Injured Men Injured Men Trauma, Healing, and the Masculine Self IRA BRENNER, M.D JASON ARONSON Lanham • Boulder • New York • Toronto • Plymouth, UK Published in the United States of America by Jason Aronson An imprint of Rowman & Littlefield Publishers, Inc A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowmanlittlefield.com Estover Road Plymouth PL6 7PY United Kingdom Copyright © 2009 by Jason Aronson Publishers All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Brenner, Ira, 1950Injured men : trauma, healing, and the masculine self / Ira Brenner p ; cm Includes bibliographical references and index ISBN 978-0-7657-0572-3 (cloth : alk paper) ISBN 978-0-7657-0692-8 (electronic) Psychic trauma Case studies Men Mental health Case studies Dissociative disorders Case studies I Title [DNLM: Stress Disorders, Post-Traumatic psychology Case Reports Dissociative Disorders psychology Case Reports Men psychology Case Reports WM 170 B838i 2009] RC552.T7B74 2009 616.85’21 dc22 2009029264 Printed in the United States of America  ™ The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992 In memory of Leo Madow, M.D., a healer of injured men Contents Acknowledgments ix Introduction xi On the Need to Be a Man Dissociation and Its Vicissitudes 11 The Enactment-Prone Patient 39 September 11 and the Analytic Process 57 A Time-Traveling Man 77 Echoes of the Battlefield 99 Forged in the Holocaust 173 Healing 193 References 207 Index 229 About the Author 241 vii Acknowledgments This book could not have come to fruition without the support of the staff of Jason Aronson Publishers, especially Julie Kirsch and Jessica Bradfield In addition, Deborah Szumachowski has worked valiantly to type and organize this manuscript Many friends and colleagues need to be thanked also, especially George Awad (deceased), Harold Blum, James Chandler, Helen Epstein, Marc Lipschutz, Dominic Mazza, Mike Mccarthy, Henri Parens, Nadia Ramzy, Anita Schmukler, J Anderson Thomson, and Stuart Twemlow, who were always available to read my papers My patients, however, remain my most important teachers An artist has given permission for use of the cover image, and a courageous Vietnam veteran was willing to offer his interview And my wife, Roberta Brenner, has been there for me through it all ix References 227 ——— (2004) Cat people revisited In Mental Zoo: Animals in the Human Mind and Its Pathology Madison, CT: International Universities Press Volkan, V D., and Akhtar, S (eds.) (1997) The Seed of Madness: Constitution, Environment and Fantasy in the Organization of the Psychotic Core Madison, CT: International Universities Press Volkan, V D., and Ast, G (2001) Curing Gitta’s “leaking body”: Actualized unconscious fantasies and therapeutic play Journal of Clinical Psychoanalysis 10: 567–606 Volkan, V D., Ast, G., and Greer, W F (2002) The Third Reich in the Unconscious New York: Brunner-Routledge Waelder, R (1960) Basic Theory of Psychoanalysis New York: International Universities Press Wallerstein, R S (1990) The corrective emotional experience: Is reconsideration due? Psychoanalytic Inquiry 10:288–324 Watkins, J G (1992) Hypnoanalytic Techniques: The Practice of Clinical Hypnosis, vol New York: Irvington Watkins, J G., and Watkins, W H (1979–1980) Ego states—hidden observers Journal of Altered States of Consciousness 5:3–18 ——— (1997) Ego States: Theory and Therapy New York: W W Norton & Co Weil, A P (1970) The basic core Psychoanalytic Study of the Child 25:442 Weston, D (1999) The scientific status of unconscious processes Journal of the American Psychoanalytic Association 47:1061–1106 White, M T (1986) Self constancy: The elusive concept In Self and Object Constancy: Clinical and Theoretical Perspectives, ed R F Lax, S Bach, and J A Burland New York: Guilford Press, pp 73–94 Whitmer, G (2001) On the nature of dissociation Psychoanalytic Quarterly 70:807– 837 Wholley, C (1925) A case of multiple personality Psychoanalytic Review 13:344– 345 Winnicott, D W (1935) The manic defense In Through Pediatrics to Psychoanalysis: Collected Papers London: Routledge, pp 129–144 ——— (1945) Primitive emotional development International Journal of PsychoAnalysis 26:137–150 ——— (1953) Transitional objects and transitional phenomena International Journal of Psycho-Analysis 34:89–97 ——— (1960a) Ego distortion in terms of true and false self In The Maturational Processes and the Facilitating Environment New York: International Universities Press, 1965, pp 140–152 ——— (1960b) The theory of the parent-infant relationship International Journal of Psycho-Analysis 41:585–595 ——— (1965a) The theory of the infant-parent relationship In The Maturational Processes and the Facilitating Environment London: Hogarth Press, pp 37–55 ——— (1965b) The Maturational Processes and the Facilitating Environment New York: International Universities Press ——— (1971) Playing and Reality New York: Basic Books, Inc ——— (1974) Fear of Breakdown International Review of Psycho-Analysis 1(1,2): 103–107 228 References Wolfenstein, M (1966) How is mourning possible? Psychoanalytic Study of the Child 21:92–126 Yates, S (1935) Some aspects of time difficulties and their relation to music International Journal of Psycho-Analysis 16:341–354 Yehuda, R (1999) Parental PTSD as a risk factor for PTSD In Risk Factors for Posttraumatic Stress Disorder, ed R Yehuda Washington, DC: American Psychiatric Press, Inc., pp 93–123 Yehuda, R., Grolier, J A., Halligan, S L., Meaney, M., and Bierer, L M (2004) The ACTH response to dexamethasone in PTSD American Journal of Psychiatry 161:1397–1403 Yehuda, R., Kahana, B K., Binder-Brynes, K., Southwick, S M., Mason, J W., and Giller, E L (1995) Low urinary cortisol in Holocaust survivors with posttraumatic stress disorder American Journal of Psychiatry 152:982–986 Zetzel, E R (1949) Anxiety and the capacity to bear it In The Capacity for Emotional Growth New York: International Universities Press, 1970, pp 33–52 ——— (1965) Depression and the incapacity to bear it In Drives, Affects, Behavior, ed M Schur New York: International Universities Press, pp 243–274 Index Abend, S., 196 Abse, D.W., 15, 31 Abu Ghraib prison, 100–103 Achilles in Vietnam (Shay), 123, 150, 172 “acting out,” 39 action-prone patients, 39–40, 55 Admiral (Barbara’s masculine self), 5–6 Adult Attachment Interview, 17 adult psychotic self, 32 Afghanistan, war in, 99, 154 aggressor, identification with, 5, 9, 26, 38n1, 93, 103 Aisenstein, M., 205 Akhtar, S., 93–94, 184 Alexander, F A., 70–71 aliases See selves allostasis, homeostasis and, 186 altered states of consciousness, 4, 6, 15, 35, 42, 46 See also autohypnosis altruism, 182, 186, 190 ambiguous genitalia, American Psychoanalytic Association, xi, xiv, 174 amnesia, 6, 8, 18, 23, 25, 27, 55 See also keys, forgetting; specific individuals analysis, goals of, 196, 198 analysts: as mediums, 194–99, 203, 205; as new objects, 71, 188, 195 analytic space, 79 analytic technique, Freud, S., on, 39– 40, 193, 196, 205 Anna O (case), 13, 14–15 annihilation anxiety, 29–30, 31, 37, 38 anniversary reactions: to death, 1, 49, 62, 66, 67, 69, 75n4, 202–3; Paul’s induction day, 124 Anthony, E J., 186 Arlow, J A., xi, 16, 81 Aron, L., 71 athletic metaphors, 61 attachment: infant, 2, 16, 46–47; precursors of dissociation and, 46– 48 See also disorganized attachment patterns; disturbed attachment auditory hallucinations, 8, 30, 34 Auerhahn, N., 47 Auschwitz survivors: De-Nur, 27–29; Hart, Kitty, 79–80, 94–95; Mendel’s father, 88 autohypnosis, 8, 21, 37, 38n3 “Baby Book,” 23 229 230 Index Bach, S., 55 Back to the Future, 90 bad news, power associated with bearer of, 65, 75n5 bad vibrations See premonitions Baranger, M., 95, 188 Barbara (case), 5–6, Bar Mitzvah, xii Bataan death march, 101, 172 “being here and not here,” 22, 29 “being me and not me,” 22 benign dissociative enactments, 42–46, 55 Berman, E., 15 Bettleheim, B., 196 bills, payment of, 193, 195, 203 Bin Laden, Osama, 154 Bion, W., 82, 94, 194, 197–98 birds, symbolism of, 63, 67 bisexuality, 2, black holes, 82 Bleuler, 13, 31 blindness, in Cambodian refugees, 176 Blum, H.P., 95 Bob (Oxnam’s self), 23 Bollas, C., 94 boots, symbolism of, 85–89 Bowlby, J., 16, 46–47 Brenner, Charles, xi Breuer, J., 11, 13, 14 Brokeback Mountain, xiv Bromberg, P M., 18, 47 brother, Mr J.’s, 202–3 Buchenwald, skin lampshades of, 175 building insulated with Styrofoam, dream of, 65 bus, package left behind on, dream of, 66 Bush, George H., 23 Bush, George W., 154 cannibalism, xvn1 case reports: consent for publishing, 71–73; disguising patient’s identity in, 71–72; patient reading own, 58, 67–74; patient’s response to, in third person, 68–69, 72 See also specific individuals castration anxiety, 92, 93 catatanoid reaction, 176, 177 causality, 95, 188 “Chair of Forgetfulness,” 74, 75n2 Charney, D., 190 child abuse: Cindy, 7; denial of, 18, 47–48; Ferenczi on, 14–15; Hannah, 8; impacts of, See also sexual abuse; specific individuals children: child survivors of Holocaust, 68, 153, 158–72, 180, 182–84, 190; gender identity, parents and, 3; of Holocaust survivors, 26, 77, 82–96, 100, 102, 103, 177–78; Mr N’s, 60, 63, 64, 65, 74; near-death experiences, 22, 26, 63, 64, 65, 74; as symbolic dissociated self, 25; trauma and, 4, 5, 38 See also infants; mother-child relationships “the children” (Mary’s self), 34–35 Churchill, Winston, 173 Cindy (case), 6–7; eyeglasses, 191n1; Jack (masculine self), 7, 9; uncle of, circumcision, xiii, 183, xvn1 Cody, Richard, 101 coffin, opening of, as metaphor, 60–61 cohesion of the self, 21, 37, 54, 197, 203 community bulwark, 186 complemental series and heredity, concept of, “compulsion to repeat,” 39 concentration camps, 78, 86–87, 92, 168–69, 175, 184, 190 conditioning, 172, 187 confidentiality, accurate scientific reporting and, 71 corrective emotional experience, 70 cortisol, 17, 100, 187, 191 cowboys, xiv, 87, 121 Crastnopol, N., 72, 73 crystal ball, from patient, 193–95 cultures: on men, xii, 1; transmission through superego, 96 Index Davies, J M., 91 DD-NOS (dissociative disorder not otherwise specified), 24, 29, 53 “dead child” self, 26 dead guy, Paul’s uncle as, 168–69 death: anniversary reactions to, 1, 49, 62, 66, 67, 69, 75n4, 202–3; confrontation with, narcissism and, 182; Mr J.’s reactions to, 49, 53; Mr N’s mother’s, 58–67, 70, 72, 74; near-death experiences, in childhood, 22, 26, 63, 64, 65, 74; Paul’s worries about, 108–9, 114 death camps, 176, 178, 185–86 “defeat reaction,” in animals, 22 deferred action, 95, 188 dementia praecox, 13 De-Nur, Yehiel (Ka-Tzetnik 135633), 27–29 depersonalization, 6; cases exhibiting, 29, 36, 50, 54, 80; Freud on, 11, 38n2 DES (Dissociative Experiences Scale), 50 DHEA-S (dehydroxyepiandrosterone sulfate), 187 Dickes, R., 14 DID See dissociative identity disorder disaggregation, 14 disorganized attachment patterns, 16–17, 22, 46–48, 89 dissociated transsexualism, 5, 9, 26 dissociation, xiv, 12; altered states of consciousness and, 4, 6, 15, 35, 42, 46; attachment and precursors of, 46–48; defined, 26, 37; disturbed attachment and, 16–19, 26; of everyday life, 40–42; fathers’ experiences leading to child’s, 102; free, 30; hypnosis, neurobiology and, 22–23; in infants, 17; motherchild relationships and, 16–22, 26, 46–48, 55, 56n1; repression and, 26–27, 41–42, 55; self-constancy and, 24, 25, 29, 37, 54–55 See also specific individuals dissociative character, 24–27 231 dissociative disorders, xiv, 12 dissociative identity disorder (DID), 4; basic assumptions about, 37–38; constriction of perception and, 176–77, 191n1; as continuum, 15, 24, 30–33, 37, 38, 42; DSMIV-TR diagnostic criteria for, 12; early psychoanalytic views on, 13–15; later psychoanalytic views on, 15–16; as lower level dissociative character, 4, 12, 20; manufactured, 13; other names for, 12, 37; personifications or alter personalities with, 24–25; schizophrenia v., 30–33, 37–38; as subtype of borderline personality, 15; trauma and, 13–16, 23, 27, 41– 42 See also specific individuals dissociative personality, 12, 24 Dissociative Self, 24 See also “It’s not me!” Self dissociopaths, 38n1 disturbed attachment, 16–19, 26 Dora (case), 40 dreams: Cindy’s, 7; ego functioning in, 25; Mendel’s, 86; Mr J.’s, 49, 52–53, 54; Mr N’s, 61, 62–63, 65–66; Mr P.’s, 43–44 Drexel, Joseph, 181–82 drowning, soldier’s, in Vietnam war, 113–15 DSM-IV-TR: diagnosis of DD-NOS, 53; diagnostic criteria for DID, 12; schizotypal personality disorder in, 32 ego, 78; functioning in dreams, 25; maturation/integration of, 32, 46, 89, 179; narcissism and, 180; survival and, 175, 176 ego resilience, 186 ego states, 15 Eichmann trial, 27 Einstein’s theory of special relativity, 82, 91 Eizirik, C L., 204 Engel, G L., 75n4 232 Index Erickson, M H., 15 Eshel, 82 estrogen, 2, exhibitionism, 202 “exposure” therapy, 189 extinction, 181, 187, 189 eyeglasses, Cindy and, 191n1 Fairbairn, 15 “false self” personality organization, 178 family safeguards, 186 fathers: experiences of, leading to child’s dissociation, 102; identification with, 6; Mendel’s, 84– 89, 91–94; Mr N’s, 59–62, 64–67, 74; Mr P.’s, 43; Orville’s, 77; Paul’s, 108, 165, 169–70; remarriage of, 59, 66; of Taguba, A., 101–3 fear response system, psychoanalysis and, 187–89 Federn, P., 15 female alters, female masculinity, Ferenczi, Sandor: on child abuse, 14–15; on omnipotence, 179; on split personality, 11; on termination, 70; “The Unwelcome Child and His Death Instinct,” 175 fetus, male and female reproductive systems in, “Final Solution to the Jewish Problem,” 175 Fleiss, R., 14 Fonagy, P., 18, 47 free association, 14, 39 free dissociation, 30 freezing, in infants, 22 Freud, Anna, 14, 41, 93 Freud, Sigmund: on aggression, 26; on analytic technique, 39–40, 193, 196, 205; on bisexuality, 3; Breuer and, 11, 13, 14; on complemental series and heredity, 2; deadline in analysis of Wolf Man, 71; on depersonalization, 11, 38n2; on dissociation, 37; on hysteria, 13, 14–15, 39–40; on identification with objects, 197; on keys, 45–46; on leasing time, 48; masculine self of, 180; on mediums, 194; on nachträglichkeit, 95; on narcissistic libido, 180; on neurologic basis of psychology, 186; on paranoia and homosexuality, 9; on parapraxes, 40–41; on psychodynamic theory, 81; on psychological defenses, xii; on repression, 14, 40–41, 95, 188; on split personality, 11, 14–15; on superego, 97n1; on trauma, 9, 80; on war, 99 Freudian slip, 202 fugue, 7, 26, 40, 46, 80, 81 gas chambers, 92, 182, 185 gaze aversion, in overstimulated infant, 20, 22 gender differences: with infant attachment, 2; with omnipotence, 179; religion on, xii–xiv gender identity: children’s, parents and, 3; development of, 5; genital anatomy and, 2–3; in women, gender-specific pronouns, generational object, 94 genocide, 175–76, 177, 191 “Gitmo-izing,” of Abu Ghraib, 100 Glover, E., 14, 15 gloves, cowboy, symbolism of, 87 Goldberg, A., 199 Goldilocks and the Three Bears, 196 grandfather, Paul’s, 154, 158–59, 162– 63, 170 grandmother, Paul’s, 105, 108–9, 158– 60, 162–64, 167–68 grave, visiting mother’s, 62, 67 Greene, B., 81 Greenson, R R., xiii gribinis, xvn1 Grossman, D., 172 Grotstein, J., 82 Ground Zero, 57, 66–67, 174 group survival, 182–83, 189–90 Grubrich-Simitis, I., 87 Index guerilla warfare, during Vietnam war, 111–20, 138 guns, fear of, 105, 107 Hannah (case), 7–8 Hart, Kitty, 79–80, 94–95 Hartmann, H., 177 health issues, 203–4, 205n1 Hersh, S M., 101–3 Hesse, E., 17 Hitchens, C., xiii Hoffman, I., 96 Holocaust Discussion Group, 174 Holocaust survivors, xiv; Aryan appearance of, 183; children of, 26, 77, 82–96, 100, 102, 103, 177–78; child survivors, 68, 153, 158–72, 180, 182–84, 190; group survival with, 182–83, 189–90; kinder transport, 158–63; as parents, 95–96; resilience of, 175, 178, 180, 182, 184–86; tattoos, 27, 85; time and, 89–91, 94–96; work with, 61–62, 174–78 See also Auschwitz survivors; concentration camps; death camps; gas chambers; specific individuals homeostasis, allostasis and, 186 homosexuality, 9, 48, 50–54, 86 homosexual self, 25 hormones: manipulation of, puberty and, 3; PTSD and, 186, 191; resilience and, 186–87, 190 See also stress hormones hotdogs, foot-long, 86 Howell, E F., 26 humiliation, men, violence and, 2, 6, Hurvich, M., 29 Hussein, Saddam, 154, 155 hypnosis: dissociation, neurobiology and, 22–23; multiple personality and, 13, 21; proclivity for, 17, 20, 22, 47; repression and, 18, 41; views on, 14, 38n3 See also autohypnosis hysteria, 13, 14–15, 39–40 id, 78 233 identifications: with aggressor, 5, 9, 26, 38n1, 93, 103; with fathers, 6; with rescuer, 77; trauma and, 102–3; with victims, 9, 38n1, 93, 102–3, 172 inanimate objects, 79, 83, 93–94, 96 See also boots, symbolism of incest, 5; Barbara, 5–6; Mary’s, 33–37 infant attachment: Bowlby on, 16, 46– 47; gender differences with, infantile non-psychotic self, 32 infantile omnipotence, 178–80, 191 infantile psychotic self (“seed of madness”), 31–33, 37 infants: dissociation in, 17; overstimulated, gaze aversion in, 20, 22 insecticide spray, running through, 84, 92 International Journal of Psychoanalysis, 73 interpretation process, 197–98 Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences and Services to Assist Recovery, 99 invulnerable child, buffering system of, 186 Iraq, war in, 99, 100–103, 110, 153–57 Israel, 91, 177 ISTSS (International Society for Traumatic Stress Studies) Convention, 173 “It’s not me!” Self, 21, 24–25, 33, 37–38, 53–54 J., Mr (case), 48–54, 199–204; 9/11 and, 201–2; brother of, 202–3; dreams, 49, 52–53, 54; mother of, 51, 202; sadomasochistic perversion, 50, 52, 54; selves, 51, 55; sexual abuse of, 51, 53, 200–201; time obsession, 48–49, 51; uncle of, 51, 53 Jack (Cindy’s masculine self), 7, Janet, P., 14, 20, 55 Jones, E., 13, 14 Journal of the American Psychoanalytic Association, 72–73 234 Judaism: circumcision, xiii, xvn1, 183; death statistics, during Holocaust, 175–76; on gender differences, xii– xiv; naming children for deceased relatives, 178 See also Holocaust survivors Jung, C G., 14 Kantrowitz, J L., 71–73 Ka-Tzetnik 135633 See De-Nur, Yehiel Kernberg, O F., 15, 27, 31, 204 Kestenberg, J.: on Holocaust survivors, 77, 82, 174; on narcissism, 180 keys, forgetting, 42–46 killing, 99, 121, 172; Paul on, 106–7, 121–23; songs about, 106–7 kinder transport, Holocaust and, 158–63 Klein, M., 42, 184, 197–98 Kluft, Richard, xiv, 15–16 “knowing and not knowing,” 18, 19, 20, 21–22, 47 Kogan, I., 90 Kohut, Heinz, xi; on cohesion of the self, 54, 197; on self-state dream, 25; on vertical split, 15 Kraeplin, 13 Kramer, S., 31 Krystal, Henry, 174–78, 190 Kubie, L S., 15 Kumin, I., 178 Lacan, 32 La Farge, L., 73 Laplanche, J., 91 Laub, D., xiv, 47 left-handedness, 202 Lemkin, Raphael, 175 Letters from Iwo Jima, 121 Liotti, G., 17, 47 Loewald, H W., 78, 97n1, 195 Lyons-Ruth, K., 17 Mahler, M., 19, 54, 179 Main, M., 17 male alters (selves), 4–5 male identity development, dis- Index identification of mother hypothesis in, xiii malignant dissociative enactments, 48–54, 55 man, becoming a, xi–xii, Marmer, S S., 15 Marshall (Hannah’s masculine self), Mary (case), 33–37; alcoholism of, 5, 33; dissociation of, 19, 33–37; selves, 33–37; sexual abuse of, 34; suicide and, 34, 35, 36 masculine identity, See also masculine self masculine self: Admiral as Barbara’s, 5–6; of Freud, S., 180; Jack as Cindy’s, 7, 9; Marshall as Hannah’s, 8; Mendel’s, 83, 92–93; in military men, 100, 172; resilient, 183–86, 190–91; suicide and, 6, 8, 9; torture and, 103; in women, xiv, 1, 4–9 masculinity: female, 1; nuances and complexities of, xii, 2; theory of, xiv Massive Psychic Trauma (Krystal), 174–78 maternal protection, 186 McDougall, J., 91 McLuhan, Marshall, 195 McWilliams, N., 24 mediums, analysts as, 194–99, 203, 205 Memorial Day holiday, 149, 150 memory: impacts on, 5, 188–89; trigger reaction, and, 94–95 See also amnesia; screen memories; specific individuals men: cultures on, xii, 1; English expressions for, xii; “kinds” of, male psychology on, xii; narcissism and, 2, 5, 9, 109, 147, 168, 179; pain and suffering of, xiv; stereotypes of, xiv, 1; trauma and, xiv–xv, 1; violence, humiliation and, 2, 6, See also military men Mendel (case), 83–89, 91–94, 96; dreams, 86; father of, 84–89, 91–94; masculine self, 83, 92–93; mother of, 84, 85; uncle of, 86 mental dividedness, continuum of, 15 Index mental space, 79 military men: DHEA-S in, 187; masculine self in, 100, 172 Miller, Geoffrey, 100 Millie (Mary’s self), 34–35 mind-body connection, 203–4, 205 mind-brain connection, group survival and, 189–90 mirroring, 197, 201, 202 mission, Paul on, 109, 120, 166 modern conflict theory, 196 “mosaic transference,” 25 mother-child relationships: dissociation and, 16–22, 26, 46–48, 55, 56n1; inanimate objects and, 79; infantile omnipotence and, 178–79; “knowing and not knowing” in, 18, 19, 20, 21–22, 47; trauma and, 31–37, 89 mothers: Mary’s, 33–37; Mendel’s, 84, 85; Mr J.’s, 51, 202; Mr N.’s, 58–67, 70, 72, 74; Mr P.’s, 43–46; Paul’s, 103–4, 105, 108–9, 119–20, 158–67, 169–71; Taguba’s, A., 102; wish for phallus, transgendered people and, mourning, Holocaust and, 177–78, 184 Mourning and Melancholia (Freud, S.), 197 Mrs Doubtfire, xvn1 multiple personality, 13, 15, 37; attenuated cases of, 24; hypnosis and, 13, 21 See also dissociative identity disorder; schizophrenia multiply determined compromise formations, 24 Musselman state, 176 N., Mr (case), 58–72; children of, 60, 63, 64, 65, 74; dreams, 61, 62–63, 65–66; family crisis for, 75n7; father of, 59–62, 64–67, 74; mother of, 58–67, 70, 72, 74; 9/11 and, 58, 64– 67, 74; oedipal issues, 63–64, 66; reading own case report, 58, 67–74; termination issues, 58, 61, 64–65, 69–72, 74; Theseus and, 60, 65, 74, 235 75n2; wife of, 60, 64, 67 nachträglichkeit (deferred action), 95, 188 narcissism, 15, 180–81; men and, 2, 5, 9, 109, 147, 168, 179; primary, 180, 181, 182; secondary, 179, 180, 182, 183; survival and, 180–83; tertiary, 182–83 narcissistic investment in separateness, 21, 55 narcissistic libido, 180–81, 182 National Center for Transgender Equality, 2–3 near-death experiences, in childhood, 22, 26, 63, 64, 65, 74 neonatal cortical sleepiness, 186 neurobiology: dissociation, hypnosis and, 22–23; resilience and, 186–87, 190–91 Newman, K., 197 new objects: analysts as, 71, 188, 195; bad v good, 189 9/11 See September 11, 2001 terrorist attacks “normal autism,” 179 Nuremberg Trials, 103 object constancy, 19, 21, 24, 54, 184 object relations theory, 197 Odysseus in America (Shay), 123 oedipal issues: in Back to the Future, 90; homosexuality and, 9; inanimate objects and, 93–94, 96; Mr N.’s, 63–64, 66; Mr P.’s, 45, 46 Ogden, T H., 94 omens, of disasters, 80 omnipotence, infantile, 178–80, 191 organismic panic, 21, 31 Orville (case), 77–78, 92 Oxnam, Robert, 23–24, 25, 29 P., Mr (case), 42–46 paranoia, 6, 8, parapraxes (slips of the tongue): Freud, S., on, 40–41; Hannah’s (“we”), 8; Mr N’s, 67; Mr P.’s, 46; repression and, 26, 40–41 236 Index parents: in Back to the Future, 90; children’s gender identity and, 3; as Holocaust survivors, 95–96; inanimate objects and, 79, 83, 93–94, 96; parting words of, during Holocaust, 182; in WWII, 101–3, 169–70, 172 See also fathers; mothers “pathological hope,” 75n3 Paul (Vietnam veteran), 103–72; basic training, 105–7; as caretaker, 118–20, 126–28, 132, 152, 165–66; college experience, 104–5; father of, 108, 165, 169–70; February 11th combat and arm injury, 129–42, 153, 163–64; grandfather of, 154, 158–59, 162–63, 170; grandmother of, 105, 108–9, 158–60, 162–64, 167–68; induction day anniversary reaction, 124; January 10th ambush, 124–28, 149, 151–53; on killing, 106–7, 121–23; letters written home, 139–40; medical school/residency and, 108, 135, 144–47, 157, 171; medication and, 135, 138, 140; on mission, 109, 120, 166; mother of, 103–4, 105, 108–9, 119–20, 158– 67, 169–71; PTSD and, 142–48, 154–55, 157–58; as radio operator, 117–20, 132–33, 135; relationship with family doctor, 108–9; on survival, 109, 114–16, 125–26, 138; ticket home for, 136–40; uncle of, 158–59, 161–64, 168–69, 171; volunteering for draft, 104–5, 171; wife of, 142–44; worries about his possible death, 108–9, 114 “penis envy,” 43 Pentagon, 101, 153–54 personifications, with DID, 24–25 perversion, 4, 25; sadomasochistic, 50, 52, 54 phallic symbols: Mendel and, 86, 87, 93; Mr P and, 44–45 phantasy, 198 photos: of Abu Ghraib, 102; of dead child, 83; of Iraq war, 156–57; Mr N.’s, 69–70; of Vietnam war, 128 Pine, F., 17 Pizer, S A., 73 pleasure principle, 80 posttraumatic dominant-submissive relational patterns, 27 posttraumatic stress disorder (PTSD): hormones and, 186, 191; likelihood of developing, 91, 173–74, 189, 190–91; symptoms of, 187; in war veterans, 99–100, 142–48, 154–55, 157–58; women and, xiv, 165–67 potential space, 79–80, 91, 96 prayer book, Holocaust survivor’s, 78 prayers, Jewish, gender differences and, xii–xiv premonitions: on 9/11, 153–54, 172; during Vietnam war, 131–32, 148–49, 151–53 See also omens, of disasters primary femininity, primary masculinity, primate research, 16, 191 Priscilla (Mary’s self), 33 projective identification, 198 protein synthesis inhibitor, 189 pseudo-externalized displacement, 20–21 psychic trauma, 14, 174–78 See also trauma psychoanalysis, fear response system and, 187–89 Psychoanalytic Dialogues, 72 The Psychoanalytic Quarterly, 196 Psychodynamic Diagnostic Manual, 12 psychodynamic theory, Freud’s, S., 81 The Psychopathology of Everyday Life (Freud, S.), 40 psychosis, 21, 31, 32 PTSD See posttraumatic stress disorder puberty, hormone manipulation and, puppy stuck in hedge (Mary’s story), 35 rabbi, torture and murder of, 86–87 Ralph (Mary’s self), 34–37 “reciprocal amnesia,” 55 Reis, B., 94 Index religion, on gender differences, xii–xiv “Remembering, Repeating and Working Through” (Freud, S.), 39–40 Renik, O., 198–99 repression, 4; “by proxy,” 20; dissociation and, 26–27, 41–42, 55; Freud, S., on, 14, 40–41, 95, 188; hypnosis and, 18, 41; parapraxes and, 26, 40–41 rescuers: identification with, 77; Paul’s, getting stuck in mud, 114–15 resilience: acquiring, 173; defined, 173, 187; of Holocaust survivors, 175, 178, 180, 182, 184–86; hormones and, 186–87, 190; neurobiological perspectives on, 186–87, 190–91; social behaviors associated with, 190 resilient masculine self, 183–86, 190–91 “reward system” pathways, drugs and, 22–23 Rose, Jonah, Rosenbaum, M., 13 Ross, John Munder, Rumsfeld, Donald, 100–101 sadomasochistic heterosexual self, 25 sadomasochistic perversion, 50, 52, 54 Schiffer, 81 schizophrenia: Bleuler on, 13, 31; DID v., 30–33, 37–38; Mary’s, 34; symptoms of, 13, 30 Schneiderian first-rank symptoms of schizophrenia, 13, 30 Schore, A.N., 178 screen memories, 44, 51, 59, 92, 177 selection fantasy, 90 self: adult psychotic, 32; “dead child,” 26; dissociation as disorder of, 20– 21; homosexual, 25; infantile nonpsychotic, 32; infantile psychotic, 31–33, 37; “It’s not me!”, 21, 24–25, 33, 37–38, 53–54; libidinization of, 189–90; sadomasochistic heterosexual, 25; social, 178–79; transsexual, 25 self-cohesion, 29, 55 See also cohesion 237 of the self self-constancy, 4, 19–22, 24, 25, 29, 37, 54–55 self-destructive behavior: cutting self, 27, 33; Hannah’s, self-esteem, 179–80, 181, 190 self-hypnosis, 14 See also autohypnosis self-object transferences, 197 self-psychology, 197 selves: Mary’s, 33–37; Mr J.’s, 51, 55; organizing influences on, 22, 25; Oxnam’s, 23, 25; patients shown videotapes of, 55; separate, development of, 4, 21–22 See also masculine self Senate Armed Services Committee, 100 senses: development of self and, 19–20; impairment with DID, 176–77, 191n1 separation anxiety, 21 separation-individuation process, 54, 89 September 11, 2001 terrorist attacks (9/11), 75n5, 91; Family Center, 58, 66; family members of, 57–58; Ground Zero, 57, 66–67, 174; impacts of, 173, 183; Mr J and, 201–2; Mr N and, 58, 64–67, 74; Paul’s premonitions on, 153–54, 172; volunteers after, 57–58, 66 serial hoaxers, 38n1 sex reassignment surgery, 3, 33–34, 36 sexual abuse: Hannah, 8; impacts of, 14, 15; Mary, 34; Mr J.’s, 51, 53, 200–201; re-victimization after, 5, 173, 174 See also incest; specific individuals Shay, Jonathan, 123, 150, 166, 172 Shengold, L., 14, 38n3 shoes, symbolism of, 85–89, 93 smile of contentment, 180 Smith College, 3–4 social self, 178–79 songs: during Holocaust, 181; about killing, in war, 106–7 Sophie’s Choice (Styron), 90 space, 79 238 Index space-time continuum, 81–83, 96 special relativity, Einstein’s theory of, 82, 91 speed of light, 82, 97n3 Spezzano, C., 198 Spitz, 180 split mind, 13 See also schizophrenia split personality, 11, 14–15 split-psyche model, 14 splitting, 4, 27; believing and not believing, 177; fixation on past, 177; of identity, 177; mother-daughter relationships and, 15; within self between victim and identification with perpetrator, 177 splitting wood v splitting father’s head, 88–89 Stein, M., 71 stereotypes, of men, xiv, Stern, D N., 19 Stoller, R J., 1, 71 Strachey, J., 95, 188 stress hormones, 17, 22, 100, 186–87, 191 Styron, William, 90 suicide: causes of, 175; Mary and, 34, 35, 36; masculine self and, 6, 8, superego: cultural transmission through, 96; heroic decisions and, 185; Loewald, H.W., on, 78, 97n1 survival: ego and, 175, 176; Krystal on, 176–78; manic defenses and, 183–84; narcissism and, 180–83; Paul on, 109, 114–16, 125–26, 138 See also group survival survivor guilt, 125, 178 symbiosis, 179 synchronous pre-object relatedness, 178 Taguba, Antonio, 100–103, 172 Taguba, Tomas, 101–3 tattoos, Holocaust survivors’, 27, 85 termination issues, 75n6; Mr N.’s, 58, 61, 64–65, 69–72, 74 Terr, L L., 80 testosterone, 2, 3, 36, 186 Tet Offensive, 136, 137 Thank You For Not Smoking, xiv therapeutic action, views of, 196–99, 203–5 therapeutic relationships, 195 Theseus, 60, 65, 74, 75n2 Thomas (Mary’s self), 34 time, 78–79; Holocaust survivors and, 89–91, 94–96; leasing, Freud, S., on, 48; Mr J.’s obsession with, 48–49, 51; passage of, 78, 80, 82; travel through, 81, 83, 90, 91 See also space-time continuum timelessness, 78–79, 95, 188 time-limited psychotherapy, 71 time tunnel, 82, 89, 96, 102 torture: Abu Ghraib prison, 100–103; during Holocaust, 86–87, 92–93, 181; during WWII, 102 “transferential-countertransferential theoretical-clinical magma,” 205 transgendered people, “transmen,” transpositional objects, 15, 96 transsexuals, 5, 9, 26 See also transgendered people transsexual self, 25 trauma: children and, 4, 5, 38; DID and, 13–16, 23, 27, 41–42; Freud, S., on, 9, 80; identifications and, 102–3; intergenerational transmission of, 6, 25–26, 82, 89– 92, 94, 96, 100–103, 172, 177–78; men and, xiv–xv, 1; mother-child relationships and, 31–37, 89; prevention of, 176–77; quality of concreteness and, 21; sequelae of, 177, 182; stages of traumatic process, 176; time, space and, 79– 80; war and, 99–100; women and, xiv, 39–40 See also specific cases “Trauma Preparation,” five stages in, 174 trigger reaction, traumatic memory and, 94–95 Tustin, F., 82 twins: death of, 75n4; schizophrenia in, 31 Index uncles: Cindy’s, 7; Mendel’s, 86; Mr J.’s, 51, 53; Paul’s, 158–59, 161–64, 168–69, 171 universal bisexuality, “The Unwelcome Child and His Death Instinct” (Ferenczi), 175 urine, drinking, 25 U.S Holocaust Museum, 185 vertical split, 15 victims: identification with, 9, 38n1, 93, 102–3, 172; splitting within self between, and identification with perpetrator, 177 Vietnam veteran, interview with (Paul), 103–72 Vietnam war, 100; booby traps in, 113, 156; conscientious objectors during, 107–8, 171; “dust-offs” during, 126, 135; grunts/cherries (new guys), 126, 131; guerilla warfare during, 111–20, 138; helicopters in, 118, 131–33; mobile rivering force during, 129–30, 149; nightmares about, 122; officers killed in, 105–6; organization during, 117, 151, 153; protests against, 109; Red Cross and, 110, 139; reunions, veteran’s, 118, 122, 125, 128, 142–43, 166; views on, 109, 137–38, 149–51, 154, 171; villages burned during, 111, 113, 148; Wall memorial, 125, 149; water crossings during, 113–15 Vincente, Colleen, violence, men, humiliation and, 2, 6, Volkan, V D., 31, 32 239 Wallerstein, R S., 70–71 war: Freud, S., on, 99; impacts of, 99– 100, 172; trauma and, 99–100 See also specific war war veterans: PTSD in, 99–100, 142– 48, 154–55, 157–58; reunions of, 118, 122, 125, 128, 142–43, 166 See also Paul (Vietnam veteran) water filling up basement, obsession with, 63 Watkins, J G and W H., 15 wave versus particle theories, of electromagnetic radiation, 81–82 Wayne, John, 130 Whitmer, G., 18, 47 Williams, Robin, xvn1 Winnicott, D W.: on dissociation in children, 17, 42; on manic defense, 184; on mediums, 194; on omnipotence, 179; on time, 79, 94 wives: Mr N.’s, 60, 64, 67; Paul’s, 142–44 Wolf Man, deadline in analysis of, 71 woman, becoming a, women: Judaism on, xii–xiv; masculine self in, xiv, 1, 4–9; PTSD and, xiv, 165–67; selection fantasy, 90; trauma and, xiv, 39–40 World War II (WWII), 101–3, 169–70, 172 See also Holocaust survivors wormholes, 81, 96 WWII See World War II Yehuda, R., 100, 191 Ziering, Sigi, 185–86 About the Author Ira Brenner, M.D is a clinical professor of psychiatry at Jefferson Medical College and a training and supervising analyst at the Psychoanalytic Center of Philadelphia He is also director of the adult psychotherapy training program at the center, where he teaches courses on trauma to students in both the analytic and psychotherapy curricula He has lectured nationally and internationally and has written extensively on the topic of psychological trauma Brenner’s works include three books: The Last Witness: The Child Survivor of the Holocaust (1996), coauthored with Judith Kestenberg, M.D.; Dissociation of Trauma: Theory, Phenomenology and Technique (2001); and Psychic Trauma: Dynamics, Symptoms and Treatment (2004) He was awarded the Pierre Janet Writing Prize from the International Society for the Study of Dissociation for his 2001 book and the Gradiva Award Honorable Mention for his 2004 book He maintains a private practice in suburban Philadelphia 241 ... Cataloging-in-Publication Data Brenner, Ira, 1950Injured men : trauma, healing, and the masculine self / Ira Brenner p ; cm Includes bibliographical references and index ISBN 978-0-7657-0572-3 (cloth : alk paper)... with Breuer (Breuer and Freud, 1893–1895) and the “splitting of consciousness” and hysteria, to dissociation and perversion (Freud, 1923), as well as neurosis (Freud, 1940a) and psychosis (Freud,... phenomena as physical and sexual abuse, unresolved grief, genocidal persecution, intergenerational transmission of trauma and, of course, combat With a perspective on dissociation and dissociative