Unmastered Masturbation Conflict
<< Anal Masturbation and Object Loss >>
Edith Buxbaum, Ph.D.<sup>1

1</sup> Associate Clinical Professor (Retired), University of Washington School of Medicine, Seattle, Washington.
Training Analyst, Seattle Psychoanalytic Institute.

In Masturbation from infancy to senescence, pp. 161-184. NY: International University Press, 1975

This paper concerns observations and conclusions regarding anal masturbation and object loss which confirm and contribute to classical theory on this subject. Freud (1905) states: “Like the labial zone, the anal zone is well suited by its position to act as a medium through which sexuality may attach itself to other somatic functions.... Children who are making use of the susceptibility to erotogenic stimulation of the anal zone betray themselves by holding back their stool till its accumulation brings about violent muscular contractions and, as it passes through the anus, is able to produce powerful stimulation of the mucous membrane.... The contents of the bowels, which act as a stimulating mass upon a sexually sensitive portion of the mucous membrane, behave like forerunners of another organ, which is destined to come into action after the phase of childhood” [pp. 185-186].

In a later paper, Freud (1917) points out, “The faecal mass, or as one patient called it, the faecal ‘stick,’ represents as it were the first penis, and the stimulated mucous membrane of the rectum represents that of the vagina” (p. 131). In this same paper he says, “The concepts faeces, baby and penis are ill-distinguished from one another and are easily interchangeable” (p. 128).

Anna Freud (1966) in her summary of psychoanalytic views on obsessional neurosis talked about a possible link between the early mother-infant relationship and the later anal-sadistic stage. She gave an example of a boy between two and three years old who soiled “as soon as he was left on his own. This remained unexplained until one day he was overheard actually to talk to his excrement and call on it to come and keep him company. It emerged that he had been exposed to traumatic separations from his mother.” Anna Freud thinks, “his libido had withdrawn from the object world and turned to the body product, thereby producing this particular exacerbation of anal concerns” (p. 120).

We are familiar with the fact that a boy talks to and addresses his penis as a friend and playmate, personifying it in this way. Frequently boys console themselves by masturbating in situations of stress and anxiety, evoking a body feeling. Bettina Warburg (Marcus, 1962) reports on a patient who comforted himself in a strange environment by masturbating and regarding his penis as his friend and his baby. In the following case, in the process of mourning, the fecal mass became the representative of the lost object.

Cheril was brought to me at the age of four and a half as an emergency case; she had been constipated for a number of days. Cheril had developed the same symptom a few months before when Larry, her adopted brother, was taken to the hospital. At that time she had not defecated for six days. She had had a bowel movement only after an enema had been administered. The current constipation occurred six weeks after the brother’s death from leukemia, shortly before Christmas. This is one of those frequent cases where the adoption of one child is followed by the birth of another. The parents, who were in their thirties, had been married for a number of years without having children. While they were on the waiting list to adopt a baby, Cheril was conceived; she was born seven months after Larry. Cheril and Larry were extremely close; they played together all the time, slept in one room and shared a playroom. They had two potty chairs, went to the bathroom together, and bathed together.

Cheril had been dry since she was a year and a half old — imitating her brother, the parents thought. When Larry became sick, he started to wet the bed again. From the day Cheril was told Larry had died, she wet the bed. She was taken to the funeral; after returning home, she finished pictures which Larry had started and continued to draw all day long. They used to draw together. During the last months of his life, while he was at home, Larry had had difficulties with painful bowel movements and was given enemas. Cheril had observed this. She went to the same nursery school with Larry. Larry had been a rather quiet little boy, usually rather overcontrolled; during the last months of his life, when he still went to school, he at times went into sudden rages. He would hit out wildly at the children at school and at Cheril at home. After he died, Cheril hit other children. Larry was preoccupied with death; he talked much about it. Cheril was worried whether she would die when she was an old lady. She imitated Larry and identified with him to a great extent during his life; she continued imitating him after his death. His death was not only a loss but a threat for her — she might have to imitate him in dying too.

Cheril was brought to me by her father, who took care of her, dressed her, and brought her to school. The mother was too upset to do anything with her or for her. This, I learned, was the case not only since Larry’s death, but from the time the parents had learned that Larry had leukemia and had not long to live. During the six months of Larry’s illness, the mother was completely preoccupied with him. When he went to the hospital, she stayed with him until he could come home again, and during the last weeks, she stayed with him until he died. During this period, Cheril lost not only her brother but her mother too. Nobody paid any attention to her — father did what he could, but that wasn’t enough. He had to leave her when he went to work. She was terribly lonesome.

Cheril was a rather large girl for her age, with shoulder-length dark hair, big brown eyes, and a fair complexion; she was well coordinated. She stayed with me alone the first time without anxiety. She spoke well. I do not recall what I did the first day with her, but I assume that I played something with her and talked about Larry, about his death and about how she missed him. In retrospect, I do not think that it was important what I played with her, but that I played with her, and that I talked with her about her brother and his death. Her parents at that time were unable to talk with her about the brother for fear that they might break down crying. Probably it would have helped them all if they could have allowed themselves to cry; for Cheril it was an example she followed — she held back her feelings, as she did her stools. My initial contact with her gave her a playmate and a mother person again, and I expressed some of her feelings for her. It was probably for this reason that she could release her stools after that first session.

Later on, I learned more about Cheril’s early history. The mother had started analysis because of severe pains and allergies, which were largely psychosomatic. She was aware that she felt, at times, violently and unreasonably angry at Larry. Larry was also her husband’s name. Through her analysis she gradually became aware of some of the important aspects of her behavior toward Larry in regard to Cheril. She knew now that she had hurt Larry by being angry with him, and that she had hurt Cheril by ignoring her. Cheril was nursed for seven weeks and then abruptly weaned because the mother got sick and had to go to the hospital. Cheril cried a great deal; she had peculiar convulsive movements until four and a half months. She was treated for a severe vitamin B deficiency and allergy, both supposedly due to the mother’s severe allergic condition at that time. From about five months on, Cheril had eczema; she was treated with shots twice a week until four or five months before I saw her, i.e., until she was four. She had also suffered from asthmatic attacks since she was two years old.

During the first year I saw Cheril, the mother’s relationship to her gradually changed. Her complete rejection of Cheril after Larry’s death gave way to dutiful behavior. The mother was cooperative, she gave me necessary information, and brought the child to my office regularly. Coming and going to the office took considerable time, which forced her to spend time with Cheril. But she resented her. She told me how wonderful Larry had been, what a genius he was, how imaginative — that Cheril had none of this. Actually school and father said that he had been an intelligent boy, but not as outstanding as the mother portrayed him. She told me that Cheril had not shed a tear about Larry. She was not aware that Cheril had not seen her cry either. But a few weeks later she added, “She went white and trembled all over” when she was told of his death, rearing away from the mother, who held her on her lap. As time went on, the mother started to read to Cheril and to draw pictures for her, which she liked to do, and she listened to Cheril’s stories. She became increasingly anxious about the child’s health, had her at the doctor’s ever so often, afraid that Cheril too might develop leukemia. As I mentioned, the mother had many somatic symptoms. She now started to treat Cheril like herself and also like Larry. But — this was better than the lack of interest Cheril had had from her before.

The father was a doctor who had his office near the family residence. He was a mild man who was troubled by his wife’s psychosomatic symptoms and her violent mood swings. Whereas the mother had preferred the adopted son and had nearly neglected their own little girl, the father was partial to Cheril. His lack of marital relations with his wife did not seem to bother him, but he finally lost patience. He became cross with Cheril, using her as a scapegoat for his wife. She, in turn, had used little Larry as a scapegoat for her husband. Peace in their relationship had been maintained at the expense of the children. Now the seeming calm in the house gave way to violent outbursts and screaming quarrels, which scared Cheril and excited her. She sensed the sexual element in these scenes she shared by acting them out in her play later on. About a year after Cheril started in treatment, the father also went into analysis, and Cheril’s role of scapegoat was greatly reduced. These episodes form a review of the changes in the family during the first year of Cheril’s treatment.

After I had seen Cheril a few times following Larry’s death, she and her parents visited during Christmas with the mother’s family. Cheril had a good time with a pony on their farm. When they returned, I started seeing her regularly three times per week. During the first session after her return, Cheril played with the dollhouse, putting an aunt and uncle into the house with their two children. She gave this fictitious family the names of her own family, including Cheril and Larry. Then everybody went to Candyland, where people could eat candy all day long, didn’t get sick, and didn’t die. The children were happy. Suddenly Larry jumped up in the sky; he was Superman; Cheril cried, “Wait for me!” and he dove into a hole in the ground. Cheril turned to me and said, “But in Candyland he will come out again.”

Cheril said everything there was to say. Candyland is a board game which she used to play with Larry. And he also played at being Superman, wearing the famous Superman cape. Cheril used to be his helper. Now he flew away into the sky and went into the grave, where she could not follow him. She changed the game into a fantasy, where he and she could live and be happy ever after and eat all the candy they wanted.

The following session, she played again with the dollhouse, but Candyland was not in evidence. She arranged the children’s room first for two children, then changed it for only one child. While she did this, she informed me that she had made some “doodles” (bowel movement) in her pants. I asked her whether she wanted to go to the bathroom. She said no. She pretended to play with Larry’s toys, and I remarked she liked to play with Larry and his toys. Thereupon she threw everything into the wastebasket, took it out, threw it back, and took it out again with a show of delight. I said that one can fish things out again when they get into the wastebasket — but that isn’t so when they get into the toilet or the grave. She answered indignantly, “That’s not why!” She let me know that my interpretation was not correct; I understood only later that she was not allowed to play with Larry’s toys, which the mother had put aside as relics and mementos of Larry. She really wanted to take Larry’s toys out of hiding. She stopped what she was doing and chose to play Chinese Checkers, a game which she had never played before. When she left, she waved goodbye and sang, “Goodbye Miss Buxbaum” — came back and left again, saying goodbye once more. This became a ceremony which she repeated for months.

This session had taken place before the weekend. The mother reported that Cheril slept for the first time through the night and did not wet. Maybe this indicates that my interpretation was not wrong, but rather that it was incomplete. The fact that Cheril wanted to keep her feces in her pants had a meaning I did not understand at the time. It became clearer only at a later point.

In the next session, Cheril showed a new house; there were only a girl and a mother; the mother went to bed, sighing. The girl got a pony for her birthday, but the mother did not allow the pony in the house; the girl was very angry and shot the mother dead — but the pony made the mother alive again with a kiss. The figures in this session had no names; the pony, apparently, was the pony with which she had played right after Larry’s death on her visit East; he took Larry’s place with her. In the play, Cheril indicated her doubts about mother’s role in his death and her anger at her. Mother had taken Larry to the hospital — she did not allow him in the house — and he died there; she took him away, but she was sad about his death, too. Cheril was angry with her for what she had done and wanted to kill her in retaliation. But she also wanted her to stay alive and be with her.

As Cheril explored the playroom, she detected some dinosaurs. She knew them by name — she and Larry had a similar set. She set up dinosaurland, playing happily with the toy animals; she informed me that they had a father, a mother and a brother. The father and the mother died, and the brother too. Baby lamb cried because it was all alone. But the parents came back again. I commented that baby lamb was afraid that his parents may die too, like brother. She asked, “Will they die?” To which I answered, “Not for a long time.” She reacted by saying she had to go “potty.” Apparently she felt reassured enough to release her stools. When she returned from the bathroom, it was time to leave, and she blew me a kiss and chanted her goodbyes.

The next day many more animals were in her play: farm animals and dinosaurs, a cat, sheep, and a baby lamb. The bad wolf ate up all the sheep and baby lamb. The dinosaurs and the cat were friends and tried to defend the baby lamb who, however, got eaten anyway. I said the bad wolf, who had eaten all the sheep and baby lamb, had a full stomach now and have to go “po-po.” She answered with an emphatic, “No!” We had a discussion regarding the wolf; I explained that he had a tummyache because he wanted to keep all these animals in him but that they were dead now and he had to go “po-po.”

During the next week or two, Cheril had a bad time. She looked for Larry in school, ran away from home, and was spanked by her father; she had nightmares, and hit wildly at the mother when she came to her at night. She woke up several times during the night with breathing difficulties. Her constipation continued, and she was given laxatives. Because of them, Cheril was soiling three and four times a day with loose stools for a few days. During this period she played that father was angry with the children and drowned them, but mother saved them. Father, mother, and the children lost their legs and arms; the whole family burned up because the children played with fire. She shot me, like she had shot mother, probably because she blamed me for losing everybody by giving up her stools as I had suggested. She played out all her nightfears, her anger and her guilt feelings. Finally, she calmed down, became a little baby, who coos and wets and soils. She said, “I didn’t wet my bed, but I have a B.M. in my pants right now.” We went together to the bathroom and I helped her clean up. She had a big, soft mess in her pants. Mother bought a pair of underpants and brought them at my request. After a few days, she went to the toilet again with formed stools. It seemed, however, that the constipation gave way to the breathing difficulties — an exchange of symptoms which became more obvious in the further course of her treatment.

During the next period, the themes which were indicated in the reported sessions were enlarged upon. Fantasies of drowning, diving, and swimming were repeated. She demonstrated her breathing difficulties and combined these fantasies with fantasies of being suffocated like her brother in his grave. Jessner et al. (1955) mention fantasies of drowning and about water as typical in patients with respiratory illnesses. Cheril expressed her fear of death this way and also her guilt feelings regarding her brother. These, however, came out more clearly in another way.

The pony and the dinosaurs represented Larry; she was either herself, or the cat, or the lamb. The animals that represented Larry were sometimes friendly, sometimes ferocious. At one point, the mean brother threw the girl from the horse. After I talked about Larry, who was sometimes mean to her, she decided to put all the dinosaurs away because “they really do not live anymore.” Another time she buried some terrifying monster and jumped wildly on the grave. When I commented that she wanted to make sure he wouldn’t come back, she corrected me; “I don’t jump on his grave, I only walk on it.”

However, the monsters and the dinosaurs did not stay dead. They returned and Cheril turned more and more into the monster herself. She played at being a boy. Supergirl, Supermouse, or a wild man. The difference between boys and girls was much on her mind. She wanted to be a boy. The wish to be a boy, however, was anxiety-arousing; it meant to be destructive and to be destroyed. Her breathing difficulties were acted out in the fantasy of drowning, of being sick and broken to pieces. In one particularly bad hour in which she wheezed badly, she played sick; I was the doctor; she fell off the couch, was broken to pieces, and I had to stick her together with lots of bandages and tape at her request. At the end of the hour, she said, “I am all right now; goodbye Miss Buxbaum,” and left without wheezing. The doctor game was played with many variations and additions. I learned about all kinds of treatment which Larry had had, and I helped her to distinguish between herself and him, her fantasies and the reality of what happened to him, the role that mother and doctor had in his illness and death. I repeatedly emphasized that she was a girl and, even when she was sick, she was not sick like her brother.

In the session in which she expressed the fantasy of shooting mother for not allowing the pony in the house, she had alluded to the fantasy that mother was to blame for taking Larry away. This theme was elaborated in plays about magic and witches. The bad witch from the Wizard of Oz and Hansel and Gretel represented the bad mother who killed the boys. I was the witch who took stools away, and she was the girl or the good mother who eventually got my magic wand away from me and now could kill me for having killed her brother. Similarly with doctors, she wondered whether they killed the patient or cured him. Her father was excluded from this play. He was at that time a protective dinosaur; in contrast to all the dangerous ones, she said, “He is not a meat eater.”

As if to find refuge from all these terrifying fantasies, she played baby. As a baby she could do no wrong, she talked baby talk, sucked on the bottle, soiled and wet, or made a mess in the room. She crawled around on all fours and left the treatment room crawling. This is where I stopped her. I did not think it was desirable that she carry her fantasies into the world outside, into reality. So we distinguished between Cheril and baby Jean — which was her second name, by which she called herself when she was the baby. She became actually sick at that time and enjoyed regressing into helplessness and having her mother take care of her. After she recovered, she continued playing sick baby with her mother. Her mother played along too much, I felt, so we decided mother and she could occasionally play baby — but not sick baby, because this became too reminiscent of Larry for both of them.

A cold with temperatures and quite a bit of wheezing came at a time when I was gone for about three weeks. I heard from the teacher that Cheril had been playing Larry is dying and burial with the children, alternately playing the part of Larry and herself. At night she had nightmares, raged and cried, talked about Larry, and told her mother, half asleep, “Get out, Mummy.” With me, she played airplanes — personifying them: I had been flying away like Larry; he was a wild Larry-airplane, who jumped into the clouds, then was killed by the other planes and buried. And then the other children jumped on his grave. This was Larry and me combined and was what she had been scared about in her nightmares.

The parents’ ways of coming to terms with Larry’s death were constantly in evidence and involved Cheril. Larry’s toys had been put away on a high shelf, together with his model airplanes, to be preserved. Cheril was not supposed to play with them for fear she might break them. Eventually, the parents were able to let her play with some of these toys; the mother gave the rest away, but kept some herself. To be allowed to play with Larry’s toys again was part of what she had acted out in getting the toys out of the wastebasket early in her treatment. There were weekly visits to Larry’s grave on which the mother took her along. On these trips, mother was upset and remote, and Cheril was left to her fantasies. Her breathing difficulties were connected with these frightening fantasies: she wondered what happened to people when they were living in the ground and couldn’t breathe. Would that happen to her? She was also jealous of the dead brother, whom the mother loved so much. She would pester the mother, “Do you love me, Mummy?” She would kiss her in an annoying way, and finally ask, “Whom do you like better, Larry or me?” Like the visits to the grave, sleeping in Larry’s bed, which she was given when she outgrew her own, aroused her fear that she would sicken and die like him. When the mother was able to talk about these things with me and to understand their meaning for Cheril, she was able to change them.

After about five months, Cheril’s play began to turn more to male symbols and daddy. She played with slithery snakes and monsters, the lizards — some present-day, some prehistoric; some snakes were poisonous, others were friendly. She called them by different names, but they were variations on Larry and Daddy. The big lizard was very sick and finally was a dead daddy. Daddy had his lungs full of water. When I asked how come, she said, “Because he lives in the water! Miss Buxbaum, you aren’t even in this game!” When she continued the play for some days and I asked her, “Did you dream about that?” she fell to the floor dying and said, “Why did you have to say that?” I interpreted her fear that Daddy and she, too, might die like Larry; she thought she had water in her lungs when she had trouble breathing. I wondered whether the slithery watersnake might be Larry’s penis, with which she played while bathing with him. The dream preceded another of her breathing difficulties.

She was quite sick; the doctor said, “Her lungs are full” and wanted to start her on allergy shots again. The parents held out to see whether this condition would clear up like the others had. The doctor was the same one who had treated Larry; he did many blood tests — fingerpricks — on her, like he had done with Larry, in order to assuage the mother’s fears of Cheril getting leukemia. Every visit was a threat to Cheril that she might become sick like Larry. During this period, she talked about her coming birthday. It was her fifth. She did not want to be five. Larry had died shortly after his fifth birthday. Cheril was afraid that she, too, would die soon. She played baby Jean because she wanted to stay a little girl and not become five years old. When Larry’s birthday came around five months later, she went to his grave of her own volition; she was surprised that she was now older than Larry.

A couple of months later, Cheril's grandmother had a coronary; her mother was upset and planned to leave in order to see her without taking Cheril. Then she had another asthma attack. Cheril brought her mother to her session because, she said, she was afraid mother might die. We talked about her fear that if grandmother died, like Larry, then the mother could die too. After the mother had left, she played “Mom is dead, she won’t come back” — that was a happy song; the father and the son, who was she, herself, have a nice time together. But then the son gets sick and needs shots for his allergies. I explained that he was sick because his mom was dead and he was sorry. That brought mother back from heaven and the doctor got another baby out. Now they were four again — and nobody got sick. Her oedipal feelings could come to the fore briefly when she was reassured that her death wishes against mother were not considered dangerous, and that she was not condemned for them by mother and me. She was constantly thinking of the possibility that one of the people close to her might die. When I told her about my approaching vacation, she added me to the list.

When I returned after a summer vacation of a few weeks, she reacted with a recapitulation of her symptoms: She wet her bed after having seen me. She also had some very hard stools and said she was “afraid to go po-po because it may hurt, just like it did when I first went to Miss Buxbaum.” A weekend trip brought back memories of Larry, with whom she had been at the same place just a year ago, when they climbed over the rocks together. She said that he had to take some medicine there which made him sick. Again I talked with her about the effects of the medicine, mother’s and the doctor’s role in his illness. Resuming her analysis, she recapitulated not only her symptoms, but in quick succession went through the material we had discussed before my vacation, as frequently happens with children after a vacation.

During the first year of her treatment, her breathing difficulties were in the foreground. Her constipation came into focus during the second year of treatment. Between September and Christmas, mother and Cheril were preoccupied with memories of Larry’s life and death; his birthday, his Halloween, his illness, and the anniversary of his death fell into this period. Monsters, ghosts, cats, and horses were much in evidence. Mother was preoccupied, got sick; father lost his composure, spanked Cheril and the cat; the parents fought. School was no help either; she was put into the first grade where the teacher, “a witch,” said she was too young to be in the first grade — she was only five years old — which was true. She was singing in the car while driving with mother, using a hymn from Sunday School:

Give to my heart to the beaten
Give to my strength to the well
I am both Larry and Cher-Cher
I do not want to be well.
I know about sickness and dying
Give to my heart to the sick
I am Cher . . . il
Give to my strength to the well
I do not want to be beaten
I do not want to be well.

The mixture between the nonsense of the misunderstood hymn and the sense she gives it for herself, is striking. She thinks of herself as both Larry and Cheril. She does not want to be beaten, i.e., spanked. She knows about sickness and dying, but what is the use of getting well when mother thinks all the time of Larry and prefers him to her.

During Thanksgiving, a 12-year-old boy visited; he and Cheril played doctor. He had exposed himself to her, “when it was his turn to be the patient.” After this episode, which was exciting and frightening to her, she complained about stomach pains; she sat on her father’s lap while she masturbated and exhibited herself. After talking with me about her fears of being hurt genitally because the boy painted her with a red pencil in the genital area, she calmed down, had no stomach pains, but reverted to her old symptom, constipation.

Shortly after this episode, her mother left Cheril to be with the dying grandmother. During the mother’s absence, she brought me a picture of a monster whose penis was hurt. She told me, “Some monsters, who are lucky, have penises. When they are cut off, they can’t go po-po. When their heads are cut off, they are dead. When they cut their stomachs, they kill themselves.” In talking to her, I said that I thought she was constipated again because I could smell it — which she confirmed, saying, “I smelled myself all day!”

Previously, when the mother had intended to leave in order to be with the ailing grandmother, Cheril had had breathing difficulties; this time she became constipated again. She had to withdraw from her genital foray to her anal masturbation; in order to preserve her mother, she had to become a monster again, i.e., Larry, who had to have a fecal penis instead of a penis. She was afraid to die without mother and without penis — the fecal mass represented both.

When mother returned from the funeral, she took an overdose of sedatives which landed her in the hospital, an incident which proved Cheril’s fears to be justified. Cheril was symptom-free, somewhat depressed. I waited until the mother returned from the hospital to tell the child we would have to discontinue soon because I was leaving for a year. In response, she pulled down her pants to show me her genitals, obviously in protest because she still didn’t have a penis, therefore could not go “po-po” — so I could not go away. The following session she played at being a roaring lioness — who was sad because her babies were taken away. She talked about wanting a baby — she had a big stomach like having a baby there, but she would also be satisfied if mother would have more children. She was constipated again. She also stayed in bed, like mother had done when she had taken the sleeping pills. She continued playing the grieving lioness-mother, who loses her babies and gives birth to them. I learned somewhat later that the mother had taken Cheril to Larry’s grave again. The mother’s mourning for her own mother and for Larry seemed to be condensed, and Cheril demonstrated this in her play. The lioness was a variation on the cat, which represented Larry for her, and the roaring mother. The mother was, at that time, not only mourning but also roaring in temper outbursts at her husband, which Cheril demonstrated. She did not only play at having lion cubs, she also asked repeatedly whether her mother could have a baby. Mother said she was too old. In talking to me, the mother said she had nothing to do with her husband. This was in answer to my question whether Cheril may have observed something besides quarreling between the parents since she was so much interested in the facts of life. Again the mother became sick and went to the hospital. Cheril was constipated and dreamed a dinosaur gave her a tummyache and tickled her hand. The dinosaur represented all the males with whom she had played genitally, or toward whom she had genital wishes: Larry, the 12-year-old boy with whom she had played doctor, and her doctor father. This time it turned out that mother was three months pregnant. Cheril’s play of the lioness giving birth took place before the mother knew she was pregnant. The situation changed quite a bit with the mother’s pregnancy. She and Cheril became very close — they were pregnant together, one might say; only this time the mother carried the burden and Cheril was an interested bystander. Father was excluded and angry.

Before my departure her parents blew up at Cheril. She had been chewing her hair, a habit which got on their nerves. So they punished her, slapped her, and finally cut her hair. She was extremely upset and started wheezing again, which she had not done for quite a while. She was miserable and wanted to see me. I did see her, telling her that I could only see her two times because I was leaving. During the session, she played at being a lion with a long mane. “He loses his pride,” she said, “when his mane is cut, and changes into a lioness.” The lioness became a wild, attacking animal who ate small animals and finally got caught and ate herself. Cheril then changed to doctor play, in which she suffered the “Saturn illness;” this referred to a dream of the night before. She exhibited herself to me, putting her hands over the genital area. I then interpreted her fear that she lost her penis while masturbating and was thus changed into a girl. The “Saturn illness” had to do with her fear that the stars would fall down; she also called it the “moon illness.” Previously she had fantasied that Larry now lived on the moon. She was afraid that the expected baby, who was to be a boy according to the parent’s hopes, would be Larry returning from the moon, who would then take revenge on her for having taken his place. She feared that he might attack her and push her out of the position of favored child, which she finally had achieved. Her wheezing disappeared again.

I heard later that the father’s mother had to be taken to the hospital shortly after I left. Cheril reacted with constipation, but got over it rather quickly. During the year that I was gone, Cheril was on the whole doing alright. When her little brother was born and the mother was in the hospital, and when her paternal grandmother died, there were short episodes of constipation.

On my return, Cheril was waiting for me. She had been functioning well until shortly before I returned. Again a traumatic situation had occurred. Her baby brother had been sick, and the parents were much concerned. He was hospitalized in the same hospital where Larry had been, was treated by the same doctor. This ominous repetition was too much for Cheril. She again became constipated and stayed so for a long time. She went through her repertoire of what her bowel movement represented: the tail, the baby; the monster in form of dinosaur, dragon, a flying monster killing me; and always Larry is preserved, hitting and attacking her. The tail represented the desired penis and the baby she wanted. She, as the monster in forms of dinosaur, dragon, and flying monster, attacked and killed me for having robbed her of her baby, her tail, and her brother. She was the dangerous, fire-spouting, roaring, introjected mother, whom she projected onto me. Cheril personified her feces with her whole being. At the same time, the feces were the preserved dead brother in her who hurt and attacked her for her hateful, jealous feelings toward him. She also nearly consciously held on to her symptom because she was afraid if she were not constipated she would not get to see me. Her parents had said if she could go “po-po,” she did not have to come to see me any more. I reassured her that she could see me regardless. Recently, when she reacted with constipation again to my canceling an hour, she attacked me with her monsters in play and made a big mess of paper and crayons in my room. She was very meticulous in putting everything back where it belonged; upon her leaving, I said to her laughingly, “You put that B.M. also where it belongs,” and she reacted with a gesture, saying, “Right in your face!”

Cheril’s treatment was terminated by agreement between Cheril and myself. After meeting once a week for a month, we both decided she could manage by herself. During the last session, she wanted to play marbles, which we had done many times. She arranged the marbles in form of a heart and yelled: “Heart attack!” When I played dead, she said; “You are not dead, I only shot the monsters in your heart.” She denied her fear that I might die, but also let me know that the heart was the place where the monsters resided, i.e., all the feelings they represented. We then talked about all the people she knew who had died of heart attacks — both grandmothers and a beloved elderly lady who babysat with her — and that she feared I might die that way too, being in the age group of these ladies. I heard from the mother, who continued her own analysis, that Cheril tolerated the termination well. I have seen Cheril occasionally by chance; she always runs up to me and quickly informs me about what she has been doing, talking a mile a minute. She says she has no desire to see me professionally, and manages her constipation, when it occurs, by herself.

Cheril is a very imaginative, creative child. She draws and writes well, and has a great store of information at her disposal. Even during periods when she was constipated, her fantasies were not only expressed in therapy, but she could draw and write them and put them into paper and clay sculptures. Her creativity is a direct offshoot of her anality in sublimated form. It certainly helped her recovery. I think it enables her to express feelings in derivative, sublimated form without having to go the full way of regression. It is something like “regression in the service of the ego” — to borrow Kris’ term. Like her body product previously, her creative productions are narcissistically highly valued.

Discussion

Cheril had either breathing difficulties or constipation. When she could not breathe, she was anxious; when she was constipated, she was withdrawn, had a stomach ache, but no asthma. Jessner et al. (1955) quote an asthmatic child saying; “If I don’t feel good and get a pain in my stomach, then I don’t get asthma” (p. 356). This description fits Cheril too.

Cheril imitated her dead brother in a number of ways: she finished his drawings right after the funeral, she played superman with his cape, she played with his toys, she hit the children as he had; she played at being Larry and herself. The line between imitation and identification becomes blurred here. Playing as he had done was an activity controlled by her ego; when she became Larry and herself, she lost control over her functions; while she played burying herself, she became Larry, who could not breathe. She became afraid to die as he had. She wet the bed and could not defecate, like him. Her functions took on a life of their own. She alternated between breathing difficulties and constipation; when she was dying like Larry, she accused her mother of killing him and was angry and afraid of her. When she jumped on his grave in her play with me, she expressed her death wishes against him; when she was suffocating, as he had in his grave, she projected her hostile feelings onto mother and hated her. She found relief in her sessions with me by letting her flatus go, breathing “with the fiery breath of the dragon,” and roaring “like a lion.” Greenacre (1951) says, “The flatus was, as it were, the ghost or spirit of the stool” (p. 181); she quotes Fenichel, who emphasizes that the respiratory apparatus becomes the site of incorporated objects in the same way as the intestinal apparatus. Cheril makes the transition from the respiratory apparatus to the intestinal one, and with it she changes her symptom from one to the other. Abraham (1920) discusses the idea of “the omnipotence of the functions of bladder and bowel” and says, “urine and flatus appear as the instruments of a sadistic attack” (p. 319). Cheril changes from her masochistic breathing difficulties to sadistic breathing attacks. In holding her breath, she does not only hold on to the introjected object, but she also suffocates it and, with it, masochistically herself. She changes to expelling her breath and directing it at an outside object in a sadistic breathing attack. The same happens with her feeling cramped from holding feces and gas, when she changes to expelling flatus and stool in order to attack — as she expressed it when she said she would put her B.M. right in my face. However, holding and expelling her stool also represents holding on to the object she feels in danger of losing, and aggressively expelling it.

The breathing difficulties represented her identification with the dying brother; in her fear of dying, she called her mother to her side to save her and sent her away for fear she might kill her. When she was constipated, the picture changed. She played with the fecal mass by pushing it and retracting it, giving her physical sensations with her fantasies: “It does not want to come out.” She played with me that I was locked up in a castle, in a cave, in a cage — “You would like to come out, but you can’t.” When she did not see me, she kept her stool locked up, but she also told me to stay locked up in my room while she was gone. Upon her return, she allowed me and her stool to come out.

As I have shown, many of the animals which she fantasized about were closely or somewhat more remotely derived from thoughts, memories, and feelings about her brother. She played a lion hiding behind my chair. When I said I can see him, she said, “No, you can only see his tail,” pointing to her anus, and added, “I can feel it now,” meaning the stool. The lion’s tail, but also the dinosaur’s tail and the dragon, represented the coveted penis, which she wanted to have and keep. Having to give up her feces not only meant castration, but giving up the part which represented Larry in her. Losing it meant losing mother’s love since mother loved Larry. It also meant surrendering that part of her to the mother, who would destroy it as she had taken Larry away from her and destroyed him. Her hatred and her love toward the mother were expressed in her refusal to defecate. As the dragon, monster, lion, she tore and scratched her victims, her food; she roared and breathed poison and fire, destroying her enemies. During the constipated phase, Cheril was not anxious, but aggressive. She held on to her feces and what they represented. Her brother had been her beloved companion, nearly in the position of a twin; she played fantasy games with him in which he was the leader. Playing with her fantasies after his death was playing with him and his representative, i.e., either with me or with her stool. When I left her, she resorted to her stool. When anybody left her temporarily or died, she comforted herself with her feces — and was not alone anymore. I think she got over her initial bedwetting — her reaction to Larry’s death, which also represented the loss of her penis attached to him — so rapidly because she resorted to the fecal penis.

According to Abraham (1924): “. . . when the obsessional neurotic is threatened with the loss of his object, and when the melancholiac, actually does lose his, it signifies to the unconscious mind of each an expulsion of that object in the sense of physical expulsion of faeces” (p. 426). He draws attention to the violent intestinal reaction which people may develop upon hearing the news of the death of a near relative or friend and considers it as an archaic form of mourning, which has been preserved in the unconscious. Pinderhughes (1971) says similarly, “Defecating, urinating, spitting, coughing, belching, expelling flatus, vomiting, blowing the nose, sweating, cutting finger nails, removing cerumen, etc. may offer opportunity to symbolically eject, destroy and get rid of renounced objects and destructive impulses within the self’ (p. 680), and in another place he says, “Fantasies of holding onto objects one fears losing often accompany the constipation associated with overt or marked depressions” (p. 681).

Holding on to her feces represented Cheril’s defense against losing the object; as long as she kept the stool in her, she made it magically whole and alive; to expel the stool was to destroy the object anally. Cheril’s libido development was fixated most prominently in the anal phase; she had easy access to orality, as in her fantasied eating of lion cubs and her occasional eating of hair, representing the lion; but her breathing difficulties in particular contained elements of sucking in and expelling by mouth.

Cheril’s desire to take Larry’s place was connected with her intensive wish to have a penis. While he was alive, she shared his penis with him like his toys. She wanted to play with it again as she had wanted to play with the toys, which were forbidden to her after his death. This was also her avenue for winning mother over to herself. Her disappointment over the missing penis made her regress to the fecal column. When she turned to her father and the twelve-year-old boy, when she fantasied and dreamed of slithery snakes and tickling dinosaurs, she masturbated genitally and expressed her wish to have babies and to be like mother. This genital development was short-lived. She quickly regressed and withdrew from these genital feelings to the anal ones when she felt disappointed and rejected.

Cheril reacted to the death of her brother and to the fear of losing her mother with libido withdrawal and turning to her body product, like the little boy described by Anna Freud (1966). It seems that she is constitutionally predisposed to this particular physical reaction to external or internal object loss, although she “can manage it” consciously.

Her superego, in accordance with its anal derivation, was a strict one. She punished herself for death wishes by having to die herself. She demanded that I train the monsters, i.e. her, in cruel ways by whipping them and locking her up. And when the monster, i.e., her stool, finally came out, it “bit” her and hurt her. The painful defecation and her play with me showed masochistic tendencies. The time she shot me and I played dead, and she protested, “You are not dead, I only shot the monsters in your heart,” she was telling me that the anal monsters were also representatives of her superego.

Speaking about the relation of the toddler to his body products, Anna Freud (1965) says, “In correspondence to this double cathexis of the body products, the toddler’s entire attitude toward the object world is dominated by ambivalence, i.e., by violent swings between love and hate (libido and aggression not fused with each other)” (p. 73). Recognizing the monster in a person she loves and wants to preserve is a sign that Cheril is able to tolerate her ambivalent feelings toward others and toward herself better than previously. It is a manifestation of the fusion of libido and aggression and, as such, proof of this important instinctual development taking place. When Larry died, Cheril dealt with her loss in terms of the anal phase. Her stool became the representative of her dead brother whom she retained or expelled according to her fantasies, so that her body functions were disturbed. The analysis helped her to separate her body functions from her fantasies and to accept the reality of his death.

REFERENCES
   Abraham, K. (1920), The narcissistic evaluation of excretory processes in dreams and neurosis. Selected Papers. London: Hogarth Press, 1948, pp. 318-322.
   Abraham, K. (1924), A short study of the development of the libido viewed in the light of mental disorder. Selected Papers. London: Hogarth Press, 1948, pp. 418-501.
   Freud, A. (1965), Normality and Pathology in Childhood. New York: International Universities Press.
   Freud, A. (1966), Obsessional neurosis: a summary of psychoanalytic views as presented at the congress. Internat. J. Psycho-Anal, 47:116-122.
   Freud, S. (1905), Three essays on the theory of sexuality. Standard Edition, 7:125-243. London: Hogarth Press, 1953.
   Freud, S. (1917), On transformations of instinct as exemplified in anal erotism. Standard Edition, 17:127-133. London: Hogarth Press, 1955.
   Greenacre, P. (1951), Respiratory incorporation and the phallic phase. The Psychoanalytic Study of the Child, 6:180-205. New York: International Universities Press.
   Jessner, L., Lamont, J., Long, R., Rollins, N., Whipple, B. & Prentice, N. (1955), Emotional impact of nearness and separation for the asthmatic child and his mother. The Psychoanalytic Study of the Child, 10:353-375. New York: International Universities Press.
   Marcus, I. M. (1962), Panel report on masturbation. J. Amer. Psychoanal. Assn 10:91-101.
   Pinderhughes, C. A. (1971), Somatic, psychic, and social sequelae of loss. J. Amer. Psychoanal. Assn., 19:671-696.

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