El alcance de los procesos de victimización

In documenting an unusual occurrence in the world of professional psychoanalysis – a psychoanalytic conference segment concerned with treating disabled patients – De La Torre (2002, p. 675) describes the issue of disability as "a topic that has been largely foreign to psychoanalysis". Indeed, with regard to theorising on disability and psychic functioning, the silence from psychoanalytic quarters has, for much of the last century, been deafening (Castelnuovo-Tedesco, 1981, p. 145). This fact is bewildering; surely, one imagines, the experience of bodily impairment, with its concomitants of culturally embedded denigration and discrimination, should be of interest to a discipline concerned with mapping the depth and diversity of human subjectivity. In reading this silence, one may consider a number of possible explanations: first, that psychoanalytic writers felt that there was no reason to believe that disability is associated with mental health concerns which necessitate its being afforded "special attention" within psychological theory. The second, more ominous possibility is that psychoanalysis – perhaps inadvertently – constructs disabled persons as "too damaged" to benefit from the work of analytic psychotherapy. Or, is there something about the mystique,

the evocativeness of impairment, which has rendered a subtle avoidance of the exploration of disabled subjectivity? On a more material level, it may be that the typically disadvantaged socio-economic position of disabled persons has placed their lives beyond the ken of the bourgeois world of couch and consulting room. Evidence from the limited literature seems to indicate that psychoanalytic accounts, like the majority of psychological theorising on disability, assume that the onset of bodily difference necessarily brings with it pathological psychic reverberations (Lenny, 1993, p. 233; Asch & Rousso, 1985; Gill, 2001). The stridently negative, at times damning, prognostications associated with these assessments lend credence to the idea of psychoanalysis' neglect of disability relating to an amalgam of anxious avoidance and therapeutic pessimism. The key issue which forms the backdrop to these reflections pertains to the origins of the psychological difficulties experienced by disabled persons. Of course, not all disabled persons encounter psychological problems, but, as in any population, a proportion will. Writing from a social model perspective, Oliver (1993a, p. 61) argues that nondisabled mental health professionals have, largely, viewed such difficulties as emanating from the functional limitations which arise from impairment. The disability movement, conversely, has averred that it is not bodily difference, but the failure of social and physical environments to provide equitably for the needs of the impaired that is at the root of the emotional distress evidenced by some of their number (Oliver, 1993a, p. 61). An influential piece of "rehabilitationist" research which is held in infamy by disability studies is that of Miller and Gwynne (1972), who portrayed the disabled persons in the institutional settings which they studied as having psychological difficulties which were an inevitable outpouring of their physical "limitations" (Miller & Gwynne, 1972; Morris, 1993a, p. 86). This penchant for forging causal links between the nature of bodies and the health of psychic functioning is echoed through most psychoanalytic contributions on the subject of disability.

Adrienne Asch and Harilyn Rousso (1985), in their cutting critique of psychoanalytic theorising on disability, describe how, in general, this work has done much to compound and reinforce prejudicial stereotypes regarding the emotional functioning and potential for productivity and intimacy of disabled persons (Asch & Rousso, 1985, p. 1). Much psychoanalytic literature, tacitly or overtly, constructs disabled persons as (relatively) unanalysable, due to the (believed) ubiquitous presence in this population of poor levels of ego integration, compounded by primitive psychic defence structures (ibid., p. 4). The logic of these investigations is one which seeks a direct impact of bodily impairment upon personality development; that is, purporting to "read" what of the self is "written" on the body. Having predicated their work upon this assumption, the attention of such investigations

then moves to questions regarding the extent to which the "psychological effects of impairment" are "inevitable, preventable or modifiable" (ibid.). By way of example, Thomas and Siller (1999) recount that typical reactions to disability include "depression, withdrawal, shame, overcompensation and denial", as well as "considerable sensitivity about the disability" and "feelings of inferiority" which are managed via a "generalised hostility" (Thomas & Siller, 1999, p. 182; Siller, 1963; see also Castelnuovo-Tedesco, 1981, p. 145). Whilst each of these "sequelae" are not discounted, and are quite plausible, the key issue at hand is that little or no mention is made in this body of research of the potential pathogenic or harmful effects of the exclusion, prejudice, discrimination and denigration which are the hallmarks of disabled life in most societies. In a retrospective review of analytic work in the area, Castelnuovo-Tedesco (1981) identifies the overwhelming focus on bodily factors within this literature, but in no way problematises this. With a similar disregard for ideological concerns, a range of authors echo Thomas and Siller (1999) in identifying unmastered aggression as a common emotional consequence of bodily defect, with severe maladaptive implications emanating from a lack of ego maturity (Bornstein, 1977; Burlingham, 1961; Castelnuovo-Tedesco, 1981; Niederland, 1965; Ogden, 1974).

Perhaps the psychological effect of impairment most reliably suggested by this legacy of psychoanalytic theorising is that of narcissistic pathology (Harris & Wideman, 1988, p. 117; Davis, 2002). Although, as we shall see, Freud's utterances on the issue of disability are somewhat ambiguous, Niederland (1965, p. 518) buttresses his own position by pointing to the fact that the father of psychoanalysis viewed work with patients with "organic disease" as a key route to understanding narcissism (Freud, 1914, p. 550-51). Note, at this point, that for the purposes of explication of my key difficulties with this early legacy of psychoanalytic theorising on disability, Niederland's (1965) work will be examined in some detail; with some minor variation in positions taken by this clutch of writers, my primary objection to their position is brought clearly to light in his writings. For Niederland (1965, p. 518), bodily "defects" may function as "nodal psychological factor[s]" in the "genesis and perseverance" of narcissistic disturbance". This purported disturbance relates to the assumption that a "damaged" body (from infancy or childhood) will necessarily lead to distortions of the body ego, which, via projection, will render a distorted picture of the world (ibid.; Castelnuovo- Tedesco, 1981). The potential import of this cause-effect assertion for the manner in which subjective distress experienced by disabled persons is interpreted, borders on the horrific; the "damage" which manifests in such distress is forcibly "pushed" into the body, cementing the locus of lack, of defect, of failure, within the individual as an inevitable consequence of a

"spoiled" body. Further, this assertion constructs disabled people as carrying an inherent psychological "difference" which – unavoidably – emanates from within, as a result of "organic factors". Perception of self and other and reality testing, evolving against the backdrop of an "essentially bodily self-image and cathexus" based on an "oral-tactile" early concept of body, are viewed as doomed to severe distortion (Hoffer, 1950 cited in Niederland, 1965, p. 527). The "damage" which inheres in body and body ego, in turn, is responded to within this portrayal by a range of desperate, narcissistic defensive distortions, such as aggrandisement, magical thinking, secretiveness, aggression, and a florid fantasy life, replete with such themes as revenge, immortality, and birth-rebirth (Niederland, 1965, p. 521; Castelnuovo-Tedesco, 1981, p. 146). Niederland (1965) restricts his analysis to subjects who have had bodily impairments since birth or early childhood, thus arguing that basic body ego development has been distorted, via the "oral-tactile" apprehension of the "bodily self". However, the onset of impairment in later life has, elsewhere within the psychoanalytic literature, analogously been viewed as a potent assault on the ego (Lenny, 1993, p. 236; Castelnuovo-Tedesco, 1981, p. 146). Again, an asocial, cause-effect relationship between body and body ego is tacitly postulated, fulfilling cultural scripts of disablement as "personal tragedy", rather than social injustice.

A central question for our consideration is whether it is reasonable to argue that the pre-social experience of an impaired body may, or will, lead to body ego distortion and concomitant narcissistic injury. Freud (1923, p. 636) wrote that the ego is "first and foremost a bodily ego"; the ego is "a projection" of the surface of the body. This would seem to suggest that the nature of bodies directly informs the nature of the body ego, hence carrying formative influence over the ego. Of interest, though, is the question of whether culturally condensed assessments of value pertaining to the normalcy of bodies mediate this "reflection" of the body as it is precipitated into a body ego. Writers such as Niederland (1965) view the imprinting of narcissistic injury upon the ego arising from "basic physical experiences" as unproblematic (Niederland, 1965, p. 522 – my emphasis). But elsewhere, Freud (1914, p. 561) seems to intimate a far more "ideologically situated" view of bodily difference or disease. He writes:

In the aetiology of neuroses organic inferiority and imperfect development play an insignificant part. Neuroses make use of such inferiorities as a pretext, just as they do of every other suitable factor.

Here, Freud (1914) locates bodily difference clearly as secondary to psychic functioning – that is, suggesting that somatic "defects" may be utilised as a rationalising "kernel of truth" which allows material sense to be made of what are, in fact, purely psychic, neurotic phenomena. Winnicott (1965) places strong emphasis on the physicality of bodily experience in shaping what he terms "the imaginative self" (Winnicott, 1965, p. 244). Dwelling within, and exploring the "inside" and "outside" of the "live body" provides the subject matter, the shape and sensation, of the coalescing self (ibid.; Erskine & Judd, 1994). But crucially, this does not mean that without the distorted socialisation which is so often the corollary of bodily difference, that the impaired body would nevertheless come to be experienced, in a primary way, as damaged. The body which the congenitally impaired infant possesses is the only body which he or she has ever experienced; its boundaries and shape, its motility and sensation – these are not aspects set against pre-existing ideals, but primary apprehensions of a unitary self. It is difficult to see how evaluative judgments, impacting upon the incremental solidifying of self, can take form without the mediation, the mirroring influence, of the social world.

Asch and Rousso's (1985) core criticism of the legacy of "traditional" psychoanalytic research on disability is expressed by the authors as follows: "Our major criticism ... is that by asking what impact a physical disability has on adult psychopathology, many authors overlook the impact of parental, familial and societal treatment on the psychological development of their disabled patients" (Asch & Rousso, 1985, p. 6). This keen observation is at once compelling and disturbing. What it might suggest is that the gripping evocations associated with disability have led psychoanalytic thinkers to temporarily abandon or disregard basic theoretical tenets of their orientation. To explain: it seems reasonable to assume that researchers operating within most psychoanalytic frameworks would place the influence of the family at centre stage in shaping the development of individual psychic functioning, be it of an adaptive or pathological sort. Yet, astonishingly, this principle seems to have been discarded here. Perhaps the hegemony of individualising modes of attribution pertaining to disability has permeated the views of these authors to the extent that, inter alia, the role of the responses of primary attachment figures in shaping the experiences of self and other of their impaired offspring is hardly considered (e.g. see Castelnuovo-Tedesco, 1981). One of Niederland's (1965, p. 521) research subjects, a woman with a paralysed arm, is portrayed in his analysis as manifesting strong signs of grandiosity which are attributable to her impairment. After recounting this interpretation, he then informs his reader of how she was kept in traction – flat on her back, and presumably in hospital – for most of her first year of

life. Niederland makes no significant mention of the potentially definitive aetiological import of this experience, instead moving quickly to a consideration of her "revenge fantasies", involving bodily dismemberment, mutilation, and the like. Again, there is no reason to question or doubt the presence of, say, revenge fantasies within this woman; the key question is, revenge upon whom, and for what? There is an inherent – even glaring – contradiction within a logic which attributes such phenomena as fantasies of revenge or grandeur to asocial origins. Surely, our investigation should be directed toward the culturally condensed meanings of lived bodies, rather than the material, banal "presumed" body. Psychoanalytic research which inadvertently performs the sleight of hand of conflating primary, "natural" bodily experience with cultural, evaluative bodily experience fail to heed the words of Susan Bordo cited earlier. These authors set up "impaired" bodily experience, even in infancy, against the myth of a "natural" body – a body which does not exist; instead, "natural" is "the script of culture writ large on the body" (Bordo, 1993 cited in Michalko, 2002, p. 58). This comment is not intended to diminish or question the embodied reality of impairment; rather, what must be emphasised is the social nature of meanings and significations attached to that impairment. Put simply, Niederland, Bornstein, Burllingham and others fail to investigate how their impaired patients have been responded to throughout their developmental years, by – in all probability – a fretful and frightened social world, deeply unready to engage with the shameful evocations and ambiguity of disablement. Later in the same paper, Niederland (1965, p. 529) does add a few caviats to the rather bald statements recounted above. He writes:

While noting these relations between disturbed ego development and early physical defectiveness, I wish to emphasise that I do not regard the latter as the sole pathogenic influence in their clinical picture. I believe, rather, that the defect, in addition to its significance as a concretising and organising experience of pathogenic import from early childhood, adds a 'kernel of truth' quality and multidimensional aspects to the pathological fantasies which are likely to arise during the developmental phases.

(Niederland, 1965, p. 529)

What the author seems to suggest here is that, to some extent, the impairment becomes – in Freud's (1914) words – a "pretext" into which more basic and universal relational conflicts are projected. Notwithstanding this helpful "afterthought", the overwhelming emphasis, and interpretive logic, of Niederland's account reflects a profound circumvention of social factors in mediating development. Relational considerations are named here in the abstract, but no

space or real endeavour is devoted to imagining the contours of such dynamics. The compelling nature of the damaged body, instead, entrenches itself into a virtual monopoly of attributive meaning.

If bodily impairment is so evocative, so compelling, to psychoanalysts as to bias attribution so, surely its "counter-transferential" effect upon parents of "defective" neonates will – especially during the crucial early years of life – be equally or more significant. The effect of systemic anxieties surrounding sight impaired infants and children, often manifesting in bizarre, even perverse distortions in socialisation and education, has been movingly, and at times disturbingly, documented (e.g. Chapman, 1978; French, 1993b; see also Scott, 1969; Armstrong, 2005). In the psychoanalytic study of congenitally blind children, attempts have typically been made to conceptualise the impact of the "naked" absence of sight upon developing object relations (Blank, 1957; Bornstein, 1977; Burlingham, 1961; Nagera & Colonna, 1965; Omwake & Solnit, 1961; Wright, 1991). These accounts proffer quite unilaterally pessimistic prognoses for what they view as the personality "sequelae" of development without vision. For example, Burlingham (1961, p. 131) argues that blind children are restricted in adaptively managing aggression, through the lack of apprehension of the consequences of their actions via the visual modality. Assumptions, thus, were often made by the children she studied that their actions brought about catastrophic effects, tending to lead to a constriction and anxiety surrounding agency. With a similar tone, Bornstein (1977) observes that blind children are "reduced to helplessness and panic" upon repeatedly failing to verify their mother's existence, through the unsatisfactory, cumulatory modality of audition (Bornstein, 1977, p. 25; Wright, 1991). The blind children studied by Bornstein (1977) showed very poor object constancy at 3 years, as against the typical achievement of this milestone at about 1 year by control children. Correspondingly, Nagera and Colonna (1965, p. 271) reported how, in contrast to sighted children, blind children remained largely rooted in pre-phallic phases of drive development. In making sense of this they argue that blindness interferes so profoundly with identifying environmental means of gratification that such means, when "captured", tend to lead to a fixated preoccupation which prevents their being abandoned, and consequently constrains development. Lastly, Omwake and Solnit (1961) describe a therapeutic intervention with a blind girl: while directing attention to the traumatic experiences of her first three years of life as influential in her (disturbed) development, these authors then frame her impairment as causal in her psychopathology, arguing that her "consequent" under-stimulation rendered it impossible for her to develop psychic imagery necessary for the solidifying of the structural foundations of repression.

Kenneth Wright's (1991) influential contribution to this area has been critiqued in some depth elsewhere (Watermeyer, 2002). What all of these contributions share is a fascination with the "dark world" of blindness, which stunts and distorts the potentially incisive power of an object relations analysis of the dynamic effects of blindness in infancy. The conceptualisations offered by these authors, quite simply, are lacking in a rigorous interrogation of the relational implications of impairment; that is, the multifarious, largely unconscious, impact of infantile blindness upon the delicate development of the early dyadic relationship, as this sets a tone for later, systemic constructions of self and other. As shall be argued in the following section, the extraordinary capacity of disability to evoke primitive anxieties in the other, may profoundly disrupt the early developmental milieu, rendering potentially calamitous distortions in key areas such as containment and mirroring. Reference within the work cited above to, for example, inadequate stimulation, is typically made with no attention whatsoever to issues such as parents' struggle in developing a healthy sense of secure belief in their capacity to contain and manage this unexpected, perhaps "tragic" arrival – a blind infant. Again, one would imagine that these issues, viz. the nature and management of parental fantasies and fears surrounding the capacity to parent, to imagine and hold the fantasised internal world of their child – would be of primary, definitive concern to psychoanalytic researchers. Instead – and familiarly – the emphasis of all these analyses begins with, and remains entranced with, the somatic. Where attention should be carefully directed to issues such as the attuned responsivity of an anxious, ambivalent, and probably un-informed world, Bornstein (1977) instead remains preoccupied with "infantile masturbatory conflicts". The realness of such conflicts, as noted earlier, is not in doubt; but it is the tacit or overt attributions made regarding the origins of these that are of paramount importance. Surely, it is incontrovertible that "symptoms" such as difficulties with channelling aggression, anxiety at not "finding" a parent and consequent poor object constancy, and a lack of appropriate gratification due to paucity of stimulation, are all situations with, at the least, a substantial relational dimension. It is only when one begins by peering in the direction of relational factors that the profound, formative influence of such dynamics begins to crystallize. Dangerously, these dynamics may produce effects which masquerade all-too-readily as the sequelae of impairment; at least in the, at times, extravagant imaginations of minds captured by bodily "defect. By way of one further example, Berger (1967), although developing ideas on chronic illness rather than disability, emphasises the experience of feeling "unknowable"