Working with chronic and relentless self‐hatred, self‐harm and existential shame: a clinical study and reflections

Abstract

This paper is the first of a two-part series which explores some of the theoretical and experiential reference points that have emerged in my work with people whose relationship to their body and/or sense of self is dominated by selfhatred and (what Hultberg describes as) existential shame. The first paper focuses on self-hatred and the second paper focuses on shame. This first paper is structured around vignettes taken from a 14-year analysis with a woman who was bulimic, selfharmed and repeatedly described herself as 'feeling like a piece of shit'. It draws together elements of Jung's concepts of the complex and symbol, and Laplanche's enigmatic signifier to focus on experiences of 'inner otherness' around which we are unconsciously organized. It also brings Jung's understanding that emotion is the chief source of consciousness into conversation with Laplanche's approach to the transference which is that by being aware that they do not 'know', the analyst provides a 'hollow' in which the patient's analytic process can evolve. These combinations of ideas are linked speculatively to emerging understandings of the neuroscience of perception and throughout the paper clinical material is used to illustrate these discussions.

Working with chronic and relentless self‐hatred, self‐harm, and existential shame: a clinical study and reflections (Paper 2 of 2)

“…In this context it felt right to raise my earlier countertransference image of her trying to force me to eat shit/her shit (see Austin , pp. 38‐39).…”

“…Again a primary point of reference in this process is Jung's understanding of emotion as the ‘chief source of consciousness’ (Jung , para. 179) and our embodied experience of emotions as having ways of ‘knowing’ and ‘deciding’ that are more efficient than thinking (Austin , p. 32). And since such patients’ shame often cannot be looked at/referred to directly, engagement with it needs to be, as Colman describes, through whatever metaphorical analogy is available.…”

“…Samuels is pointing out that we are more likely to glimpse the enigmatic inner othernesses around which we are organized through part objects than whole ones. Also, object relations’ emphasis on whole‐object relating sits uneasily with Jung's understanding that the psyche is normally dissociable (Hartman ) and can be worked with by personifying its contents (Samuels , p. 2; Austin ), both of which are central to how I work.…”

“…The first of these two papers (Austin ) explored my experiences of working with people for whom self‐hatred is an expression of their sense of self as abject. It focused on 14 years of analytic work with a patient whom I called Leah, who, at the start of analysis (age 27), presented with a disorder of the self (borderline spectrum), bulimia nervosa, self‐cutting and body‐dysmorphia.…”

Mind, brain and body. Healing trauma: the way forward

“…Austin reminds us that ‘while Freud's focus was on the drives, Jung saw affectivity as the ground and basis of personality ( CW 3 , para. 78)’ (Austin , p. 32). Mizen's innovative work with inpatients with the most severe psychiatric disorders has led her to propose the necessity of a relational affective approach if we are to understand personality disorder (Mizen ).…”