"You're a good girl and you're at home"
On creating a psychic home when resources are deficient

 
First and foremost Self psychology sees Man as an infinite spiritual being, whose final goal might be to attain a supra-individual existence.
This deep and fundamental understanding, along with the possibility of accepting "destiny" not as a "given" but rather as a choice, constitutes for me a home port, an anchor when setting sail into the heart of the storm of the human drama.
Freud was the first to suggest well- defined psychic structures, a system of forces and urges, and the mind as a "definite and objective entity subject to external inquiry."
Generations of thinkers and philosophers, therapists and analysts contributed their share to further understanding the human Psyche.
 Heinz Kohut offered a revolutionary view of Man, putting the "self" as the focus of human existence.  The "self" as defined by kohut has quantum quality –having both: a structural dimension and a cosmic quality. Becoming the essential "self" requires an "empathic matrix," a soul to soul encounter, experiencing "hospitality" in its deepest, most infinite sense [Levinas (1969); Derrida (1999)] wherein one's existence is benevolently nullified to make room for the formation of the self of the Other, becoming the 'selfobject' one needs.
The "maternal matrix" is a prototype of supplement of selfobject needs, the basic and fundamental element of human existence. As motherhood is the platform for the emergence of life, body of course, and mind as well, it is a necessary condition for the formation of a vital "self."
In this article I wish to present my therapeutic encounter with a young woman in whose context existential questions arise; her story is a human drama complete with tragedy, courage and inspiration.
I would like to ask: from where does the "nuclear self," the core of existence, draw its vitality when conditions are difficult, wherein it does not gain the acceptance it deserves: The initial matrices, maternal and genetic, into which one is born, are deficient, and the body, broken as well.
How can a girl, decreed not to be, maintain a healthy and vital soul?
*                        *                              *
 I ask her permission to tell her story; benevolently she agrees, saying "of course, if it may help someone in the world…"
 In her early thirties, single, born to an Arab-Muslim family; she has an older brother and sister. Her parents are both academicians.
The family is split over the approach to religion and tradition: The mother is an orthodox Muslim; the father – traditional but modern.
The relationship between the parents is distant and alienated. The mother never wanted to marry at all. In the very traditional society, where she came from, she was different: an independent, free woman who "did not lack anything." As she married at a relatively older age, she gave birth to a boy and a girl and with that, was satisfied.
 My patient adds bitterly, that she was "an unplanned child." The pregnancy was "discovered" at a late stage and toward the end of pregnancy, her mother frequently cried. An "existential guilt" (Buber 1957; 1988) for arriving unwanted and unwelcome into the world is shared by them both.
She describes inconsistent situations – being her mother's "baby," held close and spoiled; and situations in which her mother disregards the generational difference between them and relates to her as a friend feeling like a daughter only when reprimanded.
"Father was always on my side, but most of the time immersed in his work."
Sometimes it seems to her that she is an indigo child; that she doesn't really belong.
 
*              *                *               *              *
 
I like the soft sound of her name, I ask its meaning.
In Arabic, she explains, it is the branch or offshoot of a date palm tree.
I say: "Even then, they already knew that you would be tall and your fruit sweet." And I contemplate the offshoot sprouted through vegetative reproduction, someone not created from two: "man-woman"; "mother-father"; but an offshoot of the mother, "hers," perhaps like a phallus, a symbol of yearning for masculinity, for freedom.
Her imposing height and long limbs endow her with a different look and hint at the syndrome from which she suffers. The family does not know of other cases.
Those with the syndrome possess several prominent signs – particularly long limbs, a high palate, vision problems, and more; she describes them in detail and protests: "They saw all this before, how did they not diagnose it until it was almost too late," she laments her lack of visibility.
Until her pathology erupted, she was a brilliant and talented student, about to receive her degree in social sciences, teaching, volunteering, involved in social and creative endeavors. She attributes the difficulty in developing a romantic relationship to the demands of tradition and to her unusual appearance. She was a rebel against conservative surroundings, undermining rigid social conventions.
 Her aspiration to independence creates tension in the family, especially in her relationship with Mother.
She supplements her words with a drawing, a self-portrait from her university days.
---------------------------------------------
-- Courtesy of the artist
Her facial features are depicted in gentle lines, cloaked in immense sadness. The windows of her eyes are shuttered, there is nowhere to look, nothing to see, and perhaps there is no one "there," in the world, who will see.
She wishes to be seen. She sketches her imagined physicality. She almost avoids encounter with the actual world, she withdraws to the infinite within, inviting me in.
A rose gracefully covers her mouth; her mouth is blocked – obstructed from making a sound in the world, from partaking of it.
And only one delicate nostril hints at a possible connection to the world, perhaps by breathing, perhaps by smelling; an opening for connection, to not conceding, to hope.
 It seems, that something within her knows that which is about to be diagnosed soon: about four years before she came to therapy, she felt sharp, acute back pain; she was taken to the emergency room in a critical condition, and from there to surgery.
Since that time, her life passes from one operation to the next, moving from despair to hope, in an ongoing efforts to repair her heart, while she is struggling to find worthy meaning to her life.
The first surgery
"When I awoke, I clearly remembered the experience I had during the operation. I remember the look of the operating room. I am standing here. They are operating on me there. I remember the entire team, while I am standing on the side, watching them working.
"In the operating room I felt that maternal Grandmother was with me. It was strange: the walls were covered with books like in an ancient library; the background had royal colors: red-burgundy and gold. Grandmother stood across from me. There were no words between us; softly and silently her message to me was– 'Don't worry, everything will be fine'; I accepted and was calm.
"My relationship with Grandmother was special; I was her 'beauty queen'. When I was at her side, I felt special. I miss her. During her last years Mother moved in with her in order to take care of her and was absent from my life. I felt that Grandmother took Mother away from me.
"When I awoke from the operation I understood how much I need my mother in my life. This was a new discovery and I didn't know how to place boundaries on my neediness. Despite her being a very intelligent woman, Mother did not have clear boundaries; she wanted to be a 'total mother', maybe because I was her 'baby'.
"I took advantage of 'being the baby'. In the beginning, I loved it, I got everything I wanted, but as I recovered, I wanted to regain my independence. Mother and I didn't know how to negotiate the boundaries.
"When I described to my friends what was done to me during the operation, Mother was surprised by the detailed description; she laughed at me saying: 'How is that? Did you operate on yourself?'"… While longing for closeness she finds herself running into a wall of ridicule.
After a year, she was rushed again to surgery due to a leaky valve.
The second surgery
"During the second operation I had a dream – I met my parental Grandparents. They married for love. It was very rare in our community; they did not hide their love. After Grandfather died, Grandmother who used to say, 'we always lived together, we will die together', kept true to her word, she passed away three days later.
"In my dream I was visiting their simple house. When I entered, Grandfather was arranging plates. I looked at him and said, 'I'm dreaming, right?' he confirmed. Strange, I remembered saying this in English although he only spoke Arabic and Turkish. Grandfather asked, 'Do you want to eat something?' I said, 'If I'm dreaming and you are already dead, it's ok if I take something from you but it's not good for you to take from me.' And he confirmed, alluding to traditional belief that if a dead person comes to you in your dream and takes something from you – it's a bad sign;  if he gives you something – it's good, a sign of new life.
"I think we ate together. Afterwards, he got up, and I followed him. We went through a wall; the wall of the house turned into a window through which we saw a very beautiful, blooming garden. He stepped in; it all turned into a picture. I wanted to go with him, into the magnificent garden, but he stopped me – 'Your time has not come yet.'"
The grandparent stratum provides her with positive and enriching nourishment, alternative parenting, a model of a loving relationship and a good feeling of home, which, at times, is warm and simple and at times, a royal palace.
Grandfather protects her, nourishes her; Grandmother gives her enchantment and visibility.
 In our meetings "the work of analysis" and interpretation do not serve as a central part. Scenes and experiences are reconstructed. We are rather busy validating her abilities, enabling her to gain permission to hope, to dream, to express her wishes, to sense and realize the core potential of herself, let her feel HER SELF.
I am busy to identify her needs, constantly watching my standpoint being the selfobject she needs.
 
A blood clot released after surgery caused a stroke. "I hit the jackpot, escaping no problem or complication," she says while I am getting accustomed with her sharp, sometimes bitter, sense of humor.
During that time, her mother becomes more religious and goes on pilgrimage to Mecca.
While her mother is away, she is going through great anxiety: "Did Mother again go away from me, this time to God?"; "Am I the sin she wishes to atone for?" As if asking: Does mother's religiosity reflect a wish for transcendental transformation intended to bring closeness, or, is it a distancing narcissistic withdrawal?
The third surgery
Two years later another surgery was necessary. While waiting to enter the operating room, mother says: "You have to accept God's decision."
 After a long and complicated surgery she sinks into unconsciousness. Recuperation this time was tough and very slow, demanding a prolonged period of recovery. After long weeks, there are signs of improvement and the beginning of a long and painful process of rehabilitating the body.
She is very weak and comes to therapy in a wheelchair. As speech is difficult for her, we sit wordless in the dread of the unknown, her thin hand in mine. While I am amazed by her determination, her gaze asks: "Do you believe this?"
When she leaves, I notice creases on the sofa, on pillows strewn about, and wonder: Can the human spirit leave traces in the material world?
On the surface, life is static – her range of movement extends from one type of treatment to another, steps taken with temporary, uncertain hope and in the background, the heart's clock is ticking.
At times, depression takes over; she loses the will to live, unable to find a reason to wake up to the new day – she asks: Is there a reason? Am I at fault?
She talks about death as an encounter with God, and wonders: Will He take her unto Him, perhaps He will find her guilty?
She does not fear death, but says: "if this is what awaits me, it is too bad, as I still have so much that I want to do here."
Suicide is an option, as a choice in a narcissistic act, saying: "This isn't the life I want to live." She feels frustrated by not being able to contribute to the world and participate in it, as she would like. "What is my life worth? What a waste, So much effort, time and money are being spent on me but I can give the world nothing in return." The slope is slippery.
Following an argument at home, she drew a kitchen knife from the drawer, wishing someone would stop her; then injured herself. Father ran after her, bandaged the wound and took her to the hospital. "I tried to kill myself in front of them – I didn't feel enough intensity in their reaction, which was: Look what you have done to yourself. Now, you'll have to live with your scars throughout your whole life."
As her cry was not heard by her parents, she was left with additional scars, in her body and in her soul. 
She is familiar with the limits: on one hand, the sky is the limit; she wants to live life to the fullest, to love and to be loved; on the other hand she recognizes reality accepting her fate. We try to find the golden path between aspirations and reality. When I note her attractive appearance, she may break into tears and asks for my understanding: though she puts effort into maintaining her outward appearance, which is relatively easy, she cannot reveal her broken heart. At home, optimism is demanded of her and there is no one to contain her depression and her feelings of purposelessness. She does understand that her justified depression is a threat to her environment, but at the same time, she needs  "to be allowed" to be depressed, not in order to dive into the depths of despair, but rather, to recognize the reality of her life.
She sends me a text message: "You should have known that I am a lost case," and cuts off communication.
I am terrified as if standing on the edge of an abyss. I am torn between the desire to act, to call for help, on one hand, and on the other hand trusting her strengths and her right to choose what is right for her.  I keep calling, leaving her messages, and pray she is listening. After 24 very long hours she calls and says: "I have no more strength". "You are with me all the time" I tell her; "If so" she replies "I am in the most pleasant place in the world."
 
Before her fourth cardiac surgery, this time elective, we have time to put her fears into words.
She quotes, in Arabic, a Sura from the Holy Qu'ran, then translates for me into Hebrew: "God teaches Man what he should know."  And explains how this knowledge is a comfort to her, as God will teach the surgeons what they need to know while operating on her.
"Will you pray for me?" she asks.
 "Her" Allah and "my" God are at the ready to safeguard her.
At the following meeting, she presents me with a heavy book, a translated Qu'ran. We return once and again to the comforting words. Creatively, she deepens the connection between us by having commissioned a scribe to write the words from the Qu'ran in Hebrew Torah calligraphy.
 Abraham, our common Father, is hosting us within the folds of his tent.

 Like an infant, she asks that I make room for her in my bosom;
 Like a mother, she feeds me as much as I can digest.
 Both of us, she and me, seek to fuse us together, to eliminate barriers.
*                  *                            *
We talk about motherhood. She finds the subject difficult and demands: "You tell me, actually, what is it to be a 'mother'?"  I look for words.
"A mother begins to be when she invites her virtual child to be in her thought, desire and aspiration; then makes room for him in her body, and when the time comes and he is ready, she gives birth to him and accompanies him along the path to living his life."
She listens carefully and says: "It is sad but I don't remember that something like that happened to me. I believe mother did give me this feeling, but I don't remember it." She tries to calm herself.
"I so wanted a kiss and a hug, it took so long since I have merited any… When I was hospitalized (recounts the impressive long list) I received warmth and I felt loved, but now Mother does not want to travel with me to this operation (the fifth one, abroad). Mother says there is no need. I begged her saying that I really need her to be there because who will shower me after the operation? But she doesn't want to."
Within me arise a familiar feeling; first-hand I know the pain of being a child to a partially-available mother.
My mother, who, as an adolescent girl, had to escape from her home that went up in flames during WW2, seeking to find a home "here," sometimes sought to revert to the girl she had not had time to be. I knew that within my beloved mother there are dark areas, where I do not exist.
"When the therapist experiences, together with the patient and on his behalf, the deadly injury as actual, he turns directly to the harmed child like a panicked mother drafted to his rescue; the doctor's and patient's tears commingle and create a sublimative unity whose parallel can be found perhaps only in mother-child relationships. And this is the healing factor." says Ferenczi[1985(1932)] in outlining the direction of development that Kohut would later articulate as "empathy". 
The mother feels the damaged daughter as a narcissistic wound; the girl – feels damaged, by virtue of being.
The birth scenario is repeated at every surgery, creating opportunity for renewed choice – death or life. Birth is difficult, and the baby-girl, perhaps to preserve an image of having a "good mother," perhaps in order to be her "good girl" accepts responsibility for the choice. With each operation, she struggles with the tendency to give in to her mother, for the purpose of birth or for sacrifice. And at the same time, courageously, she does not give in to herself; she chooses life.
It is not the objective of this article to discuss the mother or to judge her; her story, the matrices that formed her becoming, are not clear to me. I observe the imprint she makes on her daughter; her difficulties in responding to and in showing compassion- pain me. I am aware of the severe life style that mother impose upon herself, of her loneliness that stems from the need to keep her free spirit at eay, an indication of intensity and "courage," whose results finds her torn between her own pain, and the pain of her daughter.
The mother overdoes being a "total mother."  By thickening the vertical split partition; she fluctuates between overdoing and distancing.
In his article, "The Unwelcome Child and his Death Instinct," Ferenczi [1929(1980)] argues that children born unwanted tend to give up on their life "easily and willingly."
Winnicott(1971), who broadened the understanding that primary processes take place in the "mother-infant" space, states that an infant who senses that his mother does not offer him space in which he can "happen," may give up on vitality and may choose to exist at a level of survival.
If this is the case, wherefrom does she take the materials she uses to create her psychic home? Perhaps the genetic matrix which conferred disease upon her has also bestowed her with the determination and courage her mother demonstrates. Her courage is not directed toward maternal giving, but in her hurtful and harmful way, she exhibits perseverance and non-conformism. It would appear that this quality was impressed upon the "branch" she grew. The daughter, however, gathers and extracts the life-giving sustenance she received from the generation of grandparents; she is helped by our therapy which does not focus on exploration and interpretation but rather, on the ongoing search for an appropriate experience of the selfobject, which is attentive, wondrous and congruent.
And perhaps, above all else, she possesses the impressive, almost incomprehensible ability of transformation to a supra-individual existence, as proposed by Kohut(1966). Easing of her painful reality is facilitated through creativity, humor, empathy, deep wisdom and acceptance of death with joy, as continuity of life, since there, in the blooming garden, beyond the window in the wall, her beloved grandfather awaits her.
 
Epilogue
She recalls a childhood memory:
"I awoke early; Mother was sitting at the dining table which was laden with books, studying. I was lying on the sofa; I was drinking milk, and then she wrote down our telephone number and home address and handed me the piece of paper, saying: "This will protect you; the world out there is very dangerous."
"Mother's face was so beautiful at that moment." She is welling up with emotion "Looking back, it seems to me that my mother was my home. She worries about me and doesn't want me to get lost." My eyes fill with a film of tears accompanied by pain and concern.  Mother worries and protects her so why do I not sense the sweetness but rather the pain of absence of contact and lack of comfort?
At night I dream her childhood memories. In my dream, a long, thin child is sent into the world wrapped in an amulet of paper scrawled with symbols. I am a girl-doll in armor of paper, paralyzed against the dangerous world.
I wake up trembling from cold and sadness; tired, abandoned, not knowing who will protect me and which God will direct me how to take care and safeguard her and me.
My passing thoughts awaken another early memory, very dear to me. A source of nourishing sustenance for me: my father's first memory:
"I slept in the room adjacent to the kitchen. I woke up towards morning when darkness still enveloped all; I saw light in the kitchen. I got out of bed and went into the kitchen. There my mother stood braiding challas for the Sabbath. Noticing my presence, she uplifted me in her arms, hugged and kissed me and while taking me back to bed said: 'You still need to sleep, my good boy!'
Before I fell asleep again, I thought to myself "I am three years old and I am a good boy, my mother just told me so" [Wagner (2000).]
My grandmother is looking at us when I seek to gather her within my arms, to feed her the sweet, fresh challah, to wrap her in a soft blanket and tell her "You are a good girl and you are at home."                                                                                                                  
                                                  *                                *                      *                      *         
In describing the contribution of self psychology to the spiritual dimension of psychoanalysis, Kulka (2005) writes:
"If the environment does not constitute an empathic selfobject matrix for the person, but he himself lives courageously, then he will be a tragic person. The tragedy is not a necessity; it is simply the outcome of a split between the person and the contextual matrix in which he lives."
The contextual matrix is the place where we wish to feel at home in the world. Tragedies are placed at the center of therapy; a lack of compatibility between the self's needs and the environment's capacity to meet them.
Therapy is an ongoing search to create a nourishing "contextual matrix", to build a safe psychic home, to enable space where meaningful life may come into being. 
References
Buber M. (1988) The Image of Man; Studies in philosophical anthropology (Philosophical writings Vol. VII)
 Buber, M. (May 1957). "Guilt and guilt feelings". Psychiatry 20 (2): 114–29
Derida J., Adieu to Emmanuel Levinas, translated by Pascale-Anne Brault and Michael Naas (Stanford: Stanford University Press, 1999)
Ferenczi S.   (1985) the Clinical Diary 1932 
Ferenczi, S. [1929] (1980): The unwelcome child and his death instinct. In: Final contributions to the problems and methods of psycho-analysis Mariesfeld Reprints, London. 102-107.
Freud S.  (1915) The Unconscious.  In: The Standard Edition vol. 14.
Kohut  H.    (1966)  Forms and Transformations of Narcissism. In: The search for the self Ch.32
Kohut  H.   (1984) How Does Analysis Cure?
Kulka R.  (2005) Introduction to the Hebrew translation of Kohut's "How Does Analysis Cure"   (Hebrew)
Levinas e.(1969) Totality and Infinity, an essay on Exteriority
Translated by Alphonso Lingis` Pittsburgh: Duquesne University Press
The Quoran:  sura 96: "A Drop of Blood"
 Translated (Hebrew) by prof. Uri Rubin (2005). 
Wagner Z.J (2000). "Five Generations"- a memoir (Hebrew)
Winnicot D.W.(1971) Playing and Reality
Psychology Press, 1971
 
 
 
 
Adina Halevy
 Jerusalem, ISRAEL                                         
Adina38@gmail.com                                                                                                  Fall 2014                                      
 
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