Essays on
Psychology & Life

Your Voice

Here, our visitors share their thoughts about the essays and/or experiences regarding giving/accepting/not having "voice" and how that's served them or others in their lives. (If you don't know what "voice" is, please read this first, then come back here.)

Maybe you have something to say? We'd love to hear it..

Name - Nickname - Email Address

Your Voice Bulletin Board: HealthyPlace.com Relationships Community

virginiavagt - virginiavagt@hotmail.com

Comments - I'm going through a very painful divorce brought on by my husband, who I believe is quite narcissitic, and has seemed to have a problem setting limits, in fights and discussions, and then would blame me for everything, like I attacked him etc,,, and it seems like he would take everything personally. I wish I had understood narcissism before, maybe it could have saved our marriage

thetada - morephallocentric@hotmail.com

Comments - I just read the essay on voice, it makes me want to cry, because it's written so simply, but you could read it and read it and read it and not hear it. I'm from a family that doesn't really function as a group, the only time we even remotely attempt it, is at the dinner table, my eldest sister always gets up and leaves the second she's had her last bite. We want her to stay, I think we want to function as a group, but all interpersonal relations are separate, I have a relationship with my sister, April, with my other sister, Jess, with my Dad, and my Mum, but we don't all work together. The second rule of voice that I've just read says "Assume you can learn as much from them as they can from you." We all sit on the fence, thinking we know best, philosophising, discussing politics, but my Mum and April have just got this big old personality clash. They find it hard to follow the second rule. Things are a lot better nowadays. Mum's going halves with April on a flat, she says April can have that instead of a wedding which is fair, and slowly, when I talk to both of them separately, they're easing off on each other. I guess I'm just being impatient, they'll bury the hatchet eventually, I just wish I could think of a way to help without interfering. You know, learn how to ameliorate rather than agitate. Thanks.

Gail Schwartz - JuneDay7@aol.com

Comments - I agree about your message regarding children perceiving they have a voice. However, your article about the Littleton tragedy does not address other factors that my have led to this tragedy. It is not only what the parents bring to the relationship, but what perceptual, intellectual, or personality limitations these young men brought to bear on their perception of being heard. I think that would have been an important aspect to acknowledge in your paper. Thanks for taking the time to listen.

Buddy - CBSavo@aol.com

Comments - Wow. Your articles make alot of sense to me. Now what to do with this new found knowledge.

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denise warfield - warfieldbobby@qwest.net

Comments - I was hoping to respond to the question about spouses and relationships, which was to be discussed on May 25th. I was 34 when first hospitalized for bipolar and am now 46 and have the privilege of being tortured by the entire hospital staff annually. After such extreme measures at the hands of people who should know better. I find it hard to correct or discipline my children. Life just has a different meaning for me now. As far as having a voice; I think my parents felt they were doing a good job if their children realized that the parents emotional need for control was far more important than their children's physical (and emotional) needs. The thing I really wanted to add to the conversation on the air tonight (but most likely will not be able to call in) was that to tune out all the emotional problems of my childhood family, the entire group busied themselves. And that does have some medicinal (and financial) benefit. After being hospitalized, my spouse and children became happier because I was too depressed or ill to keep up a normal (somewhat busy) family schedule and I became known publicly to be the problem. The interesting thing I'm trying to state the background for, is that with therapy (10 years) I feel more myself and my husband insisted that I go to the hospital, "everyone is complaining” I’ve asked your psychiatrist to meet us there just for a consultation. He had actually called ahead to be sure the emergency room would take me. I feel that the amount of attention he gets for having a "problem wife" is encouraging to him. And he has developed a type of Munchousen by proxy. Since it was publicly known that I am the problem. He can complain about my extravagant spending (at garage sales) while he buys 500 dollar suits, 30,000 cars (that only he can drive). I very much feel that as it takes two people to make a divorce, it takes two people to make a bipolar. The dynamics of this situation are very complex. Up until the last hospitalization, I was making a good wage, and doing a majority of the house, and family work. We both have perpetuated the problems in our families of origin. I am a pleaser and he is very needy. And we have used bipolar illness to keep (and exacerbate) those roles.

Richard Brown - richseanb@yahoo.com

Comments - 23 years old. just now looking to be in therapy for many situations in my upbringing that keep on bringing me down. BUT... on the issue of voice. after an argument my stepfather used to repeatedly say to me(100's and 100's of times) with this stern look in his face: "I am an adult. You are a child. I am right and You are wrong." I remember so many times in my life growing up just wanting to ask a question crying, "But I just wanna ask..." and my parents saying "JUST SAY OK!" Just say ok! Just say ok! they would tell me not to do something and many times I had no problem with not doing it I just wanted to know why or ask a question and I wasn't allowed to speak. Well I've noticed that I always apologize for talking and I have trouble believing that anyone wants to listen to me.

Patchouli - faerymomma@yahoo.com

Comments - I have been feeling invisible for too long. I feel that I have no self-worth and at times no one listens to me or dismisses me. A few days ago my father, who was evaluated with NPD and OCD, wrote a nasty e-mail to me. It came out of no where and was uncalled for. I had read up on NPD over a year ago, but I thought I could at least have a distant relationship with my father since he lives in another state. I now know that I can't. He thought he could hurt me and apologize. I'm not repeating this cycle anymore. He has been an overbearing, negative presence in my life. No more. Since I told him to have a nice life I find myself in a mourning process. Its like an empty sadness for a lost soul. I do feel sorry for him. From what I have read I don't believe he can help himself. I can forgive him, but I can not allow him back into my life. I refuse to talk to him. I've asked my brother not to talk to me about him, not to let Dad get to me through him and he has promised. My father is the type to have emotional outbursts. When we were children he was also physically abusive. He took his rage out on us. His would sometimes cry afterwards, too. His tears were fake. Even as a young child I thought he was acting. But, I also think he must feel very tormented. Its like he has his own demons to deal with, but I can't let him manipulate my emotions again. I'm very confused and emotionally raw right now. I'm trying to find more books and information for Adult Children of Narcissistic Parents. I'm searching for my voice. I want to find who I am.

Elaine - elaineegreen@hotmail.com

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dana - samlove218@aol.com

Comments - i stumbled upon this website,...at almost 30 years old i am STILL living with parents like this,...i have been betrayed for the final time last night......was just looking for a safe place to turn.......thanks

Corinne Sternlieb - KrinS@Aol.com

Comments - These essays are fascinating. I appreciate the clarity with which they are written, the absence of psychobabble and the clear descriptions of how parental narcissism affects children and adults. But I especially like your empathic regard for narcissist and those he/she affects, alike. This info is very helpful to me both personally and as a therapist; I thank you. Question: do you think our society's competitiveness and consumerism 'encourage' narcissism?

Jem - e2_14@hotmail.com

Comments - I felt voiceless growing up with 4 older half-siblings who were more confident and overbearing. Also, my dad didn't enter my world so l had to go to his 'world' to speak to him which was difficult as he is very closed. He put me down alot. I still get alot of abuse from people when working or around people. Building your unique identity and self esteem is so vital, that is my aim so l can choose a healthy r'ship and be more assertive. I tend to close up with dominant types as they remind me of my childhood. It's always very painful. Recently l've had the chance to participate in sing-a-longs and have loved using my voice, it gives you power and expresses your true self. I want to continue it.

TONYA - MAMASBOYS@AOL.COM

Comments - MY HUSBAND AND I ,DOSEN'T HAVE THE COMMUNICATION THAT WE NEED WE HAVE TWO CHILDREN AND NO LIFE TOGETHER AND EVERY DAY WE ARGUE OVER SOMETHING ALL DAY PLEASE HELP THERE IS NO COMMUNICATION AND NOW I CANT TRUST HIM

TONYA - MAMASBOYS@AOL.COM

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yikes - t#@me.com

Comments - sharing thoughts is what the site offered. How can you feel okay about sharing the name!!

Jan - jglaguire@sbcglobal.net

Comments - My personal relationships have been pretty sufferable for a large portion of my life...my raging anger has ruined my relationship with my kids & after divorce, even my boyfriend (whom I believe is more than wonderful). Your essay turned a light on inside & maybe with a lot of work & patience on my part, I can turn things around & improve on these broken relationships for them and for myself, since I can see myself being in a position of both, that of the unheard child-voice & not hearing the child-voice of my children. Thank you, Jan

Emily - tpmcgehee@yahoo.com

Comments - I like the sentence: I'm important. You are not. It sums up my entire life in relationship to my parents. It is not a moral option for me to ditch the miserable wretches in their old age -- and I am having a very difficult time coping with them. Guess I am going to have to spend money on a good book, but which one?

myminem - sdfjh@hotmil.com

Comments - I'm writing concerning the letter from the 15-year-old girl, "Needs Closure in Georgia," whose grandfather committed suicide. You suggested she write a letter to him, and then to burn it. Another useful technique is to sit opposite an empty chair and speak your heart to the person you need to communicate with. I wasn't getting on with my life after my husband died, and it worked for me. -- DOING BETTER IN MILLBRAE, CALIF. DEAR DOING BETTER: Thank you for the helpful suggestion. Many readers were touched by that girl's letter and wanted to reach out to her. Read on: DEAR ABBY: When my grandmother died, my father and his wife planted a small rose garden. Over the years, as we have lost family members (including pets), additional rose bushes have been added in their honor. It is peaceful and comforting to sit among the blooming roses and think of our loved ones. It feels like they haven't really left us. -- REMEMBERING IN ARIZONA DEAR REMEMBERING: I believe you. After Cary Grant passed away, his widow, Barbara, gave my mother a rose bush that had been named for her husband. Mama, who had been very fond of both of them, planted it outside her office window -- and when the roses were in bloom, it gave her many hours of pleasure. DEAR ABBY: I found "The Grief Recovery Handbook," by John W. James and Russell Friedman, to be extremely helpful. My grandfather committed suicide more than 25 years ago, when I was in seventh grade, and my parents didn't want us to tell anyone what happened, which didn't help at all. Perhaps "Needs Closure" could organize a memorial service with a local church, depending on what is going to be done with his ashes. If that's not possible, she should reach out to other family members and grieve with them. I hope they do not feel embarrassed about the suicide. -- LOYAL READER IN SAIPAN DEAR LOYAL READER: One thing is certain: She should not suffer alone and in silence. DEAR ABBY: While "Needs Closure" feels that her grandfather's cremation is the reason she has had a difficult time letting go. I suspect it is the manner in which he died. Suicide is a traumatic loss -- sudden, unexpected, often violent. That girl is now a survivor of suicide. One does not "get over" a suicide. The effects may stabilize, but the loss is forever felt. I speak from experience. Five years ago, my beautiful little sister committed suicide at 19. I have read many books for suicide survivors and belong to an online support group for sibling survivors. One great resource for her could be SOLOS -- Survivors of Loved Ones' Suicides. The Web site is www.solos.org. She can also write to the group for information at P.O. Box 592, Dumfries, VA 22026-0592. -- STILL GRIEVING IN WASHINGTON DEAR STILL GRIEVING: Please accept my sympathy for your loss, as well as my gratitude for suggesting this resource. DEAR ABBY: Your advice was right on the money. I was away when my best friend dropped dead of a heart attack. Since I had no chance to say goodbye, I wrote him a letter telling him what his friendship had meant to me. At first, I planned to "send it" to him by burning it in the fireplace. But it is now 2004, and I still write letters to him. What started as a way to bring closure became the beginning of a wonderful journal. -- J. IN OCEANSIDE, ORE.

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Comments - Rosemary Balsam Training and Supervising Analyst, Western New England Institute for Psychoanalysis INTEGRATING MALE AND FEMALE ELEMENTS IN A WOMAN'S GENDER IDENTITY Submitted for publication March 25, 2000 Despite advances in female developmental theory since the 1970s, there remains a lingering tendency to stereotype and polarize gender identity. The key to this puzzle may be found in the legacy of early libido theory, which offers an unintegratable solution for women. This is because in order for a woman to claim femininity according to this early theory, her masculine trends in development must be repudiated and "overcome." A contemporary theory based on primary femininity suggests that this early theoretical "either/or" dilemma puts forward a developmentally immature solution. The analysis of a thirty-year-old woman, and a commentary contrasting "old" and "newer" ways of thinking on the part of the analyst, demonstrate that an interweaving pattern of paternal identifications and male body representations, together with the female body image and female identifications, is necessary to create a mature gender identity portrait. The female bodyrepresentation and maternal identifications! may indeed be enhanced by male internalizations, as happened in this particular instance. New ideas within psychoanalysis mobilize resistance and under-go an uncertain fate, especially if they differ from those of Freud (Greenson 1969; Eissler 1969; Gillette 1992). The theory of female development is a case in point (Fliegel 1973). In spite of the many refinements that have been made in the field since Freud's first delineation of the psychosexual phases of female development in 1905, and in spite of his own advances in filling out the theory - for example, his recognition of the mother's powerful role in the girl's development (1931) - there remains a reluctance among analysts to use psychoanalytic correctives and knowledge developed since Freud in their everyday clinical work, in clinical discussions, and in clinical writing (unless the focus is specifically on gender theory). As far back as 1986, in a review of female psychology, Chehrazi wrote, "in spite of recently suggested revisions . . . it is my impression from seminars and clinical conferences that our diagnostic formulations and dynamic conceptualizations remain more or less the same" since Freud's time (p. 22). Nowadays, too, as Chehrazi noted then, the "lack of a revised theoretical framework" may be blamed (p. 22). A continued yearning in our profession for an ideal systematic theory of female development, however, may serve to shield against some changes of focus in clinical work that could be facilitated even while awaiting complete reformulation. Ten years after Chehrazi's observations, Basseches and her colleagues (1996) reported on a study of analytic treatments of women conducted by a group of contemporary female analysts. This work confirmed their suspicion that there is still a "lag between theory and clinical technique"; in the an! alys ts' discussions they discovered their "collusion with Freud's phallocentric perspective in concert with [their] patients' self-assessments" (p. 515). For example, like their early counterparts, they tended to view penis envy and the castration complex as bedrock facts and failed to consider instead their functional defensive possibilities as body fantasies. The authors believed that the "participant analysts' theories and identifications with their own personal analysts and clinical supervisors did not yield easily to integrating the newer ideas of primary femininity into clinical practice" (p. 516). One female analyst in the group reported automatically interpreting a female patient's denial of her genitals as a sure sign of penis envy - the usual male body terms. The analyst noted that it made her uneasy to shift to an interpretation of the patient's denial in specifically female body terms - i.e., "the patient's wish to deny interest in her [own] feminine space" (p. 517). This apparent stasis led Nancy Kulish and Ruth Fischer to convene a panel to discuss primary femininity and its clinical implications at the 1999 fall meetings of the American Psychoanalytic Association. Contributors agreed that there is a continuing reluctance to translate more recent ideas into the actual treatment of women patients. One can ask, Why is this so? But one can also ask, How can this happen clinically? As part of demonstrating the consequences of a shift of clinical focus that results from integrating some of the newer formulations, I will demonstrate also that challenges to "established" theory begin to emerge within the theoretical uncertainty that ensues. For example, I suggest that since approximately 1970 it can no longer be held that femininity or femaleness is "achieved" by renouncing masculinity or maleness, we are free to imagine a gender solution other than one based on an either/or conflict. We can postulate that a female can have a stable core gender identity and yet also follow dual gender developmental lines that need not necessarily be in opposition. The male line can become complementary and even enhancing to aspects of the female line. "PRIMARY FEMININITY" OR "A SENSE OF PRIMARY FEMALENESS" The most important shift in thinking about sex and gender issues in women was ushered in by the term primary femininity - first used by Stoller in 1968, in reference to the then new concept of core gender identity (the self-identification of being either a "girl" or a "boy" that is established by 18-36 months). As an umbrella concept, primary femininity has helped to underline a range of newer and apt psychological thoughts about women-qua-women, and has helped us achieve theoretical distance from the limitation of the old-fashioned Freudian girl-as-little-boy trajectory. Its introduction marks an historical watershed in psychoanalytic writing about female psychosexual development. But primary femininity can also be a problematic idea, because it has been used so elastically in discussing the many aspects of female development, such as " gender identity, innate biological traits, early object relationships, aspects of the self, and types of anxieties" (Kulish 2000, p. 1356). By 1972, Stoller himself served to obfuscate the term considerably. He conceptually melded the scientific discovery of the human embryo's initial feminized biology together with a protofemininity developed from a child's symbiotic fusion with the mother. He claimed now that this "primary femininity" applied not only to girls, but also to boys in their early development. This latter aspect of Stoller's use of the term has been persuasively challenged by Fast (1999). The different interpretations of primary femininity have been critiqued by Kulish (2000), who, though recognizing the many advances yielded by these investigations, warns us not to &q! uot; repeat the mistakes of the past and not ask the next question, 'Where do we go from here?'" (p. 1375). Suffice it to say that the concept needs to be defined carefully each time it is invoked. An alternative term, a sense of femaleness, has been suggested by Elise (1997), who prefers it because it eliminates problems with the cultural value judgments encoded in "femininity." My main point here, however, is that clinical interpretations and formulations based on the concept of "primary femininity" have been slow to be incorporated into case reports. BEFORE AND AFTER 1970 The most significant change to appear in the literature between the "old" psychoanalytic ideas and the "newer" ones is the acknowledgment that a female child develops psychosexually in relation to her female body. As I have suggested, the watershed between these views is roughly the year 1970, though Horney (1924, 1926) and Jones (1927) can be regarded as progenitors of the new. The comparison the girl makes between her own body and the male body remains important in the newer system, but it is more likely to be seen as reactive to attitudes about basic female body parts, or as a masculinized matrix of defensive fantasy as attempted solutions to other developmental problems (Dahl 1996.) This shift of emphasis to the centrality of the female habitus can make a significant difference in how a woman's intrapsychic conflict around issues of body and gender is heard by the analyst. The "Old" View In the case presentation below, I will try to indicate points at which the "old" view comes to mind as I think about the material. The shorthand designation "old" will refer to the original Freudian schema, which by now hardly needs repeating. The girl is really a little boy in her own mind until the fateful encounter with the actual sexed boy, causing her horror, disbelief, and conviction that she has come into the world with a boy's damaged genitals. Thus, "anatomy is destiny" for Freud's female, and an account is given of her lifelong pursuit of the penis which was torn off a tragic story of unfulfilled, castrated maleness. In the Freudian schema, even her baby is a glorified poor man's penis that gradually inures her to a maturity of sorrowful femaleness-as-crippled-maleness. Her sex and gender are psychologically borrowed from the male, maleness therefore being primary in the "old" syst! em. What she has not (in male body terms) is therefore viewed as the primary locus of a girl's intrapsychic conflict; what she has (in female body terms) is perceived analytically as a derivative and secondary issue. In their adherence to the "old" scheme, most psychoanalysts seemed to believe that a fantasy body was more psychologically fundamental to females than to males. Is this not curious? Although in the 1920s some analysts questioned Freud's ideas in this regard (see, e.g., Abraham and Freud, 1965, p. 375), for reasons too complicated to explore here Freud's ideas alone became dominant. For one, their theoretical elegance fitted neatly with his notion of libido being gendered as male. The "Newer" View The shorthand designation "newer" that I will use in presenting the case below will refer to the post-1970 perspective, in which the female-qua-female possesses in her own body the primary building blocks of sex and gender (just as the male does), and her "maleness," derived from relating to males, becomes an added phenomenon, however necessary and complex. In this system, the female patient therefore considers as primary (in the sense of basic) what female body parts and attributes she has (see Stoller 1968, 1976; Kleeman 1971; Kestenberg 1982; Mayer 1985; Bernstein 1990; Richards 1992; Frenkel 1996; Holtzman and Kulish 1996). The post-1970 shift to acknowledgment of the female's primary femininity (or primary sense of femaleness) holds many ramifications for revision of the old theory (Tyson 1982), and for newer, more cogent ideas regarding the spectrum of genders (Chodorow 1994). For example, much new inform! ation can be gleaned about interna! lizations specifically concerning the impact of the adult female body on all developmental stages in the girl's growing mental representations and conflicts about her own body (Balsam 1996, 2000). RECASTING THE LEXICON OF FEMALE DEVELOPMENT Crucial to an analyst's ability to shift from an anachronistic phallocentric theory of women to the newer, more appropriate theory is an increasing sensitivity to the language used in dynamic formulation. If we are to make headway, greater attention needs to be paid to this in teaching, in editorial work, and in writing papers. The technical language of our field is full of problems because our data are gathered by people about people in an interactive process; opinion becomes theory, yet simultaneously our language aspires to objectivity and generalizability. Language can thus be subject to the effects of gendering. For example, "rational" may inadvertently be equated with the value judgments strong/clear/male; "irrational" with soft/murky/female. Patients frequently embrace these mistaken affinities, but there is no need for analysts to echo the emotional accretion as "theory" (see Balsam 1994). Freud (! 1905 ) became trapped in precisely this way in his equations active/male and passive/female. Our lexicon of female development needs a definitive update. The old language keeps alive the old concepts. As Goldberger (1999) points out, our imaginations could be freer of the constraints and closures inevitably imposed by the old language. She urges "that analysts start using language that reflects our improved understanding of female development" (p. 465). Throughout our history, ever since Freud analyzed Dora, we have tended to dominate our manifestly compliant female patients with knowing formulations. We now have an opportunity to challenge these fixed attitudes. It has been argued, often and persuasively, that calling body anxiety in women "phallic castration" is misleading and that the phenomenon would be rendered more accurately by the term genital anxiety or female genital anxiety (Goldberger 1999; Olesker 1998; Dorsey 1996; Shaw 1995; Bernstein 1990; Chehrazi 1986). Since Freud, we have learned about many different kinds of genital anxieties - e.g., those concerning loss of virginity, penile penetration, or the uterine and perineal strains of childbirth - that center on fantasies, referring to the present or future, about the personal female body. Thus our scope is widened far beyond the anxiety associated with the fantasied past loss of a fantasy penis. The more inclusive terms genital anxiety or female genital anxiety have the benefit of accuracy, can be used for women generally, and yet are flexible enough to accommodate individual meanings. The term castration anxiety points narrowly to one variety of anxiety in women, the universality of which many question. One could quarrel with other terms, too, like the oedipal complex as applied to women (Parens 1990). This last I retain - uneasily - for the sake of familiarity and short-hand. Much work remains to be done if we are to arrive at consensus regarding the most heuristic theoretical language for use in this area. CASE EXAMPLE Introduction The avenue I wish to take into primary femininity (or the primary sense of femaleness) is that of maternality. By this term I mean to convey the importance of the body of the mother - not just the general mental state of "motherhood." The maternal body is for the girl the most important icon of grown-up physical femaleness, one she experiences at all stages of growth (Balsam 1996). Many difficulties attend the reintroduction of issues specifically centering on the maternal. As a focus of female developmental theory, maternality has had a spotty history. This is due to its association with, for example, ill-founded theoretical claims to inherent female masochism (Deutsch 1945) or, as Chodorow (1978) has pointed out, the sociocultural imperative that women produce and rear children. I am also aware of the perils of "biological essentialism" (Bem 1993), a term denoting the idea that everything worthwhile about being a woman resides in the female anatomy. Nonetheless, I do want to speak of childbearing as the anatomical and physiological potential of the female body, though in the context of the woman's developing psyche. I think this can ! be d one without imposing value judgments, masked as science, about how a mature woman ought to be. My interest is in psychoanatomy and psychophysiology. I will tell the story of Ms. A.'s analysis that bears on the role of her female body in her dilemmas. My theoretical underpinning is a blend of drive and object relations theory; therefore, Ms. A.'s communications about her body will involve for me a study of the intrapsychic anatomy of the internalizations of her attitudes arising from both male and female influences, from both father and mother at different developmental phases. As the case unfolds, I will keep the reader abreast of my thoughts about applying the "old" formulations (as defined above) and the "newer" ones that emerge by thinking of female-qua-female in a basic way. I will use interpolations (in parentheses) within the text of the case to show such choices in my thinking. Along the way I will discuss the implications of a particular comparison between the "old" and newer vantage points, or any useful overlap between them. This method will take the place of a formal discussion section to follow the case material, because I want to dramatize how an analyst thinks along as the material is presented, while also listening. Some readers may dislike this method, which admittedly appears to exaggerate the "old" ideas, to more of a straw man effect than sensitive analysts may identify with. However, I do believe that my point about the adherence to overarching phallocentric belief system! s in psychoanalysis is valid, despite our efforts and far better conscious intentions, and that the main evidence of this is the continuing, virtually untroubled use of a common language about women that includes and perpetuates male-derived theoretical terms (Goldberger 1999). Presentation and History A thirty-year-old female graduate student bounded two-steps-at-a-time up three flights of stairs in the Student Health Center demanding, "I need to talk to a woman analyst!" The receptionist instantly called me, saying that the young woman was either crazy or knew exactly what she wanted. Happily, Ms. A. turned out to know what she wanted, which was an analysis that lasted about four years. This was her urgent complaint: "I don't want to be married with a bunch of kids and wake up one morning hating my husband and wondering, What am I doing?" Her divorced parents had had yet another vicious fight over the children. Later from the couch I heard the following tale of events that occurred when Ms. A. was sixteen and attending a boarding school in the South. She was with her aunt, who had taken her to the horse races for the first time. "We were up in the stand. I had her binoculars trained on the starting gate. They were off! Suddenly there was this pack of speeding horses, all in unison, rhythmically thundering toward the bend. They were fast. They were intense, all in time, all together. I was transported. The jockeys were whipping them on - they rocketed past our stand. I felt giddy with ecstasy. It was perfection! It was their unison that got to me. They were so effortless, all of them together - so controlled - so powerful. God, what a high! It was love at first sight!" (I noted to myself that her fascination here, as she described it, was not with who had won, or how her aunt's bet had gone, or even the performance of her aunt's horse, all of which might have suggested a displacement of perhaps positive or negative oedipal themes of competition with the aunt as stand-in for either male or female parent. It was "all together," "speed," and "unison" that caught her imagination. That sounded like a yearning for harmony, power, and close-ness, with herself as one horse of many. I thought it might be an image of siblings. Did it encode a preoedipal love and yearning for her mother, a variety of symbiotic fantasy about blending with an all-powerful maternal figure?) Ms. A. took up horseback riding after this experience. (Riding horses is in itself a topic related to the old phallic view of the power of horses, which often overlooks female-referenced meanings of horses to girls, such as mastery in caretaking and controlling the mother.) Riding was not her only sport or even her major one. In her twenties she had became a dedicated and successful athlete in a sport that echoes her response to the horse race, that requires the intense cooperation of a team of equals, all playing fast and in synchrony with one another. (Her constitutional athletic endowment was a factor profoundly affecting the cast of Ms. A.'s character and psychodynamics. In her associations she might say casually en route to some other topic: "John and I started off the day with a nice twenty-mile run. It was great. Connecticut is so great to run in because there's all these gentle hills." This level of physical prowess in a woman was once assu! med almost automatically to be borrowed from the male and to unconsciously express male phallic aspiration. Today, however, the athletic body ideal for women has challenged this stereotype. On analysis, there can be as many female body fantasies in the creation of this ideal as there are male body fantasies.) Ms. A. was a big, shapely, tall woman with sculptured shoulders and long powerful limbs, a pretty, expressive face, sparkling eyes, and gleaming short jet black hair. She was passionate and vivacious. In a single session her face could be miserable and tear-stained or wreathed with smiles. Nothing was done or experienced by her in a halfhearted way. Ms. A. had experienced the following family chaos. Her father, from a wealthy family, was an airline pilot on Far East runs. He was never home in her early years. Her mother was a voluptuous, black-haired Italian supermodel. Her husband swept her off her feet in marriage and brought her to live in Bel Air, California. My patient was the oldest of five children, of both sexes, born eighteen months or less apart. Her mother had been a devout Catholic. As soon as the patient's mother became pregnant with Ms. A. shortly after marriage, a sweet but elderly Italian nanny was engaged to help. She grew ancient within the family. Gradually, the mother became severely alcoholic; although we unearthed evidence later of her playfulness and better caretaking of Ms. A. up to the age of six, her maternal capacity deteriorated with each successive child. The father separated from this unhappy mother when my patient was nine and went off with a young female flight attendant.! Ms. A.'s parents divorced when she was eleven. A pivotal moment in her life occurred one night when her mother was so enraged and filled with despair by the impending divorce that she made a flamboyant suicide attempt and was hospitalized. My patient, who for two years had insisted on trying to care for her mother, her siblings, and her aged nanny, finally took up her father's invitation to escape and live with him during the rest of her teens. Her father took his paternal responsibilities very seriously after the divorce. In fact, I think he saved Ms. A.'s capacity for pleasure and self-esteem and, by his increased involvement with her, helped her bear her anger and despair in growing up. She despised her father's girlfriend as shallow, giggly, and "frilly-pink." He never remarried. For high school Ms. A. elected to go to the Southern boarding school mentioned above, and it was while out with her father's sister that the horse racing scene took place. In The Analysis: Male Influences When we started the analysis, Ms. A. revealed that one of her persistent complaints was that she failed to perform up to her ability; this happenened, she said, "no matter how I break my ass." (This could be an open invitation to think "castration anxiety" and broken phalluses. But what about an anal reference? or a broken hymen? or a reverberation from a traumatic memory about the effort and disappointment at the experience of loss of her virginity?) She talked a great deal about her athletics. She hoped I could help her improve. She bench-pressed and ran stairs for hours. Her male coach urged her to more and more feats of endurance, and she thrived on the regimen. She was outstandingly active, both mentally and physically, and readily aggressive, and on the surface was quite easy with it. She was also very ambitious, and after her athletic prime and completed doctorate was headed for a top job in industrial research. She was apparently uninhibited, always striving to be number one, yet concerned and annoyed but not devastated if it did not happen. (These competitive qualities in athletics, academics, and the world of work have often been associated mainly with penis envy and male identification in a woman. Deutsch [1945], for example, shows evidence of this kind of thinking in case reports. Since libido and activity were described by Freud as masculine, any activity on a female's part needed to be designated masculine in order to fit the theory. If the modern analyst can consider newer ways to characterize the female/active/aggressive/dominant axis, further inquiry might be conducted into the nature of female aggressi! on, female competitiveness, and female exhibitionism. Schafer [1974] argued that Freud's vision of women was limited by his difficulty in appreciating the maternal transference. This "old" lens thus tends to dull the view of female maternal aggression by coopting aggression and warding it off by designating it male. These issues are particularly interesting because women notably have had a reputation for inhibition in these arenas. But how much of this "inhibition" might turn out to be in our own ways of thinking?) For about a year, Ms. A. related to me as a helpful, reliable, and admiring grown-up. The transference was positive - to "good" teachers, the middle-aged male coach, the father of her teen years and after. I was a male figure to her. In this stage of analysis her father was seen as the opposite of her denigrated mother. (This can be heard as fierce oedipal rivalry, as the standard and applicable "old" formulation. Ms. A.'s repudiation of her mother was also connected to the terrible disappointment in the mother and thus a loss of maternal ideal due to the mother's addiction and abdication of responsibilities. Blum [1981] pointed to the importance of this ideal specifically to women. Repudiation of the mother might also speak to an underlying dangerous love for her mother. This moment is a good example of the useful overlap between newer and older, more familiar thinking.) On the couch Ms. A. revealed an ease and attunement to her body and its sensations. These she included in her associations. (I have found that this is more usual in female athletes than with other women. Older thinking tends to assume greater secretiveness in a female's associations. This is an area where the jury is still out between the old and the new, and there seems marked variability among analysands. It is possible that secretiveness is not a gender-specific quality.) She rearranged pillows and space to suit her needs. If she were agitated, my couch could end up looking like a whirlwind had hit it. Curiously, at this stage she omitted any mention of her genitals. (Her overall ease with body reference highlighted this interesting omission. I would have had to force a priori assumptions from the old formulations to suppose that in unconscious fantasy she either had a penis or had lost one, and to suppose that it was these unacceptable ideas and affects that accounted for the omission in consciousness. Such fantasy is, of course, quite possible. But there were odd features here that did not seem readily explicable. For one thing, she did not act castrated, or downcast and depressed, when she failed to excel, as the old formulas suggest she would. Trying to stay in tune with her, and not to foreclose my thinking by taking up these masculinized genital connections, I thought to myself that the picture was of a young woman who admired and was fascinated with certain attributes of the male body and also of her father's mental life. She wanted to emulate these! and did not show much conflict about this. Was she was avoiding her genitals and her wish to have the penis, and avoid-ing display of her anxiety, because it would expose fully to me the fantasized inadequate vulva and clitoris? But where was the expected phallic castration anxiety here? Was it all hidden in this oblation from her verbal associations? In sum, I thought it possible that she had blotted out the genitals altogether, as they might well be an area of danger.) Yet in her associations there were many references to acquiring for herself male-like bodily strength and endurance. She wanted strong and powerful muscles "with a big hard bulge" and enjoyed watching her biceps flex in the session. She would freely ask me to look at how big she was getting. She would giggle and talk of how I would think she was showing off. I would agree that she was showing off her muscles to me. "What all do you want me to see?" I'd ask her. "I want you to see I'm strong. I'm getting results from the gym. Dad, you know is terrifically strong. He works out in his hotel rooms. He has to sit a long time in planes, and he needs to work out to absorb his pent-up energy - just like me." At a later time she dwelled on the swelling sensation of the rising muscle. "Just like an erection - I guess you think I'm full of penis envy." "What about it, then?" I said, after we had dealt with the projective element and the oedipal desire to please me by parroting Freud. She said, "Yes. I guess it is penis envy. I think it would be great to have a penis. In athletics it would be far easier than having periods, though now I'm on birth control it's totally manageable. I am very competitive, you know. I love it that I'm stronger than many men. I'm actually more powerful than a lot of guys (laughs). Having a dick - well, it would depend on the dick, wouldn't it?" She expressed these wishes and frustrations directly and rather unconflictedly, I thought. One reason for her lack of frustration in her comparisons with men was the very fact of her muscular gifts. As she said, she could achieve realistically a body strength superior to that of most of her male peers. "It is such fun to compete with them. You don't have to hold yourself back, like with women. What a kick!" She wished she had been born a boy to be like her father. "Life would just have been easier for me," she said. (Her penis envy was out in the open now, but I found evidence missing, until now, for accompanying and complicating female genital denigration. Phallic castration anxiety per se was missing.) Her dreams often depicted men chasing her. In associations she felt anxious about burglary and rape. I tried some interpretations along the phallic castrated line, about wanting to chase the men herself and "take them" - after all, she had said she'd like to have a penis of her own. She said, "Oh yeah," but it was not an idea that developed. (I felt in retrospect that this was a formulaic and mechanical interpretation on my part, an attempt to fit the theory to her case. Again I returned simply to the material. A newer idea would allow for less in the way of mental gymnastics - like the common analytic habit of turning "fears" into "wishes." I decided to just stay with her fears about being invaded. She might have penetration anxiety, for example, or some other genital anxiety about a man approaching her sexually.) These dreams often occurred when her training did not go well. We talked of her feelings of vulnerability if she could not be as strong asshe wanted. Being strong helped allay the fearful thought that a man could rape her. She proceeded in this vein for about a year. Ms. A. was increasingly successful at her sport and "in crush" (her words) with her male coach. Dreams revealedRosemary Balsam Training and Supervising Analyst, Western New England Institute for Psychoanalysis INTEGRATING MALE AND FEMALE ELEMENTS IN A WOMAN'S GENDER IDENTITY Submitted for publication March 25, 2000 Despite advances in female developmental theory since the 1970s, there remains a lingering tendency to stereotype and polarize gender identity. The key to this puzzle may be found in the legacy of early libido theory, which offers an unintegratable solution for women. This is because in order for a woman to claim femininity according to this early theory, her masculine trends in development must be repudiated and "overcome." A contemporary theory based on primary femininity suggests that this early theoretical "either/or" dilemma puts forward a developmentally immature solution. The analysis of a thirty-year-old woman, and a commentary contrasting "old" and "newer" ways of thinking on the part of the analyst, demonstrate that an interweaving pattern of paternal identifications and male body representations, together with the female body image and female identifications, is necessary to create a mature gender identity portrait. The female bodyrepresentation and maternal identifications! may indeed be enhanced by male internalizations, as happened in this particular instance. New ideas within psychoanalysis mobilize resistance and under-go an uncertain fate, especially if they differ from those of Freud (Greenson 1969; Eissler 1969; Gillette 1992). The theory of female development is a case in point (Fliegel 1973). In spite of the many refinements that have been made in the field since Freud's first delineation of the psychosexual phases of female development in 1905, and in spite of his own advances in filling out the theory - for example, his recognition of the mother's powerful role in the girl's development (1931) - there remains a reluctance among analysts to use psychoanalytic correctives and knowledge developed since Freud in their everyday clinical work, in clinical discussions, and in clinical writing (unless the focus is specifically on gender theory). As far back as 1986, in a review of female psychology, Chehrazi wrote, "in spite of recently suggested revisions . . . it is my impression from seminars and clinical conferences that our diagnostic formulations and dynamic conceptualizations remain more or less the same" since Freud's time (p. 22). Nowadays, too, as Chehrazi noted then, the "lack of a revised theoretical framework" may be blamed (p. 22). A continued yearning in our profession for an ideal systematic theory of female development, however, may serve to shield against some changes of focus in clinical work that could be facilitated even while awaiting complete reformulation. Ten years after Chehrazi's observations, Basseches and her colleagues (1996) reported on a study of analytic treatments of women conducted by a group of contemporary female analysts. This work confirmed their suspicion that there is still a "lag between theory and clinical technique"; in the an! alys ts' discussions they discovered their "collusion with Freud's phallocentric perspective in concert with [their] patients' self-assessments" (p. 515). For example, like their early counterparts, they tended to view penis envy and the castration complex as bedrock facts and failed to consider instead their functional defensive possibilities as body fantasies. The authors believed that the "participant analysts' theories and identifications with their own personal analysts and clinical supervisors did not yield easily to integrating the newer ideas of primary femininity into clinical practice" (p. 516). One female analyst in the group reported automatically interpreting a female patient's denial of her genitals as a sure sign of penis envy - the usual male body terms. The analyst noted that it made her uneasy to shift to an interpretation of the patient's denial in specifically female body terms - i.e., "the patient's wish to deny interest in her [own] feminine space" (p. 517). This apparent stasis led Nancy Kulish and Ruth Fischer to convene a panel to discuss primary femininity and its clinical implications at the 1999 fall meetings of the American Psychoanalytic Association. Contributors agreed that there is a continuing reluctance to translate more recent ideas into the actual treatment of women patients. One can ask, Why is this so? But one can also ask, How can this happen clinically? As part of demonstrating the consequences of a shift of clinical focus that results from integrating some of the newer formulations, I will demonstrate also that challenges to "established" theory begin to emerge within the theoretical uncertainty that ensues. For example, I suggest that since approximately 1970 it can no longer be held that femininity or femaleness is "achieved" by renouncing masculinity or maleness, we are free to imagine a gender solution other than one based on an either/or conflict. We can postulate that a female can have a stable core gender identity and yet also follow dual gender developmental lines that need not necessarily be in opposition. The male line can become complementary and even enhancing to aspects of the female line. "PRIMARY FEMININITY" OR "A SENSE OF PRIMARY FEMALENESS" The most important shift in thinking about sex and gender issues in women was ushered in by the term primary femininity - first used by Stoller in 1968, in reference to the then new concept of core gender identity (the self-identification of being either a "girl" or a "boy" that is established by 18-36 months). As an umbrella concept, primary femininity has helped to underline a range of newer and apt psychological thoughts about women-qua-women, and has helped us achieve theoretical distance from the limitation of the old-fashioned Freudian girl-as-little-boy trajectory. Its introduction marks an historical watershed in psychoanalytic writing about female psychosexual development. But primary femininity can also be a problematic idea, because it has been used so elastically in discussing the many aspects of female development, such as " gender identity, innate biological traits, early object relationships, aspects of the self, and types of anxieties" (Kulish 2000, p. 1356). By 1972, Stoller himself served to obfuscate the term considerably. He conceptually melded the scientific discovery of the human embryo's initial feminized biology together with a protofemininity developed from a child's symbiotic fusion with the mother. He claimed now that this "primary femininity" applied not only to girls, but also to boys in their early development. This latter aspect of Stoller's use of the term has been persuasively challenged by Fast (1999). The different interpretations of primary femininity have been critiqued by Kulish (2000), who, though recognizing the many advances yielded by these investigations, warns us not to &q! uot; repeat the mistakes of the past and not ask the next question, 'Where do we go from here?'" (p. 1375). Suffice it to say that the concept needs to be defined carefully each time it is invoked. An alternative term, a sense of femaleness, has been suggested by Elise (1997), who prefers it because it eliminates problems with the cultural value judgments encoded in "femininity." My main point here, however, is that clinical interpretations and formulations based on the concept of "primary femininity" have been slow to be incorporated into case reports. BEFORE AND AFTER 1970 The most significant change to appear in the literature between the "old" psychoanalytic ideas and the "newer" ones is the acknowledgment that a female child develops psychosexually in relation to her female body. As I have suggested, the watershed between these views is roughly the year 1970, though Horney (1924, 1926) and Jones (1927) can be regarded as progenitors of the new. The comparison the girl makes between her own body and the male body remains important in the newer system, but it is more likely to be seen as reactive to attitudes about basic female body parts, or as a masculinized matrix of defensive fantasy as attempted solutions to other developmental problems (Dahl 1996.) This shift of emphasis to the centrality of the female habitus can make a significant difference in how a woman's intrapsychic conflict around issues of body and gender is heard by the analyst. The "Old" View In the case presentation below, I will try to indicate points at which the "old" view comes to mind as I think about the material. The shorthand designation "old" will refer to the original Freudian schema, which by now hardly needs repeating. The girl is really a little boy in her own mind until the fateful encounter with the actual sexed boy, causing her horror, disbelief, and conviction that she has come into the world with a boy's damaged genitals. Thus, "anatomy is destiny" for Freud's female, and an account is given of her lifelong pursuit of the penis which was torn off a tragic story of unfulfilled, castrated maleness. In the Freudian schema, even her baby is a glorified poor man's penis that gradually inures her to a maturity of sorrowful femaleness-as-crippled-maleness. Her sex and gender are psychologically borrowed from the male, maleness therefore being primary in the "old" syst! em. What she has not (in male body terms) is therefore viewed as the primary locus of a girl's intrapsychic conflict; what she has (in female body terms) is perceived analytically as a derivative and secondary issue. In their adherence to the "old" scheme, most psychoanalysts seemed to believe that a fantasy body was more psychologically fundamental to females than to males. Is this not curious? Although in the 1920s some analysts questioned Freud's ideas in this regard (see, e.g., Abraham and Freud, 1965, p. 375), for reasons too complicated to explore here Freud's ideas alone became dominant. For one, their theoretical elegance fitted neatly with his notion of libido being gendered as male. The "Newer" View The shorthand designation "newer" that I will use in presenting the case below will refer to the post-1970 perspective, in which the female-qua-female possesses in her own body the primary building blocks of sex and gender (just as the male does), and her "maleness," derived from relating to males, becomes an added phenomenon, however necessary and complex. In this system, the female patient therefore considers as primary (in the sense of basic) what female body parts and attributes she has (see Stoller 1968, 1976; Kleeman 1971; Kestenberg 1982; Mayer 1985; Bernstein 1990; Richards 1992; Frenkel 1996; Holtzman and Kulish 1996). The post-1970 shift to acknowledgment of the female's primary femininity (or primary sense of femaleness) holds many ramifications for revision of the old theory (Tyson 1982), and for newer, more cogent ideas regarding the spectrum of genders (Chodorow 1994). For example, much new inform! ation can be gleaned about interna! lizations specifically concerning the impact of the adult female body on all developmental stages in the girl's growing mental representations and conflicts about her own body (Balsam 1996, 2000). RECASTING THE LEXICON OF FEMALE DEVELOPMENT Crucial to an analyst's ability to shift from an anachronistic phallocentric theory of women to the newer, more appropriate theory is an increasing sensitivity to the language used in dynamic formulation. If we are to make headway, greater attention needs to be paid to this in teaching, in editorial work, and in writing papers. The technical language of our field is full of problems because our data are gathered by people about people in an interactive process; opinion becomes theory, yet simultaneously our language aspires to objectivity and generalizability. Language can thus be subject to the effects of gendering. For example, "rational" may inadvertently be equated with the value judgments strong/clear/male; "irrational" with soft/murky/female. Patients frequently embrace these mistaken affinities, but there is no need for analysts to echo the emotional accretion as "theory" (see Balsam 1994). Freud (! 1905 ) became trapped in precisely this way in his equations active/male and passive/female. Our lexicon of female development needs a definitive update. The old language keeps alive the old concepts. As Goldberger (1999) points out, our imaginations could be freer of the constraints and closures inevitably imposed by the old language. She urges "that analysts start using language that reflects our improved understanding of female development" (p. 465). Throughout our history, ever since Freud analyzed Dora, we have tended to dominate our manifestly compliant female patients with knowing formulations. We now have an opportunity to challenge these fixed attitudes. It has been argued, often and persuasively, that calling body anxiety in women "phallic castration" is misleading and that the phenomenon would be rendered more accurately by the term genital anxiety or female genital anxiety (Goldberger 1999; Olesker 1998; Dorsey 1996; Shaw 1995; Bernstein 1990; Chehrazi 1986). Since Freud, we have learned about many different kinds of genital anxieties - e.g., those concerning loss of virginity, penile penetration, or the uterine and perineal strains of childbirth - that center on fantasies, referring to the present or future, about the personal female body. Thus our scope is widened far beyond the anxiety associated with the fantasied past loss of a fantasy penis. The more inclusive terms genital anxiety or female genital anxiety have the benefit of accuracy, can be used for women generally, and yet are flexible enough to accommodate individual meanings. The term castration anxiety points narrowly to one variety of anxiety in women, the universality of which many question. One could quarrel with other terms, too, like the oedipal complex as applied to women (Parens 1990). This last I retain - uneasily - for the sake of familiarity and short-hand. Much work remains to be done if we are to arrive at consensus regarding the most heuristic theoretical language for use in this area. CASE EXAMPLE Introduction The avenue I wish to take into primary femininity (or the primary sense of femaleness) is that of maternality. By this term I mean to convey the importance of the body of the mother - not just the general mental state of "motherhood." The maternal body is for the girl the most important icon of grown-up physical femaleness, one she experiences at all stages of growth (Balsam 1996). Many difficulties attend the reintroduction of issues specifically centering on the maternal. As a focus of female developmental theory, maternality has had a spotty history. This is due to its association with, for example, ill-founded theoretical claims to inherent female masochism (Deutsch 1945) or, as Chodorow (1978) has pointed out, the sociocultural imperative that women produce and rear children. I am also aware of the perils of "biological essentialism" (Bem 1993), a term denoting the idea that everything worthwhile about being a woman resides in the female anatomy. Nonetheless, I do want to speak of childbearing as the anatomical and physiological potential of the female body, though in the context of the woman's developing psyche. I think this can ! be d one without imposing value judgments, masked as science, about how a mature woman ought to be. My interest is in psychoanatomy and psychophysiology. I will tell the story of Ms. A.'s analysis that bears on the role of her female body in her dilemmas. My theoretical underpinning is a blend of drive and object relations theory; therefore, Ms. A.'s communications about her body will involve for me a study of the intrapsychic anatomy of the internalizations of her attitudes arising from both male and female influences, from both father and mother at different developmental phases. As the case unfolds, I will keep the reader abreast of my thoughts about applying the "old" formulations (as defined above) and the "newer" ones that emerge by thinking of female-qua-female in a basic way. I will use interpolations (in parentheses) within the text of the case to show such choices in my thinking. Along the way I will discuss the implications of a particular comparison between the "old" and newer vantage points, or any useful overlap between them. This method will take the place of a formal discussion section to follow the case material, because I want to dramatize how an analyst thinks along as the material is presented, while also listening. Some readers may dislike this method, which admittedly appears to exaggerate the "old" ideas, to more of a straw man effect than sensitive analysts may identify with. However, I do believe that my point about the adherence to overarching phallocentric belief system! s in psychoanalysis is valid, despite our efforts and far better conscious intentions, and that the main evidence of this is the continuing, virtually untroubled use of a common language about women that includes and perpetuates male-derived theoretical terms (Goldberger 1999). Presentation and History A thirty-year-old female graduate student bounded two-steps-at-a-time up three flights of stairs in the Student Health Center demanding, "I need to talk to a woman analyst!" The receptionist instantly called me, saying that the young woman was either crazy or knew exactly what she wanted. Happily, Ms. A. turned out to know what she wanted, which was an analysis that lasted about four years. This was her urgent complaint: "I don't want to be married with a bunch of kids and wake up one morning hating my husband and wondering, What am I doing?" Her divorced parents had had yet another vicious fight over the children. Later from the couch I heard the following tale of events that occurred when Ms. A. was sixteen and attending a boarding school in the South. She was with her aunt, who had taken her to the horse races for the first time. "We were up in the stand. I had her binoculars trained on the starting gate. They were off! Suddenly there was this pack of speeding horses, all in unison, rhythmically thundering toward the bend. They were fast. They were intense, all in time, all together. I was transported. The jockeys were whipping them on - they rocketed past our stand. I felt giddy with ecstasy. It was perfection! It was their unison that got to me. They were so effortless, all of them together - so controlled - so powerful. God, what a high! It was love at first sight!" (I noted to myself that her fascination here, as she described it, was not with who had won, or how her aunt's bet had gone, or even the performance of her aunt's horse, all of which might have suggested a displacement of perhaps positive or negative oedipal themes of competition with the aunt as stand-in for either male or female parent. It was "all together," "speed," and "unison" that caught her imagination. That sounded like a yearning for harmony, power, and close-ness, with herself as one horse of many. I thought it might be an image of siblings. Did it encode a preoedipal love and yearning for her mother, a variety of symbiotic fantasy about blending with an all-powerful maternal figure?) Ms. A. took up horseback riding after this experience. (Riding horses is in itself a topic related to the old phallic view of the power of horses, which often overlooks female-referenced meanings of horses to girls, such as mastery in caretaking and controlling the mother.) Riding was not her only sport or even her major one. In her twenties she had became a dedicated and successful athlete in a sport that echoes her response to the horse race, that requires the intense cooperation of a team of equals, all playing fast and in synchrony with one another. (Her constitutional athletic endowment was a factor profoundly affecting the cast of Ms. A.'s character and psychodynamics. In her associations she might say casually en route to some other topic: "John and I started off the day with a nice twenty-mile run. It was great. Connecticut is so great to run in because there's all these gentle hills." This level of physical prowess in a woman was once assu! med almost automatically to be borrowed from the male and to unconsciously express male phallic aspiration. Today, however, the athletic body ideal for women has challenged this stereotype. On analysis, there can be as many female body fantasies in the creation of this ideal as there are male body fantasies.) Ms. A. was a big, shapely, tall woman with sculptured shoulders and long powerful limbs, a pretty, expressive face, sparkling eyes, and gleaming short jet black hair. She was passionate and vivacious. In a single session her face could be miserable and tear-stained or wreathed with smiles. Nothing was done or experienced by her in a halfhearted way. Ms. A. had experienced the following family chaos. Her father, from a wealthy family, was an airline pilot on Far East runs. He was never home in her early years. Her mother was a voluptuous, black-haired Italian supermodel. Her husband swept her off her feet in marriage and brought her to live in Bel Air, California. My patient was the oldest of five children, of both sexes, born eighteen months or less apart. Her mother had been a devout Catholic. As soon as the patient's mother became pregnant with Ms. A. shortly after marriage, a sweet but elderly Italian nanny was engaged to help. She grew ancient within the family. Gradually, the mother became severely alcoholic; although we unearthed evidence later of her playfulness and better caretaking of Ms. A. up to the age of six, her maternal capacity deteriorated with each successive child. The father separated from this unhappy mother when my patient was nine and went off with a young female flight attendant.! Ms. A.'s parents divorced when she was eleven. A pivotal moment in her life occurred one night when her mother was so enraged and filled with despair by the impending divorce that she made a flamboyant suicide attempt and was hospitalized. My patient, who for two years had insisted on trying to care for her mother, her siblings, and her aged nanny, finally took up her father's invitation to escape and live with him during the rest of her teens. Her father took his paternal responsibilities very seriously after the divorce. In fact, I think he saved Ms. A.'s capacity for pleasure and self-esteem and, by his increased involvement with her, helped her bear her anger and despair in growing up. She despised her father's girlfriend as shallow, giggly, and "frilly-pink." He never remarried. For high school Ms. A. elected to go to the Southern boarding school mentioned above, and it was while out with her father's sister that the horse racing scene took place. In The Analysis: Male Influences When we started the analysis, Ms. A. revealed that one of her persistent complaints was that she failed to perform up to her ability; this happenened, she said, "no matter how I break my ass." (This could be an open invitation to think "castration anxiety" and broken phalluses. But what about an anal reference? or a broken hymen? or a reverberation from a traumatic memory about the effort and disappointment at the experience of loss of her virginity?) She talked a great deal about her athletics. She hoped I could help her improve. She bench-pressed and ran stairs for hours. Her male coach urged her to more and more feats of endurance, and she thrived on the regimen. She was outstandingly active, both mentally and physically, and readily aggressive, and on the surface was quite easy with it. She was also very ambitious, and after her athletic prime and completed doctorate was headed for a top job in industrial research. She was apparently uninhibited, always striving to be number one, yet concerned and annoyed but not devastated if it did not happen. (These competitive qualities in athletics, academics, and the world of work have often been associated mainly with penis envy and male identification in a woman. Deutsch [1945], for example, shows evidence of this kind of thinking in case reports. Since libido and activity were described by Freud as masculine, any activity on a female's part needed to be designated masculine in order to fit the theory. If the modern analyst can consider newer ways to characterize the female/active/aggressive/dominant axis, further inquiry might be conducted into the nature of female aggressi! on, female competitiveness, and female exhibitionism. Schafer [1974] argued that Freud's vision of women was limited by his difficulty in appreciating the maternal transference. This "old" lens thus tends to dull the view of female maternal aggression by coopting aggression and warding it off by designating it male. These issues are particularly interesting because women notably have had a reputation for inhibition in these arenas. But how much of this "inhibition" might turn out to be in our own ways of thinking?) For about a year, Ms. A. related to me as a helpful, reliable, and admiring grown-up. The transference was positive - to "good" teachers, the middle-aged male coach, the father of her teen years and after. I was a male figure to her. In this stage of analysis her father was seen as the opposite of her denigrated mother. (This can be heard as fierce oedipal rivalry, as the standard and applicable "old" formulation. Ms. A.'s repudiation of her mother was also connected to the terrible disappointment in the mother and thus a loss of maternal ideal due to the mother's addiction and abdication of responsibilities. Blum [1981] pointed to the importance of this ideal specifically to women. Repudiation of the mother might also speak to an underlying dangerous love for her mother. This moment is a good example of the useful overlap between newer and older, more familiar thinking.) On the couch Ms. A. revealed an ease and attunement to her body and its sensations. These she included in her associations. (I have found that this is more usual in female athletes than with other women. Older thinking tends to assume greater secretiveness in a female's associations. This is an area where the jury is still out between the old and the new, and there seems marked variability among analysands. It is possible that secretiveness is not a gender-specific quality.) She rearranged pillows and space to suit her needs. If she were agitated, my couch could end up looking like a whirlwind had hit it. Curiously, at this stage she omitted any mention of her genitals. (Her overall ease with body reference highlighted this interesting omission. I would have had to force a priori assumptions from the old formulations to suppose that in unconscious fantasy she either had a penis or had lost one, and to suppose that it was these unacceptable ideas and affects that accounted for the omission in consciousness. Such fantasy is, of course, quite possible. But there were odd features here that did not seem readily explicable. For one thing, she did not act castrated, or downcast and depressed, when she failed to excel, as the old formulas suggest she would. Trying to stay in tune with her, and not to foreclose my thinking by taking up these masculinized genital connections, I thought to myself that the picture was of a young woman who admired and was fascinated with certain attributes of the male body and also of her father's mental life. She wanted to emulate these! and did not show much conflict about this. Was she was avoiding her genitals and her wish to have the penis, and avoid-ing display of her anxiety, because it would expose fully to me the fantasized inadequate vulva and clitoris? But where was the expected phallic castration anxiety here? Was it all hidden in this oblation from her verbal associations? In sum, I thought it possible that she had blotted out the genitals altogether, as they might well be an area of danger.) Yet in her associations there were many references to acquiring for herself male-like bodily strength and endurance. She wanted strong and powerful muscles "with a big hard bulge" and enjoyed watching her biceps flex in the session. She would freely ask me to look at how big she was getting. She would giggle and talk of how I would think she was showing off. I would agree that she was showing off her muscles to me. "What all do you want me to see?" I'd ask her. "I want you to see I'm strong. I'm getting results from the gym. Dad, you know is terrifically strong. He works out in his hotel rooms. He has to sit a long time in planes, and he needs to work out to absorb his pent-up energy - just like me." At a later time she dwelled on the swelling sensation of the rising muscle. "Just like an erection - I guess you think I'm full of penis envy." "What about it, then?" I said, after we had dealt with the projective element and the oedipal desire to please me by parroting Freud. She said, "Yes. I guess it is penis envy. I think it would be great to have a penis. In athletics it would be far easier than having periods, though now I'm on birth control it's totally manageable. I am very competitive, you know. I love it that I'm stronger than many men. I'm actually more powerful than a lot of guys (laughs). Having a dick - well, it would depend on the dick, wouldn't it?" She expressed these wishes and frustrations directly and rather unconflictedly, I thought. One reason for her lack of frustration in her comparisons with men was the very fact of her muscular gifts. As she said, she could achieve realistically a body strength superior to that of most of her male peers. "It is such fun to compete with them. You don't have to hold yourself back, like with women. What a kick!" She wished she had been born a boy to be like her father. "Life would just have been easier for me," she said. (Her penis envy was out in the open now, but I found evidence missing, until now, for accompanying and complicating female genital denigration. Phallic castration anxiety per se was missing.) Her dreams often depicted men chasing her. In associations she felt anxious about burglary and rape. I tried some interpretations along the phallic castrated line, about wanting to chase the men herself and "take them" - after all, she had said she'd like to have a penis of her own. She said, "Oh yeah," but it was not an idea that developed. (I felt in retrospect that this was a formulaic and mechanical interpretation on my part, an attempt to fit the theory to her case. Again I returned simply to the material. A newer idea would allow for less in the way of mental gymnastics - like the common analytic habit of turning "fears" into "wishes." I decided to just stay with her fears about being invaded. She might have penetration anxiety, for example, or some other genital anxiety about a man approaching her sexually.) These dreams often occurred when her training did not go well. We talked of her feelings of vulnerability if she could not be as strong asshe wanted. Being strong helped allay the fearful thought that a man could rape her. She proceeded in this vein for about a year. Ms. A. was increasingly successful at her sport and "in crush" (her words) with her male coach. Dreams revealed Rosemary Balsam Training and Supervising Analyst, Western New England Institute for Psychoanalysis INTEGRATING MALE AND FEMALE ELEMENTS IN A WOMAN'S GENDER IDENTITY Submitted for publication March 25, 2000 Despite advances in female developmental theory since the 1970s, there remains a lingering tendency to stereotype and polarize gender identity. The key to this puzzle may be found in the legacy of early libido theory, which offers an unintegratable solution for women. This is because in order for a woman to claim femininity according to this early theory, her masculine trends in development must be repudiated and "overcome." A contemporary theory based on primary femininity suggests that this early theoretical "either/or" dilemma puts forward a developmentally immature solution. The analysis of a thirty-year-old woman, and a commentary contrasting "old" and "newer" ways of thinking on the part of the analyst, demonstrate that an interweaving pattern of paternal identifications and male body representations, together with the female body image and female identifications, is necessary to create a mature gender identity portrait. The female bodyrepresentation and maternal identifications! may indeed be enhanced by male internalizations, as happened in this particular instance. New ideas within psychoanalysis mobilize resistance and under-go an uncertain fate, especially if they differ from those of Freud (Greenson 1969; Eissler 1969; Gillette 1992). The theory of female development is a case in point (Fliegel 1973). In spite of the many refinements that have been made in the field since Freud's first delineation of the psychosexual phases of female development in 1905, and in spite of his own advances in filling out the theory - for example, his recognition of the mother's powerful role in the girl's development (1931) - there remains a reluctance among analysts to use psychoanalytic correctives and knowledge developed since Freud in their everyday clinical work, in clinical discussions, and in clinical writing (unless the focus is specifically on gender theory). As far back as 1986, in a review of female psychology, Chehrazi wrote, "in spite of recently suggested revisions . . . it is my impression from seminars and clinical conferences that our diagnostic formulations and dynamic conceptualizations remain more or less the same" since Freud's time (p. 22). Nowadays, too, as Chehrazi noted then, the "lack of a revised theoretical framework" may be blamed (p. 22). A continued yearning in our profession for an ideal systematic theory of female development, however, may serve to shield against some changes of focus in clinical work that could be facilitated even while awaiting complete reformulation. Ten years after Chehrazi's observations, Basseches and her colleagues (1996) reported on a study of analytic treatments of women conducted by a group of contemporary female analysts. This work confirmed their suspicion that there is still a "lag between theory and clinical technique"; in the an! alys ts' discussions they discovered their "collusion with Freud's phallocentric perspective in concert with [their] patients' self-assessments" (p. 515). For example, like their early counterparts, they tended to view penis envy and the castration complex as bedrock facts and failed to consider instead their functional defensive possibilities as body fantasies. The authors believed that the "participant analysts' theories and identifications with their own personal analysts and clinical supervisors did not yield easily to integrating the newer ideas of primary femininity into clinical practice" (p. 516). One female analyst in the group reported automatically interpreting a female patient's denial of her genitals as a sure sign of penis envy - the usual male body terms. The analyst noted that it made her uneasy to shift to an interpretation of the patient's denial in specifically female body terms - i.e., "the patient's wish to deny interest in her [own] feminine space" (p. 517). This apparent stasis led Nancy Kulish and Ruth Fischer to convene a panel to discuss primary femininity and its clinical implications at the 1999 fall meetings of the American Psychoanalytic Association. Contributors agreed that there is a continuing reluctance to translate more recent ideas into the actual treatment of women patients. One can ask, Why is this so? But one can also ask, How can this happen clinically? As part of demonstrating the consequences of a shift of clinical focus that results from integrating some of the newer formulations, I will demonstrate also that challenges to "established" theory begin to emerge within the theoretical uncertainty that ensues. For example, I suggest that since approximately 1970 it can no longer be held that femininity or femaleness is "achieved" by renouncing masculinity or maleness, we are free to imagine a gender solution other than one based on an either/or conflict. We can postulate that a female can have a stable core gender identity and yet also follow dual gender developmental lines that need not necessarily be in opposition. The male line can become complementary and even enhancing to aspects of the female line. "PRIMARY FEMININITY" OR "A SENSE OF PRIMARY FEMALENESS" The most important shift in thinking about sex and gender issues in women was ushered in by the term primary femininity - first used by Stoller in 1968, in reference to the then new concept of core gender identity (the self-identification of being either a "girl" or a "boy" that is established by 18-36 months). As an umbrella concept, primary femininity has helped to underline a range of newer and apt psychological thoughts about women-qua-women, and has helped us achieve theoretical distance from the limitation of the old-fashioned Freudian girl-as-little-boy trajectory. Its introduction marks an historical watershed in psychoanalytic writing about female psychosexual development. But primary femininity can also be a problematic idea, because it has been used so elastically in discussing the many aspects of female development, such as " gender identity, innate biological traits, early object relationships, aspects of the self, and types of anxieties" (Kulish 2000, p. 1356). By 1972, Stoller himself served to obfuscate the term considerably. He conceptually melded the scientific discovery of the human embryo's initial feminized biology together with a protofemininity developed from a child's symbiotic fusion with the mother. He claimed now that this "primary femininity" applied not only to girls, but also to boys in their early development. This latter aspect of Stoller's use of the term has been persuasively challenged by Fast (1999). The different interpretations of primary femininity have been critiqued by Kulish (2000), who, though recognizing the many advances yielded by these investigations, warns us not to &q! uot; repeat the mistakes of the past and not ask the next question, 'Where do we go from here?'" (p. 1375). Suffice it to say that the concept needs to be defined carefully each time it is invoked. An alternative term, a sense of femaleness, has been suggested by Elise (1997), who prefers it because it eliminates problems with the cultural value judgments encoded in "femininity." My main point here, however, is that clinical interpretations and formulations based on the concept of "primary femininity" have been slow to be incorporated into case reports. BEFORE AND AFTER 1970 The most significant change to appear in the literature between the "old" psychoanalytic ideas and the "newer" ones is the acknowledgment that a female child develops psychosexually in relation to her female body. As I have suggested, the watershed between these views is roughly the year 1970, though Horney (1924, 1926) and Jones (1927) can be regarded as progenitors of the new. The comparison the girl makes between her own body and the male body remains important in the newer system, but it is more likely to be seen as reactive to attitudes about basic female body parts, or as a masculinized matrix of defensive fantasy as attempted solutions to other developmental problems (Dahl 1996.) This shift of emphasis to the centrality of the female habitus can make a significant difference in how a woman's intrapsychic conflict around issues of body and gender is heard by the analyst. The "Old" View In the case presentation below, I will try to indicate points at which the "old" view comes to mind as I think about the material. The shorthand designation "old" will refer to the original Freudian schema, which by now hardly needs repeating. The girl is really a little boy in her own mind until the fateful encounter with the actual sexed boy, causing her horror, disbelief, and conviction that she has come into the world with a boy's damaged genitals. Thus, "anatomy is destiny" for Freud's female, and an account is given of her lifelong pursuit of the penis which was torn off a tragic story of unfulfilled, castrated maleness. In the Freudian schema, even her baby is a glorified poor man's penis that gradually inures her to a maturity of sorrowful femaleness-as-crippled-maleness. Her sex and gender are psychologically borrowed from the male, maleness therefore being primary in the "old" syst! em. What she has not (in male body terms) is therefore viewed as the primary locus of a girl's intrapsychic conflict; what she has (in female body terms) is perceived analytically as a derivative and secondary issue. In their adherence to the "old" scheme, most psychoanalysts seemed to believe that a fantasy body was more psychologically fundamental to females than to males. Is this not curious? Although in the 1920s some analysts questioned Freud's ideas in this regard (see, e.g., Abraham and Freud, 1965, p. 375), for reasons too complicated to explore here Freud's ideas alone became dominant. For one, their theoretical elegance fitted neatly with his notion of libido being gendered as male. The "Newer" View The shorthand designation "newer" that I will use in presenting the case below will refer to the post-1970 perspective, in which the female-qua-female possesses in her own body the primary building blocks of sex and gender (just as the male does), and her "maleness," derived from relating to males, becomes an added phenomenon, however necessary and complex. In this system, the female patient therefore considers as primary (in the sense of basic) what female body parts and attributes she has (see Stoller 1968, 1976; Kleeman 1971; Kestenberg 1982; Mayer 1985; Bernstein 1990; Richards 1992; Frenkel 1996; Holtzman and Kulish 1996). The post-1970 shift to acknowledgment of the female's primary femininity (or primary sense of femaleness) holds many ramifications for revision of the old theory (Tyson 1982), and for newer, more cogent ideas regarding the spectrum of genders (Chodorow 1994). For example, much new inform! ation can be gleaned about interna! lizations specifically concerning the impact of the adult female body on all developmental stages in the girl's growing mental representations and conflicts about her own body (Balsam 1996, 2000). RECASTING THE LEXICON OF FEMALE DEVELOPMENT Crucial to an analyst's ability to shift from an anachronistic phallocentric theory of women to the newer, more appropriate theory is an increasing sensitivity to the language used in dynamic formulation. If we are to make headway, greater attention needs to be paid to this in teaching, in editorial work, and in writing papers. The technical language of our field is full of problems because our data are gathered by people about people in an interactive process; opinion becomes theory, yet simultaneously our language aspires to objectivity and generalizability. Language can thus be subject to the effects of gendering. For example, "rational" may inadvertently be equated with the value judgments strong/clear/male; "irrational" with soft/murky/female. Patients frequently embrace these mistaken affinities, but there is no need for analysts to echo the emotional accretion as "theory" (see Balsam 1994). Freud (! 1905 ) became trapped in precisely this way in his equations active/male and passive/female. Our lexicon of female development needs a definitive update. The old language keeps alive the old concepts. As Goldberger (1999) points out, our imaginations could be freer of the constraints and closures inevitably imposed by the old language. She urges "that analysts start using language that reflects our improved understanding of female development" (p. 465). Throughout our history, ever since Freud analyzed Dora, we have tended to dominate our manifestly compliant female patients with knowing formulations. We now have an opportunity to challenge these fixed attitudes. It has been argued, often and persuasively, that calling body anxiety in women "phallic castration" is misleading and that the phenomenon would be rendered more accurately by the term genital anxiety or female genital anxiety (Goldberger 1999; Olesker 1998; Dorsey 1996; Shaw 1995; Bernstein 1990; Chehrazi 1986). Since Freud, we have learned about many different kinds of genital anxieties - e.g., those concerning loss of virginity, penile penetration, or the uterine and perineal strains of childbirth - that center on fantasies, referring to the present or future, about the personal female body. Thus our scope is widened far beyond the anxiety associated with the fantasied past loss of a fantasy penis. The more inclusive terms genital anxiety or female genital anxiety have the benefit of accuracy, can be used for women generally, and yet are flexible enough to accommodate individual meanings. The term castration anxiety points narrowly to one variety of anxiety in women, the universality of which many question. One could quarrel with other terms, too, like the oedipal complex as applied to women (Parens 1990). This last I retain - uneasily - for the sake of familiarity and short-hand. Much work remains to be done if we are to arrive at consensus regarding the most heuristic theoretical language for use in this area. CASE EXAMPLE Introduction The avenue I wish to take into primary femininity (or the primary sense of femaleness) is that of maternality. By this term I mean to convey the importance of the body of the mother - not just the general mental state of "motherhood." The maternal body is for the girl the most important icon of grown-up physical femaleness, one she experiences at all stages of growth (Balsam 1996). Many difficulties attend the reintroduction of issues specifically centering on the maternal. As a focus of female developmental theory, maternality has had a spotty history. This is due to its association with, for example, ill-founded theoretical claims to inherent female masochism (Deutsch 1945) or, as Chodorow (1978) has pointed out, the sociocultural imperative that women produce and rear children. I am also aware of the perils of "biological essentialism" (Bem 1993), a term denoting the idea that everything worthwhile about being a woman resides in the female anatomy. Nonetheless, I do want to speak of childbearing as the anatomical and physiological potential of the female body, though in the context of the woman's developing psyche. I think this can ! be d one without imposing value judgments, masked as science, about how a mature woman ought to be. My interest is in psychoanatomy and psychophysiology. I will tell the story of Ms. A.'s analysis that bears on the role of her female body in her dilemmas. My theoretical underpinning is a blend of drive and object relations theory; therefore, Ms. A.'s communications about her body will involve for me a study of the intrapsychic anatomy of the internalizations of her attitudes arising from both male and female influences, from both father and mother at different developmental phases. As the case unfolds, I will keep the reader abreast of my thoughts about applying the "old" formulations (as defined above) and the "newer" ones that emerge by thinking of female-qua-female in a basic way. I will use interpolations (in parentheses) within the text of the case to show such choices in my thinking. Along the way I will discuss the implications of a particular comparison between the "old" and newer vantage points, or any useful overlap between them. This method will take the place of a formal discussion section to follow the case material, because I want to dramatize how an analyst thinks along as the material is presented, while also listening. Some readers may dislike this method, which admittedly appears to exaggerate the "old" ideas, to more of a straw man effect than sensitive analysts may identify with. However, I do believe that my point about the adherence to overarching phallocentric belief system! s in psychoanalysis is valid, despite our efforts and far better conscious intentions, and that the main evidence of this is the continuing, virtually untroubled use of a common language about women that includes and perpetuates male-derived theoretical terms (Goldberger 1999). Presentation and History A thirty-year-old female graduate student bounded two-steps-at-a-time up three flights of stairs in the Student Health Center demanding, "I need to talk to a woman analyst!" The receptionist instantly called me, saying that the young woman was either crazy or knew exactly what she wanted. Happily, Ms. A. turned out to know what she wanted, which was an analysis that lasted about four years. This was her urgent complaint: "I don't want to be married with a bunch of kids and wake up one morning hating my husband and wondering, What am I doing?" Her divorced parents had had yet another vicious fight over the children. Later from the couch I heard the following tale of events that occurred when Ms. A. was sixteen and attending a boarding school in the South. She was with her aunt, who had taken her to the horse races for the first time. "We were up in the stand. I had her binoculars trained on the starting gate. They were off! Suddenly there was this pack of speeding horses, all in unison, rhythmically thundering toward the bend. They were fast. They were intense, all in time, all together. I was transported. The jockeys were whipping them on - they rocketed past our stand. I felt giddy with ecstasy. It was perfection! It was their unison that got to me. They were so effortless, all of them together - so controlled - so powerful. God, what a high! It was love at first sight!" (I noted to myself that her fascination here, as she described it, was not with who had won, or how her aunt's bet had gone, or even the performance of her aunt's horse, all of which might have suggested a displacement of perhaps positive or negative oedipal themes of competition with the aunt as stand-in for either male or female parent. It was "all together," "speed," and "unison" that caught her imagination. That sounded like a yearning for harmony, power, and close-ness, with herself as one horse of many. I thought it might be an image of siblings. Did it encode a preoedipal love and yearning for her mother, a variety of symbiotic fantasy about blending with an all-powerful maternal figure?) Ms. A. took up horseback riding after this experience. (Riding horses is in itself a topic related to the old phallic view of the power of horses, which often overlooks female-referenced meanings of horses to girls, such as mastery in caretaking and controlling the mother.) Riding was not her only sport or even her major one. In her twenties she had became a dedicated and successful athlete in a sport that echoes her response to the horse race, that requires the intense cooperation of a team of equals, all playing fast and in synchrony with one another. (Her constitutional athletic endowment was a factor profoundly affecting the cast of Ms. A.'s character and psychodynamics. In her associations she might say casually en route to some other topic: "John and I started off the day with a nice twenty-mile run. It was great. Connecticut is so great to run in because there's all these gentle hills." This level of physical prowess in a woman was once assu! med almost automatically to be borrowed from the male and to unconsciously express male phallic aspiration. Today, however, the athletic body ideal for women has challenged this stereotype. On analysis, there can be as many female body fantasies in the creation of this ideal as there are male body fantasies.) Ms. A. was a big, shapely, tall woman with sculptured shoulders and long powerful limbs, a pretty, expressive face, sparkling eyes, and gleaming short jet black hair. She was passionate and vivacious. In a single session her face could be miserable and tear-stained or wreathed with smiles. Nothing was done or experienced by her in a halfhearted way. Ms. A. had experienced the following family chaos. Her father, from a wealthy family, was an airline pilot on Far East runs. He was never home in her early years. Her mother was a voluptuous, black-haired Italian supermodel. Her husband swept her off her feet in marriage and brought her to live in Bel Air, California. My patient was the oldest of five children, of both sexes, born eighteen months or less apart. Her mother had been a devout Catholic. As soon as the patient's mother became pregnant with Ms. A. shortly after marriage, a sweet but elderly Italian nanny was engaged to help. She grew ancient within the family. Gradually, the mother became severely alcoholic; although we unearthed evidence later of her playfulness and better caretaking of Ms. A. up to the age of six, her maternal capacity deteriorated with each successive child. The father separated from this unhappy mother when my patient was nine and went off with a young female flight attendant.! Ms. A.'s parents divorced when she was eleven. A pivotal moment in her life occurred one night when her mother was so enraged and filled with despair by the impending divorce that she made a flamboyant suicide attempt and was hospitalized. My patient, who for two years had insisted on trying to care for her mother, her siblings, and her aged nanny, finally took up her father's invitation to escape and live with him during the rest of her teens. Her father took his paternal responsibilities very seriously after the divorce. In fact, I think he saved Ms. A.'s capacity for pleasure and self-esteem and, by his increased involvement with her, helped her bear her anger and despair in growing up. She despised her father's girlfriend as shallow, giggly, and "frilly-pink." He never remarried. For high school Ms. A. elected to go to the Southern boarding school mentioned above, and it was while out with her father's sister that the horse racing scene took place. In The Analysis: Male Influences When we started the analysis, Ms. A. revealed that one of her persistent complaints was that she failed to perform up to her ability; this happenened, she said, "no matter how I break my ass." (This could be an open invitation to think "castration anxiety" and broken phalluses. But what about an anal reference? or a broken hymen? or a reverberation from a traumatic memory about the effort and disappointment at the experience of loss of her virginity?) She talked a great deal about her athletics. She hoped I could help her improve. She bench-pressed and ran stairs for hours. Her male coach urged her to more and more feats of endurance, and she thrived on the regimen. She was outstandingly active, both mentally and physically, and readily aggressive, and on the surface was quite easy with it. She was also very ambitious, and after her athletic prime and completed doctorate was headed for a top job in industrial research. She was apparently uninhibited, always striving to be number one, yet concerned and annoyed but not devastated if it did not happen. (These competitive qualities in athletics, academics, and the world of work have often been associated mainly with penis envy and male identification in a woman. Deutsch [1945], for example, shows evidence of this kind of thinking in case reports. Since libido and activity were described by Freud as masculine, any activity on a female's part needed to be designated masculine in order to fit the theory. If the modern analyst can consider newer ways to characterize the female/active/aggressive/dominant axis, further inquiry might be conducted into the nature of female aggressi! on, female competitiveness, and female exhibitionism. Schafer [1974] argued that Freud's vision of women was limited by his difficulty in appreciating the maternal transference. This "old" lens thus tends to dull the view of female maternal aggression by coopting aggression and warding it off by designating it male. These issues are particularly interesting because women notably have had a reputation for inhibition in these arenas. But how much of this "inhibition" might turn out to be in our own ways of thinking?) For about a year, Ms. A. related to me as a helpful, reliable, and admiring grown-up. The transference was positive - to "good" teachers, the middle-aged male coach, the father of her teen years and after. I was a male figure to her. In this stage of analysis her father was seen as the opposite of her denigrated mother. (This can be heard as fierce oedipal rivalry, as the standard and applicable "old" formulation. Ms. A.'s repudiation of her mother was also connected to the terrible disappointment in the mother and thus a loss of maternal ideal due to the mother's addiction and abdication of responsibilities. Blum [1981] pointed to the importance of this ideal specifically to women. Repudiation of the mother might also speak to an underlying dangerous love for her mother. This moment is a good example of the useful overlap between newer and older, more familiar thinking.) On the couch Ms. A. revealed an ease and attunement to her body and its sensations. These she included in her associations. (I have found that this is more usual in female athletes than with other women. Older thinking tends to assume greater secretiveness in a female's associations. This is an area where the jury is still out between the old and the new, and there seems marked variability among analysands. It is possible that secretiveness is not a gender-specific quality.) She rearranged pillows and space to suit her needs. If she were agitated, my couch could end up looking like a whirlwind had hit it. Curiously, at this stage she omitted any mention of her genitals. (Her overall ease with body reference highlighted this interesting omission. I would have had to force a priori assumptions from the old formulations to suppose that in unconscious fantasy she either had a penis or had lost one, and to suppose that it was these unacceptable ideas and affects that accounted for the omission in consciousness. Such fantasy is, of course, quite possible. But there were odd features here that did not seem readily explicable. For one thing, she did not act castrated, or downcast and depressed, when she failed to excel, as the old formulas suggest she would. Trying to stay in tune with her, and not to foreclose my thinking by taking up these masculinized genital connections, I thought to myself that the picture was of a young woman who admired and was fascinated with certain attributes of the male body and also of her father's mental life. She wanted to emulate these! and did not show much conflict about this. Was she was avoiding her genitals and her wish to have the penis, and avoid-ing display of her anxiety, because it would expose fully to me the fantasized inadequate vulva and clitoris? But where was the expected phallic castration anxiety here? Was it all hidden in this oblation from her verbal associations? In sum, I thought it possible that she had blotted out the genitals altogether, as they might well be an area of danger.) Yet in her associations there were many references to acquiring for herself male-like bodily strength and endurance. She wanted strong and powerful muscles "with a big hard bulge" and enjoyed watching her biceps flex in the session. She would freely ask me to look at how big she was getting. She would giggle and talk of how I would think she was showing off. I would agree that she was showing off her muscles to me. "What all do you want me to see?" I'd ask her. "I want you to see I'm strong. I'm getting results from the gym. Dad, you know is terrifically strong. He works out in his hotel rooms. He has to sit a long time in planes, and he needs to work out to absorb his pent-up energy - just like me." At a later time she dwelled on the swelling sensation of the rising muscle. "Just like an erection - I guess you think I'm full of penis envy." "What about it, then?" I said, after we had dealt with the projective element and the oedipal desire to please me by parroting Freud. She said, "Yes. I guess it is penis envy. I think it would be great to have a penis. In athletics it would be far easier than having periods, though now I'm on birth control it's totally manageable. I am very competitive, you know. I love it that I'm stronger than many men. I'm actually more powerful than a lot of guys (laughs). Having a dick - well, it would depend on the dick, wouldn't it?" She expressed these wishes and frustrations directly and rather unconflictedly, I thought. One reason for her lack of frustration in her comparisons with men was the very fact of her muscular gifts. As she said, she could achieve realistically a body strength superior to that of most of her male peers. "It is such fun to compete with them. You don't have to hold yourself back, like with women. What a kick!" She wished she had been born a boy to be like her father. "Life would just have been easier for me," she said. (Her penis envy was out in the open now, but I found evidence missing, until now, for accompanying and complicating female genital denigration. Phallic castration anxiety per se was missing.) Her dreams often depicted men chasing her. In associations she felt anxious about burglary and rape. I tried some interpretations along the phallic castrated line, about wanting to chase the men herself and "take them" - after all, she had said she'd like to have a penis of her own. She said, "Oh yeah," but it was not an idea that developed. (I felt in retrospect that this was a formulaic and mechanical interpretation on my part, an attempt to fit the theory to her case. Again I returned simply to the material. A newer idea would allow for less in the way of mental gymnastics - like the common analytic habit of turning "fears" into "wishes." I decided to just stay with her fears about being invaded. She might have penetration anxiety, for example, or some other genital anxiety about a man approaching her sexually.) These dreams often occurred when her training did not go well. We talked of her feelings of vulnerability if she could not be as strong asshe wanted. Being strong helped allay the fearful thought that a man could rape her. She proceeded in this vein for about a year. Ms. A. was increasingly successful at her sport and "in crush" (her words) with her male coach. Dreams revealed

denise warfield -

Comments - I need to apologize to you mom and dad. I certainly stretched the truth. I'm sorry so much for the forth commandment. Anyone know a good lawyer? I've asked through emails and phone messages for healthplace to remove my post upon learning that they did not withhold the name as other sites do. However I have yet to be satisfied.

tadfjkaalsdfk -

Comments - -------------------------------------------------------------------------------- hte - Comments - Rosemary Balsam Training and Supervising Analyst, Western New England Institute for Psychoanalysis INTEGRATING MALE AND FEMALE ELEMENTS IN A WOMAN'S GENDER IDENTITY Submitted for publication March 25, 2000 Despite advances in female developmental theory since the 1970s, there remains a lingering tendency to stereotype and polarize gender identity. The key to this puzzle may be found in the legacy of early libido theory, which offers an unintegratable solution for women. This is because in order for a woman to claim femininity according to this early theory, her masculine trends in development must be repudiated and "overcome." A contemporary theory based on primary femininity suggests that this early theoretical "either/or" dilemma puts forward a developmentally immature solution. The analysis of a thirty-year-old woman, and a commentary contrasting "old" and "newer" ways of thinking on the part of the analyst, demonstrate that an interweaving pattern of paternal identifications and male body representations, together with the female body image and female identifications, is necessary to create a mature gender identity portrait. The female bodyrepresentation and maternal identifications! may indeed be enhanced by male internalizations, as happened in this particular instance. New ideas within psychoanalysis mobilize resistance and under-go an uncertain fate, especially if they differ from those of Freud (Greenson 1969; Eissler 1969; Gillette 1992). The theory of female development is a case in point (Fliegel 1973). In spite of the many refinements that have been made in the field since Freud's first delineation of the psychosexual phases of female development in 1905, and in spite of his own advances in filling out the theory - for example, his recognition of the mother's powerful role in the girl's development (1931) - there remains a reluctance among analysts to use psychoanalytic correctives and knowledge developed since Freud in their everyday clinical work, in clinical discussions, and in clinical writing (unless the focus is specifically on gender theory). As far back as 1986, in a review of female psychology, Chehrazi wrote, "in spite of recently suggested revisions . . . it is my impression from seminars and clinical conferences that our diagnostic formulations and dynamic conceptualizations remain more or less the same" since Freud's time (p. 22). Nowadays, too, as Chehrazi noted then, the "lack of a revised theoretical framework" may be blamed (p. 22). A continued yearning in our profession for an ideal systematic theory of female development, however, may serve to shield against some changes of focus in clinical work that could be facilitated even while awaiting complete reformulation. Ten years after Chehrazi's observations, Basseches and her colleagues (1996) reported on a study of analytic treatments of women conducted by a group of contemporary female analysts. This work confirmed their suspicion that there is still a "lag between theory and clinical technique"; in the an! alys ts' discussions they discovered their "collusion with Freud's phallocentric perspective in concert with [their] patients' self-assessments" (p. 515). For example, like their early counterparts, they tended to view penis envy and the castration complex as bedrock facts and failed to consider instead their functional defensive possibilities as body fantasies. The authors believed that the "participant analysts' theories and identifications with their own personal analysts and clinical supervisors did not yield easily to integrating the newer ideas of primary femininity into clinical practice" (p. 516). One female analyst in the group reported automatically interpreting a female patient's denial of her genitals as a sure sign of penis envy - the usual male body terms. The analyst noted that it made her uneasy to shift to an interpretation of the patient's denial in specifically female body terms - i.e., "the patient's wish to deny interest in her [own] feminine space" (p. 517). This apparent stasis led Nancy Kulish and Ruth Fischer to convene a panel to discuss primary femininity and its clinical implications at the 1999 fall meetings of the American Psychoanalytic Association. Contributors agreed that there is a continuing reluctance to translate more recent ideas into the actual treatment of women patients. One can ask, Why is this so? But one can also ask, How can this happen clinically? As part of demonstrating the consequences of a shift of clinical focus that results from integrating some of the newer formulations, I will demonstrate also that challenges to "established" theory begin to emerge within the theoretical uncertainty that ensues. For example, I suggest that since approximately 1970 it can no longer be held that femininity or femaleness is "achieved" by renouncing masculinity or maleness, we are free to imagine a gender solution other than one based on an either/or conflict. We can postulate that a female can have a stable core gender identity and yet also follow dual gender developmental lines that need not necessarily be in opposition. The male line can become complementary and even enhancing to aspects of the female line. "PRIMARY FEMININITY" OR "A SENSE OF PRIMARY FEMALENESS" The most important shift in thinking about sex and gender issues in women was ushered in by the term primary femininity - first used by Stoller in 1968, in reference to the then new concept of core gender identity (the self-identification of being either a "girl" or a "boy" that is established by 18-36 months). As an umbrella concept, primary femininity has helped to underline a range of newer and apt psychological thoughts about women-qua-women, and has helped us achieve theoretical distance from the limitation of the old-fashioned Freudian girl-as-little-boy trajectory. Its introduction marks an historical watershed in psychoanalytic writing about female psychosexual development. But primary femininity can also be a problematic idea, because it has been used so elastically in discussing the many aspects of female development, such as " gender identity, innate biological traits, early object relationships, aspects of the self, and types of anxieties" (Kulish 2000, p. 1356). By 1972, Stoller himself served to obfuscate the term considerably. He conceptually melded the scientific discovery of the human embryo's initial feminized biology together with a protofemininity developed from a child's symbiotic fusion with the mother. He claimed now that this "primary femininity" applied not only to girls, but also to boys in their early development. This latter aspect of Stoller's use of the term has been persuasively challenged by Fast (1999). The different interpretations of primary femininity have been critiqued by Kulish (2000), who, though recognizing the many advances yielded by these investigations, warns us not to &q! uot; repeat the mistakes of the past and not ask the next question, 'Where do we go from here?'" (p. 1375). Suffice it to say that the concept needs to be defined carefully each time it is invoked. An alternative term, a sense of femaleness, has been suggested by Elise (1997), who prefers it because it eliminates problems with the cultural value judgments encoded in "femininity." My main point here, however, is that clinical interpretations and formulations based on the concept of "primary femininity" have been slow to be incorporated into case reports. BEFORE AND AFTER 1970 The most significant change to appear in the literature between the "old" psychoanalytic ideas and the "newer" ones is the acknowledgment that a female child develops psychosexually in relation to her female body. As I have suggested, the watershed between these views is roughly the year 1970, though Horney (1924, 1926) and Jones (1927) can be regarded as progenitors of the new. The comparison the girl makes between her own body and the male body remains important in the newer system, but it is more likely to be seen as reactive to attitudes about basic female body parts, or as a masculinized matrix of defensive fantasy as attempted solutions to other developmental problems (Dahl 1996.) This shift of emphasis to the centrality of the female h

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