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184 Daseinsanalytic Re-evaluation of Psychoanalytic Doctrine of Neuroses

putrefaction and decay. The power which decay has over these patients forces them to gird themselves against the threat of falling prey increasingly to decay's chaotic intrusion. The more the whole existence of these patients is involved in the relationships with decomposed matter—the more it becomes subjected to this realm of being—the more they struggle against their subjection by means of the pedantic, rigid ways of their obsessional symptoms. The execu­tion of their compulsive actions strongly resembles the rigidity in which the fixed, lawful processes occur in dead matter.

It is possible that Daseinsanalysis can also contribute something toward the solution of the riddle that Freud posed by his introduc­tion of the concept of "anal sadism." No experienced analyst will argue with Freud's first brilliant observation that every time (and with astonishing regularity) that a patient's "associations" have to do with dirt and excrement, aggressive and destructive impulses also show themselves. But none of the psychodynamic mechanisms of psychoanalytic theory are capable of making us understand why anal and aggressive-sadistic behavior belong together. From the Daseinsanalytic point of view, it is understood that if Dasein has fallen prey to the realms of rigid, heavy, earthy, and resisting masses of filth (a condition which Dasein betrays by its continuous attempts at defense against such masses), then its attempts to free itself are bound to be massive and violent attacks on the earthy "crusts" which hem it in. In addition, obsessional neurotics regard their subjection to the realm of dirty chaos (which they do not admit openly) as an inhuman insult, against which they feel they must rebel vehemently. To be subjected in this manner amounts to living in existential guilt. For an existence which has fallen prey to some- thing remains in debt and unable to take_overall Jus pote ntial for. human relations, and thus to live in_a human mann er ( cf. pp. 47-48). Since the analyst is always the first who expects the obsessional patient to admit his imprisonment in the earthy, "dead" dirt, it is not surprising that the patient's fury manifests itself against the analyst first, as the one who provokes the admission.

The study of obsessional neurotics also makes plain that those theorists who attempt to generalize the anal-erotic relationship to the world into the formal instinct modalities of holding-on and ex­pelling thereby forfeit a very important discovery of Freud's. For the understanding of all patients, it is of vital importance that the specific nature of the particular beings to whom they relate in a

Obsessional Neurosis 185

given modality of behavior is not lost sight of. We have just seen how essential it is for the understanding of obsessional neurotics that their relationships—insofar as they occur in the "retentive" modalities—refer to the realm of earth, dirt, and excrement and to what they regard as being filthy, and not to any other sphere of their world. Freud took care of this fact, in his own way, when he emphasized the "regression to the anal stage of libido organization." We differ from Freud insofar^ as D aseinsanalysis canno t think of a \ \ cMld'srelatiojL.tQ„his excrement as being the cause and_ orjgin of i < hjs retentive" beh avior t"W^{grrl я1}1 other things ^ wpII Daseins- ' analysis may fully agree that a child's handling of his feces is often the first instance of this kincTof relationship, but objects if psycho- \ \ analytic theory turns a sequence in time into a causal connection. Furthermore, Daseinsanalysis no longer believes in the possibility of libidinal energy and instincts bringing about and producing out of themselves the phenomenon of man's being in a meaningful world with the capacity to disclose and manage what he encounters. Nor can instincts explain the unfolding of such a world. Actually/) we never experience or observe an instinct or a force which pushes: a subject toward a thing or a fellow man outside of itself. Rather, man is attracted to something he meets and discloses. Man, not thei encountered thing, is, so to sp eak, the one who is drawn. At any rate, the concept of instinct is but an unreal abstraction of the immediate and whole reality. This is always a particular kind of relation to something, encompassing the human being and the dis­closed thing as well. The full reality in this case is that way of relating which amounts, more or less, to having fallen prey to the thing to which one relates. Freud's concept of "anal libido organiza-1 tion," in particular, represents a technical abstraction of a specific.; relationship of ma n to his world: a p redomin a n t attachm ent fp the., spajffidj^jadojcs..

The Case History of a Sadistic Pervert

Freud contrasted sexual perversions with the transference neu­roses, but he distinguished these in a different way than he had done in the case of the psychoses. He saw sexual perversions as the negative versions of transference neuroses. It seemed to him that the different sexual instincts and partial instincts which are re­pressed in the transference neuroses break through in the sexual perversions. Later, however, he discovered that this breaking through of some partial instincts in perversions is also based on repression, though of other instincts.

Daseinsanalysis cannot regard man's instincts as the basis of human love. For this reason, it cannot regard sexual perversions as originating from instincts either. Daseinsanalysis regards sexual perversions as results of specific concealments and restrictions of possibilities for loving. Since we have dealt with this subject in detail in another context,¹ we shall restrict our present discussion to the case history that follows.

On July 15, 1950, F. F., a commercial clerk twenty-six years of age, requested admission to the psychiatric clinic of the medical school of Zurich. Previous to this he had consulted a doctor in private practice and told him that he had been on the brink of committing a crime. A few days earlier he had asked a girl he hardly knew to go for a walk with him to discuss some business matters. When, late that evening, they were walking along the dark and lonely road by the River Limmat, he was seized by an over­powering impulse to strangle the girl with his two hands. Having once begun he was powerless to stop, and he would have murdered the girl if she had not somehow managed to extricate herself. He

Translated by Mary Hottinger-Mackie, M.A., and Elsa Lehman, M.D. ¹ M. Boss, Meaning and Content of Sexual Perversions, New York, 1949.

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The Case History of a Sadistic Pervert 187

had thereupon regained his self-control and apologized to her, say­ing that he had not known what he was doing. He then fled, leaving her standing there. Since he could not conceal from the doctor that he still felt within him "an irresistible urge to kill someone," the doctor advised him to enter our clinic voluntarily for observation. F. F. did so because he actually no longer felt sure of himself.

According to the statements of our patient and of a large number of other people, there had been in his family numerous cases of insanity and of endocrine disturbances such as obesity and slight acromegaly. A maternal aunt had suffered for years from severe chronic schizophrenia. Another maternal aunt had died of extreme obesity. A maternal uncle had suffered from depressions and had committed suicide at the age of forty-five. The maternal grand­mother had died in an asylum. On the other hand there were neither physical nor mental abnormalities to note in the patient's parents or his four brothers and a sister. The father, a bookbinder, gave the impression of coolness, severity, and self-control. In a personal interrogation the mother seemed to be the more yielding, affectionate, and communicative of the two.

F. F. was the second child of six. One brother is two years older; another brother, a sister, and the two youngest brothers are re­spectively two, three, six, and seven years younger than he. The patient attended primary school for six years and secondary for three, showing throughout a better than average intelligence and making quick and uninterrupted progress in all subjects. At the age of twelve he had expressed a great desire to take holy orders, and the parents consented to his entering a Catholic seminary. Not more than two years later, however, he suddenly ran away, having heard of the practice of mutual masturbation among some of his fellow seminarians. He was so revolted and terrified by the discovery that he returned to his parents there and then. He began his apprenticeship as a clerk, and obtained his diploma, with very good marks, in two and a half instead of the usual three years.

However smoothly his intellect functioned, his emotional pecu­liarities had stood in his way since childhood. Even when he was a little boy, the rest of the family had noticed his lack of feeling for them and for everybody about him. Further, he showed a marked tendency to solitude and irritability. For his part, the patient thought that his family did not understand him. He felt that his mother had betrayed him and cast him out by telling his father of his first love

188 Daseinsanalytic Re-evaluation of Psychoanalytic Doctrine of Neuroaa

relationship at the age of eleven with a little girl of the same age. His father, whom he regarded as unfeeling and distant, had promptly and brutally "stamped out" the affair. To the patient, his parents* marriage seemed neither harmonious nor happy, and so he with-drew inwardly from his family, sharing less and less in their daily life. Even for meals he preferred to be alone, and would often come in at quite odd times, since he scorned punctuality as narrow-minded. He would not take Christmas presents from his family and gave them none. Christmas, he declared, was a purely inward, religious festival. On the other hand, he was deeply hurt by having to pay something toward his keep even during his apprenticeship. He was still more indignant over his parents' charges that he earned too little because he did not work hard enough, and yet long after obtaining his diploma he got himself into debt through his own fault and for reasons to be explained. In the end he was involved in an automobile accident which was his fault and which made him liable for considerable damages. As he could see no lawful means of getting the money, he took it from the safe at his office. Legal proceedings were avoided only because in the end his father had guaranteed the money.

The same affective abnormality also made its appearance in the development of our patient's sexuality. From the time his first, child­ish love relationship was destroyed by his parents, he was incapable of any deep feeling for girls of his own age. He had certainly had relations with a number of girls soon after puberty and, on the purely physical side, had shown perfectly normal potency, but these connections were all short-lived, and in his sexual intercourse with these girls he remained emotionally cold and aloof. According to his own statement, these affairs had always seemed to him a mere game, and had never given him any deep satisfaction. This was the case even in the early stages of his relations with his present mis­tress, an unhappily married and childless woman sixteen years older than he, whom he had met when he was about twenty. Even with her, sexual intercourse at first had meant nothing to him, but gradually it took on increasingly marked sado-masochistic character­istics. He began to bite, beat, and strangle her. Then he would make her do the same to him. At the same time, however, for the first time in his adult life, he felt stirrings of feeling for a woman, and the more markedly perverse his sexual habits became, the deeper his emotional attachment to her grew. Soon his sadistic bent de-

The Case History of a Sadistic Pervert 189

veloped into an obscure urge to strangle her to death. At first these murderous impulses had arisen in him only in the form of sinister premonitions, but in time they moved into the light of clear and conscious knowledge, the more so because the woman, burdened with her own conflicting situation, was making repeated attempts to break with him. Meanwhile, he felt more and more lonely, since he had finally quarreled with his parents, who had refused to con­done his relations with a married woman so much older than he, and he had gone off to live by himself.

The more severe and frequent his murderous impulses became, the harder and more exhausting was the struggle to master them. He was reduced to complete despair when the woman, under the pressure of a situation which was growing intolerable to her, actually broke with him and forbade him to see her. This break had taken place a few weeks before his criminal attack on the girl, which had led him to seek the protection of a mental asylum. In the weeks preceding the attack he had suffered from continual and severe headaches, and had repeatedly expressed the wish to be put in an asylum. On the other hand, he had planned to go abroad in order to forget his mistress; since she had broken with him, the impulse to murder her had grown stronger, to the point that his work deteriorated and he was reduced to earning commission as a com­mercial traveler without a fixed salary. Especially in the evening, between 9 and 11 p.m., the urge came over him with increasing force, and it drew him with such overwhelming power to murder some woman or other that he would lock himself in his room, hide the key from himself, and try to regain his self-control by perpetual smoking. In spite of this desperate struggle, the impulse to murder overcame the patient in the criminal attack on the girl of twenty. When he had asked her to go for a walk, he certainly had had no evil intentions toward her; according to his statement the impulse to strangle her had arisen quite unexpectedly and swept him irrre-sistibly into action. He described very vividly how, in the act of strangling, he was split into two. He had felt himself a double being; the one, perfectly normal, cool and collected, had no power to stop the other from strangling the girl. As he committed the act he had stood beside himself like a "scientist at a dissection," looking on helplessly while the other strangled. According to the victim's account, the second personality, the stranger, had distorted the patient's face into a "devilish" expression. The patient could not

190 Daseinsanalytic Re-evaluation of Psychoanalytic Doctrine of Neuroses

recall having felt any specific sexual satisfaction as he strangled her; he felt only considerable general relief and relaxation afterward. Here, however, it must be pointed out that his memory of the attempted murder was very sketchy compared with the excellence of his memory in general. With the best will in the world he could not remember details. He could not recall what he and the girl talked about at the beginning of their walk, nor did he remember having tried to kiss the girl before strangling her, which we sub­sequently learned from the girl herself. He could not remember how long and how violent the attack was or how she managed to escape at the very last moment when she was on the point of losing consciousness.

Clinical Findings

The physical examination of the patient yielded no markedly pathological findings. All the internal organs functioned normally. The Wassermann test for syphilis was negative. The only noteworthy finding was that his physical constitution as a whole showed signs of slight endocrine disturbances, in the form of acromegaloid and tetanoid tendencies, and there was some oversensitiveness of the neuro-vegetative system.

Mentally, the patient's sense of time and place was unimpaired. He could reflect, think connectedly, and answer questions clearly and comprehensively. During his whole time in the clinic he gave no signs whatever of schizophrenic delusions or hallucinations or any symptoms of an organic psycho-syndrome. Intelligence tests gave, at the very least, average results. On the other hand, even in the clinic the abnormality of his affective behavior was striking. During the first few days he still suffered from his evening attacks. He felt an extreme inward discomfort and agitation and was tor­mented by impulses to murder various women who came into his mind. These attacks soon subsided when he came to feel properly protected from himself in the mental hospital and realized that he had something to rely on. Yet even after his evening attacks had disappeared, his behavior in the clinic gave an impression of extreme abnormality. When telling his life story he displayed almost total indifference toward his family. He dismissed his parents contemp­tuously as petit bourgeois. Even when telling the story of his attack

The Case History of a Sadistic Pervert 191

on the girl, which had nearly made a murderer of him, he remained cool and unmoved. Nothing that had ever happened in his life seemed to concern him personally at all, nor did he feel the least repentance or pity for his victim. On the contrary, he declared that the death of a human being did not matter much; it took only a moment to die, and it was of no consequence whether a human being departed this life sooner rather than later. His frequent flippant remarks of this kind, together with his utter indifference to everybody and his unyielding affective rigidity, made him look like a case of severe schizoid psychopathy. There were moments when the doctors in charge actually suspected hebephrenia. The diagnosis now in the records of the clinic, based on the case history and clinical findings, runs "Sexual perversion (sadism) with compulsive states and succeeding impairment of memory arising from schizoid psychopathy."

The Analysis

Circumstances at the beginning of the patient's analysis could not have been more unfavorable. He had asked for admission to the mental hospital of his own free will, but since he constituted a serious public danger, the director of the clinic had no choice but to have him certified by the proper authorities and confined to the asylum for a considerable time. Although we had saved him from possible arrest by testifying to his lack of responsibility for his actions during his compulsive states, he could not but regard his certification by the authorities as a breach of faith, for as soon as those states had subsided after a few days in the clinic, he felt quite normal and actually regarded further detainment as quite unnecessary. We ventured on an analysis in spite of these difficulties because we realized that this was probably the only way the young man could be saved from being committed to the asylum for an in­definite time. The analysis took about eight months.² For practical reasons no more than two sessions weekly could be devoted to it, yet even at the end of six months, such a radical transformation of the whole structure of the patient's personality had been achieved

² The treatment was^ conducted by G. Benedetti, MXj^while the author super­vised and directed it weekly as the training analyst.'""""""'""^

192 Daseinsanalytic Re-evaluation of Psychoanalytic Doctrine of Neuroses

that we were able to discharge him from the clinic without risk and from then on treat him as an outpatient.

In the introductory stage of the analysis the patient pleased us as'"much by his exemplary endeavors to Ъзер to the fundamental analytical rules of free association as by his willingness to keep to rthe general regulations of the establishment for the remainder of the day. He had already consented to our suggestion of analysis with surprising insight and without misgivings, and repeatedly thanked us for all the time we were spending on him. No trace could be seen of open resentment, defiance, or even rebellion against his continued detention although he had long since regarded it as superfluous. But however carefully he might observe the rule of free associations, it left him inwardly quite indifferent, and his polite gratitude to us was obviously sham; thus even at this early stage we were able to interpret his behavior as a pose carefully calculated to obtain his discharge from the institution as soon as possible. His dreams at this time also led us to suspect that his confinement had become the essential or even the sole problem of his life. He once dreamed that he was being kept prisoner in a hotel; everybody else had been released; only he was unjustly detained. In another dream he tried to escape from the asylum in secret, but met his analyst outside. Moreover, the road by which he was trying to escape was blocked. He was separated from his mistress by a barrier. Thus no other course was open to him but to return to the asylum. We did well not to regard his outward, artificial docility as mere calculated deception or as a reaction called forth only by his current situation. We might easily have succumbed to the temptation of breaking off the analysis as useless. We were saved from that false step by the results of our clinical observations and the preliminary in­terrogation. We had seen that the patient's present attitude toward his analyst was by no means invented for the occasion, derived from his present and to him completely open desire to be discharged. It was, rather, a slightly cruder version of the schizoid relationship to his environment which had always been characteristic of him. It was not only now, and not only toward the analyst, but for years, and toward everybody, he had displayed the same smooth mask, concealing all his genuine attitudes behind it.

Wherever he happened to be he would indulge freely in the wildest and most abstruse speculations. For instance, he would pro­claim to those about him that all schemes of value were "mere

The Case History of a Sadistic Pervert 193

paltry checks on divine being and living, creative power." Of his real existence behind these high-faluting phrases nothing could be divined. If the patient for a long time ran true to form in the analysis by interpreting away at his dreams and ideas in a completely aloof and purely rational way, his sole aim was to appear as clever and obedient as possible; the questions and problems he touched on in so doing had not the remotest effect on him. Was it that he would not show any feeling or that he was incapable of affective participation in life and of getting out of himself? Could it be that he had become his own jailer behind this huge intellectual facade? „ From the outset we had adapted our therapy to the changing aspects of the patient's character, so we carefully avoided anyjnter-~pretation-vOf his dreams and ide^as, since that would simply have ^offered him a welcome opportunity for setting out again on his purely rationalistic interpretations and intellectual speculations. Above all, however, we avoided interpreting his inordinate amia­bility and obsequious attitude toward his analyst as a transference phenomenon, i.e., as a shift to his analyst of a behavior or even an isolated, abstracted "affect" which actually implicated his father or mother. By speaking of such a "transference" to this patient we would not only have provoked from him endless intellectualized speculations about this theoretical conception, but—much worse— we would have degraded his authentic, though still restricted, re­lation with his analyst to an unreal, falsely derived, ghostly some­thing. The error, then, would have been on our side. There was little doubt in our mind that the restriction of this patient's existence to the one attitude of aloofness and intellectual speculation about his fellow men and the things which came his way was brought about by the experiences of his childhood. From this it follows that in regard to his analyst, too, no other kind of relationship was avail­able and open to him. But in this analysand-analyst relationship it was the analyst, and not his father or mother, who disclosed himself to the patient, notwithstanding the fact that this disclosure of the analyst could happen only within the early deformed and narrowed-in world-openness of the patient's existence. The theoreti­cal destruction inherent in the concept of transference is the more dangerous, the more aloof the patient is and the more precarious and fragile his relationships to his world in general are. Much evidence is available to indicate that patients, particularly severely sick ones like our sadist, experience the usual transference inter-

194 Daseinsanalytic Re-evaluation of Psychoanalytic Doctrine of Neuroses

pretations as a misunderstanding and a cruel rebuff on the part of the analyst. The reaction of those patients tends to be further withdrawal from everybody and everything.

bsteacLfor the time being, we only tried to bring home to this patient the contrast between his conventional pose of considerate-ness, his perfect playing of a part, in his waking life, and the hatred "and aggressiveness which were beginning to appear in his dreams, which were all directed to his imprisoning environment. The patient's reaction was paradoxical. His amiability increased till it became grotesque. For instance, with an anxious expression, he began to ask the analyst if he had done anything to offend him. Only after persistent and repeated questioning on our part as to whether this exaggerated, aloof politeness was really the only ap­proach he dared to use in dealing with his fellow beings in his waking life in general, and with his analyst in particular, did serious fits of rage and truculence begin to break through. Then his passionate protest against his continued detainment and his fierce charges against all the doctors in the asylum at last found vent. Once, for instance, he wrote:

Moral ideals—conventions with rats and mice, revolting, stinking vermin, gnawing and nesting in their dusty interior through ages and worlds. Marriage is nothing but a prison, the imprisonment of life. Men—a litter of otters. Can these be men and women? Or are they mass creatures, herd animals, living only for the law and by each separate letter of the law? Man does not live for others; he lives first and foremost for himself; therefore let every man live as he likes.

It would have been an easy matter for the analyst to convince a young man of his intelligence of the factual groundlessness of most of his charges. In all probability he would then have promptly retired behind his facade again and once more cut himself off from fuller experience of his life possibilities. For this reason we assured him that his candor would in no way prejudice his future release, as perhaps he feared. The decisive factors for his discharge would be solely the maturity it was to be hoped he would achieve in the course of the analysis and the knowledge of himself which he could attain only by ruthless frankness. Thanks to our benevolent tolerance of his truculence, the patient soon began to believe us. With that, an atmosphere of sincerity and mutual confidence was established which made possible the rapid progress of the analysis

The Case History of a Sadistic Pervert 195

in spite of his internment. For weeks on end, our work in the analytic sessions consisted in simply allowing the patient to revile the analyst, the entire staff of the asylum, and the world in general. Every time we suspected that he was hesitating before some espe­cially crass insult to ourselves, we encouraged him to still greater bluntness by asking him why he would not speak out. Thus for a) long period he was allowed for the first time in his life, and within the safe realm of the analyst-analysand relationship, to learn to know his possibilities of hating the world openly and to appropri­ate this way of relating to people as belonging to his existence, too. \

On one occasion when the patient, again without hindrance from us, had blasphemed against God and the world, cursed his compulsory confinement, and abused all the staff of the asylum in­cluding the analyst, he told us a dream in which, quite in accord­ance with the reality of his waking life, he was interned in the relatively free wing of the asylum where the quietest patients were kept. However, in the dream the patient wished to be transferred to the back wing where internment was in cells and much stricter. This dream made us realize that the time had come to bring home to the patient, first and foremost, the crass contradiction between his waking rebellion against his internment and his dreaming desire to be still more strictly interned. Since he could find nothing to object to in this, we ventured a step further. We asked him if, in asking for still stricter confinement in his last night's dream, he was really rebelling only against being kept in the asylum? After all, we added, even in his waking life his own voluntary application for admission had preceded his internment, and weeks before that he had repeatedly felt the wish to put himself behind the protecting walls of an asylum. Furthermore, the withdrawal of his whole affec­tive being behind the thick walls of his impenetrably cool and rationalistic facade dated from much earlier times. After the erup­tion of his violent hatred of the whole world, he had himself realized that the hermetically sealed armor of his character was internment in its most inward form.

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