be able to gaze at her at full leisure” (pp. 232-233). The queen discovers Gyges and, realizing that the situation was set
up by her husband, feels ashamed. The next day she summons Gyges and says, “Either you must slay Candaules and possess both me
and the Kingdom of Lydia, or you must yourself here on the spot be slain … so that you mayest not in future … see that which you
should not” (p. 234). Thus, the queen who has been looked upon has her king killed. Apparently she is a very modest woman.
Why is she outraged to the point of murder? The virtue of modesty protects the private self by keeping it sufficiently hidden or
impermeable; its violation leads to humiliation, but such a violation is not generally a capital crime. But in the schizoid world, in
petrification fantasies, looks do kill, because the schizoid person fears the loss of his or her very identity if exposed.6
Consistent with this theme of homosexual love, though it is barely hinted at in the movie, is the extent to which Almásy is smitten
by Katharine's boyishness and youth. “Was it desire for her youth, for her thin adept boyishness?” (p. 236), he asks himself. Bony-
kneed Katharine is not the most feminine of women; Geoffrey sings her femininity, but Almásy loves her boyishness. Thus, the
Herodotean, negative oedipal version of the story makes up some of the latent content of the narrative, whereas the main, or manifest,
story has a positive oedipal cast, insofar as it is about being caught in an illicit heterosexual triangle. This is enacted in the film in the
steamy, furtive sex scene, which we see through a window, while the lovers' friends
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6 This Herodotean version of the Gyges story is at pains to emphasize Gyges' passivity and lack of Eros toward the queen, and has a negative
oedipal flavor. It is the king who wants to impress Gyges, the man who was “the most pleasing to him.” For a heterosexual man, the king, like
Geoffrey, seems remarkably unpossessive, naive to the covetousness of others, overly secure in his wife's love, and blind to the feelings of his
queen. Yet his actions seem less strange if we read them as an intention to use his wife to form a homosexual bridge to Gyges. Gyges, for his
part, is a “reluctant regicide” (Hanly 1992, p. 139). In contrast, in Plato's more famous version, Gyges discovers a ring that makes him invisible,
and the first thing he does is to sneak into the queen's bedroom to look at her naked. The second thing he does is use his invisibility to slay the
king. It is a frankly oedipal tale with an active heterosexual emphasis (Hanly 1992).
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are partying at Christmastime. When Geoffrey finds the sweaty couple, clothes all disheveled, they exude each other's scents.7
The cave scene. The climactic Cave of Swimmers scene in the film leaves out a detail from the book, an omission many readers
seem not to notice; indeed it is remarkable how many readers pass over this passage without taking in that Almásy makes love to
Katharine's corpse. The film's editing does not make clear that Katharine had been left in the cave not some few days, but three years.
Almásy left her immobile and dying in September 1939, to return only in 1942. At the time he turned the maps over to the Nazis there
was utterly no prospect of rescuing her alive. Glossing over this fact leaves the impression that Almásy made a noble and desperate
attempt to save the life of the woman he loved. Had he so wanted her remains, why could he not have waited until after the war to get
them? He would then not have had to turn the maps over to the Nazis. Or did he have Nazi sympathies?
Not tonight dear, I'm dead. The following scene, omitted from the film, shows the extent to which Almásy is living an imaginary
schizoid existence that reverses the values of life and death. Returning with the help of the Nazis to the cave where he left her, Almásy
chooses to take his clothes off and enter the cave naked:
I approached her naked as I would have done in our South Cairo room wanting to undress her, still wanting to love her.
What is terrible in what I did? Don't we forgive everything of a lover? We forgive selfishness, desire, guile. As long as
we are the motive for it. You can make love to a woman with a broken arm, or a woman with fever. She once sucked
blood from a cut on my hand as I had tasted and swallowed her menstrual blood. There are some European words you
can never translate properly
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7 The homoerotic theme is depicted in the relation between Almásy and Madox, “this man I loved more than any other man.” Madox is another
double for Almásy, and he too is described as a bit schizoid, with flat affect: “a man who made friends with difficulty.… a man who knew two
or three people in his life …” (p. 241). He was calm in all things. Affection between Madox and Almásy is often “left unspoken” (p. 241).
Many schizoid people are deeply troubled by bodily spontaneity, for everything must be under their cerebral control. Madox had a “slow gait.
… I never saw him dance. He was a man who wrote, who interpreted …” (p. 243). Back in England, possibly aware of what Almásy has done,
Madox cold-bloodedly shoots himself, in church, his family nearby. Almásy disowns any involvement in the death (p. 242). Yet after he hears
of Madox's suicide, Almásy goes to a dance, loses control and wants to dance “with everyone, men and women” (p. 244). It seems a
homosexual longing erupts in him on losing Madox, of the type described above by Torok. He dances with Katharine, and falls upon her, lying
across her, provocatively flaunting his sexual conquest right in front of Geoffrey.
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into another language. Félhomály. The dusk of graves. With the connotation of intimacy there between the dead and the
living [p. 170].
After he did whatever he did to her corpse, the text states that he lifted her out of the cave and got dressed. When we juxtapose
Almásy's naked approach to her corpse, his disrobing, his justification for making love to the injured or ill, the emphasis on physical
sexual acts, the reference to swallowing blood, the allusion to doing the unforgivable, the phrase that emphasizes the intimacy between
the dead and the living, followed by his dressing, we have intimations of necrophilia; the writing so strongly affirms necrophilia that
whoever doubts it must come up with a better hypothesis. Yet Ondaatje does not use the word. Still, it is worth trying to understand
why or even how Almásy could involve himself in this way with a corpse. Following are some reflections.
There is something familiarly vampiric about this scene.8 But to understand the cave scene—the unreality of it, in the midst of
what otherwise appears to be historical fiction—it is helpful to “diagnose” The English Patient in a second way, by classifying it
according to its literary genre. Manifestly, it is a realist novel. But latently, it is a gothic romance, replete with “picturesque ruins,
ghosts, moonlight, demon lovers and a dashing hero with a mysterious background[;] … antiquarianism, blood, horror, highly erotized
emotion and sentimentality… and [a]… de-emphasis on verisimilitude and characterization” (Marchand 1997, p. 56).9 Like the typical
gothic novel, The English Patient may be said to employ a medieval locale: “The last mediaeval war was fought in Italy in 1943 and
1944. Fortress towns on great promontories which had been battled over since the eighth century had the armies of new kings flung
carelessly against them …” (Ondaatje 1992, p. 69). Gothic romances tend to take place in sheltered or secluded places in the context of
the collapse and disintegration of broader society and frequently convey a sense of individual detachment from routine existence and
of oracular solemnity (Frye 1957). Love and death, which are fused in many romances (De Rougemont 1983) are fused concretely in
the gothic romance. Literary forms that descend
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8Gottlieb (1994) discusses the link between object loss, especially of those who died “before their time,” and vampiric, necrophilic, and
necrophagic fantasies. In the typical vampire fantasy the body has not decomposed, a detail that emphasizes its relative undeadness.
9 The antiquarian component is conveyed by the protagonist's interest in Herodotus, and by his quest to discover a lost civilization.
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from it—the thriller, the horror story, and vampire stories—have various concrete representations of this fusion of sexuality and
aggression, including the “love bite” that either kills or causes the victim to become identified with the aggressor (for the equation of
blood with life, see Freud 1913; Jones 1951, p. 116; Gottlieb 1994).
How closely The English Patient's corpse play echoes with the famous corpse embrace scene in Emily Bronte's Wuthering
Heights. The disturbed Heathcliff has a quasi-incestuous, triangular affair with his stepsister Catherine, who spurned Heathcliff to
marry a more respectable man. Note the similarity of the names of the characters in the two works: Katharine/Catherine, and the
presence of the “cliff” syllable in the names Heathcliff and Clifton. Yet Catherine's love for Heathcliff persists. Like the affair of
Almásy and Katharine, it is full of cruelty and ends in the heroine's death. The lovers declare themselves to be aspects of each other;
Catherine says, “He's more myself than I am.… I am Heathcliff.” Both lovers state that the other's love murders them. On the day of
her death, the two exchange violent embraces. Years later, Heathcliff enters her dug-up grave, opens her coffin to see her face again,
and expresses his wish to dissolve with her. His words betray that he seeks reunion with the buried part of himself.
A realist novel could not bring off this macabre necrophilic enactment; but the unreality of the gothic romance promotes it. The
classic gothic romance does not create real people, but represents a self and its warded-off aspects, a fact that contributes to the “glow
of subjective intensity” of this form (Frye 1957). Thus one can see the minor characters as aspects of a main character, an approach
used by Freud (1900).10 Katharine represents the warded-off feminine aspect—
—————————————
10 Caravaggio parallels Almásy in many ways. Like Almásy, he has been physically traumatized in the war, is damaged and bandaged, and
requires almost constant morphine to block, or numb, his exquisite pain and sensitivity. As with Almásy, we don't learn his name for a long
time, even after he is introduced, and he too has had much to hide. A thief by trade, a master of subterfuge, he feels safest revealing nothing (p.
27). Both men have been involved in the spying business. In the book, when Caravaggio is caught by the Nazis, it is because someone took a
picture of him at a party—he too became, in a sense, petrified by a glance. Like Almásy, he has his objections to possessiveness as ordinarily
understood. Hana says of Caravaggio, “He was a thief. He believed in ‘the movement of things.’ Some thieves are collectors, like some of the
explorers you scorn, like some men with women or some women with men” (p. 69). Caravaggio also shares the incestuous interest in Hana,
who is young enough to be a daughter (pp. 222-223). She writes in her diary that she has always loved this man twenty-five years her senior,
her father's friend. Caravaggio is a lady's man, a bad husband, and “has never become accustomed to families. All his life he has avoided
permanent intimacy…. He has been a man who slips away, in the way lovers leave chaos, the way thieves leave reduced houses” (p. 116). Both
men take what doesn't belong to them. The difference is that Caravaggio admits he is a thief; Almásy thinks that ownership is the crime.
Almásy is refined, but more globally disturbed; Caravaggio is a rake. Caravaggio's thumb amputations may be castration symbols, more focal
punishments for his itchy fingers, his excessive phallic thievery; Almásy's loss of his skin symbolizes his more global problems involving loss
of boundaries and a more global fear of women. Caravaggio, too, is amoral and clueless as to what the war is about: “The trouble with all of us
is we are where we shouldn't be. What are we doing in Africa, in Italy? … I was still a thief. No great patriot. No great hero. They had just
made my skills official” (p. 35). The war to stop Hitler's death camps is an inconvenience that interrupts his career as a burglar. Kip too is
described as an aspect of Almásy, a version of him when he was younger (p. 116). Like him, he can turn off emotion. Hana is an aspect of
Almásy as well, for she remains disconnected: we learn, on the last page, that years later, though loved, “she has not found her own company,
the ones she wanted” (p. 301).
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earthy, chthonic, chaotic, and Dionysian—tied into the fertility goddesses who create and destroy life. That is why Almásy invokes her
sexuality, her menstrual blood, her illness, her corpse. The orderly, Apollonian Almásy is the opposite of all this. Shortly after he does
whatever he does to her buried, cold corpse, Almásy undergoes his awful metamorphosis; he is burned, and becomes skinless. Now he
himself is described as a corpse, a ghost. She, a corpse, has transformed him into one as well, with her love bite. No finer place for the
vampiric climax could be chosen than a cave, a subterranean netherworld of darkness, lair of chthonic goddess and vampire bat alike.
Like Heathcliff, who anticipates becoming a corpse, Almásy does not seem displeased at his transformation. But we feel the pathos. As
Frye (1957) has observed, “Pathos is a queer ghoulish emotion, and some failure of expression, real or simulated, seems to be peculiar
to it. It will always leave a fluently plangent funeral elegy …” (p. 39). A failure of expression is of course pathognomic for the
schizoid condition; it bespeaks the psychic numbing that follows trauma.
The relation of skinlessness and being buried alive. I suggest that the damaged, skinless condition of Almásy symbolically
represents the vulnerability and overexposure that the buried self of the schizoid person experiences on real human contact. This terror
of contact, felt to obliterate the self, gives rise to the wish to be buried alive. (It is no accident that Almásy and Katharine first unite
and express their love while buried alive in their jeep beneath the sandstorm, or that they unite in a transformative and final way buried
in the cave.) Being buried alive is ultimately driven by a fantasy of being safe and united with a good mother in her body. Yet, to be
buried alive creates its own problems.
- 304 -
The fantasy of uniting with the other gives way to the reality of isolation. A fear of being alone in a black hole, understimulated for
eternity, is itself so horrifying that the self periodically attempts a premature birth. The emphasis on disrobing and rerobing at the
mouth of the cave calls our attention to the hunger for contact and touch that is part of this level of fantasy. The person cycles through
fantasies of being buried alive, and of being skinned alive (or being alive, but then skinned).
One can think of other levels of explanation for the cave scene. Katharine is now literally an object, buried and cold; she has
achieved the schizoid ideal of moving beyond desire, of becoming bone. As a corpse, she cannot reject Almásy's touch, and fear of
rejection is perhaps the deepest schizoid fear of all. Here we may call again on the ideas of Abraham and Torok (1994). Almásy,
unable to bear the loss of Katharine, must deny it; he makes love to her as though she were alive. At still another level, we may note
that this necrophilia seems also to hint at necrophagia, or eating of the dead, as seen in Almásy's reference in the scene to tasting and
swallowing Katharine's menstrual blood. In his refusal to mourn he incorporates her, and buries her within him, as it were. He, the
Hungarian, becomes possessed by the mortally wounded English woman he incorporates, giving psychological truth to his being called
“the English patient.” And, as he is dying, he incorporates all life, in a stunning reversal of the values of life and death. “We die
containing a richness of lovers and tribes, tastes we have swallowed, bodies we have plunged into and swum up as if rivers of wisdom,
characters we have climbed into as if trees, fears we have hidden in as if caves. I wish for all this to be marked on my body when I am
dead” (p. 261).
None of these possibilities undermines our sense that something sexual is alluded to in the cave scene. It is a dramatic
representation of the stubborn upsurge of libido described by Torok that denies the loss; and Katharine is truly an exquisite corpse—
particularly in the opening scenes of the film, when she “seems to be asleep” (Minghella 1996, p. 3), her flesh flawless, not three years
decomposed. She is lovely in death, while Almásy's flesh is corrupting in life—yet another reversal of life and death. Nor should
Almásy's destructive aggression be minimized. Like a vampire, our Hungarian Count Almásy seemed like a bat to come passionately
alive in the darkness of the cave. Like a vampire, when given the opportunity to choose between good and evil, he risks the lives of
countless innocents. By novel's end, his actions have led to the death not only of Geoffrey and Katharine, but to the
- 305 -
suicide of his best friend, Madox. In the end, all the main characters mimic Almásy's condemnation of the Allies, his insistence that
they are not much better than the Nazis, and long to withdraw. Kip, in his rage that the atom bomb was dropped on the Japanese,
insists that the Allies did so out of Western racism against the purer East, and that the Allies are not any better than the Nazis. He,
without much struggle, abandons Hana, as a Westerner. His outrage calls attention to the fact that that not a single character ultimately
expresses outrage about Nazi racism or atrocities, or about “Eastern” Japanese racism or the atrocities in Nanking. When told that her
patient worked with the Nazis, Hana says feebly, “It doesn't matter what side he was on…” (p. 165): “From now on I believe the
personal will forever be at war with the public” (p. 292). But if that is so, there can be no “common” good. Each of us is locked in the
prison of our privacy. This is the schizoid condition. Her isolation leads directly to the isolationist position, and she imagines sitting
out the next war and being purer for having done so. But if World War II showed anything, it showed, by being truly a world war, that
living far from the initial conflagration offers limited protection. In fact, does not the setting of the novel in the desert show that even if
one tries, at this point in history, to flee from society and its ills to the most deserted realms, there is no escape? Nor does the dropping
of the atomic bomb at the end of the novel point its characters toward the obvious conclusion that there are few bunkers beyond the
reach of such weapons. But Hana and the others opt for withdrawal into an imaginary, idealized psychic retreat, and endorse a moral
relativism which, by declaring a plague on the houses of both the Allies and the Axis powers, frees them from guilt over leaving others
behind. One might compare their high-minded lack of empathy for the European victims of the war to the attitude of the characters in
Casablanca.11
—————————————
11 Philosopher Thomas Hurka (1997) points out that in both movies “a man deeply in love must choose between a woman and loyalty to a
higher cause, and only in the 1943 classic does the protagonist get it right.” When choosing between their own libidos and the fight against
Nazism, Rick and Ilsa make sacrifices. Rick, no angel, says famously, “The problems of three little people don't amount to a hill of beans in this
crazy world.” Hurka sees the sentiment in The English Patient as akin to that of E. M. Forster, who said that if war broke out he hoped he
would have the courage to betray his country for his friends. Hurka adds, “Rick in Casablanca is a neutral and faces no issues of loyalty; he's an
American, and the U.S. isn't yet in the war. But he sees that one side is morally odious. Almásy doesn't bother to look. Rick sacrifices his love
for a larger political cause; Almásy sacrifices a cause because he cares only about his love.… The English Patient is beautifully photographed,
powerfully acted, and completely morally bankrupt.”
- 306 -
At the end of a war there can be all kinds of exhaustion—physical, economic, mental, and even moral. The characters in The
English Patient are morally exhausted, and they wish to retreat into forgetfulness—including a forgetfulness of the fact that private
ambition and aggression are often preludes to public catastrophe. All of this is swept under the carpet by the noble-sounding name of
forgiveness. Lest you think I am being hard on Almásy, let me add that he himself is not too fainthearted to ask whether his love had
caused all this destruction: “Had I been her demon lover? Had I been Madox's demon friend? This country—had I charted it and
turned it into a place of war?” Or is he asking a question at all? For maybe he is simply asserting what the schizoid person seems
always driven to assert. Love consumes.
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Article Citation [Who Cited This?]

Doidge, N. (2001). Diagnosing the English Patient. J. Amer. Psychoanal. Assn., 49:279-309
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(2001). Journal of the American Psychoanalytic Association, 49:279-309

Diagnosing the English Patient: Schizoid Fantasies of being Skinless and of

The Schizoid World

Defensive Techniques Against Falling in Love

Hypersensitivity and Hyperpermeability: Psychogenic and Biological Causes

The Intrapsychic Tomb

The Characters in the English Patient

is what a schizoid child does in the midst of deprivation.

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