Splitting 9780300146219

Table of contents :
Contents
Foreword
Preface
1. The First Interview
2. Mrs. G’s Penis
3. Charlie
4. Psychopathy
5. Mothering
6. Chris
7. Psychosis
8. Multiple Personality
9. Murder
10. Suicide
11. Identity
12. Mrs. G’s Father
13. Mrs. G’s Mother
14. Homosexuality
15. Treatment
16. Conclusions
17. Epilogue: Roots of Evil
Appendix
Notes and References

Citation preview

Splitting: A Case of Female Masculinity

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Splitting: A Case of Female Masculinity Robert J. Stoller

Yale University Press New Haven and London

First published 1973 by Quadrangle/New York Times Book Co. Published 1997 by Yale University Press with a new foreword. Copyright © 1973 by Robert Stoller. Foreword copyright © 1997 by Yale University Press. All rights reserved. This book may not be reproduced, in whole or in pan, including illustrations, in any form (beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and except by reviewers for the public press), without written permission from the publishers. Printed in the United States of America. Library of Congress Cataloging in Publication Number 96-61496. ISBN 978-0-300-06572-5

A catalogue record for this book is available from the British Library. The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources.

Contents

Foreword Preface 1. The First Interview 2. Mrs. G's Penis S.Charlie 4. Psychopathy 5. Mothering 6. Chris 7. Psychosis 8. Multiple Personality 9. Murder 10. Suicide 11. Identity 12. Mrs. G's Father 13. Mrs. G's Mother 14. Homosexuality 15. Treatment 16. Conclusions 17. Epilogue: Roots of Evil Appendix 1. Mrs. G as Textbook Psychiatry 2. Physical Illness 3. Very Masculine Females 4. Mrs. G's Dreams Notes and References

vii xiii 1 13 29 54 69 88 120 137 176 203 224 233 248 271 302 313 324 362 363 366 376 379

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Foreword

Surely Splitting: A Case of Female Masculinity, Stoller's second book, first published in 1973, is one of the longest, most minutely detailed, and most fascinating case reports in the psychiatric literature. Yet Splitting is not one of Stoller's best known books, probably because its title mistakenly leads one to think that its scope is too narrow, limited only to "female masculinity." In fact, the substance of the book explores many themes that have only recently burst full force into the therapeutic world. It is hard to believe that Splitting was written over twenty years ago, grappling as it does with such topics as the difficulty of establishing multiple personality as a diagnosis (and of determining whether multiple personality was created rather than discovered by the therapist); the impact of physical and sexual abuse on pathogenesis; the role of parents' fantasies on their offspring; and the interplay of murderous, suicidal, and sexual impulses. Here, too, are to be found, either fully developed or in embryonic form, all Stoller's seminal ideas about perversion, ideas for which he was later acclaimed by sexologists, psychiatrists, and psychoanalysts. The frame story is a brilliant example of a psychiatric genre that might be entitled "my most difficult clinical case." But the main thrust of this work covers most of the territory within the boundaries of Stoller's lifelong interest in sex and gender. In his story of Mrs. G, a bisexual woman who had an imaginary penis—not merely a fantasized one, but a penis she experienced as real—is a wealth of insight into how her fear, murderous rage, and hopelessness—all generated through parental neglect and rejection, and compounded by sexual abuse and by unconscious conflict, too—acted together to produce conflicted gender identity and thwarted sexual desire. Mrs. G's psychic pain was barely contained through recourse to fantasy, delusion, psychopathy, and splitting (which covered over an underlying multi-

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pie personality disorder) and was sometimes so intense as to overwhelm her fragile personality organization and cause her to be plunged into fugue states, psychotic episodes, or periods of dangerous acting out. Stoller's first involvement with Mrs. G, a very masculine-looking woman, occurred when he visited the county hospital to film an interview with her and other patients as one of a series intended to test medical students on their diagnostical acumen. He first regarded her as a "psychopath" but, coming to see her as more "a teasing, cute, gratifying, charming, loving, insightful, dangerous, suicidal psychotic" than a psychopath, he had her transferred, at her request, to UCLA, so that she could receive the psychotherapy unavailable at the county hospital. She was in the UCLA system as an outpatient for more than a dozen years, the last seven in therapy with Stoller himself, during which time she had multiple hospitalizations. From the time Stoller undertook her treatment, its stated purpose was not only therapeutic and exploratory but also research-oriented. And from the time Stoller discovered that she had an imaginary penis and functioned as a bisexual (a category of women Stoller calls "penis women"), he realized that he could use her as a "control" case to compare with other gender disordered patients—including female transsexuals, female homosexuals, and the mothers of male transsexuals. Stoller taped all their therapy sessions, but this volume is no dry case history, no dreary reproduction of transcribed sessions. One of the most engaging of its attributes is its gripping—even novelistic— quality. Verisimilitude and narrative drive are problems about which Stoller had profitably thought a great deal. He observes that "authors of fiction in their most convincing fiction . . . have long since learned that to make conversation come alive in a book, one must invent it and never follow nature. It must stir in the reader the illusion of reality, which, paradoxically, can only be done when the printed word does not follow reality." He goes on to note how this is impossible for the scientist: "it will not serve our purpose to invent; it is too risky to approach reality via art." Even though Stoller uses excerpts of the transcribed tapes, he was daring enough to introduce a remarkable narrative strategy that does bring the case alive and that achieves narrative drive. What Stoller did was not to invent but to excerpt according to topic. We are given not verbatim sessions but excerpts covering individual subjects such as Mrs. G's (delusional) penis, suicidal impulses and

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suicidal attempts, murderous impulses and murderous acts, and multiple personality. Each topic is of central importance to her "case history." Stoller introduces novelistic interest and suspense by not telling us Mrs. G's life history all at once but letting her story emerge under the different rubrics he has chosen. In this manner he gradually brings alive not only the trajectory of her life story but the vital and extraordinary relationship that came into being between a brilliant researcher/psychiatrist/psychoanalyst and a woman who, although aptly described as encompassing a veritable textbook of psychiatry within her person, had the virtues of an able, willing, and motivated patient. Stoller captures so artful a facsimile of reality that not only the therapeutic process but the personalities of the two protagonists (sometime antagonists) appear as living entities. What of the special insights arrived at in this work? Too many to chronicle, really. But let me share some of those I found particularly arresting. Stoller had a profound sense of the continuum among the hysterical personality, hysterical psychosis, and multiple personality and their kinship to aspects of the personalities of impostors, actors, and artists. He draws an analogy between the imaginary companions of childhood and the ability of artists to create characters, and notes the major differences when those characters become alternative selves as opposed to clearly recognizable "creations." It is the difference between fantasy known to be imagined and "fantasy" experienced as real. Of great importance is his insight that homosexuality is not a single entity but is best conceptualized as a group of "homosexualities." Though many sex and gender researchers have independently grasped that the term homosexuality is a broad rubric encompassing a number of different behavioral patterns and dynamic constellations, Stoller, writing in 1973, was among the first, if not the first, to make this important conceptual leap. Labeling had diminished therapists9 ability to note important differences in gender mixes, sexual practices, and dynamic constellations. Stoller extends his insight into the importance of diversity—of subtle shadings—to encompass heterosexuality as well, coming to refer to the "heterosexualities." (Even so, there are still those who have not grasped that "sexualities" of whatever sort embrace a wide range of significant variations.) But the heart of Splitting has to do with its delineation of a spectrum of female cross-gender identifications and homosexualities. Of particular interest in the case of Mrs. G is the circumstance that she

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took great pleasure in having sex with women but was unable to selfidentify as homosexual; that is, as Stoller puts it, "if I insist I am not a homosexual, then what I am doing is not homosexuality." While Mrs. G's imaginary penis may have been invoked to close the unbridgeable chasm "between being unwanted by her mother and having to get back to her mother" by choosing a female partner, she avoided self-labeling as homosexual (a condition which her mother deplored) by viewing herself as a person with a penis having intercourse with a (non-homosexual) woman. Mrs. G's reluctance to self-identify as homosexual is shared by many women (and men) who nonetheless practice same-sex almost exclusively. Many of them suffer relatively little psychopathology. What Stoller picked up in the case of Mrs. G was her unconscious— sometimes conscious—fantasy of being both male and female. For some female homosexuals, just as for Mrs. G, acknowledging that their sexual behavior is homosexual destroys any sense of having a penis as well as any sense of being a "normal" woman. Many therapists view the reluctance to self-label as homosexual as the product of nothing more than an internalized cultural homophobia. But some homosexuals are minimally impacted by social homophobia; a homosexual's self-hate in response to homophobia appears most lethal when it dovetails with some unconscious conflict-driven denial, some internal psychological threat. Then the acknowledgment of homosexuality poses a threat to the unconscious fantasy of being a complete man and simultaneously a complete woman or a woman with a penis. Clinically, one sees a number of women who practice homosexuality in the active role but refuse to let themselves be touched genitally or aroused by their partners. Like Mrs. G, they may be motivated not just by conscious pleasure in being an adept and masterful sexual performer but also by the unconscious fantasy of trying to satisfy an unsatisfiable mother through the fantasy of being a woman with a penis or of being a man. Mrs. G could give up her illusory penis only during her pregnancies, periods of her greatest happiness, when she attained some of the symbiosis she desired (but only if she believed the fetus to be male). To describe her as having "transsexual wishes" is incorrect insofar as she did not desire a sex change or believe herself to be a member of the opposite sex. She simply believed that she had a penis. In her in-depth uncovering treatment with Stoller, she was finally able to resolve her conflicts to the degree that she could give up the penis, own her ho-

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mosexuality, and establish a more loving relationship with a woman. During Mrs. G's therapy, Stoller formulated an insight into perversions, paraphilias, deviations—call them what you will—that was to become his hallmark theory: the idea that perversion is the erotic form of hatred. Mrs. G "often had powerful impulses to murder people which she didn't act upon, and murderous fantasies beyond which there was little conscious impulse. But from age seven she actually tried to murder a number of people." She was also suicide-prone and made many genuine attempts. (Hers is one of the few case histories I have read that brilliantly details the impulse to destroy others.) The roots of Mrs. G's homosexuality and her rage, murderous and suicidal, were intertwined: "she tried to murder because of the same conflicts that gave rise to her penis; and she was suicidal because she could not bear to think of herself as homosexual and because she had to murder." These roots included rejection, though not total, by her mother; an erratic relationship with her father, who, though manifestly loving, appeared and disappeared and eventually disappeared altogether (he ultimately killed himself); and sexual abuse perpetrated upon her by several different men in her life. Mrs. G's mother wanted sons, not daughters, and might be said to have abhorred having a girl child. Here, Stoller introduces the idea that the wishes and fantasies of the parent significantly impact on the gender identity of the child— one of the early examples in the psychiatric/psychoanalytic literature of what has come to be known as transgenerational transmission. As Stoller puts it, "'interpersonal schemas' become 'intrapersonal schemas'." To a psychoanalytic field still in the complete grip of conflict theory, Stoller made an important contribution by emphasizing the role of nonconflictual learning, transgenerational transmission of fantasy, and trauma as a pathogenic force in psychopathology. He made known to the large psychiatric and psychoanalytic community the important distinction between sex and gender that had been established by John Money and, along with a few contemporaries, transferred the locus of the search for the source of perversion from the oedipal years to the very earliest years of life. Splitting constitutes an extremely original contribution to the study of perversion. It has yet to be mined for its wealth of throwaway insights, among which are ideas about research methodology and the place in research of the single case report (which is to generate hypotheses); trenchant critiques of psychoanalytic theorizing devoid of data; contributions to understanding and

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deepening the patient-therapist relationship; the need for the therapist to be a real person; and the need for the therapist to sometimes make active therapeutic interventions in order to facilitate the flow of information. The case study of Mrs. G will continue to remain one of a kind, in part because her therapy could hardly be duplicated today. No one could take the therapeutic gambles Stoller was comfortable with without having access to immediate hospitalization, as was provided for Mrs. G in the 24-hour availability of UCLA. Because of the labor-intensive nature of his therapy with Mrs. G, Stoller justifies it—again, remember how long ago this was—in terms of his research; otherwise, he believed that to use so many of society's resources for one person only, however worthy, would be to rob others of their due. I doubt that there are more than one or two psychiatric facilities in the country today—if any—that could encompass the kind of work Stoller was doing in the 1960s and 1970s. More importantly, Splitting will remain timely because of its presentation of real data and a real story, in much the same way that the work of Krafft-Ebbing and Havelock Ellis remains relevant. Though our theories may be modified or even toppled, our observations, when sufficiently nuanced, retain their validity, their power to communicate and to reach others across barriers of theory and distances of time. What is particularly moving, especially for those of us who knew Bob Stoller, is the way his authentic voice comes through in his text. Never a stereotypic psychoanalyst, either in his clinical work or in his theory, he was flip, hip but serious, caring, real, daring, and sometimes downright outrageous. What also comes through are his patience, his fearlessness, and his empathic gifts. It is a measure of the man that not only his patients but his colleagues, too, were able to use his many gifts to their advantage. He was that rare thing then, an original, a bit of a renegade, whom members of the establishment came to cherish and who were changed by him. Ethel Spector Person

Preface

DR. s: What would happen to you if you lost your penis? MRS. G: Then I wouldn't be anything. My penis is what I am.

What would convince a biologically normal woman that she had a penis? How does one go about finding out? How reliable is the information one collects? This is a book about Mrs. G, a very masculine woman, and the pieces into which she was split in order to accommodate that masculinity. It is also about the process of finding out about her, about the development of masculinity and femininity, and about the role parents play in the creation of identity. It is also an attempt to add to a part of psychoanalytic theory. Mrs. G broke almost all of society's rules. She did what she did to survive, to maintain a sense of "I am." If this required a penis, she acquired one; if it meant creating a second personality, she did. She hallucinated and was delusional in order to have a better reality. She was addicted to drugs; used (and was used by) her sexual partners for almost everything but her own pleasure; stole; had illegitimate babies; and even attempted murder and suicide—all to experience the feeling that she existed, to keep from being swept away. Then, because she wanted help, Mrs. G became a patient at UCLA.1 I want to tell you what happened. The purpose of my research is to study the development of masculinity and femininity, or gender identity. As I noted in my first book on this subject, Sex and Gender,2 although human masculinity and femininity may have biological roots, the greater part of gender identity is learned. It is thus differentiated from "sex," a term I arbitrarily reserve for biological attributes such as chromosomes, gonads, and genitals. xiii

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To study every aspect of the development of masculinity and femininity one needs skills and interests I do not possess, e.g., the techniques of the animal psychologist, electrical and chemical laboratory experts, and the geneticist, and the perspectives and cross-cultural studies of the anthropologist. At best, the way I collect data can lead to an understanding of only some of the forces that contribute to the development of gender identity. My method has always been to start with a single case studied in depth and at length. When this cannot be done or when one is sure enough of his findings to know what questions to ask, a larger number of cases seen not quite so intensively can be studied in extended psychotherapy. If the findings of the first studies are borne out in larger numbers of patients, one is then perhaps able to construct questionnaires, projective techniques, and other instruments to test the original hypotheses. In addition to the single patient or subject, whole families must be investigated in detail if one is to see what forces were brought to bear upon the newborn infant and his subsequent development. Working this way, one is doomed to spend years and still end up with only uncertain conclusions. With this book we shall approach the subject of the development of masculinity and femininity by means of a single case studied (by treatment) over many years. We shall try to move into a disturbed woman's gender identity to find what it is like now and to trace some of its origins in childhood. It is anachronistic today to attempt to understand just one part of one person, to spend the great amount of clinical time required and then to write about what one has learned at considerable length. Such an inquiry is easily contaminated, uncertain, and, even in terms of its limited objective, never complete. Freud's case reports produced optimism about this method of discovery, but time has shown that it leaves much unanswered; so the intensively studied single case has given way to the more rapidly observed many. There is certainly good reason for this: extravagant conclusions have frequently been drawn from a single case; at times these conclusions have not even followed from the data collected. Moreover, it has often been impossible to be sure what were actually data and what was conjecture; in fact, the observer himself may never quite have known, or soon obliterated, the distinction. These difficulties have led to the present emphasis on controlled studies with adequate samples. Not only does the researcher

PREFACE XV

thus conform more to the standards of science but he also renders his activity less painful: he is spared intimate contact with his subjects and with all the responsibilities that go with it; he reduces his involvement with his subjects' distress by interposing between himself and them the formulas worked out by those concerned with proper methods; and he avoids the sense of uncertainty that besets the clinician in his one-to-one relationship with his patient. Yet, although statistical techniques may enable us to corroborate or deny a hypothesis, they do not produce one. There is, of course, the hope that if one permutates numbers long enough, a major result will emerge. But how often have important findings arisen in this way? On the other hand, as Freud's work shows, the extended case study is an inexhaustible source of ideas. I am sometimes dismayed, when reading a psychoanalytic paper, to find a series of hypotheses, each of which should become the subject of research, asserted as if each were already confirmed. Nonetheless, exposure to the hypotheses themselves provides an enriching experience. Unhappily, those of us who are clinicians, especially psychoanalysts, seem to have little feel or need for proper controls and checks on reliability, whereas those who like their facts "hard" too often deny the depths and complexities of mental functioning and thus avoid the excitement and uncertainty that facing them entails. Still, even if it is out of style, some of us must persist with the clinical case study. If what follows here shows how much can still be left undiscovered after many years of an attempt to understand another person, I hope it will also show how much can be discovered that could not have been learned in any other way. Something like an experimental design would have been useful to me; and had it been available, it would have saved time. My books show the beginnings of such a design, but I cannot claim that the design came first and the experiment later. Rather, the experimental "design" at first consisted simply in seeing any patients who were referred to me with disturbances in masculinity and femininity, then doing this haphazardly for years, and gradually sensing the outlines of different types of disorders and different etiologies for each type. Assuming that in the comfortable, relaxed alertness of hovering attention that pervades treatment the patient's thoughts and memories can lead him and us to unexpected insights, how are we to communicate our findings to our colleagues? Freud3 wrote:

XVI PREFACE

It must be borne in mind that exact reports of analytic case histories are of less value than might be expected. Strictly speaking, they only possess the ostensible exactness of which "modern" psychiatry affords us some striking examples. They are, as a rule, fatiguing to the reader and yet do not succeed in being a substitute for his actual presence at an analysis. [So far so good.] Experience invariably shows that if readers are willing to believe an analyst they will have confidence in any slight revision to which he has submitted his material; if, on the other hand, they are unwilling to take analysis and the analyst seriously, they will pay no attention to accurate verbatim records of the treatment either. This is not the way, it seems, to remedy the lack of convincing evidence to be found in the psycho-analytic reports.

"Any slight revision"—that's the worm in the apple. It is frustrating to have goals in one's research one cannot reach by his own efforts in his lifetime, for instance, to develop a technique for transmitting accurately to others one's observations in treatment. There are many reasons why this cannot be achieved, and there are times when I fear doing it right is like pregnancy: it is all or nothing. Even if one could transmit practically everything that went on, the few things missed (but not transmitted because, for example, I was blind to them while another would not have been, or because no one will notice them until they are discovered a hundred years from now) might be the most important observations. Then there also is the well-known problem that what are called "data" or "observations" are not the unassailable absolutes one might wish. It has long been noted by philosophers of science that one perceives nothing without shaping it by one's already formed concepts and theories. Yet, even knowing that two experts seeing the same phenomenon can disagree, I still feel we must give them at least the chance to look. In a half-hour evaluative interview, one can use film or videotape (though even in this, camera technique can develop or hide observations). But in psychoanalysis or a related sort of long treatment, as was Mrs. G's, the costs would be exorbitant and the storage space excessive; and it is unlikely that anyone would review hundreds or thousands of hours of filmed treatment. One can compromise by audiotaping the treatment sessions.4 This was the course I followed in Mrs. G's case.5 However, most of those concerned have given up trying to transmit accurately findings that depend on the subtleties of interpersonal interactions and have settled for impressionistic reports.

PREFACE XV11

Despite the importance of discovering the psychodynamic sources of human behavior and the extensiveness of the literature to date, there is not a single psychoanalytic report in which the conclusions are preceded by the data that led to them. If such data are not available, critics can be forgiven for not being convinced of the validity of the conclusions. Some analysts are belligerently proud of having granted themselves the status of scientists and psychoanalysis the status of a science, but such awards should be deferred until psychoanalysis can do as all other sciences do: publish data. You and I never know when reading someone's report whether he is right because he is brilliant, imaginative, and agrees with noted authorities, or whether he is right because his conclusions follow from his data; we cannot know because we have not had access to his data.. We may get the feeling from what he says that his experience with the patient was like experiences we have had and thus be convinced that his observations are valid. That may be convincing, but it is not yet scientific.6 Once we have our observations down on tape, where they can be reviewed by others, we are faced with hundreds of tapes, in a lengthy treatment, that, in our present stage of technology, need to be converted to printed words if the data are to be shared by more than a few other workers. However, there is nothing more battered than the printed reproduction of live conversation: it is almost incomprehensible to read even when at its liveliest. Authors of fiction and that most convincing fiction—nonfiction—have long since learned that to make conversation come alive in a book, one must invent it and never follow nature. It must stir in the reader the illusion of reality, which, paradoxically, can only be done when the printed word does not follow reality. Yet it will not serve our purpose to invent; it is too risky to approach reality via art.7 I simply cannot publish all the typescripts on Mrs. G. No one would read them. So what can be deleted without distorting the data? The only answer is that I must use my judgment, which immediately removes my findings from the realm of science. The best I can hope is that if the editing is proper, the end result will adequately approximate the original data-collecting experience, the treatment. What rules have governed my editing? First, if there are multiple discussions of the same material, usually only one is used. Second, stumbling and broken speech is eliminated where it adds no substance. Third, to make the material more readable, remarks made perhaps minutes apart and with other sentences intervening are at times run

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together as if spoken that way. The rule holds that words are not changed, and an effort has been made not to create inaccurate impressions through the selection of what is presented. Fourth, almost invariably the quotations in each chapter are in chronological order. Although I have not indicated how much time has passed between quotations—it may have been days or years—the reader will know that, within each chapter, there is always a progression of time. Fifth, when a large portion of an hour is presented, my remarks have usually been foreshortened if the focus is on Mrs. G. The only extended transcription of exactly what I said is by way of exemplifying how I acted as a therapist, what the patient had to put up with in me, how treatment can survive the therapist's mistakes, or a particular technique or style of treatment that produced a response that might not otherwise have resulted. Sixth, details such as names and places have been disguised, and—an unfortunate necessity—data have been left out for the sake of confidentiality. Finally, because there are more themes than any one book could encompass, huge chunks have been removed en masse, simply to reduce its size. The entire manuscript has been read by the patient, and her comments and suggestions have been incorporated. At the least, she and I must agree, or know where we disagree. For all this editing, we are still stuck with literal transcription of conversation. Whether to pay the price of losing one's audience or to pay the price of not reporting one's data is a matter of judgment. The temptation is not only to edit but to rewrite, to paraphrase, to summarize, to transmute by metaphor, and finally to end with fictionalized anecdote. Even Freud, who published the most extensive and intricate case reports, was forcec' to "limit myself to this small number [of examples] because it is impossible in such reports to avoid being very diffuse and entering into every detail."8 As traumatic to reality as the editing is the loss, in a typescript, of the "music," timing, inflections, nonverbal noises like chuckles or sighs, psychomotor behavior, and, especially, facial expressions. Without all these, it is often difficult to know exactly what each of us was thinking while we were speaking; even on the tape, though it is better than a typescript, the silences have been emptied of their life. When at times I checked back to the tape from the typescripts, I was astonished at how much more alive the two of us were than a reading of the typescript conveys.9 And what we were thinking and feeling—consciously and unconsciously—cannot always be discerned at any mo-

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ment. Without knowing that, the reader is deprived of essential information, though perhaps he may grasp enough to give him an adequate feeling of the exchange.10 When people have known each other a long time, much in their conversation is taken for granted. Mrs. G and I have talked together so long that we may have unspoken understandings that even now are too much a part of our relationship for me to notice and make conscious. I hope that where confusion exists because of this, it will be minor. Now let us imagine that the editing did not really distort the observations. How does one narrate? How does one's prose achieve a proper balance? (Think of a newspaper photo showing a politician yawning during a conference: he may have yawned only once during an otherwise alert three hours, but the reader sees only the picture of him yawning.) If Mrs. G displays behavior demonstrating a certain psychodynamic, is that dynamic a continuing and important part of her life-style, or is it an insignificant potential that is almost never actualized in her life? One eventually must choose which words he will use to describe, say, a certain behavior. Psychoanalytic language obscures because of the heavy theoretical load its words carry; for our present purpose we need as simple a language as can be used without damaging reality, even if it is colloquial, unprofessional, undignified. If things are clear, they can be described clearly. One has only to give up his disguises. But to speak clearly in psychoanalytic circles is to make oneself vulnerable, to offer oneself up to the sharp criticism that well-constructed theory fends off. Any psychiatric resident can be trained to speak psychoanalytic language in a few weeks, but it is uncertain whether most analysts can be trained not to. Although this report should stand on its own feet, I write influenced by a'perspective it may help the reader to share. As part of my larger study on the development of masculinity and femininity, Mrs. G serves as a control on the other research patients. (That is why I came to tape the actual hours of treatment only after she first told me she had a penis. On hearing that, I suddenly saw her as a control patient who could be compared with and contrasted to other women with gender disorders.) Information on her has already been used in this way (in the chapter called "A Bisexual Woman: A Control Case" in Sex and Gender).11 I have know Mrs. G for fourteen years and treated her for seven. I have spent a lot of time with her; and since much of that time was

XX PREFACE

spent in treating her, I have been permitted to look inside her in a way that a more cursory acquaintance could not have permitted. Because she was so often psychotic and also close to suicide, it was not possible to psychoanalyze her in a manner that many analysts (including myself) would call a psychoanalysis. Most important, her reactions to me (the transference) were not systematically analyzed.12 However, there are ways other than analysis of gathering information about past history, unconscious mechanisms, and primary process material in a patient who is both psychotic and trusting. The disadvantage of not analyzing the patient may be partly balanced by useful material shaken loose by her psychosis, comparable with the dreams available in our more ordinary work. Of course, to reconstruct the past from psychotic productions is risky. Still, the risks of constructions derived from dreams are not so small, as can be seen by the wrecks that litter the progress of analytic theory. To keep this presentation in focus, concentrating on the development of Mrs. G's identity, I shall minimize two interesting areas. The first is treatment. It cannot be completely ignored, both because the reader will see it occurring as he reads what we said and because he needs to feel it in order to reach conclusions about the validity of my ideas. But its presence has been edited down, especially by removing almost all interpretations. The second sacrifice is in "scholarship." While writing, I think of others who have struggled with the same issues. But to review their work and then fit it, with suitable argument, into Mrs. G's life would make this book too long and would shift its manifest emphasis from the clinical. Still, this is a book of theories, though they are introduced gently. (It is, however, much less a book of theorizing—a process of endlessly palpating and stroking one's words and thoughts.) When the work of others is not discussed, the omission has often been from choice, not ignorance. For instance, this is a book about splitting, an admirable concept that has become very useful since Freud introduced it. Splitting is a process in which the ego is altered as it attempts to defend itself; "one current in mental life" disavows another, both existing and acting as if independent of each other, i.e. split off. "On the one hand, with the help of certain mechanisms [the person] rejects reality and refuses to accept any prohibition; on the other hand, in the same breath he recognizes the danger of reality, takes over the fear of that danger as a pathological symptom and tries subsequently to divest himself of the fear. It must be confessed that this is a very ingenious solution of the

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difficulty. Both of the parties to the dispute obtain their share: the instinct is allowed to retain its satisfaction and proper respect is shown to reality. But everything has to be paid for in one way or another, and this success is achieved at the price of a rift in the ego which never heals but which increases as time goes on. The two contrary reactions to the conflict persist as the centre-point of a splitting of the ego."13 An analytic scholar might expect me, since I use the word in my title, to attempt a definitive review of this subject and then to arrange the case of Mrs. G around that review. This I have not done; it would have been only high-class hack work. I use "splitting" simply as a descriptive term to indicate a process Mrs. G constantly used to preserve her self, her identity, for instance by creating another personality. Similarly, I have not reviewed for the reader the extensive literature on the concept of "identity" or "self or acknowledged my debt to all who have contributed to that literature. I have simply tried to show how Mrs. G finally found her self when she recognized that the various parts of her that had been split off were false, and how she discovered a dependable conscience.14 Despite these qualifications and limitations, I have tried to accomplish a number of specific ends: report on progress in a study of the psychological origins of masculinity and femininity; examine the problem of reporting data in clinical research; upgrade the value of the single case studied in depth; open analytic theory up so that social learning theories and research can enter our understanding of infant development; amplify object relations theory (minus "death instinct," "psychic energy," and a libidinal zone fixation theory of neurosis), especially by emphasizing the power of parental fantasies in creating personality structure in children; study issues in the causes and treatment of splitting, such as female homosexuality, multiple personality, and hysterical psychosis; and shed some light on roots of evil.

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1 The First Interview

The patient is, as we say in the medical trade, a white, divorced housewife in her thirties, living in a suburb of Los Angeles with two teen-age sons. Mrs. G and I first met fourteen years ago. With a colleague, Dr. Robert Geertsma, I had gone to the County Hospital to film a couple of interviews with typical psychiatric patients, to use for final examinations testing medical students' skills in clinical evaluation. A list had been prepared of several patients articulate enough and showing their psychopathology clearly enough to serve our purpose. Mrs. G was among them. I spoke to her briefly to get her permission for the interview, and my heart sank: her name had been included in a list of typical paranoid schizophrenics, which she just wasn't. She was interested in talking with me, obviously enjoyed meeting somebody new, showed no disturbances in affect or thought processes, revealed no hallucinations or delusions, but rather was able to deal with me warmly. Schizophrenics do not meet me for the first time in such a fashion. In attempting to dispel my puzzlement about why she was on a locked ward, she spoke of her powerfully antisocial tendencies, for which she felt no guilt; although she understood the consequences of her acts, she was unconcerned. Within a few minutes I was again at ease regarding the filming; for although this was no typical schizophrenic, I had a textbook psychopath (antisocial personality). So we did a half-hour filmed interview, of which the following is an exact transcript: DR. S: How are you feeling? MRS. G: Fine. S: Nervous? G: Uhhuh. S: I think that's understandable. How long have you been here in the hospital? 1

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G: Three days. S: What brought you here? G: I ran away from Q State Hospital; I was still sick, and so I came back here by myself. S: You came here by yourself? Why did you come here? G: Because this was the only place I knew to come to for help. S: For help with what? G: With my problems. S: Can you tell us what they are? G: Just an inability to get along with people and my family, and I can't take care of myself. S: How old are you? G: Twenty-one. S: Who is your family—who are the members of it? G: My mother, and I have three brothers and a sister; I have a husband and two children. S: Are you all living together? Are you all living separate? What's the situation? G: Presently? S: Uhhuh. G: My husband has gone back to his family, and I was living with my mother and my two children and a sister and two brothers. S: That's quite a household. G: Mm, mm. S: How long were you married? G: I got married in July. S: Of this year? G: Yes. S: And you say your husband has left. Why was that? G: I don't know; I haven't seen him. S: Did he say anything to you? G: He left while I was in Q. S: How long were you in Q? G: Two and a half months. S: He left without warning? G: Yes. S: How did you feel about that? G: I don't know; I didn't feel anything in particular. S: Oh. Were you close to him? G: Not especially. S: How long had you known him before you married him? G: About three years.

THE FIRST INTERVIEW

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So it was nothing impulsive that you married him—or was it? Yes, it was. It was? How come? Why was it impulsive, or why did I marry him? Why did you marry him? Because I needed a father for my children. They were not his children? No. You say you have two children? Yes. Have you had any other pregnancies besides those two? Yes. How many? Four. And what's happened to those children? 1 lost three; two were stillborn, and one died after birth; and I had a single birth that was adopted out, and I had a set of twins that were adopted out. That's more than four. Then I made a mistake. I guess so. And which are the ones that are home with you now? They are three and four, if you want their ages. Who's taking care of them? My mother. How do you feel about that? I don't have much choice. How do you feel about that? I don't know. I'm sure you do. I wish it wasn't necessary. How do you get along with your mother? Fine when I am not home. By that you mean that you get along fine when you are not with her, but not so good when you're with her. That's right. What happens when you are with her? We just don't get along well. What happens? Well, we argue and—I don't know; I just don't appreciate her, and she doesn't appreciate me. Uh huh. Was this your first marriage last July? No, I was married once before for a short period.

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For how long a time? I don't remember. You puzzle me a little. Why is that you don't remember? Probably because I don't want to. How old were you when you got married, the first time? Sixteen. Did it last more than a year or less than a year, or just a few months, or even less than that? I think it was a matter of days. I see. How did you happen to get into that? I don't know; I just met him one day and married him that afternoon. That's pretty fast. How fast was the second one? You said it was impulsive. Well, in about three weeks'time. How has your mother felt about the children that you have? I never asked her. How docs she feel now? I don't know. I'm sure you could guess. Well, I imagine she is a little disgusted; practically everything I do seems to be a little beyond her understanding. It's always been that way? It seems to be. How did you feel about these pregnancies?

[Pause]

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I knew what I was doing; I know where babies come from. How did you feel while you were pregnant? Fine, very well. By that do you mean you felt better than usual, or the same as usual? . . . Better than usual? Healthy, happy, no problems. Is that the best you feel, when you are pregnant? Either pregnant or locked up. I feel fine here. Do you like to be locked up? Uhhuh. Do you feel better when you are locked up? Uhhuh. How do you account for that? You mean, why do I feel better? I don't know; I haven't any idea. Have you ever thought about it? No.

THE FIRST INTERVIEW

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S: Really? G: I just don't understand it. S: Well, it does seem puzzling, doesn't it, that at the times when you are locked up you feel better? Most people aren't that way, are they? G: No, I don't think so. S: So you feel good being here in the hospital? G: Uhhuh. S: Better than before? And you say you even came into the hospital because you wanted to be, I assume, locked up. G: This is the third time I am in here. S: In this hospital? G: Uhhuh. S: Have you been in other hospitals? G: County hospitals? S: No. G: Mental institutions? S: Yes. G: Yes. S: Could you tell me about that? G: I was in R State Hospital when I was nineteen. I was there for ten months. S: Why were you there? G: Because I had been committed. S: Why were you committed? [Pause] G: Well, I suppose I was mentally ill. [Smiles] S: What do you mean? G: My mother seemed to feel that I was mentally ill. So she had me committed. S: Are you sore at her for it? G: No. S: Glad she did it? Neutral? G: It doesn't really make any difference. S: Why did she think you were mentally ill? G: I don't know; I never asked her. S: I would guess your relationship isn't too good if you don't even ask her. G: No, it isn't. S: Did you feel that you were mentally ill when they committed you? [Pause] G: I don't know; they had been saying that since I was real small. So it wasn't unusual.

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They were kind of used to it. Who is "they"? My family. And in particular? People in particular. No, I mean: Who in particular in your family? I don't know: My mother, now that my sister is a little older, my sister and my brother, my grandparents. I lived with them for a while, when I was fourteen or fifteen years old, fifteen or sixteen, I am not quite sure. They seemed to think so. And when I was in juvenile hall they seemed to think so because the clerk released me in the custody of my parents only on the condition that I receive immediate and continuous psychiatric attention. And what happened? Did you? For a while. How old were you then? Fifteen. Have you been in juvenile hall . . . since then, or was that the only time? I was in juvenile hall three times, I think. For what? Well, the first time there were four of us; we swiped a car and ran away to Arizona. And then they sent me to a girls' school, and I ran away from there five or six times, and every time I ran away I had to spend more time in juvenile hall before I was sent back. How old were you the first time? Fifteen. And what were the other occasions for your going to juvenile hall? Because I refused to go to school. What was the matter with school? I just don't like it. How were you doing? In some things I did fairly well; in other things I didn't do so well. It just depended on how I felt. Could you have done better, or were you doing as well as you were capable? I suppose I could have done better if I had applied myself. Have you any idea what prevented you from that? No. In addition to the three times in juvenile hall, have you been arrested on other occasions? Yes. Could you tell me about that.

THE FIRST INTERVIEW

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G: I was arrested once a couple of years ago for writing bad checks. I was eighteen. They didn't keep me; they gave me a year's probation. I got arrested after writing bad checks, and they gave me ten days; and I got 110 days for receiving seven traffic violations in one month, and then once for possession of narcotics. They didn't keep me that time either. And that's all. S: What narcotics? G: We had—they aren't really narcotics—marijuana and amphetamine. S: Were you ever hooked? G: On what? S: Amphetamine. G: Yes. S: How old were you then? G: It was this year. S: Is that the first time? G: No—first when I was seventeen. S: How long were you hooked when you were seventeen? G: For three months. S: And then what happened? G: Do you mean why did I kick? S: Yes. G: Well, I was sent to Sacramento. S: By whom? G: My family. I was going to a hospital; I was going to SGH because my father was going away. He had me see a doctor up there who is a psychiatrist there. They had me confined so I could kick. S: Did you want to kick? G: Not especially. S: But you were told to? G: Yes. S: Your father? G: No, the doctor. S: How did he know about it? G: Because he was my psychiatrist and we discussed it. S: Did you have any trouble kicking it? G: Well, I suppose I had the usual withdrawal period. S: Then what happened during that period? G: I couldn't eat; I got delusional and I was hearing voices. S: What do you mean, you were delusional? G: I could see things. S: What did you see? G: Mostly people.

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Would you describe what you saw, as well as you can remember it? I can remember this time better, when I kicked here. You were in this hospital when you kicked the second time? Yes. And what happened? They put me in a room on a bed, and it seemed that there were people in the room. They came in the windows and through the ceiling and around the bed. I couldn't see them, but I thought I could see the movement they were making. I could see smoke all over the place. It bothered me, impaired my breathing a little bit. That's all. Did you see the people at any time, or just the movement? Just the movement. Aside from the smoke, was there anything else that you saw clearly? Bugs, animals? The first time I kicked 1 saw bugs, snakes; but not this time. What did the snakes look like? I couldn't see the end of them; they were long. They were long. . . . And what about the end? Was it cut off? It was coming through the wall. I see; you couldn't see the end because part was still in the wall. It was funny to me. Did you know that they were hallucinations, or did you feel they were real? I don't know; I suppose at the time I must have felt they were real. But they didn't frighten you? No. But you really did see them? Yes. When was that? I was seventeen. And when was the most recent time? In May, I think it was. I have a little trouble with the recent dates since I had the shock treatment. When did you have the shock treatment? I had my last one Friday, last Friday. And it was after that that you left the hospital—you ran away. The following Sunday. How many shock treatments had they given you? I am not sure; between ten and fifteen. And why did they give them to you? Because I asked for them.

THE FIRST INTERVIEW

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And why did you ask for them? Because I didn't seem to be accomplishing anything. What do you mean? The reason I signed myself into the hospital was for help, to straighten out my way of thinking and reactions, etc.; and I didn't seem to be getting any better and so—I had a slight understanding of the shock treatment. I thought possibly that would do it. Did it? 1 don't think so. Did it make any difference? I think that's a little hard to say because, from my understanding of shock treatment, the purpose of them is to change the brain wave pattern; and after you have completed your shock treatment period, then you should receive intensive psychotherapy. I of course didn't get any therapy because I didn't stay there. It seems I have to be on the go all the time, either walking or I have to move around or something. Is that something that's usually present with you, or is it just while you were there? Something that's usual. Whether you are in the hospital or out? That's right. Were you glad to be discharged at that time, after the ten months, or were you sorry to be discharged? In a way 1 was sorry because I just, like I said, didn't mind being confined; I would rather be confined than be at home; but I was a little glad, too, because since I did not seem to make any improvement or any great change while I was there, maybe I needed the opportunity to go somewhere else. When you talk about home you never mention your father.

[Pause]

G: Because he has never been there. S: What is the situation? G: He is in the army, and he's always been gone. They are divorced; and when they were married, he was never there anyway. He is a pretty nice guy . . . I guess. He is an alcoholic. My mother says he's crazy too, and I am just like him. S: Are you? G: I wouldn't know. I don't know him that well. S: I wonder if you don't have some feelings about that besides that you don't know. G: About my father or the comparison with him?

10 SPLITTING S: Feelings about the comparison that you are like him. G: Well, it used to bother me a whole lot because my mother would go around calling me different names, saying he was a skunk, and he did this and did that, and you are exactly like him; and it made me feel a little bit bad, but it didn't bother me for very long. S: How long ago did they get divorced? G: It was when I was in reform school. S: How old were you then? G: Fifteen. S: How did you feel about their getting divorced? G: It didn't bother me. S: Did it please you? G: Uhhuh. S: Why? G: Because if she didn't like him, she didn't deserve to have him. S: You feel that she was the one who was more deprived by the divorce? G: I don't know; I haven't thought much about it. S: You say she didn't deserve to have him. G: He may have been a little irresponsible, but he wasn't bad. S: Do you look like him? G: Uhhuh. S: Do you wear your hair like him? G: I don't think so. I don't know. S: How often do you see him? G: I have seen him maybe only twice in the last four years. S: Do you miss him? G: No, I don't miss anybody. S: I don't believe you. G: That's because I am a liar. S: No, I don't mean that you are a liar; but I don't believe you anyway. G: I miss my children; I really do. I have some fine boys. [Long pause] S: What's the matter? G: I'm thinking about my father. S: What were you thinking? G: You asked me if I looked like him. That bothers my mother a great deal. I don't think she appreciates the fact that I look like him and act like him because I don't think she likes me very well; I think she holds me as a constant reminder of him. S: Has it always been that way?

THE FIRST INTERVIEW

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It seems to be. Since you were a little girl? Yes. Do you mind if 1 smoke? No. Go ahead. You have mentioned a number of difficulties that you have been in, the times you have been in juvenile hall, the addiction to amphetamine, taking marijuana, trouble with school. Are there other things that have happened to you of this sort that you haven't mentioned? G: Well, I am not sure I understand what you mean. S: Have you been in any other difficulties? With the law, with society? G: I don't know—I don't—I—you must be meaning something specific. S. No, I'm not. [Pause] G: Having illegitimate children all the time is a little bit against society's standards. S: How has your health been? G: Fine. S: You have had no serious illnesses? G: No. S: How is your appetite? G: Good. S: Good now and good in the past? G: It's always been good. S: How has the food been in the hospital? G: AtQ? S: Here. G: The food here is good. S: How was it at Q? G: It stinks; it's terrible; it really is ... Here the film runs out; the interview is officially over. One purpose of this study is to discover what Mrs. G was really talking about in this interview. It has taken fourteen years to find out! A few words about the patient's appearance: she looked like a boy. Her hair was cut as a young man's (in those days, at least, before long hair was popular with males). All her movements were boyish: the way she sat in the chair, moved, lit up and smoked a cigarette. However, her appearance was not exaggeratedly masculine or tough; it was appropriate for a young man, inappropriate only in that one knew this was a woman being interviewed. As to her mood: she was quiet, interested, obviously comprehending, in contact, thoughtful, enjoying being interviewed, but not ex-

12 SPLITTING hibitionistic. At times she was pensive, a bit wistful; at others, amused. I felt that the most important clues to her feelings came in the moments when her eyes fell into sadness and when there was a very long pause following her saying she had fine boys, during which time she seemed in a poignant reverie. I returned with the patient to the ward and was saying good-bye when she asked if she could be transferred to UCLA Hospital for treatment; she feared the path from the county hospital would lead back to the hospital from which she had run away and to the unavailing experiences she had had in the past with state hospitals. Intrigued by the flickers of sadness that had crossed her eyes during the interview, and being at the time Chief of the Inpalient Psychiatric Service at UCLA, I told her it would be arranged. My main reason, I must confess, was less one of humaneness than the thought that she was an interesting and unusual patient of the son not seen at that time on our Inpatient Service and that it would be helpful for the residents to work with such a patient. And so Mrs. G went across town to UCLA, for the first of the twelve psychiatric hospitalizations she was to have with us during a period of twelve years. She has had, all told, twenty-one psychiatric hospitalizations. In the extracts from treatment sessions that follow, the quotations from the transcripts are in chronological order—that is, within each chapter, there is no going forward and back. Although the time span between quotations may be a day or a year, the movement is always forward, from as far back as seven or eight years ago, toward the present.

2 Mrs. G's Penis S: As far as you know, no woman has a penis. G: Yes. S: You are not, then, a woman in the same way as other women, or are you? G: Of course I am. I feel I have more advantages than most women because . . . I don't know. When a man ... a man who has a penis is a strong and capable individual, and a woman has a different kind of strength and a different kind of capabilities; but I have both. A man always has an advantage because he works and he supports himself, and most women aren't capable of doing that; so if a man chooses a woman to be his wife, then he has the advantage because he can take care of her where she may not be able to take care of herself. Being feminine means you're vulnerable to males. I'm feminine enough to be a mother and a housewife, and I don't know that I really need any more than that. S: What would happen to you if you lost your penis? G: Then I wouldn't be anything. My penis is what I am. S: And if your penis disappears?... G: It's not going to. S: . . . If your penis disappears, then you'd be empty, and in order not to be empty, you must keep it. G: Or be pregnant. S: Or be pregnant. How do you keep it? G: I don't understand what you mean. It's right here S: Look, physically, biologically, according to a doctor's examination, there's no penis. Right? G: I don't know that I've ever been examined that closely. S: Do you seriously believe that your penis exists anatomically inside there? Or do you mean that it exists because you feel it and psychologically it's necessary? G: That's sort of a weird question because I do feel it, and it has to be there S: Suppose you feel a penis? 13

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G: Doesn't that prove it's here? S: Like hearing a voice, does that prove the person was there? G: And if the voice wasn't real, so the penis isn't real? But you don't know that it's not real. Because you've never examined me. You don't believe. I have a penis? S: No. G: Well, I think I just haven't made it clear enough to you so you can understand it. I just feel it in here. S: No, no, no. If I ask you about what's your tongue like in your mouth or some other object that you can feel inside, you can say more than "I just feel it." How big is it; what's the consistency, hard or soft; what does it do; does it itch? G: I feel this inside of me, and it's hard and it's average size—whatever that is. S: Is it erect? G: Yeah. S: Always? G: Yeah. S: Does it come when you have intercourse? G: Yeah. S: Inside? G: Yeah. S: You actually feel it? G: Yeah. S: Does it ejaculate? G: Yeah. S: Do you feel that? G: Yeah. S: You've got to make that clearer for me. G: How can I make that any more clear? S: Can you understand that I wouldn't understand? G: When I have a relationship with a woman, it comes and I ejaculate and I feel it. I told you that before, and you weren't so astounded. S: I'm astounded now. . . . I'm not astounded, but I'm trying to understand it. I am also trying to understand how much you believe in this. G: I don't have to believe it. It's real. S: Why does that penis stay erect after you ejaculate? G: I don't know. S: It never goes down. Have you ever known a penis that never went down? That's better than any man. Do you believe that you could give a woman a baby?

MRS. G'S PENIS

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No. Why not? Because I'm a female. But you're a female with a penis that ejaculates. Why can't your penis that ejaculates make a woman pregnant? Because I'm a female. Not good enough. If you're a female, you can't even have a penis. I don't want to make anybody pregnant. I never have put it into anybody. How can I put it into anybody when it's inside of me? Why should you want to take it away from me? I'm happy the way I am. You never bothered me before Nothing bothered you. Listen, you used to drive your goddamned motorcycle 70 miles an hour through fences; that didn't bother you either. Nothing bothered you. What in the hell—you name me one goddamned thing in your whole life that bothered you up until you began talking with me. Nothing bothered you. You were crazy as a hoot owl—that amnesia, practically killing people, a really homicidal woman and a suicidal woman, hallucinating, delusional—you couldn't have been sicker, but it didn't bother you. I grant it didn't bother you—big deal, it didn't bother you. Why worry about this one little thing? It's not hurting anybody. I'm not hurting anybody with it. And it's not hurting me. It's not a delusion. It's inside of me. This is something I've always known, and I've always felt; and it's there, and it's real, and it's mine; and you can't take it away from me, and neither can anybody else, so you might as well kiss my ass. Does this penis ever show up in your daydreams? How can it show up when it's really there? What are you talking about? You make it sound like it's a dream. Have you ever had sexual daydreams in which you had a penis like a man? No. What's the matter? Nothing. Don't say "nothing" to me. You're just bugging me, that's all. I've told you all there is to know. [Shouting] I have this. I have it and I use it and I love it and I want it and I intend to keep it, and there's nothing you can do about it. It's mine. It makes me what I am.

S: Have you ever dreamed you have a penis? At night? G: These questions are ridiculous. Why should I daydream or even

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dream about it when I know it's there? Why should I dream about something that's a reality! G: When I had my children, I was excited because I had done something a man couldn't do, that even though I had a penis, I could give birth. Can't you see the difference? Just like I had really accomplished something, like I had really created something all by myself. I didn't need anybody and . . . I didn't want anybody—it was just something I had done alone. I always forgot that it took two to make a baby. S: Did it grow as you grew over the years, or has it always been the same size? G: Of course it grew. How could it always be the same size? S: Look, if you're talking about magic, anything can happen with magic. G: I'm not talking about magic. Naturally it grew if I wasn't always a big girl. G: I need it because it makes me strong. Most women are weak and timid and scared. I need it when I go to bed with a man. S: What for? You make it sound like it's a duel between two swordsmen. G: It is ... or I'll just be another woman. S: You confuse me because some months ago when you were talking about this you said you didn't feel the penis when a man was making love to you but only ... G: I don't, but I have it. I don't mean that I feel like I'm having intercourse with it when I'm having relations with a man. S: With a woman you feel like you're having intercourse with it? G: Yes. S: When you masturbate, do you have a penis? [Shakes head yes] Do you masturbate the penis? How? G: With my hand. It's just there. I don't understand what you mean. S: Where's the penis? G: It's in my vagina. What I mean is, I still rub my clitoris, but I feel my penis. S: Is it inside in your vagina, or in your pelvis? G: It depends on whether I'm having intercourse or I'm with a woman or I masturbate. If I masturbate, it's inside my vagina. During intercourse with a man, it's not in the vagina, but in my pelvic area. I think it's only in my vagina when I masturbate.

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S: How about when you're with a woman? G: Then it's outside. S: And fills up the whole vagina? Right to where it would stick out, but it doesn't stick out? Have you ever put a finger in to feel if it's there? G: I don't want to. If you have a vagina, you have a hole; but if you have a penis, you don't have a hole. S: Why couldn't the vagina just turn into a penis? G: Because I know that's not possible. S: Oh boy! Everything else is! So the walls of the vagina are still there, right? Does your penis move into your vagina, or does it just . . . does it suddenly develop, or does it get an erection that makes it fill it up? Do you feel it fill it up, or is it one moment you've got a vagina and the next moment you've got a penis in a vagina? G: I don't really know. It must move in because I wouldn't just one minute have a vagina and the next minute have a penis. It must move in. I didn't even think about it. I don't want to think about it. I can't think about it. S: I'm asking you to. What's there? G: Nothing. S: Right. Where did it go? G: I don't know. I'm not thinking of anything. S: Well, start whenever you're ready. G: Why do you want to do that? S: Because I want you to be normal. G: What does it hurt? It doesn't hurt anybody. S: Yes, it does. G: No, it doesn't. S: Yes, it does. It prevents you from being a woman. G: No, it doesn't. I can screw a man just the same as any other woman. S: That's not all it takes to be a woman. And you don't screw a man like any other woman. You screw a man with a penis hidden up in your pelvis. Look, I don't think you're a freak, and I don't want you to think you're a freak, because any woman who has got a penis, in your book, is a freak—even if you don't tell yourself you are. You know damn well that you would be different from every other woman in the world. Well—you always told yourself—that's marvelous. I'd rather you be a completely normal female because I think you would also. You just never dared to be one because that would mean, according to you, that you'd be weak and vulnerable. G: Do you want me to be like my mother? S: No, I want you to be like what you could be. Too much for you? G: I don't know. I don't understand . . . I don't understand why I have

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to give up something that protects me. I was just trying to imagine what it would be like, and I can't do that. I'm sitting here thinking about i t . . . dozens of times of having intercourse, and I don't know what I felt. I had an orgasm. I felt it in my belly; I don't know if I ever felt it in my vagina. I don't know. The only time I ever remember feeling my vagina is when I give birth to a baby. When I'm sitting here thinking about having intercourse, I think about the penis. I don't think about a man putting his prick in my vagina. I think about having a penis, and I try to ... I'm sitting here thinking about the last time I went to bed with Bill [husband] or anybody, and I visualize being in bed with somebody. I do not feel my vagina. I don't think about that. All men move their penises when they're having intercourse. I know it because that man is moving. The next session Mrs. G told of a psychotic episode she had had after the last hour. G: It started Friday. It must have started when I had intercourse. S: Who was it? G: Oh, just somebody. Just some guy that's been hanging around. I wanted to have intercourse with him. Because I wanted to see what happened to the penis. So I went with him, and it was like an experiment [to test what we had talked about the last hour]. So I went to bed with him, and we had intercourse, and I got scared—I thought he was killing me, because I felt his penis in me, and I felt like I was going to choke to death or he was stabbing me or something—I don't know what, but it scared me. When he first put his penis in me, it felt like a hot wire going inside me. S: Did you touch his penis? G: No. Because I thought maybe it wouldn't be there. When I put my hand inside of me and mine wasn't there I thought maybe if I touched him, his wouldn't be there either. [Just before intercourse] I put my hand inside of myself. S: What did you feel? G: Nothing. No penis. It scared me. I knew it wasn't there. I probably won't be able to have intercourse again. Don't laugh at me! S: I'm laughing at you because you know you will. G: Not if it was like the last time. S: At the moment that you put your finger in, you thought he wouldn't have a penis? G: I guess I thought that was possible. I thought maybe his would disappear. When I touched me, mine disappeared. If I make one disappear, why couldn't I make another one?

MRS. G'S PENIS

S: G: S: G:

S: G: S: G: S: G: S: G: S: G: S: G: S: G: S: G:

S: G: S: G:

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Does that make sense to you now? No. Would you have wanted to make it disappear? His? Yeah. I've thought about it coming off inside of me. I can't give you more than that. I know that having had intercourse, I've thought about it coming off inside of me. I've thought of it several times. I just imagined him getting off of me and his penis still being inside of me. How did you get a penis in there? None of your business. What difference does it make how I got it? I just got it. I was born with it. I always had it. As long as I can remember. Or did you steal it? No, I didn't steal it. What is a penis? It's nothing anyway. [Laughs] Oh, yeah, wait until you get to telling me what happened when he put his penis in you. O.K. Now tell me. That's because I was sick. What was the matter? You had female trouble? [Sarcasm] Yeah. You're a little delicate flower? What do you mean, you were sick? My head was sick [i.e., psychotic]. If my head wasn't sick, it wouldn't have felt like he was killing me. When did you get sick? When he put his penis in me. Instantly? Yes. His penis made your head sick. You're nothing but a lousy, old, nogood, weak female; and his penis is big and powerful and it's everything in the world, and you're just shit. How's that? Well, that's not true. A penis is nothing. What's it good for except to shoot sperm into somebody to make them have a baby? And I can't have a baby [as we shall see later, she had been sterilized some years before], so it's no good to me. That wasn't a good try. You can do better than that. [Laughs] That's the best I can do today. Then you have been really wrecked by that penis. Christ! You can do better than that when you're crazy. . . . O.K. So he puts it into you, and you get sick. Now what else happens to you? I told him there was something wrong with my lungs and I couldn't breathe. Because I wanted him to get up. To get out of me. It hurt. It was terrible. I thought he was killing me. It was just like you took a sharp stick and ran it all the way up inside of me. I could feel it

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clear up in my throat. Starting from the entrance of my vagina all the way inside of me. I could feel it come all the way up. Burning hot. S: You sound like one of the saints of the Church. [Mrs. G was originally a Catholic.] It felt like it was burning hot, or it was burning hot? G: It was burning hot. If I had had my penis, that wouldn't have happened. S: Right! Absolutely. G: So you did that to me. S: Right. Thank you. Christ, I worked hard enough. [Several years of treatment precede this moment.] G: Well, thanks a lot. S: Yes. G: I came near dying, and you're pleased. S: Does that mean that the penis has gone? G: Yes. It just won't come back. You made it look ridiculous, that's what you did. How can I keep something that looks ridiculous? S: Are you relieved? G: I knew it wasn't right to begin with. I guess I always knew it wasn't right. It was something I never wanted anybody to know; and if I thought it was all right, then I would have been proud of it. I needed it. I don't know why you can't understand that, but I needed it. Do you know how many men have screwed me since I was six years old? It's been a lot. I had to have them screw me. I'm thinking about a time when I was six or seven years old and there was a guy. He didn't screw me though; he just fondled me, but I went back. See, if it hadn't been me, I wouldn't have gone near him again; but I went back. Why would I do that? S: I wonder whether you didn't need a real penis. What was the matter with what you had [without adding on a penis]? G: I think because what I had was really nothing. S: When you were four or five you strapped on something. Was it a milk bottle? [She had told me of this years before.] G: Yeah, a baby bottle [nipple]. S: You wanted a penis. G: Yes. S: Did you know that then? G: No. S: You know what happened to you the other night? You lost your virginity. G: My virginity, Jesus Christ! I'm going to have to be careful now. Because I don't have the protection I had before.

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S: I'll say to you what I've said before: Did it ever occur to you that woman can be strong? But not masculine-strong. G: My mother was talking about all the times my father left her with five kids, and she had to go out and earn a living and buy clothes and provide food and be strong in herself because she didn't have a man. We had a long talk about a lot of things. She was telling me that six months ago she couldn't talk to me, that six months ago she was afraid to talk to me for fear that I would go out of my head. She said she's not afraid of me any more. [This is twelve years after I first met Mrs. G.] Mrs. G's penis was invented when she was about four years old. From then on, it was present always as an erect organ the size of an "average man's," usually in the lower abdomen, except in circumstances to be described. As we shall see, it was created at the same time as her hallucinated companion, Charlie, who also served to protect her. Her penis was literally a defensive weapon to be used in dangerous interpersonal situations. When Mrs. G had to talk to a woman in authority who could stir feelings of fear and inadequacy, she would feel the penis fully, which saved her from the painful affects she would otherwise have felt. This was one reason why for years she told me—and demonstrated—that she never felt anxiety or related sensations. As we just saw, Mrs. G also unsheathed her penis to keep her from danger in sexual relations. When she had intercourse with a man, her penis changed from being silent to being intensely felt, on the alert, in her pelvis. With masturbation, it moved into her vagina; and with intercourse with a woman, it protruded as a man's does. She never tested if this was true by putting her hand to her genitals until, seeming to take everything she said literally, I pressed her to such an experimental act with my concrete questioning, which I used to force reality upon her and to attempt to interrupt the hallucinatory process. In her sexual relationships with women, her penis protected her from a fear we shall be repeatedly encountering: a fear that she would be labeled a homosexual. Despite the penis, Mrs. G never thought of herself as a male— only as a female with a penis. (Her penis was never a procreative organ; that would have made her a male.) This made her better than any other female. When we look later at her mother, we shall see that it was no coincidence that she felt that being a woman with a

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penis restored her to value in her mother's eyes while avoiding those qualities she felt her mother found unacceptable—homosexuality and not being male. And so Mrs. G lived out in the real world the oftenencountered, unconscious and conscious fantasy in women of having a penis.1 But she differed from such women in that her conscious experience was that she was unquestionably a female, but a female with a penis, a complete female with an additional, precise piece of maleness, which, however, did not make her a male. (She wished she had been born a man, but never thought she was, or would become, one.) These convictions "solved" problems in dealing with her parents that she could not have dealt with by other variations on the theme of bisexuality. Many women at times imagine they are men; there are those who even picture themselves with a penis. For some, this is a conscious daydream; for others, it appears only in dreams. Unfortunately, writers on the subject do not try to indicate the strength of the wish or the form it takes: it is as if all fantasied penises were created equal. But they are not, and the differences point to marked differences in gender identity disorder. For instance, believing one is a member of the opposite sex (transsexualism) is far removed from the transsexual feelings nontranssexuals may have. Here is a dream, of a sort familiar to all analysts, of a very nontranssexual housewife: There was a man and I; we went together. We were in a room. It kept building up—our having sex. Then I turned into a man and I was with another woman, but my feelings were that girl's feelings. She really wanted that man. I as a man tried to kiss her and laid my cheek against hers. It was horrible. It was uncomfortable and wrong. I was watching those two people, and I was both the man and the woman.

Even without associations, one can immediately sense the difference between this patient and Mrs. G. Greenacre2 has written: "However strong the masculine identification may be in conscious or unconscious fantasy, still there is a reality knowledge supported by body image from reality sensations which does not permit the girl to abandon completely her feminine identification (except in those rare and extreme states of psychotic development where fantasy takes over)." To this I would only add that conscious fantasy and hallucination are very similar and very different. An illusory penis (or "the fantasy of an

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illusory penis" [Kestenberg3], which makes it even more ethereal) serves many of the same defensive purposes in the average woman as Mrs. G's penis did, but the woman who wishes she had a penis and knows she does not functions differently in the real world. Because being a mother was "good" in her mother's opinion, Mrs. G tried to be pregnant as much as possible, filling the years from thirteen to twenty with pregnancy. When she was pregnant, the penis disappeared. She distinguished that sensation from the day-to-day experience of not noticing it but knowing it was there much the same as we all preconsciously notice and do not notice the greater part of our sensate body. Her penis would disappear as soon as she felt herself pregnant and never for a moment be manifest during the pregnancy, during labor and delivery, or during the period she was responsible for the infant's care following delivery. Once the infant had been relinquished, the penis returned. So, in Mrs. G's conscious awareness, we can distinguish three experiences: first, the penis as absent; second, the penis as present but not felt, or if one asked about it, then noticed, but "in its usual position"; and third, the penis in the forefront of consciousness and taking part in an interpersonal experience, such as sexual relations. These held true until her penis became involved in treatment. Then there were increasingly long periods when it was gone, as a reaction to a particular treatment experience. The first time this happened extensively was when Mrs. G was operated on to repair the tubal ligation that had sterilized her: postoperatively, her penis disappeared completely for weeks (p. 71-72). In the year or so before this was written, she was accustomed to the penis's being gone much of the time, but not surprised when it returned. Mrs. G's penis has an interesting quality with respect to psychotic mechanisms in identity development: a delusion fitted early enough into the construction of one's identity may be as automatized, accepted, unnoticed, and "neutralized" as, say, a body part like an arm or a belief like "I am a girl." Mrs. G created her penis to make herself acceptable to her mother. Later, she also used it defensively to protect herself against anxiety precipitated by others. It was, then, a hallucination protected (rationalized) by a delusional system. That part is easy enough; it fulfills the criteria for a psychotic mechanism. However, this penis was created very early; and, although it was the result of conflict, it was more stable than a symptom. Rather, it

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was almost as solid as a part of (nonpsychotic) character structure, to be used as an essential part of body ego much as were her nonhallucinated parts. We know how resistant to treatment are psychotic character structures seen in people psychotic since childhood. Mrs. G's penis did not change according to the degree of psychic distress: I have often seen her grossly delusional, or in a fugue state without psychosis, in a panic, or suicidal, homicidal, sad, lonely, enraged, anxious, phobic—the whole wide range of pyschopathology that was hers to use—but none of these states had any more effect upon her penis than upon her right foot. Her penis was just a part of her body. Now let us return to our case history. Later on, we can see Mrs. G's masculinity from a different angle as we watch her struggle with the word "homosexual." [About a man1's penis] G: I think: That really is a beautiful thing. I really wish it was mine. And then I think: Jesus Christ, I hate that. I hate it for what it does to me. And then I think about wanting it and I think: God, that's really repulsive. What is there that makes me want it inside of me and makes me want to have one and ...? I just think a lot of things. A penis—that's a weird name. Whoever thought that up? When I think about a penis, I think about an erect penis. S: What do you think of an erect penis? G: It's a very healthy thing. A penis means strength. . . . What's a bigger word than strength? What's the biggest word you can think of that means strength? That's what an erect penis means to me. You know my mind doesn't... I look in the dictionary. I don't see a big enough word for that. And a nonerect penis . . . What does it look like? Nothing—just a piece of flesh—nothing. How can a man look masculine with a nonerect penis? It's funny-looking. It doesn't... it doesn't do a thing for me. A piece of wet spaghetti. A wilted flower. A penis is wrinkled. Have you ever seen a tomato worm? That's what a nonerect penis looks like, a tomato worm. I think all men should walk around in the nude with an erection. S: You did. Didn't you always have an erection? G: That was beautiful. It was made out of satin and firm, really firm, not like a rock, firm but giving when you touch it. Do you know what I mean? And good, it was a good penis; it wouldn't hurt anybody. S: Oh, no? G: It wouldn't hurt a woman. It was big enough that it filled me up,

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but it didn't choke me. If I had put it in my mouth, it wouldn't have blown my head off [as she felt a man's would]. S: You couldn't hurt a kitten, but you could murder a man. G: Well, that's different. An animal is pretty defenseless. A man can step on you, spit on you, stick his penis in your face. S: O.K. Question: You loved your father, and your father loved you. Then what in the devil is the reason that you hate men? G: I don't hate men. What has that got to do with my father? What about my oldest brother? He's a sadistic, mean, rotten bastard. He used to beat me up just for kicks. He used to tie me up because he knew how frightened I was to be tied up. He used to like to humiliate me. He's a Christian now. He's been saying that he found God; he loves everybody. He's beautiful. I hate his guts. There's somebody I'd love to kill. Well, that would be too simple. I'd like to really do something rotten to him.4 My father . . . I did love my father. But he was a bastard. He was as big a bastard as you are with his trips and wandering away. He didn't care. That's the difference between you and him—you care. He didn't care. I'm not scared of men. There's not a male alive that can hurt me except you. S: Not even with his penis? G: It won't hurt me. It just makes me angry. My brother had a big penis. He was a big man. I don't remember him when I was little. I just remember him from the time when I was about ten; and when I was ten, he was seventeen, almost eighteen; and he was a big man, really big. Do you know that son-of-a-bitch never wore clothes in the house? He walked around the house nude or with nothing but a pair of shorts on, and I couldn't hide from him because there was no place to hide. , G: There's a nurse on the ward that I'm very fond of, and I've always been very uncomfortable talking to her; and when I would talk to her and she would sit in my room and talk to me, I would notice that my penis was there. With the penis there, that makes it a healthier relationship. I can sit in my room with this nurse and know I'm not having homosexual feelings. I think she would be very appalled and very disgusted and everything else if she thought I were having homosexual feelings for her. I am what I am. I'm somebody who sometimes likes women and sometimes doesn't; who sometimes likes men and sometimes doesn't; and who sometimes gets confused about who I am and what I am and sometimes gets scared about who I am and what I am. That's why sometimes I have a penis and sometimes

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I don't. Is that O.K. with you? What do you want? You tell me what I can give you that will please you, and Til do that for you. O.K. I'd like you to be a normal female inside. O.K. A hundred percent of the time, day and night, awake and asleep, with girls and with men. Then how will I protect myself? How do other women protect themselves? I don't know. Well, do they protect themselves with a penis? No. Well, then, you just stop using a penis. What have you invented that makes penises different from what they really are? What's a penis? A penis is just a thing that gives life. It could give life or death. The orgasm is what gives life. I guess an orgasm . . . if an orgasm can blow the top of my head off, what can it do to my insides? If a man wanted to kill me with his orgasm, what could he do? He could blow me up. I sense that every time a man has an orgasm inside of me.

[Closer to the present] G: I would like to talk about the penis for a minute. It's different now. You know, it's . . . maybe the penis itself isn't different, but I'm different with it. I don't use it like a weapon as much. First of all, I don't screw anybody. I don't have any sex at all, not at all, and I haven't for months. And I don't miss it or anything. I don't have any interest in it. Oh, once in a while I think about it, but I'm not interested enough to make the effort to approach Bill or anybody else as far as that goes. [She soon recovered from this.] When I applied for this job, the woman who did the hiring was a very . . . a nice person, but very stern, and she was demanding, you know; I had to ask for the job, and I had to tell her what my qualifications were; and I suppose she's like anybody else who does hiring—I don't know, except that I was scared of her. And ordinarily that would have been the time when I would have needed the penis and would have, you know, told her to shove her job up her ass or something; but it didn't work out that way. And we talked very quietly and for a long time, and she told me, well, she just didn't have an opening, and she was sorry. But she told me that if she had an opening, I would be the first one she would consider. And it wasn't the penis doing that. I don't know if I'm making myself clear. I did that myself. / got the job. And this lady and I are friends now, you know. It's there, you

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know; it's in the same place, and it's the same thing that it's always been, but I'm not using it. Does that make sense to you? [This is the first job Mrs. G has ever held.] G: I was just thinking: It would be nice if I had something like other people had instead of a penis to use in the same way that other people use whatever it is they have. I don't know what it is they have, but I know it's not a penis.5 Mrs. G's penis went out in a blaze of glory: during an LSD psychosis (an experiment she undertook without my knowledge), she saw her penis extrude itself from her vagina, explode, and disappear— never to return. G: I'll tell you about the acid. First, I didn't plan on taking it. After the first time, I didn't think it would do anything anyway. And this little boy, who is about seventeen, eighteen years old, said, "I've got just the thing for you." And he put it in my mouth, and I swallowed it without even really thinking about what I was doing. And about two hours later I was just in another world. Everything was so bright— maybe that's why they call the stuff sunshine—and everybody was so beautiful, and I could see inside myself, and I could think about . . . oh, I could think about my kids and be honest about it to myself. I didn't do much . . . well, they said I kept repeating myself, but I don't remember talking very much. B u t . . . I don't know how to explain it. It was just something that was very exciting and . . . I found out I really don't have a penis. It just kind of blew up and exploded. I could see it and feel it and it just blew apart. I took the acid about 11:30 at night, and I was still hallucinating at six o'clock in the morning. And by that time I was getting to the point where I was tired of it. S: Was it different from your other hallucinatory experiences [spontaneous psychoses]? G: Yes. It was beautiful. There was nothing frightening about it. I was tired . . . I was tired of the experience, you know. I could look at certain things and see them changing shape and changing color and so forth; and I thought: I've had enough. So I laid down and I thought I was asleep, but I couldn't have been asleep . . . well, maybe I was . . . I don't know if I was asleep or not. Anyway, I saw myself as a little child with an enormous penis. Standing there in the room. S: How did you know it was yourself? G: Because I recognized me. S: Did it look like you when you were little?

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Yes. I didn't have any clothes on. I was probably five or six. And I had a big penis. Like a man's penis on a child. Erect. I thought: How horrifying! What am I going to do with it? How am I going to hide it? And I thought: What are people going to think when they see it? And then I went of! into something else. I don't even know what. It had to do with shapes. And then I looked inside of myself, inside my stomach, inside my guts, and I saw this penis; and it was the same one I had when I was a child, but now it was hidden, so I knew what to do with it: just leave it hidden. And then I thought: I can't do that because I'm a woman; I can't have a penis. And suddenly it started to grow, and it came outside of me, the woman lying on the couch; and then it just exploded and went away. And I got up and went into the bathroom and took my pants down because I thought I must be bleeding. But I wasn't.

3 Charlie

Charlie was invented when Mrs. G was about four. She originally knew him as "David," but this I did not learn until long after he had become familiar to me as "Charlie." He served as an imaginary companion, real far beyond the imagination of children who create such companions.1 Mrs. G sensed him as constant, ageless, and unchanging; yet he did change with treatment. As with many aspects of Mrs. G, editing the material makes our work seem more coherent than it was and foreshortens the stretches of time filled with my incomprehension. My treatment style being what it is, I doubt if the process of my understanding Mrs. G could have gone more quickly (though this is not to say that another therapist, with a different personality or greater skills, could not have moved the treatment along faster). Still, I feel rueful about the long periods when I was ignorant. Several turning points occurred at which I finally understood what Mrs. G had been saying for years. Then, understanding her freed the two of us to move to new insights. The business with Charlie was of this sort. My understanding of Mrs. G's psychosis evolved somewhat as follows: When I first met her, I thought she was a psychopath, but with a touch of anguish that suggested a more engaged personality. Then, watching from a distance while others treated her, I was dimly aware that her pain was less disguised and that her apparently guiltless antisocial behavior was diminishing; she began to seem more like a "character neurosis." Still later, when she no longer used impulsivity and denial of feelings as much as she had previously, thanks to the therapists working with her, she developed intermittent, short-lived, acute, nondeteriorating, psychotic episodes. I never questioned that she was psychotic during these episodes, and all other observers (and all too many colleagues have had a chance to know her) have agreed on this. However, for years my understanding of an outstanding feature of her 29

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psychosis was incorrect. She had auditory hallucinations the nature of which I had never bothered to learn. She would admit, if I asked her if she heard voices, "I guess so"; but if I asked, "Are you hallucinating?" she would say, "If that's what you want to call it." Only much later did 1 realize that she never admitted that her "voice" was a hallucination. Mrs. G finally forced me to understand: after having been corrected a few times, I learned that what I was calling auditory hallucinations —more accurately, what I would refer to as "voices"—were not "voices," but always the same voice. (She did sometimes have auditory hallucinations other than the voice, but they were not usually of people speaking clearly heard words.) Even when she told me it was always the same voice, I ignored what she said.- Having given up the presumption that she heard voices (plural), I still clung to the idea that she heard the voice only when disturbed. After that had been clarified, my understanding was still further delayed until I came to know that the voice could be heard at any time and that it was present as much during those periods when I considered Mrs. G, without question, to be not psychotic as when she was psychotic. The voice was independent of a state of disturbance, of her feeling "crazy," or of my recognizing her as clinically psychotic. As Mrs. G's trust deepened, she let me discover the foregoing about the voice. Then she spoke about its personality, its moods, desires, and style. Since I was interested, she told me more. I finally recognized that the "voices" were really one voice, which had been present for years, a person independent of her, but contained within her. The voice then cautiously told her it was all right to reveal some of its qualities to me, and I began treating the voice not as a "hallucination," but as a thing (person?) worth respecting as she did. She and it became sure I would not harm them. They knew this when I said I was not going to try to get rid of the voice (which to Mrs. G meant to kill it), an assertion that caused a wrenching shift inside of me. It ran against my grain to respect a hallucination, and I could not pretend to accept the voice as an independent being if I actually did not. It is easy enough to recognize a delusion or hallucination and to sympathize with the person possessed of it, and it is perhaps even easier to lie to psychotic patients and pretend to take their reality as one's own (that I do not do); but it is very hard, especially after teaching psychopathology to medical students and residents for almost

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twenty years, to accept a reality of the patient's inner world on somewhat the same terms that she does and still not suffer a folie d deux. I could do this only after letting myself know what I already knew: that the voice was real and had its own personality and lived independently of Mrs. G while still within her; that that was the way it was with her; and that if I liked her, I could also like the voice (when it wasn't obnoxious or murderous). I could then let her know it was no longer necessary to kill the voice, which, until then, had been my unspoken goal; for, as a competent psychiatrist, I measure remission of psychosis in part by the disappearance of hallucinations and delusions. As soon as I recognized that the being, the "person," the structure, the collection of functions—call it what you will—that was expressing itself through the voice was an essential element of the best state Mrs. G could achieve—wholeness—I could feel easier with her and myself. To kill the voice, I now recognized, would be, as she had kept telling me, to kill her. It was her conscience, her superego, her ego ideal, her moral code, her control mechanism, the parts of her ego that warned her about the realistic dangers in the external world and advised her how best to live within the restrictions that those dangers put upon behavior—all that is handled by the rest of us through conscience and reason. No wonder she was afraid of me when I tried to kill her voice, and no wonder things got better between us when I could see what now is obvious. Why "Charlie"? When all the above became clear, he felt safe enough to reveal himself and began to become an ally. At that point he congealed even more into a separate personality; and I hoped that by dissecting him free from Mrs. G, we could make out better who he was, and that eventually (my new goal) he would cease being a foreign body and become a part of her. At the moment of naming, Mrs. G was feeling affectionate toward one of the residents and was measuring her lack of fear of him (despite his being a male and a doctor in a white coat) by nicknaming him after a comic-strip character, Charlie Brown. So I named the voice "Charlie." She took to the name immediately, and that is what the voice was ever after. I used "Charlie" for the same reason she had used the name for the resident: I wanted to disarm him (Charlie) with amusement. Let us become acquainted with Charlie, the ultimate imaginary companion.

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S: Your giving me only one sentence is a way of making me tell you what to do, isn't it? You say a sentence and then I protect you by asking you what you should say next. Then you stop, and I drag you along another few feet with my next question, and then you stop; and it's just like taking a dog on a leash. I act for you as if I were your voice when you're in here, telling you w h a t . . . G: Well, maybe you are. S: Maybe. I've been your voice sometimes. G: Yeah. S: So would you please talk about the voice and let me sit and listen. That's another thing. It's very difficult for me to listen to you with all of me when I'm so damned busy dragging you around with my questions. I don't get a chance to really sink back in my seat and really take in all that you're trying to tell me, not just your words but the rest of it. G: Well, I don't know what to say about the voice. That's something I've always had, and sometimes it's better than other times and sometimes it's just silly. Like when my mother is talking to me and my voice says, "Don't answer her because you know it bugs her." My mother has a fit when she says something to me and I don't respond, and that's kind of silly because that's just inviting trouble. And sometimes it tells me how bad I am, and I don't need that either, because I already know how bad I am; and sometimes it tells me to do bad things, and I have to be careful because sometimes I don't know what's bad. Sometimes it's not there at all; sometimes it's there so much that I can't hear anything else, and that's confusing, especially when other people talk to me and I can't hear what they're saying; and sometimes that happens when I'm here. I can't listen to both of you, and sometimes I don't know who is more important to listen to. I don't want it to go away. S: Doesn't it make you nervous when I work against it then? G: Yes. S: It makes it nervous too. G: It scares me. Because if I got well and you were gone and the voice was gone, then what would I do? I wouldn't know what to do. S: You couldn't fall in love with someone? G: Fall in love with someone? [Astonished, confused] S: Are you in love with the voice? [Shakes head no] Has it ever acted like a completely separate person? G: I don't know what you mean. S: I mean, has it ever asked you the kinds of things that people in the outside world do? G: Uhhuh.

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S: For example? G: It might say, "Are you happy?" or "Are you lonely?" Things like that. S: Tell me more. I want to get to know it. Do you think that the voice would permit me in enough that I could get to know it? Why not? G: Because you want to destroy it. S: I'm not sure. That's the first time I've ever said anything like that. You know, I automatically, as a psychiatrist, I have to be against voices, and that's what I've always been; but you're making me think there's something different now for the first time. I'm not sure mat I have to destroy it. That's why this is the first time—I don't think you have realized it, and I don't think I have—I've really wanted to know about the voice. I've always wanted to know, but as a psychiatrist looking in, you know like doctors do—they open up your belly and they look in to see what's the matter. This time I'm not asking you that way. I'm asking to become acquainted with your voice, and I'm n o t . . . You see, it isn't the voice .. . Are you listening to me? . . . It isn't the voice that I'm against. I've been against the voice destroying you or having you destroy somebody else or terrifying you. I'm not against the voice itself. I'm against some of the things that it has wanted to do, but not against the voice. If the voice got to be as nice as you are, I wouldn't want to harm it in any way. I'm sorry—that really is rough, isn't it? You see, I like you. I don't like the voice when it does those things to you. Are you listening to me? Am I making sense? What do you make of what I've said? G: That you don't want to destroy the voice; and as long as it's kind to me, then you don't see any reason to prevent it to continue. S: Do you believe me when I say that? Or am I playing a trick? G: I don't know. S: I could be playing a trick, couldn't I? G: Yeah. S: It would be very cute. It's a possibility. G: Yeah. S: See, it is just absolutely against anything I've ever believed in to be for a voice. Voices have always been to me nothing but sickness. But if I get to know better what your voice really is, I am not sure that I.would take the same position. See—right now I'm just being theoretical—but it's possible that the voice is you; it's possible that you can feel the voice as you. That's what you started to tell me. It's possible that the voice is you in the same way as the voices that the rest of us have that we don't hear. Does that make any sense to you? Most people don't hallucinate. Will you grant me that? Most people

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nonetheless hear, let us say, the voice of their conscience. It's always called a voice even when it isn't anything that you hear. It's possible that your voice is like my voice, but I never hear my voice; I sense it. I don't think of it as something separate from myself. You talk about your voice as if it's almost another person. I think of my voice as a part of me; it's me; it's an aspect of me. It depends on what I need. Yeah, but your voice is too separated from the rest of you. You see, I would never think of trying to get rid of your voice . . . that part of it that's like my voice. Let me give you an example. I'm a kid. I'm playing baseball. A guy throws a strike. In an instant, I have to decide: Should I swing, or should I not swing? There's a "voice" within me, that is, a judgment. It has nothing to do with conscience; but I'm trying to give you the most dull, prosaic example of how all of us are getting advice from ourselves—even in such simple things as swinging at a strike or not. I am now myself here now. Should I or should I not speak? Should I answer a question or not? Should I say it this way, or should I say it that way? It happens automatically —it's not like an actor reading lines. There's also a quote "voice," but not a voice that I hear, but a matter of judgment that I must have or I wouldn't exist. But I don't hear it as another voice. O.K.? I don't want to destroy you. I don't want to destroy that part of you which is your judgment or your conscience. I would hope that the voice would stop making sounds or confusing you or frightening you or threatening you or getting you into trouble, but I don't want to destroy the voice. Because if I understand you right, then I would have to agree with you: to destroy the voice would be to destroy you. Am I correct? [Her silences are sometimes very difficult.] But I would wish that the voice would become you. Would you permit me to try and do that? That it would feel more comfortably like you. For example, it's a man's voice, isn't it? To me that sounds like there's something abnormal going on. My voice to me is a man's voice, but I'm a man. For you to have a man's voice, I think, in part is like your having a penis inside. Does that make sense? You see it? Yes. Why do you agree with me? Because it is so logical. That's what you have been telling me for the last six months. What? That you've got a voice inside that's like a man's voice, that's like your penis? I've never said that before. It sounds like that's what you've been saying. No. It's very similar, but it's somewhat different. All right, I've talked now. Please talk to me.

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G: You know when I say to you: "What am I going to be when I'm going to be well?" you always say, "Well, you're going to be a female . . ." and I don't know what else; and I can't believe that. I believe I'll be a female; but if you make me well, you're taking everything away from me. S: I wouldn't consider you well if I took everything away from you. That's not my idea of making you well. G: Now, I don't know when I got sick; but the voice and my behavior, such as it is, and my feelings and everything, I've had all my life; and if you take all those things away from me, then what am I going to be? It never bothered me—and you're going to laugh and say it's not true—it never bothered me, my feeling about other women. Maybe it scared me and I ran away and things like that, but I didn't have nightmares and things like . . . I wasn't aware of bad feelings a lot before you started bugging me about it. If I've survived that way, then why stop it? S: You couldn't have survived without it; you could not have survived without it. You can now survive without it, meaning: .in the same form that it used to be. G: How do you know that's true? How do you know that's true? S: Because you're in treatment. You could not have done it alone. I absolutely am convinced that you can survive—as long as you have this treatment—by going into the dangerous areas. G: Well, you better be sure, because I'm not. S: And you barely survived your way. G: But I did. S: Yeah, by being put in the hospital, by being given electroshock treatment, by having your tubes tied, by having illegitimate pregnancies, by holding up gas stations, by writing bad checks, by spending half your life in some kind of a prison situation, by never being able to love anybody—some survival! By suicidal attempts that have almost killed you on a few occasions and other semisuicidal attempts that you didn't feel to be suicide but—driving wildly is an example of it. By chronically hallucinating: not just your voice, but by seeing holes in the ground, blood on the floor, fog in the sky. Now, do you call that a great way to live? It's survival, but just barely. I really believe, honestly, and I think you do, too, that if I hadn't just by the dumbest of luck pulled you out of the hole that you were in ten years ago by just simply yanking you over to this hospital, you would not be alive today. I believe that. G: How do you know that I'm going to be alive next year? Before, I didn't know what fear was [Later]

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Aren't you afraid of my getting inside too much? I guess so. Isn't your voice afraid of that? Yes. You say you won't destroy me; but still, if you knew everything about me, you would be taking from me the things that have made it possible for me to survive. I might not take them. I'm getting less and less interested in taking them away from you. The more I understand, such as today, the less I have any interest in taking them away. I have wanted to take certain things away from you—you were right—and every time I said I did want to, I was wrong because I didn't know any better, because I was stupid, and you've taught me so . . . I don't want to take things away from you. . . . I'm still not sure if I'm telling you the truth; we'll have to see. You'll have to teach me. I've always thought that I just had to get rid of that voice of yours, but today for the first time I see it differently. I'm not sure that I care much whether the voice goes away or not. What I misunderstood was . . . I thought the voice was always evil, that the voice was going to kill you; and since I thought that, can you forgive me for having been so filled with hatred for the voice? Can you understand why I would hate the voice if it wanted to kill you? O.K. I can't understand why you would think that. Because that's the way it's been in my life every time I've worked with people with voices. Now maybe I was wrong every time— maybe I've learned something about voices, not just yours but others. But look, I am really opposed to murder—and to suicide, under most circumstances. So am I. But wait a minute, now wait a minute. My voice is mine; and if I thought about suicide and killing people, then that was me that was thinking it. Yes, I know that. And then I would hate that part of you, if you would rather I put it that way. Yeah, I'd rather you put it that way. You know that . . . I don't know if this makes any sense . . . but that thought is repulsive to me, to want to kill somebody! But you have often wanted to. Have I? I don't think I thought about it as their being dead. What I'm trying to say is, I don't think I thought about death as death. Yeah, but maybe you'd better. O.K. I was against you, a murderer. If your voice is you, then I was against your voice, a murderer. To the extent that your voice is just you, a person I like and I enjoy being with, I don't want to get rid of your voice. But I do have a

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right, I think, to stop you from killing either yourself or someone else. Or when the voice tortures you, I hate your voice then. G: Maybe you don't understand that either. S: Maybe. Then why don't you help me to understand? G: Sometimes I deserve to be tortured. See, what you don't understand is what bad things I do and the bad thoughts I have; and if I have bad thoughts and do bad things, then I deserve to be punished for it. And you don't understand that. Here is what Mrs. G said about Charlie's first appearance: G: The first time I heard Charlie was [age four] when I hit the little boy on the head with the rock. The neighborhood boys had dug a hole in the field, and I used to hide there all day long—and another little boy who was close to my same age. [We shall listen to this told again in the chapter on murder.] I used to play with him. And he and I were in the hole together, and he had to pee, so he peed in the hole; and it made me so angry, and I heard a voice say, "Hit him!" So I picked up a rock and hit him on the head with it S: You heard a voice—meaning like my voice now [Shakes head yes], not a voice in your head? G: No. So I hit him. S: Who did you think it was who said it, at that moment? G: I don't remember being surprised or anything. And he went running home screaming. And a few minutes later, or a half hour later or whatever, my mother called me—we just lived right across the street from this field. And the voice said, "Don't answer her"; but I knew if I didn't answer her, it would be worse, so I went home; and I got a beating for hitting the little boy. And the voice said, "Ha, ha, that's what you get for answering your mother," you know [Laughs]. And then I just remember that if I talked to the voice, it would talk back to me. I don't remember hearing him every day. Then I remember the first day I went to school—111 never forget it—and I went to school, and I was quite excited about going to school. My mother didn't want to send me because I was only four, and she thought I should wait another year; but they sent me anyway. And the teacher said, "I want each one of you to stand up and tell your name." So all the kids stood up and said their name, and when it was my turn I got up and said my name, and all the kids laughed because I said my name was Sugar; and I was very, very embarrassed. And the teacher said, "Well, what's your real name?" or "What's your given name?" or something. And I didn't know. And she told me to go home and ask my mother what my name was; and

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Charlie said, "Do something to the teacher for embarrassing you"; and I thought, "Well, it's not the teacher's fault"; and I talked to Charlie about it. So I went home and I told my mother I was very sick, and every time my mother would come near me I'd vomit on her. And even to this day I vomit . . . you know. But that's when it started, when I started puking on my mother. You mean you never had before? You said when you were an infant... When I was an infant I had trouble eating, and I vomited a great deal; but this reaction just to my mother being near me didn't start until I was about four. It must have been easy for me to vomit. Did you ever have reason to believe later on that Charlie had been there before age four? Well, now, many years later, I feel like I always had Charlie, although I can't remember him before age four—I can't remember anything else before age four either. So it's possible 1 had Charlie before then. What was it that got you so angry? [No answer] What did you think of the boy's penis? That he was pretty lucky to have one. I just felt that he was lucky that he was a boy and his penis proved that he was a boy. I remember being surprised that his penis was just like my brother's—you know I had a brother just a couple of years younger. I don't know what I thought other penises would look like . . . but I thought that if all boys had one the same as that, I wanted one just like it. So I got one. How soon after you hit the kid did you get it? I don't know. It was around the same time, wasn't it? Yeah. I wonder . . . I wonder when it became hard, because penises when I was four years old weren't erect. . . . Charlie used to get me in a lot of trouble. Like I was in kindergarten the first time I ditched school, and I hated school—God, I hated school! And Charlie would say, "Hide in the park"; so I'd stay in the park all day until I saw the kids coming home from school, and then I would trot on home. And my mother would get my report card, and it would say "Days Absent" 5 or 6; and she would say, "Gee, they must have made a mistake on your report card"; and I'd say "They must have" ... or I don't know what I'd say. But I never got caught until in the first grade; and I had this little girl in school with me, and for some reason they called her parents; and her parents said, "Well, she left for school"; and, Jesus, they called the police and everything. And here we were in the park. And I really got a beating for that.

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The following selections about Charlie are in chronological order: as one reads, the years are passing. G: When he is tormenting me, and when he is there because I need him, that's two different things. [If there were no Charlie] I would just be nonexistent. It would be like if I was a baby and my mother left me and I cried because I was hungry and nobody came to feed me. G: S: G: S: G: S: G: S: G:

Charlie is liable to kill me. How many times has he tried? Twice. I almost died. It wasn't Charlie's fault that you did not die? Is that right, or did he somehow stop it at the last second? No, he didn't stop it. One time was the pills and the county hospital. When was the other time? When he drove my car into a brick wall [age nineteen or twenty]. Why didn't you get killed? I don't know. Just pure dumb luck. I was going about 65. [At that speed she drove the car into a concrete abutment on a freeway. The result is a cortical scar, the focus for the grand mal seizures that still attack her.]

S: Has Charlie ever created your sexual feelings? G: Yeah. When I want a female, that's Charlie's fault. He just makes me think about it and want it. He just tells me how nice it would be, and he describes the sexual part of it, and it excites me. What's so unusual about that? S: Does Charlie think you are gay? G: Yes, Charlie thinks I am a stupid queer. And he laughs—he thinks that's funny. S: How can you say you don't have a conscience? G: What if I did have a conscience? Where would that put Charlie if I did have a conscience? Has it ever occurred to you that Charlie would not want me to have a conscience because it would be telling me what to do, too, and he would not like that? S: But he has known it all along. G: Well, maybe if he doesn't admit it and I don't admit it, we can just ignore it. S: Yeah, that's right; but I gave Charlie more credit. G: Maybe you should not give him quite as much credit as you do. Sometimes when Mrs. G suddenly stopped paying attention to me, it was not only because her mind had wandered or because hallucina-

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tion dominated but because Charlie had specifically instructed her to stop listening. S: Has Charlie ever showed up in any form in a dream? [Shakes head no] Has he ever controlled your dreaming in any way? [Shakes head no] Where does he go when you go to sleep? G: I don't know. He is not always gone when I am asleep. S: He is just there silent? [Shakes head yes] He doesn't ever condemn you for the things you dream? [Shakes head no] Why? G: I don't know. S: Sure, because like your mother, you can't control that [i.e., her mother does not condemn her for what she cannot control]. G: When I was little and my mother was making me into a young woman—or whatever she was making me into—there were things that she didn't teach me. And when I was little and Charlie came, there were lots of things that he didn't know, believe it or not. And we didn't know anybody to teach either one of us. . . . So things that might look like something insane to you that Charlie might do might be perfectly all right as far as he is concerned because he doesn't know any better. But Charlie knows what's good and bad for Charlie, and he also knows what's good and bad for me is different than what it is for Charlie. S: How close is Charlie to the average person's morality? G: About equal. S: If Charlie merged with you, you then would be able to debate inside of yourself, like the rest of us do, the pros and cons of good and bad. If you had all the information Charlie has and all the information you have, then you would be like the rest of us. See, you are split down the middle where the rest of us, our Charlies, are part of ourselves and part of our decision-making. For you, it is much more awkward. G: It isn't awkward. If I do something bad, Charlie lets me know it. S: It is awkward. It's awkward to be two people in one bag of bones. G: I have never found it awkward. S: Charlie is a voice. Charlie doesn't have a personality, does he? G: Yeah. S: Does he? Oh, I didn't know. At least up until recently all Charlie said was, "Don't do that. Drop dead." Not much substance to him. G: Oh, he's funny. And he's comforting and helpful and demanding and nasty, but he doesn't have a body. S: Are you ever Charlie? G: No. S: Has Charlie ever taken you over?

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G: It's time for me to go. S: Oh boy, that was a good question. Has Charlie ever taken you over? 3 G: Why do you want to scare me? S: So that we can get to the bottom of this and never again have you scared. Listen to me. Have you not been afraid that Charlie might take you over? G: Ummm. [Meaning yes] S: When you get crazy, isn't that one of the reasons that you call me so that I w i l l . . . G: Keep us separate. S: But Charlie and you are two different people still, even though Charlie is inside of you; and the question is whether Charlie could take . . . Have you ever had the feeling that any of your babies, when they were inside of you, could do that to you? G: Yeah. I used to think about maybe they couldn't get out, and they would grow up inside of me, and then I wouldn't be any more. That used to scare me. [Later] G: When I was living with another man one time, he [Charlie] almost made me kill my kids. And as a result of that, I was committed to R State Hospital. I don't remember it clearly. I locked myself up in the house and took an overdose of pills and gave the kids pills. [Patient was age eighteen or nineteen. We shall note this in "Homosexuality," and again under "Suicide." This is the way a subject could come up repeatedly over the years, each time in a different context or with another historical detail added.] I think it was Seconal. I had two bottles of it. It wasn't enough to kill us, whatever it was. S: Did you think it would be? G: Yeah. S: You used all of them in both bottles? G: Yes. [Later] G: I was going to say: "How can we be talking about something that's not real?" But it is real. I don't know if it's real. Now I'm getting confused. If Charlie is a hallucination, then it's not real. It's real because I feel it, and I hear it; but it isn't real; so maybe that's why it seems like a game because it's something that's not really real. He doesn't have a life of his own. He can't possibly have a life of his own. He's too involved with me. S: All right. That's the first thing. He knows that though, doesn't he?

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G: Yeah. S: And he can forgive you for that. But I think what's . . . G: No, he doesn't forgive me for that. Why do you think he hassles me all the time? S: You mean he wants to be free of you? G: Yeah. S: It's almost as if he exists as a separate organism inside of you. Is that how it feels? G: Uhhuh. G: Without Charlie I would be nothing. S: Let's try this one on, and you tell me if it's right. If he abandoned you, you, that body, would still be here. If your nose itched, you would still scratch it; and if you got hungry, you would still eat, and you... G: I don't know if I would. S: You feel if Charlie is part of you, he's a separate part of you. He has his own independent life; he can talk to you; he can make you do things that you don't want. But there's a you which is you. If in this fantasy that we're talking about now Charlie were to leave you in the bad sense, you would still be here. G: I'm sorry. I didn't hear what you said. S: What was going on? G: He was telling me to get out of here. I can't remember when I stopped listening to you. Something about me and Charlie being separate. I would just be nonexistent. It would be like if I was a baby and my mother left me and I cried because I was hungry and nobody came to feed me. I remember that. S: What do you remember? G: I don't know. I don't know what made me say that. I just said that. I was just thinking about being a baby and being in agony; but that's not true—I was never in agony when I was a baby. I couldn't remember that. G: Charlie's one thing my mother couldn't hurt. She didn't even know he existed. S: Of course not. That was one of the qualities he had to have. Isn't that right? That she couldn't know. If she had known, what would she have done? G: She'd have probably killed him. G: He's away from me now. He's up in his room reading his books on morals. Maybe if he took a long trip, he'd find some place else he'd like better.

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S: He'll haunt somebody else. G: Yeah. I'm really going to pay for this [joking about Charlie]. I can laugh about it all I want, but I'm really going to pay for this. G: Charlie thinks I don't need him any more. He has been telling me to put baby toys away, and I guess that means I just don't need him any more. S: Can you stand that? If you don't need him any more, then you have to take over his functions. G: I don't know if I'm strong enough to do that. Does that mean I'll have to do things like cry for three weeks? You're telling me that I have to take over what Charlie feels and expresses to me. If I do it, I will have to accept all the things that Charlie feels, including crying for three weeks. He's been screaming for the last three or four days. I can just feel him screaming. I keep asking people if they can't hear him. S: They can't Jesus, don't you know that by now? Do you understand what I said before about he screamed because you imprisoned him? You sit there with that flat face and that unmoving body, and so that pan of you which is called Charlie is captured. It can't get any satisfaction. It can't get to people. You take that pan of yourself and lock it in and then go around like a zombie. G: That's what Charlie's screaming about. Because he wants to get loose. I don't want Charlie to scream, and I don't want to scream. I don't want anything bad to happen to me. Bad things happen to people who don't have control over themselves. G: Even though I get angry and have other feelings, is it a good idea to express it regardless of what Charlie says? Charlie won't let me cry or get angry or do a lot of those things because that's bad. G: I have been a bit crazy this afternoon—you made me crazy. When you commented on the way I was dressed. I have been thinking of those words that you said all day, and I really am concerned about it. You said, "If you have tennis shoes and pants and a sweat shin on and your hair's cut short, is it any surprise that the nurses ask if you are bisexual?" Charlie said, "Either change your clothes or know what you are." [By this time in treatment, Charlie had become much more benign and my ally.] G: I have been talking to Charlie all day. He's been making me laugh all day. He tells me funny stories in Spanish. They wouldn't be funny in English. He speaks Spanish when it is difficult for me to think in English . . . when I am very anxious. It isn't really easy for me to talk in Spanish; I can if I have to. It's easy for Charlie to

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speak Spanish; he speaks Spanish quite well. Sometimes when I ... like when I was talking to Mr. Ramirez and I was trying to think of a word and couldn't think of it, Charlie could tell me what the word was. G: There is some times when Charlie does, like he did today, gets angry and then starts screaming. Do you want to talk about me being afraid of you? I am afraid you are going to fuck me, but not physically—I know you would not do that. Nobody ever fucked me physically. Do you know what you are? You are a mental virgin. You don't know what it feels like to be fucked. I just know it happens over and over and over again and just. . . just like if I was a flower bush and everybody that came along picked a blossom, and pretty soon there was nothing but roots left. And the only protection I have is Charlie, and you want to take that away from me. And don't say you are not taking him away from me, that you are giving him to me, because I don't understand that. All I can see is that you are taking these things away from me and I can't let you do that. I'm thinking of all the things that would happen if I keep Charlie inside of me. Remember what I used to tell you about when I was pregnant, how good I felt? And I wasn't crazy, and I was comfortable and healthy and all good things—I felt'all good things when I was pregnant. Maybe I could put Charlie in my belly and be pregnant all the time. S: That's not being whole. That's still being two pieces. G: The thing is: I could be whole; that doesn't mean I want to be. Do you mean I have to take Charlie inside of me before I could be whole? S: Yes. G: He's talking to you. He's just telling you to tell me more so I can understand what's happening. He understands, but I don't understand. S: I want to hear what he says. I am feeling lazy today. G: He says that if I was whole that I would be just like other people. I wouldn't have to get fucked and be afraid and meet people inside of me, and I wouldn't have to kill people, and I could do things I want to do without vomiting and, I guess, just all kinds of things. He just goes on and on. He really has a problem lately. He just talks constantly. G: I used to be able to depend on Charlie. If I did something bad, Charlie would let me know about it and he'd punish me. Now he's just like you are. I don't think he knows what's good and bad any more. You don't know what's good and bad, and I don't think he

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knows any more, and 1 think you have done that to him. Something has happened to him... . Charlie knows funny things about women, that women have a strength that men don't have. Now I don't believe that . . . because women are so ... I don't know . . . I was trying to think of a word. . . . I want to say "disgusting," because that's the only word I can think of. I am sure Charlie could think of a better word, but women are so disgusting, they just. . . they cry and . . . You know, my mother is a good example of a disgusting woman. Feminine women aren't even feminine. There's no honesty in women. S: That's not true. I am sorry you don't know that. And Charlie knows you are wrong. G: [Interrupts] Charlie says all women aren't my mother.[!] It was through Charlie that the rapid growth of insight was manifested later in treatment. As he came to trust me, he began expressing attitudes like mine more and more (and, of course, I believe those attitudes had always been present in Mrs. G, not that they were newly manufactured by her taking in my attitudes de novo). Mrs. G felt, then, as the months passed, more and more amusedly comfortable with Charlie's opinions. I pointed out to her that this could indicate he was gradually becoming her; although she would dismiss such remarks, the look on her face revealed she had little difficulty agreeing —at least when she was feeling good. When a bout of "craziness" hit (and sometimes it would hit just because this was happening), she would revert to a greater separation between herself and Charlie; and he would once more tend toward being what he had formerly been— a separate personality living within her. At any rate, through her trusted Charlie's advice and consent, she could gain insight. However, equally by means of Charlie, she could regulate the amount and the speed of the process so that the acquisition of insight was safe: the process did not require of her a wrenching shift, but rather used the same stream beds (Charlie) through which her thoughts had always flowed. In this way some part of the process of acquisition of insight could still be unconscious, though what was learned moved to consciousness. I have tried to show how I used Charlie to accelerate that movement to conscious acceptance, this having occurred only when I both came to know him and stopped trying to kill him. From that day on he began listening to me until finally he—the one person she always believed—began telling Mrs. G the things I was telling her. At this

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point, though she still relied on projection (that is, her own opinions were still felt as not being hers, but Charlie's), she could partially internalize (accept) my goals as her own. (Let us not forget, however, that if she had accepted none of my goals, there would have been no treatment.) Then, during the last year, came the final major advance: an occasional flash of awareness informed us that an opinion of Charlie's was identical to her own; and as that began happening more frequently, and as the flashes changed to an experience lasting minutes, Charlie began telling her that he was going to be leaving. He gave her many months to adjust to this (that is what she felt consciously; but below the surface, of course, was the process of her giving him enough time, and below that the process of giving herself enough time to give up what she was beginning to see was, in fact, in anybody's sense, a hallucination). Here is an example of the sort of experiences with insight that became commonplace: G: You now, a penis . . . a penis is quite a thing, as you must know. A penis makes you what you are: strong and courageous and all the things . . . all the things that you cannot be if you are a woman. S: [Sarcastically] The reason that all the men you have known have been such fine people—courageous, true, strong—was just because they own penises. G: 1 have never known a man that didn't have one. S: Did you ever know a man that was courageous, strong, etc., etc.? G: Yeah. S: How many? G: Lots of them. Three. [Laughs] S: What does Charlie think of your penis? G: Oh, he thinks it's silly. He thinks I am silly. He thinks it's like pretending you have a dog, and you talk to the dog, and the dog follows you around, and you sic the dog on people, and you make it bite your enemies; but there isn't a dog there, and you know there isn't a dog there, and everybody else knows that there isn't a dog there, so why pretend there is such a thing? S: Is Charlie right? G: No. Because when you pretend you have a dog, you cannot feel it or... S: [Interrupting] You're not answering. You and Charlie are arguing. G: I don't care if he's right or wrong. It doesn't make a damn bit of difference. S: Doesn't it depress you to know that he's right? And to have him

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ruin things for you? It was bad enough when 1 did it, but it's worse when Charlie does it. Yeah. Because he should know. He knows more than anybody how bad 1 need him. He says . . . he says that's part of growing up, being done with childish things. It's enough to make you weep, isn't it? Yeah. . . . It's like being scared of the dark. My father used to say, "The same things are there in the dark as there is when the light's on." And he would turn the light off and he would say, "What do you see?" I would say, "Nothing"; and he'd turn the lights on and say, "See, it's the same thing whether the lights are on or off; there's the same thing there." I forgot what I was going to say. We were talking about Charlie. If you are afraid of something, you need someone to turn on the light. Maybe there'll be a monster there. Maybe there won't. Yeah, but I'm the one that has to take the chance of finding out.. . . You're telling me I'm strong. You're saying, "You can handle this." And Charlie says, "You don't need to be afraid to talk to women and you don't need to be afraid of getting fucked, and you don't have to be afraid of all those things that the penis protects you from, because you're a big girl now. You're not a little girl any more, so be done with it." You say I'm strong, and I don't know that, and I don't know that I don't need to be afraid any more. I don't know that. I would have to try it. But Jesus Christ, what if I am done with it, what if the penis goes away and I am destroyed? I have to think about what people can do to me. And I can't think of what they could do to me that would be so horrible, so that really takes the logic out of my having a penis. What can a woman do to me? She could hurt my feelings or make me cry or something like that, but what would be so devastating about that? I can't think of anything that might destroy me. Maybe somebody might take a gun and shoot me, but my penis isn't going to protect me from that. So there's no reason for me not to give it up. Just like there's no reason for me to be scared of the dark. But I am scared of the dark. . . . I'm going to have to grow up pretty soon. Who ever heard of a thirty-three-year-old child? It's all childish, isn't it? Charlie and the other part of me and the penis and the whole business is childish, isn't it? I wonder . . . I wonder how Charlie knows things like that before I do. How could . . . how could Charlie be me—this is kind of ridiculous and I hate to say it—but how can Charlie be me if he's smarter than I am and his vocabulary is better? . . . I was thinking about the parts of him I don't like . . . like Charlie can be very de-

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manding and very . . . I guess I can be demanding too, but in a different way than Charlie. Charlie demands immediate attention and immediate response to whatever he happens to be demanding at that particular time, and that really isn't very fair if you're dealing with everyday people. You can't expect that from everyday people. If I'm going to get all of this inside of me, I'm going to have to weed out the bad parts and learn how to handle whatever is going to come out. . . . It's going to come out of me, not out of them, but out of me. Shortly before Charlie said good-bye, there was this exchange: G: I was thinking that Charlie told me to hit the little boy, but I don't remember if that's true or not. S: Do you ever use Charlie as an excuse? G: Oh yeah. It was easy for me to use Charlie as an excuse because Charlie told me so many things, you know. It didn't hurt if I just added little bits and pieces to it. S: You've also told me at times in the past that Charlie never told you to kill anybody. G: No. I was thinking last night or this morning or some time: the only thing that Charlie never made any comment on of any kind was my sex life. I'm sure I've told you that before. He just never had any comment to make about my sexuality or anything that I had to do sexually with anyone. He never said it was right, and he never said it was wrong; he never said it was good, and he never said it was bad. . . . I don't think he had an opinion. I'm sure if he thought there was something wrong, he would have told me. It was his feeling that I never hurt anybody and nobody hurt me, and I was doing what was pleasurable for me and to the person I was with; and he just never thought that was wrong. I thought it was wrong, but he didn't think it was wrong. One of Charlie's last acts was to interrupt Mrs. G, who in her spare time was writing for me whatever came to her mind about herself. He became impatient with her, told her to hurry up and finish, because it was inadequate anyway, and to give him the opportunity to go over her early life and to correct her flawed memories, to add details she had forgotten, and to introduce into the narrative the feelings he knew even at the time she should have felt. This went on for several weeks; and at times during this period, he let her know that he would probably be leaving not long after it was finished. When I asked Mrs. G to write about Charlie, this was what ensued:

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G: There's nothing to tell about Charlie except that he's . . . [Laughs] . . . except that he's bugging me to death. He doesn't like the way I'm writing about him. Not doing it accurately and not doing i t . . . he doesn't feel that I'm doing it honestly; but I don't know what more I can do. I'm writing about what 1 remember, and that's the best I can do. He thinks that there should be more feeling behind what I'm writing: my feelings. Like writing about a time when he suggested I kill myself, so I took pills; but I didn't die, and he felt that was pretty funny. I should have more feeling about that [now]. S: What was funny? That you didn't die? G: Yeah. S: I don't believe that's all he felt. G: Well, he doesn't believe it either, and he feels that I should have felt more and should be expressing more. You shouldn't be impatient with me about not feeling feelings, because Charlie is the one that doesn't want me to feel feelings. Charlie just does that to protect me. You know, it started when I was little when I was so scared all the time. But he doesn't know how: he doesn't know how to make me start feeling feelings again. Like when I was in the hospital after I almost killed myself. Those doctors came down and they said, "Do you miss your children?" And I said, "No." "How do you feel about them being taken away from you?" I said, "I don't feel anything." They just went on and on and on, and they asked me all these questions. And every time they'd ask me a question, they'd say, "How do you feel?" And I'd say, "I don't feel anything." That's why they sent me to R State Hospital, because I didn't feel anything. . . . It was Charlie's idea that I marry Bill. The first day I met Bill, I took him home with me, and we talked and talked and talked and talked; and he talked about all the things he wanted to do and all the things he didn't like and all the things he did like; and I told him I was crazy, and Charlie told me to tell him everything, and I told him everything. . . . I don't hear from Charlie . . . Charlie said strange things to me [in the past], things that I don't understand. I can't think of one. I'm sorry but I'm just aware that he says things to me that I don't understand, and he expects me to understand, and he gets very impatient when I don't. S: HeVquiet right now, huh? G: Yeah. He doesn't have to protect me from you; that's not what he's doing. He's not demanding anything, but he doesn't see any reason why I can't do it. He thinks I'm a grown woman now, and I should be able to do things like that for myself. S: That sounds like Bill.

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G: Yes. But Charlie's compassionate about being sloppy. He wasn't always. Charlie used to be just too demanding; it just got to a point where 1 was so involved with Charlie that I couldn't think about anything else. I was about sixteen, I guess—no, maybe it was when I was older. It happened once when I was sixteen, when I just got so ... he just demanded so much of my time and energy that I just didn't have time for anything else. I couldn't think about anything else, and 1 couldn't function and . . . He's not like that any more. Now he's a peacemaker. I guess he's getting old and he's getting . . . not placid but . . . mellow. Do you know what Charlie said last night? I was so tired. I came home from work yesterday morning and instead of going to bed and getting some sleep, I thought: I'll just stay up all day, and then I'll sleep normally tonight. And about seven o'clock, I got real tired; but I couldn't go to bed because I had to go out, so I lay down for a minute; and Charlie said, "You've got no guts." He said I was flat. Do you know what that means? He said there were so many things I could be doing and so many things that I could be expressing that I just don't do. So he said I'm flat, and he said I'm just like a big blob, just doing nothing but eating and breathing, and he's really getting disgusted; and he said maybe some of the way he used to treat me was better because at least 1 moved. Now I don't do anything; I just lay there. And I hadn't been laying there very long, but he acted like that's all I do is lay around —but I know that isn't what he meant. When I'm doing my own writing [information for me], he expects me to do it; but when he does his, then he'll do his own. He thinks I don't remember correctly. Like yesterday, I was writing about when I was in R State Hospital, and they were going to sterilize me, and Charlie told me not to be afraid. But he says that's not all he told me, and I can't remember what else he told me. But he won't help me. S: Did he want you to be sterilized? G: TSto. S: That was partly what else he must have told you. He must have told you that in some way they were screwing you; and he may have told you that there's not a damn thing you can do about it, but that you shouldn't be making it so easy for them in that sense. He probably also told you not to break the place up; but that isn't what he meant by you're not making it. ... But you made it easy for them—and he knew it—by saying, "I don't care" or "I don't feel." He probably wanted you to say, "I feel. I hate what you're doing. You're ruining me. This is a disaster. I'm a young woman. How can you do this to me? How cruel this is." . . . You know, to have been weeping, but

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not to have fought them physically, because it couldn't be done; but to have at least honestly expressed your sense of disaster. Do you know Charlie dislikes my mother very much? I haven't thought about that before, but Charlie really dislikes my mother— not my mother as a person; but the things my mother does. He disapproves. Yeah. And he speaks out and, you told me that [just now], because it's almost the same thing that they did at R. You've never spoken up with her until recently, have you? No. You took a lot of crap from her that you had to take, but you made it too easy for her, didn't you? You told her, "I don't feel and I don't care. You can't hurt me"; and what you should have done, Charlie is saying, you should have made her pay. Well Charlie . . . Charlie had ways of making her pay; but he made me pay, too. Sure. He made you pay because you didn't make her pay. And do you know what you've done? . . . The thing that he's getting at you about is that you let everybody do what they wanted, with your saying, "I don't feel anything"—your saying, "I have no feeling and I don't care, and it doesn't make a difference to me" when all kinds of things made a difference to you. You were always very tough, and that is what Charlie's getting at you now about. He says to you, "When you were a little girl, you needed to be tough and you needed to not feel and you needed to not care because you were too small to take care of yourself. But the mistake that you made was that you kept on doing it when you grew up and that you really threw your life away." For years you wasted yourself, that's what he's saying. And what he's telling you now is, "Now that you're better, now that they're not doing things to you any more, don't keep on doing what you always did. You start feeling and you start telling people and you start asserting yourself and you start having more feeling." That's what he's saying. And he's saying to you, "You know this, and it's your responsibility. Don't expect Bill to do it; don't expect your mother to do it; don't expect Dr. Stoller to do it." He's telling you, "They'll help in their own way, some more and some less; but only you can do it." He's telling you to not let people crap on you. To speak up also; you know if you do, you don't have to be sarcastic, you don't have to be enraged, you don't have to pull a gun and shoot people, and you don't have to kill yourself. Those are desperate things that came because you didn't do what Charlie now

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says you should have done. You would wait until you were so desperate that all you could do was drive your car into a wall, right? G: I have to unlearn . .. G: I feel a little confused for some reason. I had trouble driving out here today. But nothing's happening at home. At work the night before nothing particular happened. I worked the same as always. S: Then tell me what you've already thought might have caused it. G: I haven't thought anything. I thought . . . I thought: Oh Jesus, not this again. I really can't be bothered with it. That's what I thought. S: Charlie? G: Oh, Charlie! He just . . . of course he's bugging me a lot about not having enough time to write. [I had asked her to have Charlie dictate to her the material about himself.] S: I don't believe you don't have enough time. G: Well, 1 object to a lot of the things that he wants me to write. S: Then you decide what's to be written. G: No, I can't decide. He won't let me decide. He sees things differently than I do. He makes me sound like a liar. I can't think of an example. S: My hunch is that you may be afraid that your relationship to Charlie will change if you actually pick up the pen and let it be Charlie who tells you to say it, that somehow or other you'll think differently about him. G: Yeah. I'm already thinking differently about him. So it's not the same as it was before. I always never questioned anything he had to say . . . not really. I may have said: "Well, I don't go along with that"—or something like that. But when he sees things entirely different than I do, I wonder if he's not a little bit more confused than I am. That scares me because I depend on him to tell me what's right and what's wrong. S: Aren't you afraid to put things down in writing because he's not going to look so brave when he's actually there for a third person to see, namely me? G: Yeah. S: Haven't you been afraid of that all along? G: Yeah. Not only you'll see him: I'll see it. S: How does Charlie feel about that? G: It doesn't seem to bother him any. He never claimed he was perfect. But I did. I was just thinking about Charlie, how goddamned demanding he is. He never cares how I feel about it ... maybe he does care, I don't know. But if it's upsetting for me to do it, then he shouldn't be so demanding. He should wait until I feel better

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about it or something. But he wants everything right now, right this instant. He's like a little kid who is running scared all the time. He's so impatient. He's got to have it right now. It doesn't make any difference what it is. He's always been that way. It's got to be right now, right this minute. All right, what were you doing when this [psychotic episode] started? I was getting out of bed. Oh, no, I was coming home from work. I was coming home, and I had trouble driving home. I was thinking about the writing. I was thinking: Today's my day off. I should get to it and get it done. And then I thought: Well, I really can't because I've got to do housework, and I've got to do this, and I've got to do that; and then I felt guilty about it. You started feeling guilty, and then it went on to confusion? Yeah. So that's what did it then. Yeah. Why didn't you tell me? Because I didn't know it until just this minute. There's only one way to get over it then, really. That's to do what Charlie wants.

Finally, Charlie just faded out. He is no longer necessary, for he gave back to Mrs. G the functions for which he had been needed. Charlie and Mrs. G's penis are related. Each took over attributes of power she felt she did not possess because she was female. Charlie, she told me, had no penis. Her penis was disembodied. Both were with her from her first memory; and both, I believe, were created to help her survive her inability throughout infancy and childhood to reach her mother.4

4 Psychopathy When I first met Mrs. G, she was a psychopath (sociopath, antisocial personality). In our first interview she reported many antisocial acts, performed unfeelingly. The list (probably incomplete—to date there seems no end to revelations of the past) is impressive. Leaving out attempts at murder, there were, by her early twenties: armed robbery (six gas stations, no arrests); car theft (three cars, one arrest); bad-check writing (two arrests); being a subject in pornographic movies (two); innumerable sexual relations with men (including family members); over twenty homosexual affairs; four marriages by age twenty-three; five illegitimate pregnancies (no legitimate); addiction to amphetamine six different times, with two episodes of drug psychosis, and mainlining and sniffing of heroin, but without addiction; association with motorcycle gangs, criminals, drug pushers, thieves, and corrupt policemen; over thirty moving traffic violations, drag racing, and many serious vehicle accidents (with no driver's license). Such conduct was the essence of Mrs. G's adolescence and early adulthood. G: Did I ever tell you that I drove in the Powder Puff Derby? I had a trophy for winning. My brother taught me to drive when I was about fourteen years old. I never had a license. Do you know I never had a license until I was twenty-two years old? I could drive better than any man on the road, or the men that I was encountering at that time; and I never had a driver's license because I was scared to go take the test. I used to ... I still do ... just drive because it makes me feel good to drive. It was . . . fifteen laps, and it was a dirt track; and I drove around it and drove fast; and I was scared shitless. And I won—no big thing. S: How come you won? G: Because I outdrove anybody on the track. Maybe I had been driving longer—maybe I drove better. I don't know. There's a lot of little chicken-shit things you can do. 54

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S: How did you know them? G: From drag racing all over town . . . The first time I drove a car by myself, I stole one. I had to go to school. I went the first day, and that was so horrible that I ditched the second day; and I went half the third day; and the fourth day I said "Fuck it'* and I stole a car and went to Arizona. S: You were fourteen? G: Yeah. After the baby was born. This was after . . . Let me explain to you about the seventh grade. I went to the seventh grade; I didn't go to the eighth grade because I had rheumatic fever, and they tested me and they passed me on to the ninth grade. I didn't go to the ninth grade because I had a baby that year. They tested me again and passed me on to the tenth grade. In the tenth grade, I went two and a half days.... S: And then you stole a car. G: Yeah. I went to a used-car lot and hot-wired it. Fifteen years ago it was very simple. S: And what did you do for money for gas? G: I wrote bad checks. I wrote personal checks made out to me signed by my mother's name. In the good old days, they'd take a check from anybody. Those days are past. . . . They caught me in Kingman, Arizona, when I tried to cross 'he border into Arizona. I couldn't open the trunk of the car for them to inspect the car, so they asked me for my driver's license, and one thing led to another. S: Were you scared when one thing led to another? G: No. What was there to be scared of? They put me in a jail in Kingman that was made out of adobe; and the toilet was broken and there was shit all over the floor, and it stunk. And they only fed me once a day. It was really awful. In Arizona they have no facilities for juvenile care. And then I was a federal prisoner—taking a stolen car across the state line is a federal offense. So they just shifted me from jail to jail until somebody from California came after me.. Do you know how they brought me to California? I had on levis—I wore these same clothes for five weeks. They put a chain around my waist and handcuffed my hands to a chain. You should have seen me trying to pee. [Laughs] I had to pull my levis down to go to the bathroom with my hands handcuffed to a chain. I pissed all over myself. That's life. I guess the Kingman jail was the worst jail I've ever been in. S: How many jails have you ever been in? G: Let's see ... I was in about four in Arizona. [In California] I've been in the X jail and I've been in the Y County jail, and I've been in the Z federal prison, and I've been in the O jail, and I've been in

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the B city jail and in the S rehabilitation center and . . . you know . . . what difference does it make? A jail's a jail. I like being in jail. I was in jail once when I was seven. For telling a lie. My mother took me to the police station. I told her a lie that got me out of jail! [Laughs] I told her I was scared. I wasn't really scared—I kind of liked it. But she wanted you to be scared? She sure did. Was that the first time you were in jail ? I guess so.

Marriages S: Why did he want to marry you? G: I don't know. 1 never asked him.

Mrs. G lived with this man, husband No. 3, only about two months, because she developed an amphetamine psychosis and was hospitalized. They were divorced after eight months; and although he was wealthy, she asked for almost no settlement. She said that she divorced him "because it didn't seem fair to me to be married to him. First of all, I wasn't interested in him. Second of all, I was crazy and I was in the hospital. I really didn't ever see not being crazy." Although she had known the man slightly for many years, the marriage was impulsive on her part, in that she did not care whether she married him or not. He asked, and she agreed. He asked her to marry him, she said, because "I had two kids that he wanted. He had known them since birth, and he loved them." S: G: S: G: S: G: S: G: S:

Were you ever angry at each other? No bad feeling? No. You drifted in, and then you drifted out. Did he ever marry again? He is nice-looking, and he has a nice personality. He says once is enough. Who was your first husband? L was my first husband.* I was seventeen, I guess. Why did you get married? I don't know. Because he wanted to get married. How old was he?

* Not true. She later revealed she had married a neighbor boy, father of her first child, when she was fourteen or fifteen. It was annulled a few days later.

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G: About twenty-six. S: How did you meet him? G: 1 don't remember. He was the one who was a check writer. I was married to him for ten days. We got an annulment . . . because it hadn't been consummated . . . because we hadn't had the opportunity . . . because we were both using drugs, and neither one of us was interested in it. S: What drugs? G: Anything we could get our hands on. S: Did you mainline? G: I did mainline. S: Were you ever hooked? G: No. S: How come you were not? G: How come I was not? Because I had no desire to be hooked. S: You didn't take it regularly? G: I took it pretty regularly for about three months. Once every couple of days. Once or twice a day every couple of days. Mainline. S: Did it do anything for you? G: It did the first time. Ahh, I had a giant orgasm. I'm not kidding you —it just hit me. I got hot all over, and I was coming and coming and coming; and then I barfed, and every time I puked, I had the same sensation all over again. It was fantastic. S: While you were vomiting you had an orgasm? G: Yeah. Much later in treatment, when the sadness, anger, and frustration underlying the psychopathy had become conscious, this emerged: G: I guess if I wanted to mourn for something, I could mourn for marriages. First there was the guy I should have married, and I didn't marry him. I just made him screw me, and he didn't want to, but I wanted to get pregnant and made him; and then I kicked him out. And then there was the time I got married just for something to do to amuse myself for the weekend. And then there was the time I married a nice guy and I screwed him every way but the right way. Then there was another time I should have gotten married, but I just got pregnant again. I am not sorry I married Bill. I am sad about the babies, all those babies. Do you know my first baby is seventeen years old? Jesus Christ, he is almost a man! I was thinking about all the men I screwed, and you know it wasn't something I wanted to do—it was something I had to do. I

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don't understand that, why I had to do that. And I wanted a baby so bad. That's the thing my mother does to me. I don't know how she can do that. I have got to do what my mother tells me to do, and it just tears me up. That's not sad, that's scary. G: I was just thinking about men that I've married. You know, one time I married this guy named L. And he was a crook, and he was a paperhanger; and he wrote thousands of dollars worth of checks, but he never told me; and here I had just gotten out of jail for writing several thousand dollars worth of checks. And I thought about it afterward, after he got arrested, I thought: Jesus Christ, if he had let me know what he was doing, the two of us could have really cleaned up! [Laughs] S: Was that your first husband? G: Yeah. S: Wash? G: No. S: How many times have you been married? G: Four times. S: That's news to me, isn't it? G: I don't know. Is it? S: I think so. I think all I knew was three. But I'm asking you: Did you keep a marriage from me? Were you embarrassed to tell me about it, or have I just miscounted? G: Well, there's just one that I don't want to discuss, the first time I got married. S: Who was the first? G: Just a kid that I married, and my mother had it annulled. S: How old were you? G: Fourteen. I was pregnant. S: Was it his? G: Yeah. S: Is this hurting? G: What difference does it make? S: Answer me. Is it hurting? G: Maybe if I'd stayed married and had a baby, I wouldn't have had four more after that. S: Maybe. Did you want to stay married to him? G: Yes. S: Is it your mother who ruined it? G: Yeah. That was the only time I ever wanted to be married. What does a fourteen-year-old kid know? G: Well, the men I married were all the same kind. They didn't drink;

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they didn't smoke; they didn't swear; they were all stable except for L. [Laughs] I never went to bed with L. How long were you married? About two weeks. I can't remember ever being interested in going to bed with him. I felt that that was the one thing he would want, but when he didn't, I was relieved. Because I didn't want to go to bed with him. I just married him on a whim. I met him one day and married him that night. He was fatherly and . . . I just don't know why I married him. We had no sex in two weeks. And do you know what? He went to the penitentiary and got one to fourteen. And about two years later, I was out with this girl and we went to this bar, and this guy said, MIf you can drink ten straight shots of V.O. and water and get up and walk away, I'll give you ten dollars." So I did, and he gave me the ten dollars; and God, I was drunk. I was so drunk I couldn't find my ass with both hands. So this girl I was with said, "Lets go get something to eat" So we went to this drive-in, and we're sitting there; and I'm sitting in the passenger's side of the car, and this car drives in, and I look over and it's L. And I said, "Hey, you"; and he said "What?" And I said, "Didn't you and I used to be married?" And he said, "I'll be damned!" So he had a phobia about driving cars; he could not drive a car. He knew how, but he was scared to. So we went to this girl's house, and he followed us over; and he said, "How would you like to go to San Francisco for the weekend?" I said O.K. So he said, "I'll be over tomorrow about three o'clock and pick you up." So I stayed at this girl's house, and I called this friend of mine at the sheriff's department, and I said, "Do you want L for anything?" And he said, "We've got eighteen warrants, felony warrants for his arrest." This was after he had just gotten out? Yeah. Jesus, you're a pal. No, I didn't tell them where he was. I just asked them, but they knew; and the next day they picked him up when he got to the girl's house.

Illegitimate Pregnancies 1. 2. 3. 4. 5.

At age fourteen: boy (alive). At age seventeen: boy (alive). At age eighteen: boy (alive). At age nineteen: spontaneous abortion. At age twenty: twins, girl and boy (alive).

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Armed Robbery G: Something I did that I never got caught at—and it was a miracle I wasn't killed—and that was holding a gas station up with an empty gun. I did it a half dozen times [age twenty-one]. S: You were never caught? G: No. It was my idea to do it; and I thought I was doing it for kicks, not because we needed the money especially, although we spent the money—you know, we used the money . . . after I left here [i.e., after some treatment]. I had the idea that I didn't want to use a loaded gun because I was afraid I'd hurt somebody—I had a real fear of that. It never occurred to me until maybe lately that I could very easily have been shot. You walk into a gas station, and most gas-station owners carry guns or have guns in the station for protection against that sort of thing. I could have held up a man and turned around and he could have shot me. S: When you did it, you knew that most of the owners have guns? G: Yeah. S: And it was exciting to run the risk? G: Yeah. S: I wonder whether you didn't have the thought that if they shot you, it would be all right? G: Of course it would have been all right. I would have deserved that. S: O.K. Then to what extent is holding up a gas station a suicide attempt? A Russian-roulette type of suicide? That is, if you get away with it, it's thrilling; and if you get killed, it's appropriate. G: That's true. That's like playing chicken in your car, the same principle. S: Do you do that much? G: I've done it a few times. S: Do you still do it? G: No. I can't find anyone to play with me.

Driving Accidents G: Do you know I hadn't had a ticket in over three years? I haven't even been stopped in two years. S: You manage to confuse me because I remember one time several years ago you said you'd never had a ticket in your life for a moving violation. G: I never had. S: How many accidents would you say you've had that you were responsible for on a wheeled vehicle, like a motorcycle? . . .

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G: Six. I can think of one I had. There was an old man that used to scream at us about riding on the din road in front of his place, so I ran over him . . . just ran over him. I hurt him. Sure, it hurt him— a 1,100-lb. motorcycle running over him isn't anything to sneeze at. S: Weren't you arrested or ...? G: No, I just took off, and I never went back to that area again. S: They didn't know who you were? . . . How did you know he was hurt? G: Because he didn't get up. S: Weren't you afraid you killed him? G: No, never thought about it. Didn't care whether I killed him or not. I just left. S: How old were you? G: Oh, about eighteen. Nineteen maybe. S: I don't know if I can stand hearing all six, but then . . . That was the first one. Next. G: And then the next one on a motorcycle was—Bill had just really fixed the bike up, painted the tank, put a new headlight on it and a new front fender and had it just beautiful. And he said, "O.K. Now you can't ride it. Every time you get on it, something happens." And I said, "Bill, just let me ride it around the block once"; and he said, "No, it's beautiful now. You can't ride it." And I said, "Just let me ride it around the block. Nothing will happen." So I went around the street, and it ran in front of a car, and the bike was demolished. The bike went this way, and I went that way. It tore all the skin off my belly and my legs—you know, I skidded along the street on my stomach. . . . One time I rode the bike off an embankment that was pretty high, maybe a little higher than this room; and when I came down, the bike came down on top of me and burned me pretty bad, burned my legs because the engine was hot, the exhaust was hot. I was going fast and when I ... and the embankment was here, and there was a corner I should have turned, and I just didn't turn it; I just kept going. S: Why? Why? G: I don't know. S: Now, in addition to the ones where you hurt other people, how many have there been altogether if we count the ones that you were in? G: Oh God, I don't know. A couple of dozen, I guess. S: Were they all motorcycle? G: No. S: How many car? G: Well, I ran my car into a wall.

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S: That one 1 know. That was the suicide. I know about one with the motorcycle going through a fence or something. G: Yeah. S: At 70 miles an hour. G: Yeah. And I hit a pickup truck one time S: With what? G: With a car. He made me so angry, though. It was his own fault. [Chuckles] Have you ever been behind one of these guys who ride their brakes all the time? Just irritates the shit out of you? S: Yeah. I'm tempted to do what you did—that's the difference between us. I'd never do it. G: Well, I did. S: So what happened? G: I had to pay for the damages. S: What were the damages? G: I don't remember. S: How bad? G: Oh, I just bent up the back . . . you know, he had kind of a door that swings down off the bed of the truck? I just bent that up pretty bad. S: What happened to your car? G: Oh, just smashed up a fender and wrecked the grille. [Another hour] G: One time I was loaded on Benzedrine, and right down at Santa Monica and Wilshire . . . Is there a big fountain there that has colored lights in it? S: Yeah. G: O.K. One night . . . one morning about four o'clock in the morning, I was loaded on Benzedrine—I hadn't slept in three or four days— and I took a look at that fountain and I stopped right dead in the street and I was just fascinated by the goddamn thing—you know how you see traces and everything. And I was just sitting there hallucinating, and this policeman came up and he said, "Is something the matter?" And 1 said, "No. I was just looking at the fountain." And he said, "Well, you've been here quite a while." . . . He said, "You'd better move the car. If you want to look at the fountain, park and look at it." And he said, "Are you sure you're all right?" And I said, "Yes." And I didn't want to move—I was just like I was frozen to that spot; I didn't want to move. And he made me so angry that I hit the police car. Then he had to find out if I had insurance and a driver's license and all that, which I didn't have; and he gave me a ticket and he made me call somebody to come and get

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me because I couldn't drive without a license and, oh, just a lot of bullshit. You know what happened one time? The first time [Chuckles] I ever hit a policeman . . . well, I haven't hit that many of t h e m . . . . How many have you hit? I don't know . . . a couple . . . But one night my sister and I ... my sister had her car, and I had my car, and we were drag racing down the street. And there was a drive-in on one corner, and this policeman came out of the drive-in, and he saw us drag racing, and he pulled me over—she took off—and he pulled me over. And I went to parallel-park, and there wasn't enough room; and I didn't realize that the police car had pulled up alongside of me, and I pulled out and pulled into the side of him. And he was so angry and he said, "God damn! I'm going to really write you up!" And I said, "You can't give me a ticket"; and he said, "Why?"; and I said, "Because I don't have a driver's license." And I thought if you [Laughing], if you didn't have a driver's license, they couldn't give you a ticket. And he took me to jail for reckless driving. . . . Anyway, that ticket cost $550. Who paid that? Well, I did. Where did you get the dough? Well, I didn't pay it off in money, I paid it off in time—you know, it was either $550 or 110 days; and I did 110 days in jail. How old were you? Eighteen. But in the last three years you've only had one accident? Two. I had one last month, or the month before last. What was that? I don't know—six weeks ago maybe. I stopped too suddenly, and a car piled in the back into me; but I don't think that was my fault. Well, it was my fault. Why? Because there was no stop sign. What made you stop? I don't know. Were you crazy [i.e., hallucinating and confused]? Yeah. And I could see this guy behind me. He was really barreling. You should see the back end of the car. Did you do it to stop him? I don't remember. He stopped, though. Well, weren't you bugged at him coming on so fast? Didn't you

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want to teach him a lesson? Had he been a woman, would you have done it? I don't know. Women can be hurt easy. Men really can't be hurt, can they? I don't sec how. You still don't see how? Aren't you well enough yet to see it? Haven't you yet learned that men are vulnerable?

Truancy

G:

I would wake up feeling crazy. It was uncomfortable, and usually when I'm just uncomfortable like that, I just get in the car and drive somewhere. And it was about ten o'clock at night, and I drove to a park where they had a duck pond and everything; and I just drove into the park to the duck pond, and I just sat there and watched the ducks. And it got later and later and later. And about 2:30 this police car pulled up, and this policeman got out and he said, "What are you doing?" And 1 said, "I'm watching the ducks." And he said, "Why?" And I said, "Because I'm writing a book on the sex life of the average American duck." [Laughs] He made me go to the station, and he said 1 was crazy. And I was crazy. But I was just teasing him, but he ... Did you know the first time I ditched school, I was in the first grade? I just fucked school one morning; and I thought: I just don't want to go in there. And right across the street from school was a park, and I just stayed in the park all morning long until the kids got out of school, and then I went home. [She did this innumerable times.]

Drugs S: What techniques have you learned in your life that create the softer feeling inside, quiet and relative safety? You just mentioned alcohol. G: 1 can take Benzedrine. Better than alcohol. Benzedrine makes me feel warm and comfortable and secure and at peace; most people get frantic—you know, they run around in circles. It just doesn't affect me that way. If it affected me that way the first time I took it, I probably wouldn't have taken it again; but I've taken it over and over and over again. I love it. I can eat them like candy. It's very hard for me not to take Benzedrine. . . . Heroin to me is like sex— why use heroin when I can go get laid? When they put the needle in my arm—I can't do it myself—but when they put the needle in my

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arm, I get real hot and my body gets hot, and I get excited and 1 experience something just like an orgasm, only more . .. just greater, and it just happens . . . it just continues and then it goes away; and I just dream beautiful dreams and . . . It's all over my body. S: But you do have orgasms? That's not typical of heroin, is it? G: 1 can't help it—that's the way it happens to me. . . . Morphine makes me sick—it makes me sick to my stomach—and heroin I'm scared of because I liked it so much. I knew I could become addicted. I've seen too many heroin addicts. 1 don't want to be a heroin addict.

In retrospect it is clear enough. Now we see the feelings and mechanisms that underlay Mrs. G's antisocial behavior. But she spent her "criminal years" without consciously knowing she was motivated by pain or from where the pain sprang. For years I despaired of getting her to know that she did feel at these times and, perhaps more difficult, of getting her to live with those feelings, not just to know them. Given such repression of feeling and the accompanying impulsive behavior, one has trouble being optimistic about treatment. With insight psychotherapies in impulse disorders, the difference between success and failure depends not on the signs and symptoms officially assigned for diagnosis, but rather on such factors as the mobility of the patient's guilt or his capacity for a loving relationship with another person, on the balance between self-destructiveness and the desire to survive and grow. Psychopathy used to be called "moral insanity" or "moral imbecility" because its outstanding feature is a profound defect in adhering to a society's moral standards when the person not only knows those standards but agrees they are standards. Mrs. G seemed to qualify for this diagnosis in the first interview. Pleasing (so often a part of the picture), intelligent, and able to judge right and wrong, she gave, in a slightly amused and calm manner, a straightforward account of years of impulsive, criminal behavior, for which she showed no remorse. In the absence of a history (at that time) of a predominating neurotic quality, such as anxiety, depression, obsessive-compulsivity, phobias, or the like, and in the absence of a history of psychosis (except for two episodes of organic psychosis due to amphetamine addiction) or

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of the habitual use of psychotic mechanisms, one could scarcely have diagnosed her as other than a psychopath. However, one element in the first interview, which the typescript cannot reveal, was crucial to our story: the momentary flicker of sadness in Mrs. G's eyes, which I have previously mentioned. The energy that flicker revealed is what has moved treatment for fourteen years. I am still not optimistic about the treatment of psychopathy; for if it takes so many years of one's time to help such a patient, even if we all are invariably successful in our help (which we aren't), the treatment is of little value to society. There are those who affirm that every psychopath is at bottom psychotic, that psychopathy is only a brittle shell over the inner vulnerable substance, the psychosis. So it was for Mrs. G. Yet that concept is too wickedly clever for my taste. Too often, in too many conditions, we hear that the patient has a psychotic core when no psychosis is ever demonstrated. When used extravagantly, this argument makes everyone clinically psychotic, which is all right as argument; but then we have to start all over with a classification of degrees of psychosis from least to most—and "least" will be no different from what we used to classify as not psychotic. So, although Mrs. G indeed used psychopathy daily to ward off psychosis, there is no evidence that all psychopaths are so threatened. The question is not whether the unconscious impulses are present, but, as we all know, how well they are controlled. Why did Mrs. G behave this way? From her point of view, most of her impulsive acts were an effort to ward off pain. She has no word for the feeling she had to avoid; it was not sensed as fear, anxiety, sadness, grief, rage, guilt, or any other painful affect for which we have labels. She has never been able to put it more clearly than to say that she was driven to dangerous, impulsive, criminal behavior to end that "excited sensation inside . . . I don't know how to explain that sensation." But from our viewpoint, we can see several sources, all filled with pleasure, for her impulsive behavior. The acts had a primitive, "instinctual" gratification in them: murder and other destruction, volcanic explosiveness, or—more mildly—fracturing of authority; suicide and a sense of mastery from having risked it and survived (megalomania); excitement to fill the chronic emptiness that overlay chaotic affects; pleasing her mother, who was amused by Mrs. G's criminality; being

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like her father/ who admitted to his own illegal acts; a sense of humor (black). Mrs. G's psychopathy thus sprang from the same sources as her penis. But delusion (hallucination) is always too small a vessel to contain as much as is asked of it; as a "cure" it usually requires satellite cures and cures within cures, a never-ending creation of epicycles. Tough, unfeeling of psychic pain, a leader, a lover of women—Mrs. G had to be better than the men she knew. The penis was to accomplish all this. Since it could not, she enhanced its effects by becoming a psychopath—ruthless, impulsive, dangerous, yet humorous. G: When I first met you I lived on the street, literally lived on the street, because I had no place to sleep sometimes. When I was telling men older than myself how to rob gas stations, and I was teaching young boys how to steal hubcaps and how to hot-wire cars . . . when I was doing those kinds of things, and I had a penis—I did have it, and it was big and it was strong—and those boys and those men respected me for my knowledge and my ability to do things that most men do. How many women do you know that go around hot-wiring cars? Not very many. S: I know hardly any. G: [Laughs] I wanted to be a prick, that's what I wanted to be. Soft and hard. S: You must have really been something when you had sexual relations. Did you have any with men in those days? * G: I thought my father was so beautiful that he could get along with anybody. When I was about twelve, I guess, my mother refused to have him back; and I cried—I don't know why I cried. No, I don't mean that. I wish he was alive because I have a lot of things to tell him. He was always laughing and drinking and singing—he liked to sing—and he used to do crazy things; you know, just crazy things. Like one time he bought a whole truckload of Tampax machines. He was going to go in for that, into the business of putting these up in restrooms and making a l o t . . . he was always going to make a lot of money. Like one time he stole a truckload of oranges and went out on the highway and sold them for so much money a bag, you know. S: How did you know he had stolen them? G: Because he joked about it. He thought it was funny. He wrote bad checks, too. He used to charge things to my mother's name and then give them to other women, and then my mother would have to pay for them. I thought that was kind of neat. What a neat way to get even. But he wasn't bad, you know. He wasn't bad. He was just kind of like a kid that never grew up. Do you know he went into the army when he was fifteen years old?

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G: Uh huh, all the time. Listen, some of those men still come around for sex with me. Some of those men that 1 knew then. I was outfucking each man. I was a better man than he was. Then I'd kick his ass out of bed and get another one because he wasn't good for anything any more. Those were the good old days.

At bottom, this massive effort at creating herself was aimed at reaching her unreachable mother, at finding somehow the clues she heard, or imagined she heard, emanating from her mother, that instructed her how to act. To have (to be) a penis should satisfy her mother, and it seems it did to some extent. Her mother never complained about Mrs. G's masculinity, or even her criminality. The identity theme in her criminality was "I am bad only when I am good, and I am good only when I am bad'1 ("good," in the first phrase, meaning society's definition and, in the second, "acceptable to mother"). As we shall see after looking at other attributes of Mrs. G, her struggle to maintain identity was the origin of her psychopathic behavior.

5 Mothering

The only extended period during which Mrs. G felt intact was in the years she was a psychopath. There were, however, shorter episodes when the pieces fell into place: when she was in jail, or when she was pregnant, and right after delivery. Without question, she was most at peace when she felt purely female. Then there was no criminal impulse, no homosexual desire, and no penis. No wonder she wanted to be always pregnant (and came close to succeeding between the ages of thirteen and twenty). Pregnancy did what her penis could not. Then, against her will, at age twenty, she was sterilized, and never again felt whole until she forced us to repair her tubes. The two sides of bisexuality can scarcely take more intense form than they did in Mrs. G. On the one hand, she had a penis inside and, on the other, she had no doubt that she was a female. As a result, there was one mass made up of masculine behavior, and another that was feminine. No part of her sense of femaleness or of her femininity meant more to her than mothering, her capacity to become pregnant, deliver an infant, and be a mother. Only when pregnant was Mrs. G free of pain. Then she was tranquil, hearing no accusations from Charlie, not toying with thoughts of suicide, and not feeling her penis. She was never ill or otherwise uncomfortable during her pregnancies. Her deliveries were a joy, accomplished easily and without complications. At the moment of delivery the last two times, she had a moment of terror wondering if she would have a girl (she never even consciously thought she might with the first two). If she had the opportunity to nurse, it was a blissful experience (though it would have been obscene with a daughter). But her chance to mother her newborn infants was always limited by illegitimacy; the babies never belonged to her. Mrs. G assembled a fantasy of parthenogenetic conception in the manner of other very masculine women (See Appendix 3). Although 69

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she could not deny the biological necessity of a male, she usually denied that the chosen male had significance other than that he had to be physically healthy and intelligent (only late in treatment did it appear that this was far from all). She then had intercourse for procreation, not pleasure; and once pregnant, she immediately ended the relationship. The above was not true of Mrs. G's first and last pregnancies, however. In the first, she became pregnant by a neighbor boy she liked. By this time (age thirteen) she had had intercourse with so many men that, she claims, she never thought of getting pregnant, and even denies knowledge that sexual activity led to pregnancy. The father of her last pregnancy (the twins) was the only man she has loved; he met the genetic requirements she demanded of a father, but he was not used in parthenogenetic fantasy. Mrs. G's craving to be a mother is a constant theme throughout the years of treatment. In the chaos of her life and mind, Chris (see the next chapter) and the two sons she was permitted to raise a few years after their births were easily the most valuable objects of her existence. She invariably struggled to keep from them the intensity of her madness and the consequences of her acting out. Although she denied having a conscience, she always controlled her behavior if it might upset her children. When hallucinating and delusional, she would still, for a time, succeed in preventing her children from seeing the psychosis. I know her two boys well, having talked with them many times, both casually when they have chauffeured their mother for her appointments, and more intimately, when they have talked with me as their occasional therapist regarding their own pathology. They are intelligent, manly appearing young men with an air of casual assurance and (intermittent) lightheartedness that is contrasted with psychopathology, this mix being unlike that of any adolescents I have ever known with one exception: their mother. They have much the same quality of weirdness embedded in unusual ego strength that has made Mrs. G so intriguing and dangerous, though they are far less disturbed. Along with Mrs. G's ever-present theme of raising her sons successfully has been concern for her female body. That she should be so concerned that her femaleness be intact anatomically and physiologically is paradoxical in the face of her having a penis; but, as we have seen, the latter never made Mrs. G doubt that she was a female: she defined herself as an anatomically normal female who additionally

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had a penis inside. Her greatest sense of having been cheated came whenever she recalled her sterilization. She had been living with the one man whom she had loved; and following a psychotic episode during which she attempted to murder her children and herself (see chapters "Murder" and "Suicide"), she was hospitalized in R State Hospital. Although she quickly recovered from the episode, she was not released because no one would take responsibility for her (she was not yet twenty-one). "No one" was her mother, who specifically requested that Mrs. G be kept at R. A few weeks after she was hospitalized there, she was discovered to be pregnant. When she delivered— her twins, her last infants—her tubes were immediately tied. She says her permission was not asked. Her mother gave permission for the procedure. It is not surprising that Mrs. G looked on this as an intentional, wanton destruction of her femaleness by her mother—an additional proof to her that her mother had never wanted a female child. No one understood how her sense of being a female and able to bear children was such that to take it away was to scoop out all that was creative inside her. Her life seeming without value, the sense of this loss disappeared from consciousness and emerged only when, after years of treatment, Mrs. G was beginning to get well and be tormented by hope. In the midst of one of her lengthy hospitalizations, during which understanding and a sense of her own worth were growing, she asked me to arrange for a tubal reconstruction operation: she had learned on her own that plastic repair of the fallopian tubes was possible and that the sterilized woman would then, perhaps, be able to bear children. When Mrs. G first requested this, I hit the ceiling. She was getting along badly with her husband, and so I felt that she was once again planning to use men only as a sperm bank. For her to be talking about a procedure that would perhaps give her another baby made me feel that *y efforts had not, after all, done the job. But I had misheard her. Mrs. G often makes a remark that, in the face of all she has said in the past, may plausibly be interpreted a certain way, yet the interpretation may be wrong. I had understood her to be saying that she wanted the plastic repair so that she could get pregnant, but in fact what she had said (the hour was not taped, and so must be paraphrased) was that she wanted to have the potential for getting pregnant. When I finally could hear what she was saying, the difference from what I had understood was obvious: she

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wanted to be intact as a female, which required that her tubes be patent; but she had no intention of getting pregnant. The operation was then performed. Mrs. G responded immediately, postoperatively, with a sense of peacefulness, and from that time to the present has felt more intact anatomically. The operation succeeded. Three years later Mrs. G inadvertently became pregnant. She had herself aborted, but experienced subsequent feelings of guilt and sadness. She dealt with her feelings and the realities surrounding the abortion in a sensible manner that would previously have been beyond her. Her life circumstances were such that she could not have the baby, but she did not go through with the procedure in a state of emotional blankness. Instead she suffered, but felt that she had no choice but to proceed. It was painful for her to have found she was once again capable of being a mother and then not be able to fulfill that need. However, she did discover that potential, and is saving it for the future. When she had recovered from the abortion, Mrs. G went on to learn what I had always known: that her inability to mother a female infant covered a powerful desire for a daughter. She could not know this because her fear of being labeled homosexual and its implications in her own relationship with her mother made the thought of a female infant nuzzling at her flesh too much to bear. Only when she was better could she begin playing with infant females and little girls and discover how much joy she got from their femininity and femaleness. Being a mother was the one clean thing Mrs. G could feel in her life; in the rest of herself she had no pride, only the part that could create a baby and then love it being of value. Intelligence, ability to draw and paint, musical talent, voracious reading, ability to intrigue admirable people into being her friends—all these attributes were pleasant but unimportant. But from her depths she could create another person through whom she could undo her own corruption and whom she would protect as her own mother had not protected her. Until just recently this was the only laudable piece of herself, but it was worth so much that it helped me in the job of keeping her alive. G: H [son] is constantly doing little things that he thinks will please me. Like he can't pass somebody's yard without stealing a fistful of flowers. He brings me flowers every day. I don't know whose yard he's denuding, but he brings me flowers every day.

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G: 1 can't make them understand that it isn't that I don't trust them [sons]; it's that I'm trying to protect them—I don't know what I'm protecting them from, but I don't want them on the street at night, and I want to know where they are and what they're doing; and I can't help that. And I don't think that's wrong. S: Tell me about your deliveries. G: I loved it, every minute of it. Just to think that I could do something like that. I can remember being in the labor room every time and laying there listening to the women hollering and carrying on and thinking: Jesus, here I am scared shitless this thing isn't going to get out of me, and they're screaming. 1 wonder what they're screaming about. And then . . . even the first time I thought it must be because it's going to hurt, and I kept waiting for the pain, and that didn't come; and then when I didn't have pain, then I thought: Jesus Christ, it's not going to come out. You've got to have pain before it can come out. One time they had to strap me down because I tried to pull it out. S: Yourself? They must have thought you were crazy. G: I was crazy. I was so frightened it wouldn't come out. Another thing I remember. They laid me on my stomach on the guerney to take me out of the delivery room, and they put the baby in my arms. And the doctor spread his legs and said, "See, it's a male child and it's got ten toes and ten fingers." And I thought: Jesus, what a stupid ass, of course he has—there wouldn't be anything wrong with him. I was concerned about how big he was going to be. He weighed over ten pounds; and I thought: Jesus Christ, what if he had kept growing—you know, what if he hadn't come out? But it never occurred to me that there would be anything wrong with him, you know. When they ask you to examine the baby, it seems to me they're saying, "See, there's nothing wrong with this child"; but I never thought that there would be; I just thought that they wouldn't come out. The first baby I had didn't count because I never saw that baby. You know, that was just something that happened. But when I had H, I knew I wasn't going to give him up; and when I breastfed him, I thought: How much closer could you get to somebody; he came out of my body, and now he's eating, and I'm holding him and everything. Then I thought it didn't have to be me. When he had colic, my mother could comfort him. She did as much for him as I did. He didn't need me, so I knew he ... They aren't really mine. It's . . . it's like they were . . . it's like my mother, my mother never was mine either. The only time I ever had anything that was

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mine was Chris, and he was mine. So to raise the boys I had to give them things that I didn't really feel that I should give them because they weren't mine. 1 . . . It was something like a game without an end to it. You know—I'll be a good mother and Til take good care of them even though they're not mine. . . . The first time I got pregnant and I found out I had a baby inside of me, at first I was scared, you know; and then I thought I'm really going to have something that's mine. It's going to love me, and I'm going to love it, and I'm never going to need anything else again. Wouldn't you even need Charlie? No, nothing. Then the baby was born, and they wouldn't let me keep it. I didn't learn. I tried it again and again and again. Well, each time you learned it more. You learned it and didn't believe it the first time; but you learned it, didn't you? You were really shocked that they had this power. You learned that they had the power. All I had to do was be smarter than them. That's why I screwed the psychiatrist. Because the court gave me into his custody, which meant that he had more power than my mother. So if I had a baby by him, and he said, "Let her keep it," they had to let me keep it. And that was the deal you made with him? You'd screw him if he'd work it out that way? And then what happened? I kept him. I kept him, but then my mother still had more strength than I did. She still threatens me. She still threatens me with taking him away from me. She said it on the phone today. She said, "Bill came and got H, but H wanted to stay with me. I'd keep him if I could." And that's one of the things that made me want to kill Bill. I could have had another baby. He wouldn't let me have one. I could have had all those feelings, all that warm, good . . . all that . . . I don't know what it is. I felt it once. The first time I had a baby, the nurse said to me, "You aren't really going to give this beautiful baby away, are you?" And I said, "No"; and then I said, "Yes"; and she said, "Would you like to see him?" And she brought him to me, and he was a beautiful baby. And then they took him away, but for a minute I had that feeling. . . . It doesn't make any difference. Look at me. Look at me. Does it make any difference? Look at me! I don't want to look at you. Because you're going to make me feel bad. Yes, right. Now what else is locked in there besides your being a mother? How about your capacity to weep? What do you want from me? I can't tell you. You want me to cry because I feel sad?

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Yes, that's one of the things 1 want from you. You want me to remember things and feel what they were? Yes. Do you know why 1 smashed the place in reform school [the first episode of being "crazy"]? No. I don't either. I was thinking about a girl that was there. She was just a little girl, not young; she was older than I was, but she was a little girl. She needed somebody to take care of her and somebody to love her and somebody to hold her when she was scared; and I gave her everything I had. And she went away, and I felt like I was . . . I felt like I was just going to come all to pieces, like my whole body was just going to come to pieces. And I got scared, and I started to cry; and then I just went crazy. I don't know what that has to do with me being a mother. It was right after they took the baby away from me. You're making my chest hurt! I can't show you too much feeling. Because then I don't know what you'll do to me. You'll probably go away. That's just the way it is. That's just the way everybody is. With my father and . . . with the girl at reform school. The babies? The babies.

G: He was a psychiatrist, and when I was at reform school they told me I could go home if I had psychiatric care. He . . . I used to lie to him a lot. I used to tell him fantastic stories. He was also my son's father. I wasn't particularly interested in him or what he did one way or another. My only concern was getting out of reform school; and he was the only way I could get out, so what he did was immaterial to me. S: What kind of treatment did you get? You're what . . . fifteen, sixteen? G: Yeah, sixteen, I guess. He just talked to me. I can't even recall what he looks like. S: Why and how did you come to have intercourse with him? G: What difference does it make? Why are you bugging me about it? S: I guess one reason is because it means something to you. G: Well, it doesn't mean anything to me. S: Then why are you giving me ... G: So just drop it. S: No. G: Because you're a bastard. Why did I have intercourse with anybody? I screwed thousands of men. What difference does it make?

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S: Yes, but you didn't choose them to be the father of your children. G: He was available. My behavior was confined. I was only allowed to do certain things, and men were not available to me. He was, and he was willing and he was able. So he became H's father. It's as simple as that. S: Did you really want to be pregnant? G: Yes, I really wanted to be. Yeah, I can remember really wanting to be pregnant. Because I wanted to be happy. Either I seduced him, or he seduced me. I don't see where it's of any use to know one way or the other . . . I don't remember what happened. All I know is that we had intercourse, and I became pregnant. He called my mother and told her that I was pregnant; and he suggested to her that I be allowed to keep the child, that it would be beneficial to my mental health to keep the child S: Did you work a deal with him? G: Yes. S: What was the deal? G: That was the deal. S: You mean he could screw you if you could keep the baby? G: That's right. What's wrong with that? . . . That wasn't the deal. We didn't make a deal until I got pregnant. I assured him that I was taking care of myself, that there wasn't a possibility of my getting pregnant. And when I did get pregnant, then we made the deal. I can rationalize, I can say, "Well, that was a bad thing for him to do. I was sixteen years old; I was his patient; and he was supposed to be treating me and making me better, and instead he screwed me. That was a bad thing for him to do. He was a bad man." That doesn't mean a goddamn thing. He was not a bad man. If it hadn't been pushed in his face and made available to him, I'm sure that he wouldn't have taken advantage of it. He was just a kid. Jesus Christ! He wasn't even a man, literally. I don't know what made me say that. I just said it. I was just thinking about him as a person, and he was kind of a Casper Milquetoast kind of person. He wasn't a big masculine thing. He was tall, but he wasn't a big masculine sort of thing. He was pretty. If ho had been a man and a good psychiatrist, he wouldn't have screwed me even if I had pushed it in his face. G: I can't afford to get sick. Don't you understand that? I'm alone with two kids—I can't afford to get sick. I felt crazy, and that scared me because 1 don't want to get crazy. 1 don't mind being a little bit sick; I can handle that, and my kids don't know the difference—you know, when I'm me, they accept me for what I am—but Jesus, don't

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let me be crazy around my kids! 1 don't want that to happen. And they weren't home, see, and I felt it getting worse and worse and worse; and I was having all these wild thoughts about Chris, and I knew they were going to come home any minute, and I started to cry. In fact, when I was talking to you on the phone, H came home, and he saw me sitting there crying. He wanted to know who I was talking to. And I said, "Dr. Stoller"; and he seemed to think that was all right—if I was crying and talking to you, that was all right. [Later] G: I want to talk about children. If we're going to talk about children, we have to talk about boys and girls. Boy children are healthy and strong and close to their mothers; and they can do funny things like they can pee standing up; and they don't cry when they play football; and they can swear, and it doesn't sound nasty; and boy children are beautiful to look at, and they smell good, not all the time, most of the time they smell good—they smell warm. And girl children are always nasty because if they pee in their pants, that's not ladylike; and if they get their dress dirty, that's dirty; and they have to hide when they go to the bathroom; and they have to play with dolls because they're supposed to—from this they're going to be mothers; and they cry when they get hurt, and they're always scared, and they're cold, and they wish they could be boys so they can be all the good things. That's most little girls. There are some little girls who can pretend they're boys; but they're still cold, and they don't cry when they get hurt. I don't know too much about children. I just know about my own children, and they're boys. Girls are scared of the dark—not very good for little girls to pretend they're boys, because their mothers always know what they are—most of them know what their daughters are; some mothers aren't sure. Some mothers don't want their children to have any pleasure. S: Some do. Do you know any mothers who enjoy their daughters? Enjoy their daughters being girls? Who send out waves of pleasure in their daughters' femininity, and the little girls respond with joy? You have seen that? G: I've seen it in my sister's relationship with her daughters. They go to dancing school, and they always are cute. One of them is named after me. Except my sister changed a letter because she didn't think that was feminine enough. It's my father's name. Oh, I knew how they felt—I never wanted a girl either. Girls are obnoxious. G: I was thinking about that girl baby I gave away. I was just thinking: Too bad I don't give birth to her nine months from now instead of

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twelve years ago. Today's her birthday, by the way. Not just hers— they were twins, his and hers. S: Terrible, terrible thing to have to do. But I think you were like a mother in a burning house who throws her baby out the window and knows that there are firemen down there and just hopes to God that they'll catch the baby. I don't think—you correct me if I'm wrong— 1 don't think you got rid of that baby only because you couldn't stand having a female baby. I think that was the case, but I would like to think that you did it also to save the baby's life. Do you know that? You shake your head.... G: Yeah, I do know that—and you know how I know it—and I never thought about this before. . . . When I brought the babies home from the hospital, they were already a month old; and I was really frightened about having them. And my mother said, "Well, maybe you should put them in a foster home or do something with them until you can get a job and support them"; and I didn't know what to do with them. And my sister had this friend, had a girl friend whose mother is a really wonderful person; and she said, "I have a friend who knows all about twin babies because she had twin babies and lost them; she has two other sons who prove that she's a good mother and she would love to take them and keep them for you." So I went to this woman's house, and it was a nice house, and she was a nice woman, very feminine, very dedicated to her husband and to her children, just a right kind of mother. And I said, "Would you take the babies?"; and she said, "Yes, for as long as you want." And I went away, and I never went back. She called me about eight months later, and she said, "I have to go out of state. YouVe going to have to come and get the babies." And I was terrified, just panicked. And I said, "I don't want them. You have to keep them." And she said, "Well, the only way I could keep them or take them out of state or take them to a doctor or do anything like that was if I had some legal consent." And I said, "Would you adopt them?"; and she was very overcome by emotion or something. And meanwhile I talked to her husband—I don't remember how the conversation went—but I wanted her to have those babies. And then I met with a lawyer and signed the papers, but I never . . . I went to her house a couple of times when I knew that they weren't going to be there. I went there, and I talked with the woman and saw pictures of the children; but I never felt like they were really mine after that. I felt like she was a good mother, and they were her babies, and she could do what needed to be done for the babies, and she really loved them, and she really took care of them. That was what was important.

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So you have a daughter who is feminine. Yes. And you saved her life—you saved her from you. Yes, that was a good thing. Because you were the house that was burning down. I do have two sons that could use a well mother—they don't know what it is to have a healthy mother. I think they would know if I were well, although even though they never had a well mother, I think they would know . . . that would be a good thing for them. You know, I have to think about children again, about children who don't learn the things they should learn about good and bad and right and wrong and maybe . . . maybe grow up never knowing those kinds of things.

G: Do you know what they do when they bring you out of the delivery room at some hospitals? They put the baby in your arms, and they roll you out of the delivery room, and they call the father over. They spread the baby's legs, and they say, "See, male child. Count his fingers and his toes." And then they take the baby and take it wherever they take babies, but they do that. So when they rolled me out I knew it was a boy; my mother knew it was a boy . . . I lost the point I'm trying to make. [Laughs] I'm feeling so strongly about that that I just can't . . . Nobody knew it was a boy. My mother didn't tell anybody: "Look, I saw him—he was a boy." My brother came in, and he said, "Gee, isn't he cute?" He . . . "Isn't he cute?" I said, "Yes, he is." "He looks just like a girl"—that was his comment: "He looks just like a girl." It started before that. When I was on the ward and all the nurses . . . they had his hair all in curls and in a pink blanket. There he was with nothing on, with his penis hanging out. Why couldn't they see he was a boy? I thought if nobody knew he was boy, maybe he'd start thinking he was a girl. When he was about eight months old, I went to R State Hospital, and I was gone a year; and when I came back, they hadn't cut his hair . . . he had curls down to here. . . . Jesus Christ, I almost went out of my mind. I said, "What are you doing to him?" And my mother said, "He's so pretty." I took him right over and had his head shaved. I almost got kicked out of the family, but no kid of mine was going to have curls all over the place. I've got pictures of him. My mother took pictures of him the day I has his head shaved. I have before-and-after pictures—gold curls all over his head. I almost shit. Can you imagine that? I took rompers off of him and put him in levis. I let his brother beat the shit out of him, and then taught him to fight back. He had dolls—I let him have his dolls; I didn't see anything wrong with

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that. 1 don't know how to explain that, but the dolls . . . at first I was horrified when I . . . my grandfather had made him a doll bed, and my mother had bought him a doll. He wanted to play with dolls. I thought maybe if he knew how to care for a baby, he would learn to be a father, not a mother. He had levis on when he was playing with his dolls. And finally he left the dolls alone. All right, so you had eight months. Then comes the craziness and trying to kill the kids and yourself, and then they put you in the hospital for a year; and when you come out, you find that they have let his hair grow long and put him in rompers. Now, who had him? My mother. Was she trying to feminize him? Oh, yeah. Not letting him get dirty and play with the other boys, protecting him and . . . I have pictures of him in dresses. I really do. I'll show them to you. [I have seen them.] Where my sister dressed him up like a girl to play with him like a doll. I put a stop to all of it. I cleaned house. I made myself very unpopular. I raised hell about it. She thought the pictures were cute; she thought I'd appreciate them; and I raised hell about it. I said, "Don't ever do that again. Let him know what he is. Don't let him be confused about what's happening to him. Stand him up to pee; don't let him squat on the pot like a girl." They had been potty-training him and never stood him up. They kind of let me have my way. He was my son. The only one they ever fought about was H. They wouldn't let me be H's mother. Did they do any of these things to H? Why not? I don't know. They bought boxing gloves for him when he was six months old. Maybe because he wasn't pretty. They both went through a period where they wanted to wear my clothes—you know, just play-acting. Four and five. Five and six [years old]. I let them. I didn't see any danger in what they were doing. You know, they were playing a game. When they were with me and maybe they put a dress on, it was for maybe a half hour to play a particular game; and they took it off and put their levis on and went out and dug a hole to play soldier. They interrupted it without your saying anything? Yes. Did they act like girls? No. What would have happened if they had? Do you know what I almost said? I almost said I would have killed them. I don't know what I would have done. I have no idea what I

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would have done. I was just thinking about ail the good things that happen to men. When your boys were little, did you tell them these things? What would you tell them? Oh, some day they would be able to be a father and that they would be able to pick out what kind of a job they would want to have and become educated in the way they wanted and that they'd be able to have a wife and babies and ... I don't know. Was this in the air very much in your family? No. Is that because the boys [in your family] were masculine? I guess so. See, what I'm asking about is: What was your childhood like? And what do you wish for yourself? Let's go back. Your mother has just had a baby, and she's wheeled out in a guerney, and they open up the baby's legs, and they say to all the world, 'This is a girl." Now, how should it have gone? She should have been pleased that it was a girl. She should have been proud that it was a girl. She should have dressed it as a girl. Do you have any information that you weren't dressed as a girl? The only times I can remember, I was dressed like a boy. [I have seen photographs of her dressed as a boy.] How early do you remember? Three, four. Why were you dressed like a boy? I suppose it was just because I was always dirty and it was easier for my mother. Across the street from where we lived, there were two girls living who were . . . one of them was a year older than I was and one was probably two or three years older than I was . . . and my mother used to say to me, "Why can't you be nice and clean like they are?" I just remembered thinking that I wasn't like they were. Little boys don't keep clean. You're sad. I'm not sad. Are you sad? It would have been nice if somebody had told me the advantages of being a woman. The only advantage I ever found in being a woman was being able to give birth to a child, and I did that many times. At least five times I proved I was a woman.

[When one son was born] G: The doctor held him up for me to see; it was a boy, and I was

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pleased. In fact, I wasn't just pleased. I knew it was going to be a boy. There was no question in my mind. I never would consider the possibility that I might have a girl. I wanted a boy so bad. To say I was pleased doesn't mean anything because it doesn't tell you how I felt. I was ecstatic. I was just all full of love and life for that boy. Then they cut the cord and did whatever they do, and they put him in my arms, and they drove [wheeled] me out of the delivery room; and my mother and my sister were standing there. When did you see that he was pretty? When they laid him down on me ... And he was pretty. He's got a beautiful complexion; he was dark, kind of an olive complexion and big eyes and long eyelashes like a girl and curly hair; and oh, he had the most beautiful hands. If I hadn't known that he was a boy, if I hadn't seen his penis and known he was a boy, I could have thought he was a girl. If I were a stranger walking down the hall and saw him, I would have thought he was a girl. O.K., so they wheel you down the hall; and the strangers, or at least outsiders, nurses, what did they say? "What a pretty baby. He looks just like a girl/' Did they really say that in those first few moments? My sister did specifically. I remember it very distinctly. What did your mother say? I don't remember. O.K. Then they opened the blanket up and they showed everybody; they showed my mother and my sister his penis, which proved he was a boy. That's very important that you remember that. And I saw again that he was a boy. Then they put me to bed and they took the baby away. I am not sure about the time element. They brought him back. They brought all the babies to all the mothers. There were six of us. I had the only boy; all the rest of them had girls. I had the only one that looked like a girl. And the nurses would comb his hair and put a curl down on his forehead. And I don't know if you know dark babies, but they look pretty in pink; and they put a pink blanket on him. Sometimes a yellow blanket, but usually a pink blanket. And they would take him and show him to all the mothers before they brought him to me, commenting on how pretty he was. Nobody commented that he was a nice big boy. A ten-and-one-halfpound boy is a good-sized boy. Nobody said, "Boy, that's a nice big boy." They said, "That's a pretty baby." And they wouldn't let me unwrap him. They wouldn't let me take his clothes off. Every time I unwrapped him, I got hell for it.

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S: Why did you unwrap him? G: Because I wanted to see that he was a boy. Then we took him home. First of all, my mother brought the stuff for me to take him home in, and she brought me girl's clothes. They looked like—you know, a flowered nightgown. That's for girls. So I took him home in a tee shirt and a diaper. And then I got him home, and my brothers and the neighbors and everybody that comes to see a new baby commented on how pretty he was and how he looked just like a little girl. I thought about how they made me turn into a boy. I would have been a nice girl. And then I just kind of let him go. I just thought maybe I can't fight it, maybe I have no business . . . I don't know what I thought. I just let him go. And then his father came to see him, and he was so pleased that it was a boy, just like I had created a miracle, just like I had really done something beautiful all by myself. He saved his life. That's when I knew he was my son, not my daughter, not my half-and-half, but he was my son. You know, if you're not . . . if you're not what your parents . . . if you shit on your parents, and your parents don't like it, you can tell. They get a look on their face if you mess your pants. If you're not what your parents want you to be, you know it. You just know it. They look at you; they handle you different; they hold you different; everything about them is different. The one thing you want to do is please them so that you can get the warm feeling, so that you can be held close, so you can get all the good things that you could have. If there's a little boy and his parents want a girl, I guess he'll become a girl for his parents. S: Where did you hear that? G: I never heard that anywhere. You told me to imagine it. My mother wanted me to be a boy. [The story of the psychiatrist again, two years later] G: I'm thinking about when somebody took me to bed when I was sixteen. I wonder where he is now. The psychiatrist. I felt sorry for him really because he was such a little boy; he was so naive. He really was—if you can imagine anyone his age, thirty, and with his education being naive—but he was. I felt the same kind of affection for him that I felt for my little brother. He was just a sweet guy. S: How did it happen? Let's presume that he was not a typical screwer of patients. Is that correct? G: That's correct. He used to take me out on the grounds of the hospital for a session, and we just talked about all kinds of things—you know, just like you and I do, only different. It was different because

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. . . first of all, I didn't think I was crazy then, so I didn't talk about crazy things. I just talked about things that I wanted and things that I wanted to do; and we talked about things that he wanted and things that he wanted to do. I guess it wasn't a very good doctorpatient relationship. And a couple of evenings . . . I was working at the beach, at a place down there, and he would come down there and take me home after work. How did he get talked into going down to the beach? I don't know that I talked him into it or . . . I don't know. Maybe I asked him, and he was willing. Anyway, he came down to the beach and picked me up a couple of times and took me home; and one night he took me home, and there was nobody there but he and I— my grandparents were gone for the weekend. I said, "My grandparents aren't home. Come on in for a while." And he came in. I was scared to be alone in that house anyway because it was always so dark. And I was doing some cards, painting some Christmas cards, and he wanted to see them. And he went into my room, and there wasn't any place to sit except on the bed, for him. There was one chair. Anyway, he sat on the bed and I sat next to him and . . . it just happened. I guess I kissed him. I did, and we just started making out, and we finally went to bed together. That was the first time. There were several times after that. I don't think I decided him as the father of my baby until after several times I'd been to bed with him. He could have been the plumber, and I still would have wanted him. That doesn't sound like you. You've never been one to pick the plumber. You only pick policemen and men in certain positions of authority. No, I'm saying the type of man he was; he could have been anybody. Which was what? Naive, gentle . . . Yes, soft. I mean, it wasn't just a tumble in the hay for him. It was just a good relationship. We had something to talk about, and we felt warm together, and it was a good thing. Books, painting, and children, and . . . we talked about children. Do you know I don't even know if he was married? I don't think I ever asked him; and I don't think he ever volunteered the information. Maybe he wasn't, but I don't know. Because he didn't get nasty until I got pregnant. I made it nasty because then I started to make demands. I wanted him to see to it that I got of! probation and got out of psychiatric care and got home to Los Angeles, where I wanted to be, and got to keep my baby and . . .

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S: Did you double-cross him? G: Yes. I took something that was partially his and used it against him. The baby was just as much his as it was mine. S: That's true. I never heard you say that about a baby. They're all yours, always. G: But I know that that's not true. S: The man is just a penis with a bag of sperm attached. G: Yes, but I know that's not true. S: How long have you known that? G: All the time. I've always known it. Just like F's [son's] father. He's come to the house, oh maybe a dozen times, since Fs been born to see how he's progressed. Well, I could have said, "Look, asshole, I don't want you here; I don't need you"; but I let him come because I knew that he was just as much F's father as I was Fs mother, and I knew he knew. I never admitted that to anybody. I've always been scared. . . . His father's a big lawyer, and his mother's very rich, and they go here and they go there. Maybe someday I'm in the hospital and he decides maybe I'm not the mother for F after all, so he's going to take him away from me, maybe. Maybe one of these bastards will try and take my kids away from me. I always had that idea. S: It's getting too late for that. G: Yeah. S: O.K. What I meant—to go back to the psychiatrist—was not that he shared in the baby—I never would have believed that you would say what you've just said. No, I was thinking that the relationship had been genuinely affectionate and that you had double-crossed him in the sense that he thought that that's the way it was set up, because of something in common—as freakish as it is for a doctor to be screwing his patient. There was something genuine going on between the two of you, and you double-crossed him because he only knew the genuine part; he didn't expect that you were going to ruin that. And that you must have been aware of, and you must have felt some guilt whether you felt it or not... G: Yeah, I did. I feel it now; I feel the guilt now where I didn't then. S: So you really were more powerful than he was. You were only sixteen; he was thirty; and you were nothing, and he was a doctor; but nonetheless you screwed him, and you feel guilty about that. Not the baby part of it, but breaking the nice relationship. What happened the first time you hit him with that? G: Well, he was scared, for one thing, because I was pregnant. He wanted me to have an abortion.

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S: Did you hit the minute you got pregnant, the next time you saw him, or...? G: No, 1 was about two and a half months pregnant before I told him; but I hadn't been seeing him regularly after that. After 1 got pregnant, I didn't see him regularly; and I wasn't seeing him in therapy at all—then I just told him that that's the way it was going to be. G: 1 was so scared to have a little girl, and I can say that . . . I'm scared, i say that all the time, I'm scared about this; I'm scared about that—I don't know if you know what that means when I say I was scared to have a little girl. You know when I was nineteen, when I was in R State Hospital, I didn't think there was anything wrong with me. When I first went there I thought: Well, they're punishing me for something that I've done. And there was a man there, a psychologist, who thought that he could help me. He said, "You really have problems. You're really a sick kid"—and things like that. And I thought: Jesus, maybe there is something wrong with me. Maybe these thoughts and feelings and things that I do, maybe they're not right. When I first went to R, I didn't know that I was pregnant, and then they told me I was pregnant, and that was the first time 1 thought: Jesus, what if it's a girl? 1 just never believed it. And then my mother wrote to me, and she said . . . when they found it was going to be twins . . . she said, "Wouldn't it be marvelous if you had two little girls?" And I said, "Oh, my God. What could be more horrifying than having two little girls?" I visited them, and I looked at them, and I thought: My God, what am I going to do with them? I should have put them out for adoption the minute they were born; but I kept thinking maybe this is going to be the last of them, I'll never be able to have any more; maybe I can do something—you know, maybe I could get married and really have a family or something like that. G: There's a boy out there that came with us today with H, and he's really curious, really curious; and so the two boys are talking back and forth. And his friend said, "Well, what do you have to do to get into a place like that?" And H said, "You have to be crazy." And he says, "Well, how many times has your mother been there?" H said, "Several times." And his friend said, "Well, aren't you scared when your mother goes in there?" And H said, "No, Dr. Stoller will take care of her." And the whole point was the way he was about it;*he just takes it for granted that I'm going to come here occasionally, and he just takes it for granted that you're going to take care of me; and he feels comfortable with it. It's O.K. by him that

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I'm crazy and that you're going to take care of me, because that's the way it is; and he accepts that. G: I figured the operation [tubal repair] wasn't successful and it [pregnancy] just wasn't going to happen. Then I started having symptoms, and I went to the doctor, and he did a urine test, and it was positive, so I went to the abortionist. I told him I needed him to fix me up, and he said, "O.K. Step into my office." And he did. Of course, being raised a Catholic didn't help any. That's kind of a silly thing to say, but ... After it was done, 1 thought: Jesus, my boys are going away, and it would really be nice to have a baby so I wouldn't be alone. And then I thought: Jesus, what if it was a girl? Am I ready to have a girl baby? I don't know . . . it's difficult. I see other women with babies, and Jesus, they do such horrible things to those kids. I'm a good mother . . . sometimes. But I think I'm ready to be a good mother.

6 Chris

During the several years before I began treating Mrs. G, she would stop by my office from time to time to say hello and would also write a letter every month or so to keep me up to date; but I was not really informed about her life, and certainly not paying much attention to its details. I did not think of her as my patient, but rather as a UCLA patient, for whom I had a warm but uncommitted feeling, to be treated by others. I cannot recall whether one time when she stopped by she said she was pregnant; for all that is left of a first announcement to me is a remark that appears in a letter in which, without anything having been mentioned earlier to introduce the subject, she wrote: Ignoring this baby in my belly has become impossible. It squirms, constantly reminding me of its existence. I am making baby clothes because I honestly know it's a baby and someday it's going to be born. I wonder how Til be* then. Not really. I just hope I can be a good mother. Even if it should be a girl. And I wonder if my mother will allow me to keep it.1 I vaguely remember that Mrs. G had told me she had been sterilized and that I was therefore mildly surprised that she was pregnant. However, such things can happen; and I thought no more of it. A month or so later, in hef next letter: My baby is due sometime during the next four or five weeks so I am sticking fairly close to home. The next letter, almost two months later: Still no baby, and I am beginning to think this is just a weight problem. I know wishful thinking won't get me a thing; The baby is actually due the 27th. . . . I will write you when the baby comes. It should be soon now. 88

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The announcement was dated four days later, and said, in its entirety: Hi! 1 delivered him myself and will never wonder where babies come from. Now I know for sure. I am not overwhelmed with mother love, but I find him extremely fascinating. He is also quite ugly, being at this minute 32 hours old, but everyone assures me hell improve. I am almost positive he is an Albino. I'm anxious to have a good doctor sec him, and I wonder what 1 did wrong. 1 hope they will see him at UCLA, and I will bring him to see you then. He has not been named. 1 want to be sure he is 100%. Then I will decide on something appropriate! In the first week, she wrote: For my honest opinion, I think he is a doll. I can hardly wait until Bill goes to work and the boys are in school so I can have him all to myself. I am sure he knows me and I think he loves me. I love him, and this is one baby no one will be able to take away from me. Since I will be at UCLA on Thursday I sincerely hope I will be able to see you. Then you can tell me what a beautiful, intelligent looking son I have. No other opinions are being accepted! Difficulties indicated at birth began to unfold: Unfortunately the baby has a rupture, among other things, and our neighborhood witch doctor doesn't want to care for him any longer. The baby is definitely Albino, regardless of family opinion, and I am not sure whether he requires any special care. I do realize that his complete lack of color pigmentation makes his skin extremely sensitive, and I wonder if his eyes won't need some special consideration. Anyway, there are a million questions I have for some poor doctor in the Medical Center, and I plan to go there. The last time I had the baby there, when he was 10 days old, they would not see him except through the Emergency Service. I was pretty angry at the situation and said the usual nasty, ignorant things. I sure hope they have forgotten and will see him this time. [We shall see later the near catastrophe that this only signaled.] Chris really is a beautiful baby, white hair included. My entire family, husband included, seem to be of the opinion that if he's an Albino, he is some kind of freak and should be placed in an institution. They continually try to convince me and themselves that his hair and skin are getting dark. Pretty ridiculous, but it disturbs me. They seem to think this whole problem is my fault, forgetting, conveniently, that this is hereditary and comes from Bill's family. Oh well, they've accused me of worse.

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As the months passed, it turned out that the baby was albino; and, unhappily, as may be the case in this condition, he was almost blind. But it became even worse: to jump ahead a few years for a moment— the child was eventually found to be suffering from an organic brain deficit falling in the undiagnosable range between mental retardation and infantile autism. Of necessity, since I was neither recording our meetings nor keeping notes, I return to Mrs. G's letters. However, use of her letters can be helpful: they reveal how she writes, which is somewhat the way she talks. They also show how she insisted on remaining in contact with me for years, especially by letters, before she officially became my patient. What cannot be seen are the changes in her handwriting, which are as useful in determining the degree of her contact with reality as talking with her would have been. Her normal handwriting is even, legible, careful, neat, with everything in place. Her degree of upset and confusion can be measured by the degree of scattering of space between letters and words, a shaky quality in the writing, difficulty in keeping margins and spaces from one line to the next, and— most obvious—at severely disturbed moments, scattering of thought processes. By the time the baby was a little over two months old, Mrs. G already knew that he was physically defective, and she had plenty of hints of trouble ahead. Nonetheless, her love for him was fierce and excluded almost everyone else, with the exception of the two sons who were living with her: I guess I did lie about the baby [I no longer know to what this refers], but I got a consistently hard time about my behavior with him at home. I guess it puts me a little on the defensive I do love the baby. I love him more than anything I know. He is all mine and no one can take him from me and have him even for a minute. I have had him from the instant he was born, with an exception of 5 hours during his operation [for hernia]. He needs me and I need him. Bill objects to this, and that's what the hassle is. If it continues I will just leave, but the baby will go too. Bill objects because I don't let Chris cry, because Chris sleeps with me, because I hold him too much, because I won't let anyone else handle him, because I bathe him too often—because of anything I might do for him. Yet I have never neglected my household duties since, and Bill requires damn near as much attention as Chris. I can understand my other boys feeling jealous, but I expect Bill to start wetting his bed again at any

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time. For a long time I needed someone to talk to and be with, to hold and to love. And Bill did not have time. I did not go out and find someone like I might have three years ago. I just stayed home and had a baby. Now I don't want to be bothered—it's as simple as that. . . . [Let's throw in a few things in the letters that are not related to Chris, as background for other issues discussed in other chapters. For instance, at this point in the letter she goes on:] Til be at the Medical Center this Thursday. If you have a couple of minutes just to say hi! Don't misunderstand. I realize how valuable your time is and how generous you have been with me. I am afraid I am making too many demands on our relationship. I realize you are not my therapist. I don't need you. I don't even know what you are. I just enjoy talking to you. Probably because you frighten and are a challenge no one else has been when it comes to what you refer to as "games" [manipulation]. Sometimes I even tell you the truth to see if you can tell the difference [I cannot]. . . . I am honestly sorry if I did or said anything offensive last week. When the baby was three months old, this letter came: On Wednesday I had another hassle with Bill so I took my baby and left, but I had an accident and wrecked the car. I have a specially built car bed for the baby that is stable and well padded so he wasn't hurt, just scared. Of course I wasn't hurt; I never am. Actually there was nowhere to go anyway. My only choices are my Mom's, and back to the streets. I wouldn't go to my Mom's. She'd just take my baby and a baby doesn't belong in the streets, so I am home and lucky I have a home. Bill just goes on as usual. Never saying anything or doing anything. Just nothing. He and the boys made me a birthday cake and gave me a beautiful stereo hi fi. I just don't understand how he can go on day after day not giving me 5 minutes of his time and then go out and buy me something I want so bad. I guess he does like me. I sure hope they will give me another appointment for Chris at the Medical Center. I am also wondering whether I will ever get back into therapy. Actually, I am not really sure I need any more therapy. I suppose I still have a few problems. I don't think I am any different than I was five years ago. I have just learned a little self-control and how to be a better liar. That's about all that's needed in this hypocritical world with its millions of ass holes. The only difference between my playing games with words and everyone else's is that somewhere along the line I forgot how to tell the right kind of lies and when to tell them, but I am adjusting real well through the help of the PTA and neighborhood housewives. I

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listen to these women when they are in my home or I am in theirs. They talk about their husbands, kids, wants, likes and dislikes, and sex, and they make me want to vomit. They aren't any different than me, just sneaky and better liars. They screw around with each other's husbands, have abortions and steal. I gave birth to all my babies. I went to jail for stealing and until six months ago I never once goofed on Bill. I still haven't gone to bed with another man. I just see this guy and talk to him. I have to talk to someone once in a while. None of these women go to a psychiatrist and none of them have been locked up. But 1 guess they are smarter than I. They have never gotten caught.

The next letter, one month later: 1 have had two dreams about you this week so I guess that means I am thinking about you or something. Maybe it's because I have an appointment at the Outpatient Clinic for the baby, and I have been wanting to write and ask if you will have any free time that day. Dreams are sure a goofy thing. Sometimes I go on for weeks and don't dream. Yet when I am asleep most of the day and night, like I have been lately, 1 dream often. First I dreamed I fell in a deep hole in the sand at the beach, but I didn't mind because I was at the beach and that made me happy and then you looked down into the hole, and you had on a long white coat but you didn't say anything. Then I got a frantic urge to climb out, but I couldn't because the loose sand wouldn't hold me. Then you gave me your hand to help me out, but a wave came and washed you away. In the other dream you and I were sitting at a table next to a window and I was asking you why you did not have on a shin but I couldn't hear your answer because there was a car horn blowing real loud. We looked out the window and a man was blowing his horn because his car was running out of control. Then the man fell out, the car turned over and he was underneath and his head got smashed. I thought he was screaming, but it was me and you were laughing, then you said, "He's not dead" and the man got up and laughed too. Boy those are two goofy dreams. They're nightmares. A few days later came the first knowledge for me that she might be disturbed rather than simply a weird, impulsive person. Probably at that time one or another of her therapists had already noticed the episodes described in her letter below; but I was not talking with them, for she was not my responsibility then. This was about ten years ago.

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This last two weeks has been one continuous hassle for me. I have tried to remember and exercise all the things I learned from Dr. T [her therapist], but I am not having very much luck. I either feel as though I want to sleep all the time or I cannot sleep at all. Not sleeping at all is worse than anything else. There are certain times of the day when everyone else is asleep, then I am alone. That doesn't bother me. I like to be alone, but then I feel like I am on something real high, then I have this scarey feeling in my stomach because I want to jump, but I am afraid of the dark and if I jump it will be into the dark. I guess that sounds pretty silly, but it gets goofier. I know I don't hear voices, that voices are loud thoughts of my own. Yet these thoughts are capable of carrying on a conversation with me. I am not talking to myself, because it isn't my voice, and we have terrible arguments. I lose all conception of time. Bill sent me to the store for bread and milk last night at 6:30 p.m., and I didn't get home until 1:00 a.m., but I know I didn't go anywhere else or someone would have seen me or I'd at least remember. And you should hear the stories I have to tell Bill to account for my time. It's a lot easier to lie to him because he always believes me. If I tell him the truth he either gets upset or he doesn't believe me. There is also the problem about the money. We have been on a pretty tight budget lately because of the baby's bills, etc. During the last month almost $200 have disappeared. I don't have any idea what I did with the money and I don't have anything to show for it. I haven't been drinking or using anything and I don't go anywhere except to the park and I only go there at night. Anyway, except for losing time and money I am aware of what's happening and I don't think I am doing anything wrong even when I don't remember. Because I am aware of what I am doing most of the time I think it would be beneficial for me to get into a therapeutic program before I get sick. Possibly I am exaggerating a lot of perfectly normal happening. Quite probably this will pass as it always does without anything serious or destructive happening. But I'd sincerely appreciate it if you would advise me or make some suggestion. It seems like I am always bugging you about something and I don't mean to. No one else knows me. This reaction did not become more severe, but passed out of sight in a week or so. Now that I know Mrs. G, I say "passed out of sight**; formerly I would have said that it "ended." I now know better, treatment having revealed the mental state to which the letter gave clues. After one year, Mrs. G wrote:

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1 think the whole difference in me now and me before is the kids. The boys need me and I need them, and I have to keep myself on an even keel to be ready for their daily demands. The baby was a year old this past Monday, and don't spread it around, but he is the one thing that's capable of giving me something each and every day. My Mom says I would not appreciate him at all if he were a normal baby. Maybe not. Bill says 1 am going to smother him, and I should allow him to be a boy. I just love him, that's all, and I know what I feel, and that's new, and I like it. It seems as though I have to be continually defending my relationship with Chris, and yet I am fully aware he's only the youngest of my three sons. I think I love them all equally, just differently. Gradually the madness I was to know began revealing itself in the letters. Six months after the episode noted above, there was this: I want to go away somewhere that's real quiet and clean, but I cannot leave the baby and I don't know how to take him with me. I want to hurt someone very badly and I know I shouldn't and it's probably me. I have to listen to this filth in my head all the time, and it won't let me sleep, and I don't have to do anything I don't want to do, as long as I remember who I am. So I write it down to remind me. It's the number that's significant and not many people realize that. [I have no idea what this meant.] When I come to see you it will be O.K., just like before if it doesn't hurt too much or get too loud. I cannot remember where they all are when I need them. I guess it's because they are all alike. Six months then passed before Mrs. G surfaced again, once more with her "craziness," which was by then moving more into my awareness. I still was not her therapist; but behind the various doctors who were treating her, she sensed me and was asking me to treat her (as is apparent in her letters). . . . I am scared, but I don't know why. I think I am scared I am going to get caught being sick, and I am scared to death that no one knows I am sick. If this makes any sense at all. I want to run in the street and beg someone to please, please help me. I cannot understand why no one sees me hurting so much, crying so hard and running and running. If someone, even you, said—O.K. I'll help you, tell me what's wrong—I don't know what I'd do because I swear to you I don't know what's the matter with me. My mind puts out filth, but no more than usual. I find myself eating constantly. But I'm hungry constantly. I vomit quite a bit, but I am drinking considerably

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so that's not hard to figure. 1 go to bars and talk to anyone, but I am not sleeping with anyone. I take care of my responsibilities at home, no better or no worse than usual. I am writing you these things because I can forget them 20 minutes from now and I always lie to you. Not always, but often. 1 had a dream not long ago that I was in prison and in a cell with two other women. We all slept in the same bed, and they were men from the waist down. We were discussing masturbation and I found I could not because I didn't have a penis. Then you came and told me to go home because I didn't belong there, but I did not want to leave. There was another one I have had many times where I am in a hole and every time 1 try to crawl out I fall back in and you are standing at the top in a long, white coat but you cannot reach me. I just found out it's you. I think I need to do something bad, but I cannot leave the baby. I am so very tired. I am getting too damned old to be running scared. I get tired very easily and I find pain almost impossible to contend with. Following this, I told Mrs. G that it was silly for her to come around to the back door, sabotaging her treatment with the other doctors, and that I would like to start treatment with her myself, since she was not seeing anyone else just then for psychotherapy. There followed a series of broken appointments. This next extract is from the first letter she sent after our treatment relationship had become official; its purpose was to break the first appointment: I sincerely wonder if I can be your patient. I am a little afraid you will demand more of me than I am capable of giving. I trust you. I know what that means now. I just don't want to be afraid of anyone. I don't run as much now, but I have started to vomit again. That's kind of funny. My Gram says when I was a baby and lived with her I was good, but every time they sent me to my Mom I'd puke all over the place. That must have been why my Mom never wanted to keep me for very long. Every time I stayed with her and got sick she would try to fix it. I had my tonsils out and appendix and later she got the babies. When I saw her Tuesday, I threw up all over her. I am sure it gave her fond memories. During this period one of the precipitants of the later emergency began developing: One doctor was sure Chris was retarded. The lady that tested him said that in her opinion he is not retarded, but that he is autistic.

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Anyway, next month they will see him again and explain his problem to me. I have never heard of it before and cannot find any reading material on the subject so it must not be very serious. I am just glad he's not retarded. Mrs. G later did read about infantile autism, but still maintained her feeling that this condition had a good prognosis whereas retardation was hopeless. It was her plan to cure Chris of his autism by infinite love, for she had read that the condition was not a brain defect and therefore not hopeless. However, as months passed and she talked to many authorities, the uncertainty of the diagnosis was never (could never be) resolved, which made her more frantic. They are also going to send him to a class for children who have visual problems. I used to think he could not hear, because he never responds to anything I tell him and he has never said a word [he was now two] but he hums musical tunes he hears and imitates some sounds so his hearing must be O.K. Bill says that he's just spoiled rotten and as soon as he discovers he isn't the only individual in this world he'll be O.K. After three months, during which she kept only one appointment, she wrote: It doesn't really do any good for me to see you. You are really not any different than the rest. You just seem to make it worse than the rest. At least things hurt worse. You won't believe me, but I am not lieing. When I was a little girl I had these exact same feelings and hurts and thoughts. I couldn't have been less than 8 or more than 10 years old because I was living with my mother. I can remember that I believed in God and I would beg him to help me because the pain was too intense and I cried too much. Then I knew there wasn't any God and I learned not to cry. Then my guts cry and I hurt most of the tune and I don't know why. It's worse now than ever. I can't think or clean house or take care of family responsibilities. I have whipped my baby until I have left welts on him. I sleep and sleep but cannot sleep enough; I am always tired. My body aches. I vomit for no reason. The most frightening part of all is that I've forgotten who I am. Until just lately, I always knew. No one else did, but I did. No matter how hard I try, I can't remember. So now all these years of hassle have been for nothing, because now it's too late. I can't remember just when it happened, when I was very young, I suppose. I have told you and the others so often, but you never listened. I am going to tell you once more. When I was little there was something terribly wrong with me. I

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have never really been sure of what it was. I guess it was because I was ugly or stupid or something, but nobody liked me and no one really wanted to keep me. So they started shifting me around so no one would have to keep me for very long. Then when I got older juvenile halls and jails, and hospitals, because I eventually ran out of relatives and they ran out of patience. I don't know when I found out but I found out each one was different so I had to be different for each one, always different, but never me. My mother wanted me to be a no-good bastard like my father; my Gram wanted to be worshipped; my grandfather wanted to lay me; my brother needed someone to beat and on and on and on—except my father. Never my dad. My dad always knew who I was, but he was always gone, either in a war or my mother sent him away and now he is dead. I think he is dead. 1 went to the funeral. Yet I find myself waiting for him to come for me like when I was little. Sometimes I have to wait years, but he always came for me even in jail and the hospitals. This is ridiculous. I say these things again and again and again for nothing and now it is too late. I think, for a change, I will handle this myself. Not asking anyone for anything and not waiting for someone. I think I am finally old enough to make this final decision for myself. I cannot take your way anymore. I will see you on Tuesday. She did not come in. And so on and on, week after week, I made appointments, and she broke them. I planned to see her once a week to get to know her well enough to decide what would be the best frequency, but there was no opportunity to do so. I knew she was frightened at finally getting me for her therapist, and I presumed that eventually the next phase of treatment with me would start (the first having been the years of treatment-not-labeled-as-treatment). Then Mrs. G was arrested for a minor traffic violation, and it was discovered she was on probation, with a horrendous record of previous arrests. The judge reluctantly suspended the sentence, if, among many conditions, she would actually participate in her psychiatric treatment. And so (no doubt happily somewhere within herself) she was forced really to start. During the first year of treatment, the correspondence continued at about the same rate; she kept only a few appointments. Her main concern was Chris. She believed no hospital could treat him except UCLA; she had been seen with him by our Child Service, but her hopes that he would be a UCLA patient were being dragged down in the administrative morass. She then wrote:

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Dear Dr. Stoller, I received your letter on schedule and have been up to my ears in family hassles or I would have written sooner. Please excuse my lack of stationary. Thank you for explaining the word "autistic" to me. It seems to fit Chris. I wonder to myself just why Chris acquired this particular personality problem, when I gave him all the love and attention I was capable of giving anyone—And maybe that's partly the answer. I need to tell you something. The truth about the biggest lie I've ever managed to tell and get away with in my life. I'm going to tell you as my doctor, and if my understanding of ethics is clear, that means you can't tell anyone else. Maybe you already knew, but I don't think so. Anyway, Chris is not my baby. I mean I didn't give birth to him. My being pregnant and giving birth was all a lie and no one knew the truth except me, Bill and the girl who had the baby. I delivered him myself and brought him home when he was forty-five minutes old. And with the exception of a few very short days, he's never been away from me for more than a couple of hours since then. He was his mother's 7th illegitimate child and she's had two since Chris' birth. Of all the children born to this woman, she had two defective boys, Chris and a seven year old who is to be admitted to F State Hospital as soon as there is an opening. He is also an albino, thought to be retarded as he has never spoken a word. I'm not telling you this because I want you to know I lied or because I'm ashamed of lying, but because I think the doctors should know the truth for Chris' benefit—And yet I can't tell them for legal reasons. I have no legal right to have him treated—I have no legal rights period. All of the surgery and medical care he's had has been because no one knew he wasn't mine. I'm afraid to tell anyone for fear they'll take him away from me and, Dr. Stoller, Chris is my life. I never think of Chris as not being mine except when something like this occurs and its pretty frightening. I see Chris' mother occasionally. He is three years old and she's never asked me for anything or gives any indication she feels anything towards Chris. She can't read or write very well so two weeks ago she asked me to help her get the other boy admitted to F. We took him and Chris with us and talked with a Dr. C. This is a weird world and my experiences with it never end. Anyway, Dr. C used to be director of R State Hospital and sterilized me there. How about that for a coincidence? He didn't recognize me anymore than the fact that both boys were hers. And I didn't mention it. That's for sure.

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You know, I'm an ignorant, uneducated person and that there are many things 1 have a limited understanding of if any. I have been attending some psychology lectures and have just learned a little of heredity. All of this time the doctors who have discussed Chris with me must have been thinking I had him illegitimately, (smile) You'll have to admit that's kind of funny when I've had five and their births are never questioned. I didn't know Albinoism was hereditary. How come you never questioned it? Anyway, I see all sorts of possibilities in relation to Chris and his actual parents. Fortunately I know who fathered Chris and quite a bit about his mother's background. His father is The mother could never be considered good breeding stock. Although the majority of her family seems to be fairly intelligent and educated, there's a whole history of birth defects, prostitutes and a brother who is confined as a sexual psychopath. Maybe all this is unimportant and has no bearing on Chris or his behavior at all, but I haven't taken him back to the Medical Center for these reasons. I just don't know what to do. I could never imagine the welfare department allowing me to adopt him, with my background they might even take all three boys from me. I can't take that chance. There are no birth records and eventually there will have to be. Chris has no more legal rights than we do. If Bill and I were to die, he has no rights of inheritance or anything else. No one else would want him and he'd end up in an institution. These aren't things that have just occurred to me. These are the first things that have entered my mind every morning for three years. I love him, Dr. Stoller, and I suppose, as much as I hate to admit it, I use him because I need him, because he needs me—If that makes any sense. I didn't realize how much I was writing—I hope I have an envelope to hold it all. (smile) I lie to you pretty often and unless you question it the lie stands. I've wanted to tell you about Chris many times, but I was afraid to. I think I was afraid you'd tell me to give him up. Now that you do know, maybe you can help me to help him. I don't know what your knowledge consists of in relation to a situation like this, but I'll sincerely appreciate any help or suggestions you can give. I can't adequately express my feelings for Chris, but you must have some idea after three years. I am asking that you don't give my name to anyone who could take him from me or make it possible for the situation to become known to anyone with the authority to take him. That's all. I'll be looking forward to hearing from you again at your earliest

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possible convenience and will call for an appointment as soon as I can arrange for the necessary transportation. Sincerely, Mrs.G On finding my reaction benign, she sent this next letter, explaining further: I'm glad I've told you about Chris. I was afraid you'd be angry. And yet you've never ever asked me about his birth. I only promised to tell you if I were lying if you asked. I doubt if you remember, but I returned from M in 1960. Prior to returning to California, Bill was bugging me till I thought I was completely losing my mind. We lived 15 mi. from town; I had no friends, radio, T.V. or phone and wasn't allowed to have money. So, I told him 1 wanted to start therapy. The closest clinic was 150 mi. at K Hospital where his mother is. He agreed and I had access to the car. I then called the State Police Narcotic detail and offered to work undercover for them. So, while I was supposed to be getting therapy, I was earning money. Anyway, by the time I was ready to leave M I still didn't have enough money, so I simply told Bill my sister died and he bought plane tickets for the boys and I. When I got there I gave my Mother an explanation just as fantastic. Friends helped me find an apartment. The day 1 was supposedly returning to M we moved to the new apartment. 1 put the boys in school and went to work for the L.A. County Sheriff's Department. Eventually Bill and my Mom got together, but it took Bill 2% months to find me. Bill promised to change—The boys and I needed him so we went back together. He did change. Things were exactly the opposite. I had my own car, spending money and went out every night while he baby sat. To this day Bill has never once asked me what I do when I'm out all night. I met Chris' mother when she was three months pregnant. I mentioned to a neighbor that I'd like to have a baby, but couldn't. She said she had a niece that had one every year that was put out for adoption. I talked to the woman, agreed to provide her with maternity clothes, pay the hospital bill and six weeks post-partum care. Then I told Bill. He blew his cork and said definitely no. I just ignored him, per usual, told my family and everyone else I was pregnant, made baby clothes, took care of the mother and finally ended up delivering Chris on her living room couch. It was quite an experience, and I was frightened to death. I've been afraid ever since then that I did some-

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thing wrong to make him like he is. And that's where I got Chris. Never a dull moment, (smile) . . . She told me the following, years later: G: I'm writing a story about me and Chris, not for anybody, just for me. I suppose you can see it. I'm just writing it so I'll understand more about Chris and 1. I had to go all the way back to the first minute I heard about Chris, and that was when the lady, my next door neighbor, said, "Do you know anybody that wants a baby?" I really didn't want a baby, but I did want a baby. That doesn't make any sense. I ... my boys were growing, and I was getting to where I would be a little independent from the boys. Not really; they still needed care, but no bottles and diapers and all that crap; and I really didn't need a baby, but I had this feeling inside of me about wanting something warm to hold, you know. And I told the lady yes, I wanted a baby. And I knew I was going to get the baby; there was no doubt in my mind that the girl would tell me, yes, you can have the baby; there was never any doubt in my mind that I would get the baby. And we went . . . and I insisted we go right then, the same day, fifteen minutes after the woman made the remark, I insisted we go right then. And we jumped in the car, and we went to this girl's house. I would have promised her anything. All she wanted was some maternity clothes and for me to pay her traffic fine. I never even asked Bill. I just told her yes, yes, I would buy her maternity . . . I didn't even know I was going to get the money because I didn't have any money then, and Bill didn't give me money. And as the months went by I grew like I was pregnant, and I could feel the baby inside of me; and I told my family I was pregnant, and I told you I was pregnant. S: Bill? G: No, not Bill. Bill knew, but I just ignored what Bill knew. S: But you knew you weren't pregnant. G: No, I didn't know I wasn't pregnant. And when she went into labor, she called me in the morning, and I went to her house and I was experiencing the labor. S: You were imagining it, or you were experiencing it? G: No, I was experiencing it. S: It hurt? G: Yes. S: Cramps? G: Yes. S: You felt the same sensations in your belly? G: Yes. And I knew the baby was going to be a boy; it had to be a boy.

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1 thought that it was going to come out of me, and 1 was surprised when it didn't—when it came out of her. But it didn't make any difference. And when the ambulance came to take her to the ... Say that again, 1 wasn't listening. I was already doing an experiment [trying to feel in myself how she could so split herself]. Say it again. When . . . 1 knew it was going to come out of me, but when it came out of her, it didn't make any difference. I felt that it was mine. Yes, I understand. You knew that it was going to come out of you? Yes. And yet there was a part of you still that knew you were not pregnant? Yes. But another part thought that it would come out of you. And another part knew that it was her baby. And no part of you questioned this impossible situation? No. And when the ambulance came to take her to the hospital, I rode in the ambulance, too, just like it was mine. And when we got to the hospital, the doctor wouldn't let me stay in the Emergency Room. And you got sore! Yes. I told him that it was my baby; and he said that he understood there was some kind of an agreement between she and I, but he wasn't interested in that. And I told him that I felt I needed some attention, and he said he would give me whatever attention I needed after he was through with her. [Laughs] So I sat in the lobby. The guy thought I was crazy. Yeah, I wonder why. Did you lose weight? Yeah. Did anything come out of you? No. Not a thing? No liquid, nothing? When did you start losing weight? Immediately afterwards. How much? I lost twenty pounds. What do you mean by immediate? Well, by the end of the week I knew I was losing weight. How long did it take to lose the weight? A month. How much did you lose the first week? Five pounds.

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This new information did not jeopardize Chris's chances of evaluation and treatment at UCLA. However, the ways of institutions may be less smooth than the private care of the wealthy, and Mrs. G was desperate and too sophisticated about such places to rest easy with a slow and uncertain workup of an uninteresting child with a bad prognosis. She began to get frantic. I'm sorry 1 brought up the subject of Chris, while talking to you on the phone today. Through no fault of your own, I'm sure I got just enough out of our conversation to leave me slightly confused and extremely frustrated. All of this time I've been hoping Chris would prove to be autistic. Evidently I've been under the mistaken impression that autism is a not too severe psychological problem, easily corrected through therapy. This belief in autism has kept me on an even keel for quite a while. I swear to you that I have never believed Chris to be either mentally retarded or defective. I have seen retarded children and know they are capable of a great deal. I knew a mongoloid boy who could do fantastic card tricks. 1 can't bear the idea of him being put in an institution—not because of my loss, although where he's concerned I'm very selfish, but because of Chris as an individual. I am the only one who understands his wants and needs. I ask myself, how will strangers know when he wants a drink, or needs to be changed or wants to be held and rocked —who would hold him and rock him anyway. I have lived enough and seen enough to know the impersonal attitudes in any state hospital. I know the statistics, the lack of facilities and competent, trained personnel. I've read about the various hospital investigations and the case after case of children being mistreated. I, myself, have been confined in four state hospitals, two private hospitals, five county psychiatric wards and one military hospital. I will never claim to have been abused, but I have been slapped, kicked, sedated, strapped, ignored and called filthy names. I have been privileged enough to have been committed to California's best. Ill be the first to admit that UCLA was the best, and I was so lucky to have been a patient there, with a minimum of patients and a maximum of individual attention. It was also the first place I was ever able to buy special consideration from an attendant with a piece of ass. It's so easy to be objective about a variety of subjects and easiest of all is being a complete ass about this baby that has come to repre-

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sent unbelievable things to me. Why couldn't I have felt these things for one of my own sons? Until Chris there wasn't anything for me but "this minute" and I lived only for what was happening at that particular moment, no matter what. I can't honestly claim that my behavior has been the best since Chris' birth but I haven't used narcotics, I don't drink as much, I don't screw around and I don't want to die. When my thoughts turn to self-destruction I know Chris needs me and can't be left alone. I don't know if I saved up a life time of love or what, but 1 love Chris and he loves me. I need Chris and he needs me—Then there's the other side. I'm not helping him and he's tearing me into little pieces. He screams until I think I'll go mad, then I slap him and we both cry. I don't know what this atmosphere is doing to the other two boys, but I know that it's completely destroyed whatever relationship Bill and I may have salvaged out of a not too healthy marriage to begin with. I need Bill for the roof over our heads and the food we put in our bellies. I see him a few hours a week, that usually ends up in an argument—And this, too, is detrimental to Chris and the boys. I ask you and any professional individual I come in contact with for advice concerning Chris, but I don't think I really want it. I want someone to tell me that Chris is an intelligent child, who, with a few therapeutic sessions, will begin to talk and function like any average three-year old. I want to take him and run away and hide, just he and I and forget the rest of the world. I did that once—but I can't survive alone. This whole situation is bugging me to death. How can I possibly make anyone understand . . . Obviously, Mrs. G's worry came from several sources: her uncontrollable need to have Chris close to her to cure her emptiness and loneliness; her fear that institutions would treat him the way they treated her; and inability to hate him for his defects and the concurrent need to protect him from the outer world's cruelties, which she believed to stem from hatred like that she could not accept in herself. Obviously, her identification with him was profound and destroyed her judgment. A short while later, she wrote: Chris is becoming increasingly difficult for me to handle and I am beginning to get very honestly frightened—for him and of him. He won't leave me for a minute and won't sleep unless I am holding him in bed with me. Bill has been sleeping in Chris* room for a month now. It seems like he is always screaming and crying and because of

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a complete lack of communication, I never know why. Sometimes he screams so much I just want to slap him and I am afraid mostly of what might happen someday when I am not feeling well. A doctor friend of mine gave me some liquid phenobarb for him, but I can't keep him sedated and I am afraid I will addict him. I know you are going to immediately suggest I return him to the Medical Center, so, I might as well tell you the truth and explain why I came. First of all, just the physical testing, EEC, etc., takes months. Each appointment involves hours of hassle that is hard on him and almost impossible for me. People stare at him and I want to smash them. He starts screaming, and I cannot control him. But worst of all, I cannot stand crowds of people. Even grocery shopping is difficult for me. In a crowd, like the waiting room at the Medical Center, I hear everything so loud and in five minutes I am ready to crack up. I don't know what to do, because neither one of us are getting the help we need. Chris is 3 years and 3 months too old now. Too soon he'll be school age. A few days later: I just wrote, I don't know how many pages, on my problems with Chris, not realizing just what he was really capable of ... he didn't attempt to wake me, I really don't think. We sleep in the same bed. He went in the kitchen and smashed everything he could lay his hands on. He dumped everything out of the refrigerator, including 2% gallons of milk! He broke a bottle of wine, cutting his hands and wiped blood all over the hall, both bathrooms and the living room walls. He took a dozen eggs and smashed them all over the living room carpet. He smashed a dining room chair and broke the player arm on the stereo. No one in the house heard him but the dog. When I got up and saw what he'd done I honestly felt that he was not only pleased but that he had made the entire mess very deliberately. That's a pretty frightening thought. I have no idea what his mental capacity is but I know that his behavior dominates this house and he has me completely worn down. I tried to discuss him with Bill just a few minutes ago, and his remarks were that I shouldn't have been allowed to have Chris in the first place, and as far as he's concerned, the sooner Chris is removed from our home the better. I don't know where he thinks Chris should go, but I know that I'd rather see Bill dead than lose the baby. And God help him if he ever makes any attempt to remove Chris from me. I should think that after 6 years he would be fully aware of my being a very capable, vindictive, thoroughly nasty bitch if he pushes me, but he seems to forget in between times.

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The same week: I have no idea how many letters I've written you on the subject of Chris. I know that no matter how many pages I write I can't possibly adequately express any of the feelings I'm so full of. Do you know that I was committed to Q State Hospital solely because I was pregnant with my fourth illegitimate baby. Lies were told, with my consent, on the commitment papers, because my mother said the state would handle the expense of my pregnancy and support my sons. Do you know I could have and begged to get married during my first pregnancy and she wouldn't let me. Did you know that I didn't know that 1 didn't have to give my baby up, that they told me if I didn't my family would suffer, my Mom would die of disgrace and I would go to reform school. Did you know that my Mom kept my son because the doctor who got me pregnant paid her. Did you know I was never allowed to touch him until he was over a year old. Did you know my Mom let me have my other son if I'd let her have the first one. Did you know that when I was discharged from R State Hospital with 5 week old twins my Mom told me to come home, and then after 10 days told me if I didn't get rid of them she'd put us in the street and have me recommitted. Did you know that for as long as I can remember all I've ever wanted was something that would be mine, that I could love, that my Mom or sister or someone couldn't take from me. Other people do, but never me. Never, ever have I had anything that was mine to hold and love and keep. The state even took away my ability to have a baby of my own. Then I was given Chris. My baby, my love, my whole life. I made Bill move away from my family. They only see him on holidays. In my arms. He's my son, no one else's. I swear to you that I've never done anything but love him and care for him and try to make him a healthy, happy individual. I've taken him to skin specialist, and eye specialist. He's never had the skin or eye problem prevalent in albinos. Now I'm told he needs to be institutionalized, that the hereditary factor that came out in her 8 year old shows in Chris. Everyone tells me it's best for Chris and best for me to give him up. You tell me why, in your 50 minutes you tell me how to tear the guts out of myself and like it. Tell me about Bill and the two boys, the three that have never needed me. You can't and no one else can. No one can tell me that this is right or just or good. The terrible thing is that none of this ever had to happen. Before UCLA I didn't have anything, but it didn't make any difference, be-

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cause eventually my desire to die would have become a reality and that would have been the end of a stinking dirty mess. I never wanted any part of. I didn't ask to be born, I don't think I've ever asked for a whole lot since I've been born. I know this—I'm not handing my son to anyone freely. It's going to have to be proven to me that it's necessary for Chris' happiness and survival. And if that happens, I'll know for sure that this filthy, rotten, stinking, fucked-up world won. I'll be able to, with a clear conscience, be able to ignore the rules and regulations as well as the lies and shit you and people like you have been pouring into my mind all these years. I'll know 1 was right, that my way was right. I'm stuck with psychiatry until the end of my probation. That only means I'll have to sit in your office so many hours per month, nothing more. Maybe I'm sick now, but I know what I'm writing and you can believe every word of it.

Because she could go from being so disturbed to so healthy, I never had the same feeling of danger with Mrs. G that I would instantly have had with others who signaled possibilities of suicide and murder as she did. However, the situation with Chris was slowly becoming more serious. My hopes that it would more or less resolve itself as everything in Mrs. G's life seemed to do—more or less—were wearing thin. New qualities of despair were appearing, and the suicidal-homicidal threats seemed less manipulative and more as if she felt them to be her only workable solution. Thus I was forced, against my own good sense and heavy schedule, to look for a solution in insight. On top of everything else, this hardly made me happy because I knew how the treatment itself might lead to murder and/or suicide—though it was (and is) my opinion that not to try guaranteed those outcomes. I now felt forced to dig in, to try to help Mrs. G find the unconscious roots for her need to keep Chris as part of her own body. And this was the third phase of the treatment: the introduction of insight therapy (the search for psychodynamics, for lost memories, for origins), the main part of the treatment, the part that merged into the fourth phase, the treatment as a part of my research in gender identity. And so, seven years ago, this shift was marked by a letter from Mrs. G that responded to my remarks in her last treatment hour and to a letter I wrote answering questions she had written. (I was not yet using a tape recorder.) First you write a full page on the advice you'd give to anyone but

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me, so you say. Then you ask how Chris came to be so much a part of me. 1 would like you to explain to me what you mean by an "appropriate" institution. I wasn't aware that there were various types of institutions. You underestimate me. I have honestly admitted that I keep Chris for my sake as well as his, and I think anyone would have mixed emotions when considering placing their baby in an institution. I know I need help, I know Chris needs help. This entire situation is tearing me up. Am I really so different than other mothers?

This next letter marks the shift as she tries to understand a piece of behavior, in response to my demanding insight of her. You ask how Chris came to be so desperately a part of me, and I'm not sure I can tell you, but I'll make a sincere try. My mother told me once, that I would never have appreciated Chris if he hadn't been different. That's a pretty interesting thought, as much as I rejected and resented it at the time. In the beginning, before he was born, I'm not sure why I wanted a baby. I think my pretense of pregnancy may have been an effort for me to establish myself as a wife and mother—for me, in my own mind. I had a chance to be a wife and mother, just like other women, for the first time. I don't think I was thinking about a baby, as a baby and an individual. Then he was born. I delivered him and took him home when he was only 45 minutes old. All of a sudden I was holding a warm, wet little white haired individual, whose very existence depended on me. He was sick in the beginning and was operated on for hernias when he was only two months old. Anyway, when he was about ten days old he hadn't opened his eyes and was having trouble digesting his food. I took him to UCLA and was told he was an albino, requiring some special care. I have a written record of every event in his three years—The dates, events, even when he cut his each and every tooth. He was a little slower than average, but not much, until he was about 16 months old. He smiled at two weeks, reached for an object at 10 weeks, sat alone at 29 weeks, crawled at 9% months and pulled himself into a standing position at 1V> months. He even walked at 11 months and said and sounded definite syllables. I swear to you that at 15 months of age he could say, "I want night-night." My mother thought it amazing. Then when he was 15 or 16 months old he quit. He not only didn't make any further progress, he seemed to regress. The slower his progress became, the more the attention he demanded

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and received. At this point my sons were hospitalized for several months with the injuries they received in an automobile accident. As usual I'm going on and on about Chris, forgetting my original subject. As long as I can remember I've been different in one way or another. Different in behavior mostly, different from other kids and my brothers and sister. The older I got the more the differences apparent and otherwise. You must have some idea, by now, how it's been most of my life. And Chris was different. Not the same kind of difference, but not like other kids either, a visible kind of difference. I had for Chris all the love I hadn't been able to give five babies and more besides. I didn't have to be afraid to love him; he needed me, and I honestly believe I felt all the things for him I couldn't possibly to anyone else because of the things, emotions and thoughts, that were different More than once my emotional involvement with Chris has frightened me. I hurt for him because of his frustrations that make him miserable. I have never wanted to hurt him and most of this situation of mine was based on the fact that because of our "differences" we could never hurt each other. I've re-read this and I still haven't made myself clear. I'm probably trying too hard to explain something I can't understand. Maybe I'm only trying to justify something I don't understand All it took to precipitate a psychotic episode was a shift I made to trying to find why Chris was so vital, a question the simple asking of which Mrs. G sensed as a wedge being struck to split the two of them; and so she reacted with psychosis. Now, in another letter, she writes (with psychosis apparent in her handwriting): I'm not going to come to see you any more because I don't think I need you for a doctor anymore. I think it would be better if I didn't have a doctor anymore and then I would probably be feeling better. For a minute I forgot about the probation but I'm going to call my lawyer or write the court and ask them to release me. So I won't have to go to jail if I don't go see you and if you tell about Chris 111 tell them you lie. You're just like my father and he wasn't very dependable either. I know I don't feel good right now so I don't need you to tell me but after all this time I know what to do. I bet I knew it all the time and just forgot and if every one leaves me alone it will be all right so no one is going to know. And the baby too. Thank you for being my doctor and I'm sorry but I was always bad.

110 SPLITTING Psychotic episodes alternating with lucidity increased. It seemed easy enough to control these episodes: since they were precipitated by the small traumas of daily life, it took no more than discussing the precipitant and its meaning with Mrs. G for her to clear up in a few moments.21 was even able to do this by phone, when she called in an agitated state, as well as on seeing her in the office. I became used to her being this way, recognized that the episodes were not only painful but were exhausting her, and expected that in a few months I would be able to get more understanding of them and that she would settle down. There were so many events to set off the episodes. I began to work on the more permanent underlying conditions that would have to change; I could have chased precipitating events forever: the moments that made up her empty and angry relationship with Bill, chance remarks by her mother, frustrations in trying to keep Chris close, and fear that his condition might be used by authorities to separate him from her. Then, one day she came in very disturbed; as the hour progressed, the disturbance increased. She could not attend to what I was saying but was absorbed by auditory hallucinations, saw blood flowing on the floor, had difficulty completing even short sentences, made cryptic remarks, and—most dangerous of all—had a confused and blank look on her face with a whiteness around her eyes and lips that signaled she was close to the end of control. I prefer keeping patients out of the hospital as long as possible. On the basis of many experiences with Mrs. G's psychosis, I had learned she could hang on and that the episodes could be resolved psychotherapeutically. As this hour passed, she began to relax, focus, and even, at the end, joke a bit—appropriately. She left, not only with the understanding, always present in the treatment, that she should call me at any time she wished but with my additional advice that she call out if she needed help. This was all during a period of wordy negotiations with authorities about Chris's management. For months he had been seen intermittently at one clinic or another, by one doctor and social worker or another, with varying opinions being expressed that increasingly perplexed Mrs. G. Under serious consideration at the moment was the possibility that Chris might be hospitalized for extended evaluation in a state hospital for mentally retarded and autistic children, but the final plans had not yet been made. It was Mrs. G's responsibility to carry through with all the appointments; and despite increasing episodes of confusion,

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she was driven to attempt to work through this administrative mess, which would have tried anyone, much less a psychotic mother. What she could not (would not) tell me during the hour reported above was that it was becoming likely that Chris would be hospitalized and thus taken out of her hands. She was fearful that since she had no legal hold on him, she could lose him permanently. And so, terrified at that possibility, Mrs. G went home from her appointment with me, packed Chris up, and drove off. Hours later, she stopped somewhere, went to a pay phone, and called me. (For years, this episode has been covered by repression; and even now, although she can remember the episode, she does not know where she was.) Terrified, psychotic, and shiveringly out of control, in the uncanny and terrible manner she had of expressing her horrors, she told me she had a gun and was going to kill Chris and herself. (She didn't put it that clearly, but the way she put it was shatteringly clear.) I talked passionately, in the end calming her enough so that she promised not to do anything but wait at the phone until I called back. (It has always been a rule, no matter how crazy she has been, that she would keep promises—and she has never broken that rule.) I then got to work to get her hospitalized. I shall spare the reader an account of the fight to get a bed for an emergency on an already full service. That the patient would come only to UCLA, to no other hospital, was interpreted as manipulative, which is exactly what it was; but that she would kill herself if she didn't get her way was regarded by the hospital authorities as her problem—until I got nasty. But that was only half the problem, for the Children's Service had a rule of simply not taking emergencies; and Mrs. G had set as one of the conditions of her not committing the murder/suicide that Chris be admitted only to UCLA. My threatening the Children's Service with the blood of murder on their heads was insufficient; I had to invoke exalted administrators. That worked. After some hours, I was able to promise Mrs. G she would be hospitalized on the Adult Service and Chris on the Children's Service. She came in, and within a couple of days she had come down from the panic. Then she was able to speak articulately of her terror that, had she not been able to bring Chris to UCLA and come in herself at the same time, the authorities and Bill would finally have had the opportunity to separate the two of them. Now she felt that would not occur. The hospitalization was a long, hard one for both of us; but it

112 SPLITTING enabled me to learn how to treat Mrs. G psychodynamically. The essence of this was that 1 spent several hours a day with her, going willingly into her mind wherever she went, and listening without needing to understand right away. (I have to learn this with each patient.) This was a listening it had taken years to acquire. With Mrs. G it was best done with her in the hospital, where we had concentrated periods together and could not get free of each other by appointments spaced days apart. Thus it was, for example, that I finally learned the difference between auditory hallucinations and Charlie.3 The primary problem with which we dealt during this hospitalization was how to get Chris out of Mrs. G's belly-—and when she was psychotic, this literally was her experience, a hallucinated reality of him inside her abdomen even while she knew he was outside on another ward. When I said something that cut into her belly and loosened Chris's position there, she suffered physical pain and sensations of pressure, tugging, movement, swelling, wrenching. (This led to a laparotomy when she developed the classic physical and laboratory findings of appendicitis, but no intraabdominal pathology was found. See "Physical Illnesses," Appendix 2, page 379.) I remember only roughly what we said as I worked to externalize Chris, for our interviews were not taped at that time. Mrs. G had always remarked that she felt best when pregnant. Now, with her implacable but psychotic logic, she had discovered a way once again, despite a tubal ligation, to fill the emptiness in her belly and, this time, to keep it filled. She and Chris were locked in a struggle to the death, and she could recognize all too well that nothing she did could keep him her loving, doll-like permanently-belly-filling baby. He was fighting against her influence with what shrewdness he could muster from his damaged brain, and her experiment in bliss was failing. No wonder she thought of killing him! Yet this aroused enough guilt in her so that she knew she would have to kill herself at the same time. However, she held in reserve the one last hope that UCLA and I would save her if only she could discover how to alert us, and that she did. Once Mrs. G had been hospitalized, I did little (that I can now recall) but work on making her sense that she was using her baby to rid herself of the physical pain in her abdomen. She was helpful as usual. When I was lost, confused, or blank, we would both fall silent; and before I would have a clue, she would say something like,

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"I don't know why I am thinking this, but you told me to say whatever comes to my mind . . ." and then would express exactly the thought necessary to clarify what had gone before. I am used to working with patients in which there are such silences, especially when the patients have no idea what is happening inside them; but I am not used to the luxury of having a patient who at these moments is almost always more insightful than I. At any rate, Mrs. G came to see how she felt that Chris filled her up inside and thus assuaged her sense of abandoned loneliness. I no longer recall exactly how we got Chris out, except that we had a bitter struggle. It was a comfort to know the real Chris was only a couple of floors below so that, as she tried to let go of him, she could see him. When she first experienced the sense of freedom in her belly, the stunning awareness he was not inside, she rushed to the children's ward to look at him and saw him outside of herself. She stared, astonished that she could observe that her little boy was mentally disturbed. She knew, finally, that she could not cure him by her frantic loving. And so she experienced a rush of grief, something she could not recall ever having felt before. Not that Mrs. G's new knowledge became permanent right away: it came and went from hour to hour, and in the process she was swept by episodes of suicidal psychosis that required the closest observation. But the periods of lucidity increased, the capacity to feel sadness grew, and the need to kill Chris ended, never to recur. After returning home, Mrs. G still had a long mourning process to complete, and she now did this in a normal manner. Here are excerpts from two letters two days apart: I think I am an addict, but I don't have anything now to be addicted to. Once it was alcohol, once it was narcotics and sex and running crazy, and more narcotics and even Chris, but now I have nothing. I am in a constant state of withdrawal with a craving and a need that I cannot feel that everyday living can fill. Once an addict, always an addict. Unfortunately, I like alcohol and narcotics and sex, but I can't bring myself to live for them—and that's what I really need, something to live for. No matter how hard I try my two young sons, my home and my husband just aren't enough. If I could get pregnant and stay pregnant for 10 or 15 years then that might help, but that isn't even real. That's what I want from you. Something that's real, that I

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can become addicted to, and that I can live with legally, happily, etc. When you can give me that 1 won't need you anymore. I won't need to be constantly running scared, looking for something—not even knowing what it is—always "sick" because that's what my sickness really is.... I continue to cry for Chris and nothing happens or not an hour passes that 1 don't remember and want him. How long will this last? Everyone tells me what a wonderful thing I have done—giving Chris up and putting him away—and I hate every foul mouth that pukes this particular garbage.... When the evaluation of Chris ended, she allowed the Chldren's Service to transfer him to the appropriate state hospital. In the years since then, Chris has remained there. At first, Mrs. G used to bring him home, and he would make a shambles of the house and family; but she rarely brings him home anymore. She used to visit constantly; now she visits only regularly. She used to be distraught after visits; she now enjoys them. Chris used to be unmanageable after his mother's visits; he now is a healthy, retarded (or autistic) boy who is making the most of the talents left him. She still loves him, but she never aches any more. There was one remnant. "It is interesting that it is only since I gave up Chris that I began this tremendous weight gain." Mrs. G had been overweight for a few years; but precipitously, some months after Chris was hospitalized, she "blew up" around her abdomen. She looked pregnant; the weight was not distributed all over. Accompanying this was a look of sickness so severe she was evaluated for physical illness; and as usual, an extreme one was diagnosed by the authorities (see Appendix 2, pp. 379-80). As always, despite the positive physical examination and laboratory tests, the condition did not progress, and eventually all symptoms disappeared. The mourning took years. The insight from the hospitalization provided only the foundation on which the subsequent working through was built; but without that first physical recognition that Chris had been inside her and that she could survive with him outside, there would have been no working through. Once Mrs. G had attained the physical feeling of truth, she could never again forget. And I had a fixed point to which to refer. Charlie (not yet named) helped (the only time I know of in these earlier years). My notes report:

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Yesterday she said that her voice that is with her almost all the time was saying, "He is mentally retarded. He is mentally retarded. He is mentally retarded." She looks at me with a peculiar look and a smile and she said, "Do you think the voice is working for you?" The voice never has. The voice has always been a vicious, primitive conscience making accusations and telling her to kill. This is the first time that the voice has not done that, and what the voice was doing was confirming what I said and was helping her to understand that the child was mentally retarded. When she knows that he is mentally retarded, then she will give him up—and so she has never admitted that. Yesterday when she was talking about this, and she looks relieved and she looks easier, she looks sad; and she said, "What's an I.Q. of 35?" and I said, "Oh, come on, you tell me." And she said, "Well, I don't know." I said, "What would you guess your I.Q. is?" And she said, "100?" And 1 said, "No, it's higher; but if yours is 100 and Chris's is 35, then what does that make him?" And she said, "I don't want to say it ... mentally retarded . . . But you know, I'm trying to understand it but it's just up in my head." I said, "I don't know that it's just up in your head. Your voice is now saying it, and that's the first time the voice has ever done anything like that." And a few days later: 1 am still continuing to see the patient every day except Sundays. The last three times I have seen her there has been some change, too early to say that she is through the crisis although I keep thinking that she almost is; and then she isn't quite. All weekend she was terribly sad which when she would tell me about it I would respond to by saying "Fine" and then go on to tell her that I understood what she was suffering and that it was fine only because it meant that maybe the ice jam was breaking up and she was beginning to get a capacity to feel her feelings. She is always comforted when I talk with her and she always looks better by the end of the hour, in the beginning looking somewhat dazed at times and psychoticy. The voices continue and they are very clearly split now into the old familiar voice, which tells her to kill herself and that there is no hope, and my voice telling her, especially, that Chris is mentally retarded and that she has to give him up. Today's hour was an interesting one. She began by telling me in what pain she is and also telling me that she feels that she will have to kill herself now that she is aware that Chris is mentally retarded because she is empty on the inside and there is nothing to fill her up and she can't go on with this kind of agony. This was not the voice-telling-her-to-kill-herself kind of ex-

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pression but something less psychotic but not really necessarily less dangerous. I let her know in effect by describing in sufficiently vivid terms that 1 understood what she felt so that she could never say that my reasons for disagreeing with her were because I don't understand, I can't comprehend really the suffering she is going through. But I said to her that she takes it as inevitable that with saying good-bye to Chris there will never be any chance to fill up the emptiness on the inside. But I pointed out to her that this didn't seem true, that I have seen in her a capacity for loving other people, that she could do this with Chris and that wasn't all pathological. She could do it with her boys, and she has been able to do it with me and every other therapist she has ever known because she knows how each person has noticed that in addition to her sarcasm and pushing them away that somehow there's something about her that reaches out so that they like her and want to continue working with her. She asked me if I liked her, and I said, "Yes, of course I do. I wouldn't have been able to spend all this time with you if I didn't." And I tried to just describe to her my motivation for working with her. 1 pointed to my selfish motivation of wanting to know what goes on inside of her and being insatiably curious, and I hoped that this would spread to her so that she would be as curious as I was; that I also had the selfish motivation of wanting and needing patients to get well, which also works well for the patient, and that without it I didn't see how any therapist could help a patient if they really didn't care whether a patient got well or not and that some of my less intense and less selfish motivations were my hoping that she on her own would be able to have... etc. Here is an hour, about two years after the breakthrough, indicating how long working through can take (taping still had not started): . . . I warned her that the price that one pays is that one feels pain as well, and this price she then paid throughout the following week. What happened all of last week in effect was that she gave up Chris. She said she wanted to go home again the following weekend [she was hospitalized at this point]; this time the big challenge was to go visit Chris and she was kind of frightened by this. She wanted at one time to take him home, at another time to just go visit with him; at one point she wanted a long pass. She finally decided that all she wanted was a pass on Sunday and didn't want to go home overnight. She was nervous all week about the confrontation with Chris. She knew it was going to be a real challenge and she didn't know how well she could take it. My feeling was that even if it made her a little crazy for a bit, she now is so strong that she can handle a psy-

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chotic episode, that there's no question now that she might kill the baby or kill herself and that the value of her being able to see him even if it upsets her is great enough to take any risks. Mostly we worked on her capacity to grieve. At one point when she was quite disturbed we had another one of our misunderstandings, which always work out well nowadays. I had said that she had to abandon Chris, and she had gotten quite angry with me. We had quite an angry hour though always there's a strange quality to the anger, in that, as angry as she gets at me and as angry as I get at her, both of us are still very friendly—not put on either—just our feeling that we have the right to get angry within what is a perfectly safe relationship. After a while she made it clear to me that what had upset her was my having said on a previous day that "You have to abandon Chris." I then apologized to her that 1 had been shortcutting in my language, that 1 hadn't meant that she had to abandon Chris, the person in reality, but that she had to abandon Chris, the person inside, namely, the wishes that she had, which at times are delusions, that he will get well and that her love will cure him and that she'll be able to take him home a normal boy. I made it clear to her that when I had said "abandon" I had meant only abandon hope, not abandon the child, that I thought it would be fine if she wanted to visit with him if she could stand the grief that she's going to feel; and if she's able to abandon her hopes that he is going to be the marvelous, normal boy that he can never be, then she'll be able to grieve; she'll be able to get over it; she'll be able to visit with him; she'll be able to enjoy him; he'll be able to enjoy her; he will then be a retarded child in a state hospital where he can get better care than she could give him and she can go on about her life. She went home on Sunday and visited with him after having had a week of very painful sadness and more crying than she has ever had before, including even getting comfort from the nurses, who have held her at times. The visit went better than could be expected; in other words, everything went well. She has in fact been grieving and she is now just about over it. She scarcely can comprehend ever having had thoughts of wanting to kill him; she enjoyed being with him and then she said that after a few hours she left and I said, "Why?" and she said, "Oh, I had had enough," in a very normal tone. She had gotten tired of this mentally retarded kid —and that's the first time [she has recognized] that's ever happened. She feels now that she will visit him from time to time, that he obviously recognizes her and he enjoyed being with her. He kicked and fussed when she brought him back to the hospital and she dealt with it very realistically and firmly and brought him back on the ward and

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he stopped all the fussing. And if it should continue like this, she will—and this is what I told her—be just like any normal mother is with her mentally retarded child. She feels bitter that the child was abnormal, she grieves on occasion, she cries on occasion, she had cried for a few moments in the mental retardation hospital, and that she will then be able to say good-bye to the child at the end of the visit and go on about her business, not forgetting the child but also not having this retarded child dominate her. And that's the way it was and that's the way I hope it will be and she will have joined the ranks of the normal mothers with mentally retarded children.

Later in treatment, Mrs. G reported: G: I haven't called the hospital to see how Chris is in about three or four weeks. I hadn't thought of him until just this minute. That's beautiful. I had him home, and he didn't want to come home. He didn't want any part of it. And he was happy to be back. When I took him back to the hospital, he was glad he was back. You know, you can tell. So I'm not going to have him home any more. He was very upset about being taken away from the hospital. When they were first dressing him—I don't know where he thought he was going, but I don't think that it occurred to him that he was coming home—and I got there and they were in the middle of dressing him, and I told the nurse that I would finish dressing him. And I went in, and as soon as he heard my voice, he started to scream. 1 said, "Come on, Chris, let's get dressed and go home." And, boy, he just bit and kicked and just threw a fit; he just didn't want any part of it. I finished dressing him, and I had a rough time getting him in the car; and he cried all the way home. Once he got in the house, he wasn't too bad, you know; but when I told him he was going back, his whole body relaxed. He dresses himself completely now. He even puts his own shoes on. Because they taught him. He is going to be discharged. To a foster home. I already told them that I wouldn't take him, that it would have to be a foster home. He's doing really well. You know, he dresses himself completely, even his shoes. Of course, he can't tie them, but he puts them on. And he's completely potty trained. You ought to see how he feeds himself. He -holds the spoon in this hand like this and he picks up the food with this hand and puts it in the spoon and then puts it in his mouth. But he always uses the spoon, and that just kills me. And he eats everything in sight. He's eight years old and he wears size fourteen clothes. And I haven't seen him in almost two months, but I suppose he's all right.

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And, a last quote on the subject of Chris: G: I am going to have Chris home. S: Good luck. Remember how you wanted to kill him? Remember how attached you were to him? What is it like now with him? It was pretty wild for a while—you may not remember. G: I love him and enjoy having him for short periods of time. I can't stand it for too long. S: What's the matter with him? G: Oh, he's an albino and he is blind and he is mentally retarded and he's autistic and he is a handful. It's too bad, but that's the way it is.

7 Psychosis

It seems nothing was straightforward with Mrs. G, the epitome of this being her favorite paradoxical statement "I am a liar." When announced at the proper moment, this was guaranteed to confuse; and when one adds to this Mrs. G's unusual ability to live in reality and fantasy at the same time, one can appreciate how intricate communication with her could be. To complicate matters further, Mrs. G could vacillate from moment to moment between secondary and primary process, between warm and direct contact with me and a frightening vagueness, between startling insights and long stretches of affectless "I don't know." She could go from sudden, intensely relived memories to amnesias, from fugue states to clarity and presence. And then there were times when she would play games and tease me, and then shock me with a show of her murderous or suicidal intent. A clever person, if willing to accept risks, such as being killed or murdering someone else, has the advantage in game-playing. In treatment, I was usually running behind Mrs. G; it was her (usually invisible) desire to get well, her respect for me, odds and ends of good identity formation from early childhood, and previous moments of gratifying body experiences and of loving intimacy with others that prompted her to slow down enough so that I could catch up. All this is by way of introducing the questions, Was Mrs. G psychotic; and if so, what was her psychosis? Most diagnosticians would not hesitate to label her "psychotic," because she suffered from hallucinations, delusions, bizarre behavior, extremely unreal appraisals of reality, and poorly controlled, dangerous impulsivity. G: To be crazy is to be terrified and to hear those sounds in your head; when you have no control over them is to be crazy. And then they get so loud that you can't hear anything else, you can't hear somebody speaking to you, and then it's dangerous. And then when it's 120

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just like that, all it does is confuse you, and that's just . . . I just don't like it. When psychotic, Mrs. G was always diagnosed on her hospital records as schizophrenic.1 Clinicians focusing on the manipulative and game-playing aspects of her behavior, however, might have noted that her psychotic episodes seemed self-serving, that she was aware of and could articulate the secondary gains of being classified as mentally ill, could usually control her behavior so long as the appropriate person did what she demanded, and could start and stop the psychosis almost instantaneously when the right button (interpretation) was pushed.2 Those favoring a diagnosis of hysterical psychosis (or variants of that diagnosis) could point to the lack of deterioration in her condition over many years; the episodic nature of her psychosis, which was set off by distressing events in her life; the acute onset of each episode; the instantaneous remission with interpretation; secondary gain; and the histrionic quality, in which were mingled manipulation, dramatic visual hallucinations, and depersonalization, but no major thought disorder.3 Given enough information, one need not be too concerned about such labeling, since the labeling is supposed to serve only as shorthand for a shared body of information. However, that "shared body" is a myth when it comes to terms like "psychosis" or "schizophrenia." These terms are loaded with too many unspoken but insistent connotations about prognosis, proper treatment, psychodynamics, and etiology—connotations that are all controversial. (If they were not, they would be less likely to remain connotations.) For instance, what about the arguments concerning the proper treatment of this allegedly unitary4 condition schizophrenia? There is a massive, no-nonsense literature regarding organic treatments for "schizophrenia" and a smaller, but equally influential, literature on psychodynamic or interpersonal treatments. Some of the most thrilling and humane reports on schizophrenia reveal how the therapist, after fifteen years of poetry reading, dancing, painting, singing, modeling in clay, or swimming in the same pool, reoriented the helplessly afflicted schizophrenic into a warm human being (and then either therapist or patient writes a book with a tender, wry title).5 These reports add up to much puzzlement, and one cannot judge which is valid except by the careful application of his prejudices. I believe Mrs. G exemplifies just the sort of case that brings these

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issues to the fore. If she is a chronic paranoid schizophrenic, then probably she should not get well by the treatment she received, so that if she did get well, she either did not have that form of schizophrenia, or that form of schizophrenia can be treated psychodynamically. If she had a different psychosis, then the prognosis from the start was better; and all that was necessary to save her life was to let time and kindness run their course until she was better, since, according to this view, most patients of this sort (i.e., with hysterical psychosis) have a good prognosis unless mismanaged. This is one of the reasons I have used direct quotations extensively in this report. Perhaps many of the research questions still unanswered in psychiatry could either be answered or asked in more fruitful ways if we had detailed reports of what literally was observed rather than —as is almost invariably the case in the psychiatric literature—summaries of summaries of summaries, so that the original data exist only in fantasy form in the reader's mind. Unfortunately for the desire to report accurately, Mrs. G's psychosis cannot be sensed from a typescript. Most of the time she was silent; and usually if she said anything, it was just a word or two in response to my attempts to describe to her what I thought was going on. Yet, as is true of all psychotherapists working with psychotics, there was never a time (for I got to know her well) when I could not instantly recognize when she was disturbed. There would be a look on her face best labeled "dazed," so that she would not be looking at me (though not avoiding looking at me either), but just be focused nowhere in the outside world. At such times she would not be able to talk, but would sit silently and, if spoken to rudely—which I often did at such moments—she would flicker her eyes at me for a brief moment, half see me, say a word or two, and drift away. Sideways glances would indicate intense auditory hallucinations. If I could get verbal clues— I would pound at her in every way possible to extract them—she would reveal something sufficient to orient me again, such as powerful suicidal impulses, ideas of having to murder someone mixed with delusions motivating such behavior, a feeling of being dead or of impending annihilation, or inability to concentrate on what I was saying. This is what Mrs. G called "crazy." It took me a long time to realize that she also had psychotic symptoms (in my language) when she was feeling quite herself. For instance, for years we misunderstood each other because I thought her hallucinated companion "Charlie" was evidence enough that she was

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in a psychotic state; it was only gradually that I realized he was there all the time, not only when she was grossly psychotic but also during those long stretches when I did not find her so. Only after years did Mrs. G and I come to agree on what we meant by "crazy": only the confusional episodes described above. I became able to distinguish such episodes clearly from the many other moods she might have whose differences from the "crazy" states I, as a proper psychiatrist, had overlooked, calling them all "psychotic." Perhaps according to some current interpretations of this adjective, Mrs. G was "psychotic" all the time (after all, she hallucinated much of the day); but nonetheless she could distinguish without difficulty her usual state from the condition in which she literally was not herself and in which she suffered a flooding of psychotic mechanisms rather than an isolated few that did not disrupt her dealings with reality. (Psychotic symptoms, psychotic mechanisms, and psychosis are three different concepts; they are far from synonymous.) It should be noted that in her non-"crazy" state, Mrs. G was sufficiently intact so that for years I did not consider her what I call "psychotic." I have always been as much impressed by the ego functions that remain as by the primary-process thinking that prevails. Still, during all those years when I did not regard Mrs. G as clinically psychotic, she not only had an eccentric view of the world but also was regularly hallucinating (auditory most of the time, visual occasionally; visual hallucinations appeared only when she was the most severely confused). Mrs. G's florid and dangerous psychosis was the last of three stages. The first stage, reflected in her basic personality, was rather fully laid down by the time she was five or six, with primary-process thinking, hallucinations, and delusions already being fundamental, egosyntonic parts of her experience. The second stage consisted of fixed, chronic, unmentioned delusional perspectives about herself or the world. It derived from traumas occurring in childhood and adolescence, which acted as precise blows punching holes in her flimsy character armor. Examples of these traumas are the numerous seductions she suffered, from the age of seven on, and her abandonment, at fifteen, by her mother, who left her in a girls* penal institution for many months. None of these, however, produced overt psychosis, though they did once or twice bring her to panic, which she feels is an essential part of the "craziness." The third stage, the pounding repetition of psychotic moments or psychotic days, began only in Mrs. G's early twen-

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ties, after she had already been in treatment a few years.6 These episodes were set off by conditions of life which in another person would cause only ripples of anxiety or guilt but for which she used her by now familiar retreat: psychosis. What would precipitate such an episode varied as issues changed in treatment. For instance, during one phase of treatment (and only at that time), being appreciated by someone important would make her "crazy." One day I saw her thus, a few hours after her mother had remarked, with a bit of surprise in her voice, that Mrs. G had turned out to be quite a good cook. The outstanding features of Mrs. G's "crazy" states are nonverbal, but here are a few examples of how she occasionally spoke at such times: G: Sometimes I sit there in that house and I think, oh my God, I am going crazy, and I'm scared; and I hear loud sounds and time passes, and I don't know what happens; but I am alone—see—that's not bad. When I'm alone it's not bad. The kids are at school, and they're protected; and if I did anything to myself it wouldn't make any difference to anybody. But at night, I'm not alone; and what if time passed and I didn't know what I was doing? G: You asked me if I am crazy, and I don't think I am. I think I was. I don't even know if I was. I was thinking crazy things. If that makes me crazy, then I was crazy. I didn't go to school. I was afraid they'd know at school I was crazy, so I got drunk, and I stayed drunk. And do you know what? I can be drunk and still be crazy. G: Your books are floating around and you look strange to me. G: I thought this morning that I was dead. S: How do you encourage the illness to come back? G: You make me sound like a sorceress. Well . . . it's a hard thing to explain because sometimes when I encourage it, I get scared of what I have done; and then it's hard to get rid of. Let me give you an example. It seemed like the world was on fire. I was just laying there; I was watching it burn, and I thought, "Now, I can either get up and get out, or I can lay here and burn to death." It was just that stupid. Then I thought about how it would feel to bum to death, and I liked it. So I just lay there and burned up. S: What made it stop? G: I went back to sleep. One day Mrs. G wandered out of the hospital and, in a daze, got lost:

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G: I got lost on the street [a street she had walked many times], and I wasn't sure it was all real; and there were a lot of buses, and I wasn't sure which one would take me to where I wanted to go. So this man came by and asked me if I wanted a ride, and I said yes, and then he wanted to go someplace, and I said no; I had to come back here because it was time for me to come back. I was already late, and then I came in the hospital and then I got lost in the hall, and I wasn't scared. . . . My eyes are bothering me. Everything is changing shape. [Later in that hour] G: Am I screaming now? It's not real. Am I dead? It's almost time for me to go, isn't it? What if that thing [a vase on a window ledge ten feet away] falls on me? S: I won't let it. G: I knew you when you were happy. S: Who am I? G: I don't know where to go. S: Who am I? G: I really don't know where to go. There's all those places to go, and I really don't have any direction. We should go to a place where you are supposed to learn things. Is it time for me to go now? S: No. G: What did you say? S: Nothing. What did you hear? G: I don't know who was calling me. That vase is going to hit you. Now I know why this room breathes. Some people don't learn those things. Some people don't know about . . . about . . . I can't hear you. S: I'm not saying anything. G: Why don't we talk about . . . why don't we talk about nice things? O.K.? Quiet things. You tell me a nice thing, and I'll tell you a nice thing. G: S: G: S: G:

Is it time for me to go now? It's time for you to talk. It's time for me to scream now. Can you hear me scream? No, but I can see you. Don't you know what I want? How come nobody ever knows what I want? I keep asking people to give me something. I want peace. I want it to be quiet. I want it to be real. . . sometimes, not all the time. I want to find out who I was. I don't know who I was. If that thing falls, it will be better if it hits me on the back of the head.

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I have remarked earlier that Mrs. G's psychosis did not progress, in the sense of deterioration, over the years. Although this is true for the individual episodes, each of which had as good a prognosis as any previous one, something like deterioration was occurring in that the episodes, as the years passed, became more and more frequent and could be set off by more and more benign external forces. One might guess that in time the episodes would have become contiguous, with no hours, days, or weeks between free of the "craziness." Then, too, they might have no longer been set off by even mild external forces, nor have been remitted by my interpretations and her insight.7 Let us look at an extended example of the second stage of Mrs. G's disorder, caused by a traumatic experience. The horror of this experience had pierced through the defenses we call her personality or character structure; and it festered silently (unconsciously) within her, always present, like an abscess encapsulated by the surrounding tissue, the unconscious source of a chronic delusion with which she lived so continuously that it came to be felt as simply a part of herself. I had known Mrs. G twelve years, which is a long time not to know something integral to a patient. She was again in the hospital, for what turned out to be her last extended hospitalization. She had been an inpatient for many weeks when she suddenly developed rectal bleeding. The resident told her that he wished to do a rectal examination and that it would probably be necessary for her to go to the proctology clinic for more extensive testing, including proctoscopy, to see if a rectal lesion was present. Mrs. G became psychotic (an example of stage three, precipitated by reality), but not so psychotic that she could not fight us bitterly and well. I finally brushed aside both her panicky craziness and her surprisingly effective arguments. I told her that I did not care what she felt, but that she was going to have this examination. (Psychosis is no excuse for bad medical treatment.) G: What do you want to talk about? Ill start again. Wednesday, I got up in the morning, and I was a little unhappy because you were gone [on a trip]. I passed some blood from my rectum, which upset me a little bit more. They put me to bed, and I stayed in bed all night. Thursday they wouldn't let me get out of bed although I had a pass to go home Thursday night. They said they were going to do some terrible thing to me, and that scared me. S: What was the terrible thing? G: I don't know. They were going to do a bad thing to me. . . . I don't want to say what it is.

PSYCHOSIS

S: G: S: G: S: G: S: G: S: G:

S: G:

S:

G:

S: G: S:

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But you know? Yeah. Then why do you say you don't know? Because I don't want to know. Oh, so if you don't say it, then you won't know? Yeah. And that's a good way to go through life. Why are you picking on me? I want you to speak clearly. Anyway, they were going to do this bad thing to me. And then I got angry with Dr. B about something—that I don't remember— but I was very angry, and that was kind of a bad thing and I had a choice to make: I could have been angry and been scared and been uncomfortable or I could have been crazy. So I picked being crazy. And then I kind of lost control of that. Then I went to sleep and I slept all night. And Friday when I got up, I felt better; and Dr. B said I was still upset, which wasn't true—I was feeling a little bit anxious—and Saturday morning I went home. I went to my mother's; and she told me all kinds of things about how she doesn't feel responsible for me and how she's not going to worry about me; she's not going to be concerned with my problems any more because she's through with that. And that was O.K. I'm not clear. Does O.K. mean good, bad, or indifferent? Indifferent. And then this friend of mine happened to be hi town, and we went out, and I got pretty well loaded, and I went to bed with him. Then I got up and came home. Then Sunday Bill came and he took me out for lunch, and he was very nice; and then he went home, and I came back to the hospital. [Spoken without affect] Is that better? Better? Let's do it again and find out what went on inside of you, and what motivated you. "My friend came and I got loaded and then I got laid and then I got up and I came back and Bill took me out and I have a dog; his name is Jack; Jack jumps. Jump, Jack, jump. And then I came back and I bled from my rectum . . . and I went crazy and Jack has a cat. Its name is Zip." I told you what I have to tell you!... I was thinking about Wednesday, and you were gone; but I didn't think you were really gone, and I waited for you to come Wednesday; and that's when I got crazy, when I knew you were really gone. But nobody knew I was crazy. Why didn't you think I was gone? How did you manage that? I don't know. Please, "I don't know" stinks.

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G: I just got up in the morning and I thought: He's really not gone.... But they really scared me—and not scared me so that I was just scared: they scared me so that I couldn't breathe. I was really panicked. They scared me so much that I couldn't feel anything else. I can't even tell you how scared I was. I think I tried to tell them, and they wouldn't listen to me. . . . Do you know what it is that I'm supposed to remember? . . . Wednesday I had some bleeding, and Thursday they were going to do a test on me. I don't know what it's called. They stick something up your rectum. I told them that they couldn't do that to me. They sent for this doctor anyway, and he came in and he said he was going to do it. Anyway, that's what happened Thursday. That is the bad thing. It's a bad thing to do to me. S: Would they see something that they shouldn't see inside of you? G: I don't know. I really don't care to talk about it. S: I don't care whether you care. G: I don't have to do what you want me to do. S: No, you don't. G: Why do you want to do this? S: Because ... G: I don't have to have it, do I? S: Have what? G: That. S: I don't know whether you do or you don't. That's not what I'm interested in now—I don't mean I'm not interested in whether you've got something wrong or not; I don't know enough to know whether you have to have it or you don't have to have it. What I'm interested in right this minute—we'll worry about whether you have to have the sigmoidoscopy when I can find out more—what you have to do is talk to me and answer my questions and go and find out about these things even when you don't know them. That's what you have to do; because if you don't, I'm going to give it to you. I'll give it to you by being cold and by being irritated and by bugging you; but I'm not going to let you get away with "Nothing." Partly I'm not going to let you get away with that because I think that you'll do what I want if I bug you enough. G: You know sometimes . . . sometimes I think things are bad. I don't know why I think they're bad, but when I think something's bad, I vomit and I get scared and I feel shaky inside, and things like that —I don't know why. I think that's a bad thing. I don't want anyone to touch my rectum. I don't have a rectal when I go to the doctor. I will not permit that. I think that is a bad thing, and I will not allow that to happen. They're not going to do that to me. S: Are there other parts of your body that that could happen to?

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No. Only your rectum? Yes. All right, tell me about your rectum. What I mean by that is—let your mind go loose and tell me what is your rectum and what does it mean to you. And then if any thoughts come into your mind, crazy thoughts or disconnected thoughts, you know our old way of doing things, but tell me about your rectum. [After many years of treatment, when the patient was sufficiently upset, it would take only this nudge to get her to free-associate into a fugue or psychosis.] First of all, it is mine. That's about the only thing I have that is mine. That's not even yours. My brain might be yours. Anybody can have . . . I see people with my eyes, and I hear people with my ears, and I smell things with my nose, and a man or a woman can have my box—I don't have anything else that's mine. How about your stomach? That's not mine. I know it. I brought it up because it would seem to be, but it isn't. Why not? Because . . . because when something makes me crazy, my stomach is one of the things that is affected the worst. It's also in touch with the outside world. Yeah. And I prove that by vomiting. And also food goes into it. That is, other people can give you food. You buy it from the grocer; your mother feeds you when you're little . .. [Patient suddenly glazes over and slides into fugue state. I'm sorry you cannot hear her now. The whole experience has become weird, more than the next words will indicate.] One time . . . one time a long time ago, I don't even remember how long ago, when I was a lot younger, on Saturdays I used to have to take my brother, my two little brothers and my sister, to the park . . . [Pause] I forgot what I was going to say. I have no clues to help you. Was it about your rectum? No, it was about a man. There was a man at the park, and he did something to my rectum, and he had to go to jail for it, and I had to go to court. When was this? I don't remember. When I was a lot smaller. Maybe about ten. What did he do? I don't remember. Come on, now, it's time to remember. He made it bleed. Then I had to go to court and tell them.

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What did you tell them? I don't know. Open it up. It's all right—you're here now with me. I'm trying to ... I remember what the man looks like, but I can't remember what he did. I'm trying to picture what happened, and I can see myself in the park with the kids, but I can't see me with him. Afterwards his family was very angry. At you? Yeah. You mean because he went to jail? Yeah. How did he get to be able to do it? I don't know. I know now—a little. You let him. No. That's why it was bad. You may not have wanted him to—do you get what I'm saying? Do you know—you have always done what men wanted? Maybe not always—but isn't that true? When they have assaulted your body, they came first and not you. Isn't that true? With your uncle and your grandfather and the rest of them? Please talk to me now. I just remember being very afraid of what was happening. I don't remember what he did to me. I never remembered it [i.e., it was repressed for 23 years]. I think I remembered it a little bit Thursday. I was thinking about that man. Tell me about him. He was an old man; he was a dirty man. He stunk; his clothes were dirty. How did he get to you? I don't know. I want you to remember. I had on a bathing suit. I don't remember; I swear to you, I don't remember. Don't swear to me. I know you don't remember. I want you to remember. What you're trying to say to me is: Don't make me remember. Look, I want to tell you something about your rectum: it's not yours as long as that man is in there. Isn't that true? Yeah. We have to get him out. Do you know that he's been in there all this time? Him and others like him. Yeah, but I don't know what you mean. It sounds right. Have others done it to you?

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G: No. S: What do you mean—"Him and others like him"? G: A lot of times when a man goes to screw me, I think he's going to do that to me again. S: And you're afraid? G: Yeah. It's such a bad thing. If it hadn't been bad, they wouldn't have sent him to jail. And if it hadn't been bad, the policeman wouldn't have hit him. When we were in the park. I must have told somebody. I think I was scared because I was bleeding and I told somebody. He [the man] was still in the park. . . . He stuck something in me. S: How do you know? G: It's just a feeling I have. In my rectum. It hurts. It's dirty. S: Because he's dirty? G: No. S: You don't mean physically dirty—you mean the thing that's being done is a dirty thing. Is that what you mean—in the sense of "bad"? G: Yeah. S: How does it hurt? G: You know, like being cut. S: Is there other feeling besides just hurt like cutting? G: It made my brain rot. S: What do you mean? G: I don't know; you said to say what I think. . . . I know what he did. He screwed me in the ass; and when he had an orgasm, it blew in my brains. That's why I could never go down on a man. Because it makes your brain rotten. S: If you take it in the mouth, it's close to the brain? [Nods yes] It can get right into it. [Nods yes] If you take it in the ass, it gets to the brain. Why? G: I don't know. It doesn't make very much sense, does it? S: It makes sense.... G: I guess because my mother always told me my brains were in my ass. S: You smile. G: She's been telling me that for a long time. S: [Laughs] Why do you feel better? G: I don't know. S: Come on. G: Maybe because I told you what happened. S: Do you remember it now? G: Yeah. I was just thinking that I could still feel it. You see why it was bad? I always felt so dirty—you know—I felt bad because they

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put him in jail for something I let him do—that was a bad thing. What he did to me was bad ... the whole thing was bad. Worse than bad, it was awful. But I think you would use the word "bad" because you played a part in it. A very big part. . . . I think it's possible that somebody could blow my mind through my asshole. Sperm. Little tiny bugs that can get up in your brain. Like worms. It's rotting in there . . . Yes, that's it. It never came out, did it? No. Sometimes when I'm crazy, I have flies in my head. You know what a sperm looks like. I have an idea that it looks like a worm with a tail. When I'm not crazy, I think about those worms in my head. When I'm crazy, I think about flies eating my brain. Did the sperm turn into flies, or is it just rotting that produces flies? Just rotting. But when you're crazy, are the sperm there also? I don't know. But the flies are. Do you actually feel them rattling inside your head? [Nods yes] Do you hear them? [Nods yes] Are they buzzing? [Nods yes] The first time it just made me sick, physically ill. I know it's rotted. I don't have a picture of it—I know it's rotted! I just know that it's rotten. It smells, and it's rotten—I can see it, it's rotten. It feels like . . . it feels like a sponge that's soaked up a lot of smelly water, stagnant water. Now I think about the fact that a year or so ago you were in the hospital because we thought there was something wrong with your brain. What you must have thought was: Oh, they're finding it, didn't you? Yes. Why didn't you tell me? I think I did tell you, and you didn't listen to me. I didn't understand it at the time, I guess, because I don't even remember that. What did you tell me that I didn't understand then? That is was rotten. I didn't need to have it verified. It was something I knew. Do you know what it does to me? I can't read right, you know; I can't retain what I read very well, and I try to go to school, and I can't study. . . . Maybe it [brain] is getting smaller in size. Even Charlie knows my brain's rotten; that's why he has to do my thinking for me. That's not true. Charlie was doing your thinking before you were ten. Yeah, but that's why he has to do more of my thinking for me, because it's getting progressively more rotten. That's the truth.

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[Later] S: Do you now remember clearly what happened? G: We were . . . I was in the park with my two little brothers and my sister, and we'd been swimming; and this man had his grandchildren with him, two grandchildren, and they were the same age as my little brothers, and they were all playing together. And the man told me to go with him, that he had something to show me; and I went with htm in the bushes. There was a big, like a big heap of leaves, you know, rotting leaves; and he said he wanted to show me something, and he showed me himself, exposed himself to me; and then he said he wanted to make me feel good. And I was all for that, and then he did it to me. I did fight with him. He forced me. He held me down with his hand and he put his leg on my leg and he forced me to do it, and he slapped me once and made me cry. He really frightened me. I thought he was going to kill me. And when I couldn't kill him, I told somebody else about it so the police could take care of him. S: And kill him. G: Yeah. [She is blurred with fear and feeling "crazy."] S: Now let me go back to the beginning of the willingness. He gets you off in the bushes where nobody can see, and he takes out his penis. It's erect? Were you interested at that point? G: Yes. S: You liked that. Did you think that he was going to put it in where it belongs? G: Yes. S: And that had been done to you before? G: Yes. S: And that you liked? G: Yes. S: Did you know how to have intercourse by then? G: Yeah. . . . When he started to put it in the other place, I pushed him away, and that's when he held me down. And when I was saying "Don't do that," then he slapped me. S: And so then you fought. G: Yes. S: And he still got it in. G: Yes. Maybe because he was bigger and stronger or maybe because I quit fighting him. I really don't know. And I wasn't very big when I was ten. I just laid there. S: Did he hurt you? G: Yes.

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S: And then? G: He got up and pulled his pants up and . . . and said "See, I didn't hurt you after all"; and then he left . . . as far as I can remember. I don't remember him doing anything else. I got up and put my bathing suit on, and I went and told a lady what he did. And she called the police. S: What happened to him finally? G: I don't know. S: A terrible story; and you never got over it. G: I guess I got over it—I don't think about it anymore. S: But your brain has been rotting ever since. Your brain remembered it. G: I thought about it when they wanted to put that thing in my ass. Let us orient this episode a bit more. A woman in her thirties, hospitalized for a month because she wanted to kill herself for failing to extricate herself from marriage by poisoning her husband (see "Suicide"), reveals for the first time a delusion-hallucination of a rotting brain. Although at this point I have known her for twelve years and been treating her intensively for five, I have never known about this delusion. However, fragments of it had been mentioned casually at other times, in the midst of so much other material and in a manner so appropriate that I did not take it seriously (i.e., as a delusion), but rather as a joke or figure of speech, with roots in her unconscious. I had never suspected that it was the result of anal rape. Now, precipitated by the threat of proctoscopy because of rectal bleeding, fear of a rectal examination surfaced, but not the repressed memory at the core of the delusion, one of anal rape that had occurred when Mrs. G was ten years old. Once her appearance in court was over, she had forgotten the episode; but the memory had persisted, not in consciousness, but as a delusion, with hallucinatory confirmations that her brain was rotting away and that this was accompanied by infestation with worms or flies. Had I known enough to ask her the exact content of the delusion, I am sure that in earlier years she would have told me not only that her brain was rotting but what the actual hallucinatory experience was. Yet had I asked her about her rotting brain when she was not "crazy," she would have spoken of it smilingly and without fear, in such a manner that I would have discounted her commitment to this belief. But since I had never asked, as with so many other things, she had not elaborated, simply taking for granted the state she

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suffered and presuming that I knew all about her, because I knew everything (though Charlie always knew 1 didn't). In part, Mrs. G had been responsible for the rape. For three years previously, she had been having sexual experiences, ranging from being fondled to intercourse, with older boys and adult men. She had always enjoyed these experiences and had encouraged the men to continue them; for although she did not have orgasms, the events were physically pleasant and, more important, she always felt good doing what the men demanded of her. That she was cooperative sexually was the result of many traumas of early childhood, and that she responded to this particular terrible experience by inventing a delusion with appropriate hallucinations (of a rotting brain and flies) was not surprising: she had had experience in creating hallucinations and delusions since age four (when she created Charlie). Thus by age ten Mrs. G was apt to use psychotic mechanisms, known only to herself and not suspected by others; while a very "difficult" child, she seemed reality bound. Even after the invention of this new psychotic nucleus, the surrounding personality looked nonpsychotic; in fact, the belief about her brain's rotting was a subterranean one, without any noticeable influence on her behavior. Years later, when she developed the spells she called being "crazy,** she could differentiate the quality of this almost permanent psychotic structure by whether she felt as if there were flies buzzing in her brain. When they buzzed, she was crazy; when they did not, she was not, but was only in her normal state of having worms in a rotting brain. To complete the story about the rectal bleeding: When the patient discovered the lost memory of anal rape, two things happened. She permitted us to do the rectal examination (and nothing serious was found), and the conviction that she had a rotting brain disappeared. It did not return. What would precipitate Mrs. G*s "crazy" episodes? Usually it was the same sort of thing for a period of weeks or months, until the underlying issue was cleared up. Then that particular precipitant would no longer cause the reaction, but another would take its place. Only in the last couple of years has there been a fundamental change, in that, first, the craziness has felt different to her and second, the episodes have become so superficial that they almost lack the quality she used to consider "crazy.** Psychotic episodes now almost never occur, whereas formerly Mrs. G was "crazy** every day for several hours, and sometimes for weeks on end without any letup.

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The most persistent precipitant was fear of homosexuality, which we shall consider later. For years we could scarcely approach that subject with reference to her own feelings. She could talk all day long about her sexual relations with women, but it took no more than for the word "homosexual" to be attached to the description of those activities for her to go "crazy." Other events that set off psychosis were unrecognized guilt, feelings of hopelessness (e.g., regarding closeness with her husband), justified praise, unrecognized anger at me, fear of certain types of body manipulation (e.g., spinal tap, rectal examination), fear of abandonment (e.g., the threat of going to jail years after the psychopathic behavior had ended, or of my going on a trip). In brief, any sharply felt unpleasant affect, such as anxiety, guilt, or grief, from which another person would suffer only the affect, was apt to set off psychosis in Mrs. G. S: G: S: G: S: G:

You're resting and waiting. Waiting to wake up? Yes. Resting from years of being crazy? Yes. And you know being crazy does tire me out.

8 Multiple Personality I have discussed Mrs. G's psychosis in some detail partly for us to understand Charlie, who is hardly a typical psychotic hallucination. Nonetheless, he shares enough with familiar mechanisms of hallucination in psychosis to illuminate them. Still, Charlie was so formed. He really felt like a separate person to Mrs. G, and that separate person had many capabilities that she lacked but that one sees in normal people—and many more of these than are reflected in the hallucinations of most psychotics.1 Whatever his shortcomings, Charlie keenly appreciated reality: not only what was going on in the physical world but what was occurring psychologically in other people. But Mrs. G could not make use of what Charlie knew except when he talked to her; and never, before he left, did she feel she could draw the same information from the world directly. His knowledge was split off from that person Mrs. G experienced as being herself. In other words, Charlie possessed qualities both of psychosis and of the condition called multiple personality. Multiple personality is a dramatic state.2 One of those freaks of psychiatry (for which we reserve the term "classic" or "textbook"), it is found in a person already possessed of hysterical features—suggestibility, exhibitionism, manipulativeness, repression as a major mechanism, preoccupation with sex masked as innocence or ignorance—who carries within himself/herself another personality who has qualities different from those of the visible person known to the world or the person the subject refers to as "I." The hidden personality seems a projective device, rather like hallucination, for permitting a person's forbidden desires to express themselves without his having to acknowledge ownership. The patient with a multiple personality invents a new person who is usually more interesting, more exhibitionistic, more impulsive, amoral, and fun-loving. The barrier between the person's usual personality and the newly invented one is clear-cut; the two are 137

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sensed as being two quite different people. In some cases, one of the personalities exists unknown to the patient, appearing only in fugue states; in other cases, it is known. Occasional subjects possess more than one additional personality; but however many there are, each expands the activity in which the subject can indulge. One of the outstanding features of multiple personality is the part the investigating psychiatrist may play in revealing and probably helping to create it. These patients are suggestible and inventive; and if their imagination is congenial to the psychiatrist, one can sometimes hardly distinguish who is enjoying himself more. So perhaps multiple personality should be regarded with some skepticism—the same skepticism that we should apply in dealing with other, related conditions in which splitting takes place: hysterical psychosis; Ganser syndrome; malingering versus conversion reaction; secondary gain in all medical and psychiatric conditions, including psychoses; amnesias and fugue states; imposture, imitation, and identification; and the mechanisms drawn upon by expert professional actors. All such conditions eventually touch on problems of free will versus determinism, the influence of unconscious forces upon behavior, and moral and criminal responsibility. Where does the acknowledged daydream end and a break with reality begin? What does it mean "to know"? What are the clinical observations that lie behind the now so glibly used phrase "splitting of the ego"? One might imagine a continuum upon which are ranged the ways a piece of one's sense of himself can be separated off from the main body of his self (identity, personality, ego, character). First can be put dreaming (the most prolific of all producers of multiple personalities), and then conscience, the conscious sense of morality and impulse control; at times they speak to one as if other than oneself. Next might be the angry conscience of the guilty or the nonpsychotically depressed. Perhaps more clearly separated are the imaginary companions of children, the people who populate the daydreams of the lonely, or the characters created by some schizoid writers. Next would be the split-off parts of personality that can sometimes be produced by hypnosis, and then the dissociations of fugue states. After that come multiple personalities and, last, delusion-hallucination. Mrs. G is intriguing in that at one time or another she could have been placed at any point on this continuum. Let us here look only at material that represents the vivid daydream,

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the fugue state, and the multiple personality, without discussing Charlie or psychotic hallucination. At a time in treatment when we were resolving symptoms and increasing understanding—that is, when the therapeutic results finally began to be visible in treatment—I learned for the first time about the following long-standing, very vivid daydream, on which the patient could spend hours a day. She was in the hospital recovering from a psychosis, had been hospitalized for about a month, when, in the middle of a session, this unexpectedly appeared: G: Sometimes when I get scared, when I get really anxious, I build a room—you know, in my head—I build a room; and I'm safe in the room. I don't know when I started to do it. It wasn't too long ago. Oh, yeah, maybe when I first knew there was something wrong with me. When I first knew I was really crazy . . . when I first met you. [Each time] I have to build it piece by piece. And it's not a big room, but it's a comfortable room, and it's yellow. And it has a place for me to cry and it has a place for me to throw things . . . and it's got toys in it. It's got a doll house in it, you know, with people in it and furniture and a tricycle and things like that. There's a mother and a father and a little girl. And then in the dollhouse there's a black room. That's a place where a little girl can put her mother or her father if they're bad and . . . It's just like a house, you know, with bedrooms and a kitchen and a living room with dolls and things that little girls like. It doesn't have any footballs.... Most houses have footballs. And my room is always warm. My room is a nice room where people like to stay if people could go there; and it has books and it has paper to write with and to draw on and it has milk . . . just a pitcher, you know, a blue pitcher. It's a round, fat one with a handle on it. Pretty. Because it's full of milk. There's a bed there, not a big bed and not a little bed, just a bed that's just big enough so you can lay down and you can cry if you want to. It's all mine. That's all I need. I'm just quiet there. There's not even any room there for Charlie. It's all mine. Are you going to to take that away from me too? I have a dress on and shoes and stockings and underwear. A yellow dress. It's designed with a high neck and long sleeves, and it's just plain. I'm not sure if I'm wearing shoes. With heels on but plain shoes. I'm not fat. Just feminine with breasts and all the things a woman is supposed to have. [With a body] like I used to have when I was twenty-one years old. Except I don't have any babies. But I'm not lonely. I can't do it very often. Because it's a hard thing for me to do, to go in that room. She's capable of sexual feelings but hasn't had a need for them.

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What about homosexual feelings? I don't see anything like that. I just don't have any feeling about it. Is the dress the same color yellow as the room? No. A bright yellow. The room's kind of a soft color. I don't see anything in here that's that color. [Later] G: I can picture her with another woman, but I can't picture her with a man. When I picture her with a woman, I picture it being a mutual thing, which is more than I'm capable of doing. Women don't [are not allowed to] do things to me sexually. She's dull because she's quiet. I never think about her as being either interesting or ... she's existing. She doesn't have to shop or read books or do anything else, but she's alive—that's the important thing—she maintains that. Just literally alive. S: Yeah, well I'm grateful for that, let me tell you. I'm grateful that she exists, as I already have told you. But she sure is ... kind of blah, superficial. Is that correct? [Shakes head yes] Tell me more about it. G: I can't tell you more about her because she doesn't do anything. All she does . . . she's alive inside. She doesn't need other people. Maybe she will later. Give her a chance just to be alive. I was going to say maybe it's very difficult for her to stay alive. It takes a lot of effort to make a person lively. She feels excited inside herself. She's just not able to express it. So we see that the most comforting of all Mrs. G's daydreams is one in which she is a female, a feminine, young woman, withdrawn, placid, like an infant, soft, tired, empty, but peaceful. Although the yellow girl was quiet and seemed very dull to me when I heard about her, what Mrs. G meant was what she said: "She's alive inside"; and for this lost soul, that was the best of all daydreams. [We continue:} S: What are you thinking of now? G: I was thinking about if what you say is true about Charlie that it would also be true about the girl in the room. Why do I have to be three different people at one time? S: If what I say about Charlie is correct—meaning what? G: Meaning that I am Charlie. S: Yeah, but the girl in the room you never had any question about, did you? G: No. I was just wondering why that's necessary. In the next few months, the girl in the yellow dress was used less

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and less; and later in treatment, she faded away. Interestingly, years later Mrs. G's grandmother gave her a picture of Mrs. G—then Sugar —at age three, showing a totally feminine-looking little girl, with long, curly hair, in a lovely, frilly dress. Her grandmother said, "That was a yellow dress. You loved it." Although Mrs. G had innumerable fugue states over the years (as well as amnesias for psychotic episodes), an example of the relationship of the fugue and the presence of another personality can be shown most clearly in the following episode, which marked the first time an amnesia-fugue was restored to consciousness in the treatment. At the same time, it was associated with the discovery of another personality. Shortly before the session here reported, there had been a serious fire that had almost burned down Mrs. G's home. It was the most recent of many fires in and around the house that she had mentioned casually over the years. G: They almost have the house rebuilt. You know when the house burned down, they had to rebuild it; and they almost got it finished. They have put the roof on. S: That's nice. You don't remember anything? [Shakes head no] Do you remember the fire engines coming? G: Yeah. S: Good. Is that your first memory? G: Yeah. S: And you wondered what they were doing there, or did you know? G: Well, I knew. The flames were sky high. S: Did you know that you had done it? [Shakes head no] Have you ever started a fire when you were aware of doing it? G: I don't think so. S: Have you ever done it anywhere except your own home? [Shakes head no] Who does it? G: Who does it? I do. S: There's another you. [A hunch; I had never thought this before.] G: You mean the quiet one? S: You tell me. Who is the other one? [A look on her face encourages me to press on.] You've never told me about that one, have you? No, you answer me! You've never told me about that one, have you? G: No. S: Have you always known about her? G: Yeah. S: For how long? G: Always.

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Since you were a little girl? Is she quite different from you? No. Does she have a different name? Well, she doesn't have a name. Why did you never tell me about her? I don't know. I . . . I guess I just assumed you always knew. If I didn't know, is it important? No. Is it something that is part of you that takes place all day or every day or ... could it? Yeah. All right, now tell me. Since it's for the first time and since I haven't known, tell me. It's just . . . you know I ... there's a lot of things about me that you already know, you know; you know I'm not very smart and that I'm not very feminine and that I'm not very good at a lot of things. And Charlie . . . Charlie's really smart, knows a lot of things and takes care of me and tells me what not to do. ... And then the other one just does the bad things, not bad things . . . It's like if I ... It's like if I was married and had a good marriage and was happy and everything but 1 wanted to screw somebody else just once to see what it was like, then the other person would do it. Do you understand what I'm saying? Yes. It's very efficient, isn't it? Yes. Does she feel like she's a different person from you, or just another aspect of yourself? Not different from me, not a whole other person like Charlie. Does that make sense? Yes. [Here, perhaps, is where the interested psychiatrist might begin the task of leading the patient to create a new personality from what was something less. But see p. 151 ff. for my surprised discovery that that personality way more.] O.K. You know I have the feeling and the thoughts about what it is, but I don't have the words to come out of my mouth. When I was little and my big brother or somebody did a bad thing to me and I couldn't do anything, she ... if I was . . . like I don't get very angry, but the other part gets angry and then does a bad thing. Sometimes I'm full of the other part of me, so it's O.K. for me to cry or for me to do a bad thing. Do you understand that? I think so. The other person is so much you that the two become one.

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G: One, yeah. That's like Charlie said a funny thing the other night. He said, "Grow together." S: Would he include himself in that? G: Yeah. That's what he was talking about. S: All right, tell me more about her and tell me particular things that happened and how she influenced you; and I realize that she's not as separate . . . Charlie is separate. You could never talk about Charlie at this point having merged with you, could you? You always felt him as a separate person, and she is not that. She is more or less separate, but never as separate as Charlie. Right? But tell me more; and just my talking this way may make you invent her as being more separate than she is. I don't want you to do that. G: No, I don't think I could do that because I can't think about a "her." I keep saying "her," but that's not really true. It's another part of m e . . . . She's got more nerve than I do. S: She does bad things! G: Yeah. S: Who held up the gas stations? Let me see if this isn't right . . . she was involved in it, but you actually were holding the gun. G: Yeah. S: Does she ever take over so that she's the one who does the things? Or is it always done through you? G: Well, I think she must take over sometimes because, like, I don't remember lighting the fire. Have you seen the things they do on tele . . . I don't know if it's on television; I don't watch very much television. But in movies sometimes they show a guy walking, and he's having flashes in his mind of something he almost remembers but not quite. Well, that happens to me. There isn't any other way for me to describe it. Charlie knew I was going to set fire to the house. Our garage was so full of things. You know, we had some beds out there and newspapers that Bill prized and just all kinds of things in that garage; and the man next door, who lives next door to me—his garage is so neat and so perfect—and I went over to him, and I haven't spoken to him in two years, and I went over to him just before the fire, and I said, "Gee, I wish my garage was as neat as yours"; and then the next thing I knew, the garage was on fire. The boys came home, and I told them to leave. I didn't want them to burn up. S: This was before you set the fire. G: No, the fire was already burning. S: Oh, but it wasn't visible? G: I don't see it. Then I got the dog. I don't remember setting the fire!

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S: But you remember the fire. Apparently you remember more than you did when we first started talking about this because then it was just when the first engines came up and the flames were shooting. Now you remember that the boys came home. And just before you started it, you saw and you felt it was important to have a neat garage. Is that correct? Yeah. You also were angry at Bill. Is that correct? [Shakes head yes] Didn't you combine those two ideas into one marvelous thought? G: I moved the car. The car was parked right in front of the garage, and I moved the car out into the street. That was before the fire engines came. S: Was it before the fire started? G: No. The fire was already burning. I don't remember. I don't remember starting the fire. S: Didn't you decide to start the fire? G: I don't think I started the fire. S: Who did? G: I guess I did. S: Why do you guess? G: I can see me doing it. I was talking to my sister on the phone, and she talks and talks and talks and talks; and I told her I was sorry, there was something I had to do so I couldn't talk to her right now. I can see me starting the fire. I can see me putting the match there. I can see me in the garage with the fire. S: Just when it started? G: Yes. S: How did you start it? G: The first time I tried to start it, it wouldn't bum. S: Did you burn up a lot of goodies of Bill's? You did! Oh, you dirty bastard. G: All his prized political material. All his books. S: Now you know partly why you did it, don't you? G: Yeah, I guess I . . . I don't really know. I don't have a feeling for it. S: Did you want him to suffer? G: Yes. S: O.K. Didn't you burn that part of the house that was appropriate, and not just any part of the house? G: Yes. S: Not only that, but you planned so that you wouldn't be hurt, the car wouldn't be hurt, the kids wouldn't be hurt, that the house wouldn't burn down completely. It was very specific, active revenge. But it was so mean and evil that you had to forget it, didn't you?

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G: I didn't do it. ... Yeah, I had to forget it. [Slight laugh] You just confuse me. S: Why did you say you didn't do it? G: I don't know. That just came out of my mouth. S: Right, because that's what you believed all along, isn't it? I'm showing you that you did do it. That's tough. That's hard to accept, isn't it? Oh, you're swinging in and out of clearness so fast Your eyes blur and they come clear and you smile appropriately and you sit up and you blur second by second. Right? Can you feel that? G: Yeah. S: Good. Don't you feel good that you found out about the amnesia? G: You know, if it worked for me, why not just keep it? S: Jesus Christ! Because you were going to burn down the house! You're supposed to say, "So what's so bad about that? I got rid of Bill's shit and they rebuilt the house and it's almost finished now anyway. Not only that, but Bill had to spend some extra money; and not only that, he couldn't do anything to me because I'm a crazy nut and I didn't know what I was doing." G: He doesn't know that I burned down the house. S: But he has a suspicion. How many times have you burned things down before? G: A couple of times. S: Come on. Dozens—when you started fires. G: Not bad ones. S: No, I'm talking about the others. When's the first time you ever did it? G: The first time I ever set a fire? When I was about five. Because I was angry with my father. Because he was just going to leave. He left anyway. S: Do you now remember the whole thing completely about the fire? G: No. S: There is one pan that's forgotten, and that is the forgetting. When did you start to forget it, and how were you able to? G: I must have forgot it right after I lit the match, because I went back into the house; and the boys came home, and the fire was already burning when the boys came home; and I suggested they go down the street. Then I went to my neighbor's next door. First I moved the car. So it wouldn't... so it wouldn't [amusement in voice] burn up. S: That's what you know now. At the time you moved it, why did you move it? G: So Bill could get into the driveway.

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S: So you went next door to the neighbor for what reason? G: She had asked me to come over earlier. S: Now somewhere inside of you, you knew that the place was burning. But you don't. . . G: When I heard the [neighbor's] kids hollering "Mrs. G! Mrs. G!" I went out and I said, "What's the matter?" You know—here the house is in flames, and I'm saying, "What's the matter?" But it was obvious; you could see it. The flames were sky high. S: But you at that point had no memory that you had lit it? G: No. S: How did you feel about it? Were you upset? G: Upset that the house was burning? Yes. S: Did you at any point at all think you might have lit it because you have been involved in so many fires? G: No. I never lit a big fire. This was a big fire! S: Tell me about the others you've lit. Do you remember them now? Would you please? G: Oh, I set chairs on fire and wastepaper baskets on fire and beds on fire and . . . S: How many would you estimate . . . how many fires did you set? G: Several dozen. S: Have they always been in your own home? G: Yes. S: Do you ever remember setting a single one besides the most recent one? G: No. S: That's what I'd like you to do. Think of the fires. Be interested in them. Think of fires. G: I guess I could pick the one that I set when I was a kid when I set the garage on fire. S: That was the first one, when you were five? G: That's the first one I remember. S: What do you remember? G: I remember being in the garage, and there was a box there, and I was hiding in the box—I don't remember what I was hiding from. And I was crying. And then the garage was on fire, and my father thought that I was in the garage. S: You were? G: No, I was hiding. S: Outside of the garage. Do you have any idea why you were crying? Was it something about your father? G: I don't remember. S: That's not what you told me earlier

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G: Because my father was leaving again? I think I quit crying about my father leaving before that. S: Were you angry? G: Yeah. S: At what? G: At my father. S: I mean when you lit the tire. G: Was I angry when I lit the tire? I don't remember. S: What are you thinking about? G: I was thinking about another fire I lit once. That was when we were in M, and I lit a tire in a trash can; and my son had played with matches a couple of times, and I didn't know that I lit the fire, and I didn't think that he did. I knew. I knew—that's a lie. S: You knew what? G: I knew I lit the fire. S: How do you know? G: I just know. S: No, you didn't just know. How did you know? G: Because it happened so many times before. And Bill made him sit on a chair with a box of matches and light every one of them, hundreds of matches, until he was so tired of lighting matches that he swore he'd never light another match. But what was so horrible about it was that he didn't do it in the first place. I don't think I'll do it any more. [And she did not.] S: Might you on another occasion have done something like burning things for that kind of an episode [anger at Bill], or would it be more than that? G: No, it would be that kind of a thing. S: That would require a small burn, wouldn't it, not a burned-out house? You didn't plan to burn down the house, though, did you? G: No. S: This was supposed to have been just a little one to burn up some papers. G: Yeah. S: And then something went wrong. G: There was so much paint and things in the garage. S: But the other times you'd burn a bed, and could have also, except it burned slower. How did you light the bed? Remember how you actually did it. What did you actually do? How do you start a bed on fire? G: I guess . . . the only time that I'm aware of how I set the bed on fire was because Bill found out how I set the bed on fire and that was by leaving a burning cigarette on it.

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You mean the one time he found the cigarette burning? Yeah. Do you remember leaving a cigarette, ever? No, but I have a bad habit of doing that. 1 leave cigarettes burning wherever I go—I leave the tray with burning cigarettes. That's a little bit different, though, from specifically setting out to burn at a specific time. What led us to this was that other part of you that's bad. Let me tell you . . . have you ever seen? . . . Oh, you've got twins. The twins I've known, one of them can be very quiet and the other one be very mischievous. Anyway, if it was me—if I was a set of twins—that's what it would be like. One part of me would be rather quiet, and the other part would be mischievous, not really bad. Of course, your definition of bad and my definition of bad are two different things. It's kind of funny. Sometimes, like when I go to a bar to have a couple of drinks and some man might start talking to me, she comes out then and talks to the man. Just teasing and laughing and just kind of ... just kind of bubbly. Me in a good mood ... I don't know that I'm ever in a good mood, in that kind of a good mood. I'm in a good mood where I'm comfortable and happy and things like that, but I don't treat people like that. What would your mother think of you in that mood? I presume she wouldn't approve. No, she wouldn't approve mostly because this person is so straightforward and honest. She would have been very disapproving. She would have told me ladies don't act like that. You know that's a funny thing—when I think of a statement like that: ladies don't act like that. You know my grandmother raised me part of the time, and my grandmother has theories about what women should and should not do. And do you know that I never chew gum—I have never chewed gum!—because my grandmother always said, "Ladies don't chew gum"; and it would never occur to me to smoke on the street or ... maybe in a restaurant, but not out, because ladies don't do things like that. And it's funny that I would be so concerned about what ladies would do and ladies wouldn't do, because I never wanted to be a lady. Apparently you did—or something like it. Or you wanted to obey your grandmother at any rate. What doesn't make sense in all of this is: Ladies don't shoot cops in the ass. Ladies don't take dope. Ladies don't pose for pornographers. Explain that. Or did it have to be specifically said before you knew that ladies don't? If your grandmother never got around to saying "Ladies don't hold up gas sta-

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tions," then you don't know that ladies don't hold up gas stations. Is that the way it is? No, I don't think so Now, how do you recognize the other person taking over, and what does she do? It happens when I'm on the ward a lot. It's . . . it's bullshit. You know . . . if one of the nurses had a new uniform on, and it was really atrocious, I would probably tell her I thought it was atrocious. You would? Yes. But she would say she looks charming and everything and make a big, long bullshit thing out of it. That's not a good example either. I know what you want, but I can't . . . If you asked her if she was lying, she wouldn't tell you the truth. Oh. What does she think of me? That you're kind of funny. Silly. How close is she to the surface now? I don't know. Answer me honestly. I'm not going to answer you honestly. Who is answering me now? She's always right at the surface. Was she at the surface then? Yeah. . . . What does she do when I eat! She doesn't eat very much. First of all, she's not fat. Her behavior is cute. It doesn't make any difference to me whether I'm fat or thin. Because she can be thin. Do you know she always wears a dress? She wouldn't be caught dead in a pair of pants. Is she gay? No. Not at all? Well, she's impartial. I mean she has no feelings about it one way or the other. Does she like it both ways? I don't know that she's ever tried it both ways. What has she tried? What has she tried? She's had relationships with men, but she has never had a'relationship with a woman. But she's not against it. You know, she's kind of like Charlie in that way. She doesn't say anything about that one way or the other. You're the only one that has relations with women? Yeah. And I'm the only one that thinks it's bad. They don't think it's bad.

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S: What does her satisfaction consist of, as different from yours? G: I was thinking about that last night. She hasn't got a penis. She's not in competition with anybody. So she can be just like any other woman and be completely satisfied with her relationship. Right now, if I were to have intercourse with a man right this minute, she wouldn't come because she's not inside of me. If she were inside of me, she'd come with the man, and I wouldn't come because she would be me. Does that make sense? S: No. Because you said that you and she are not completely separate. So what do you mean sometimes she's inside of you and sometimes she isn't? G: I don't know what to tell you. It sounds to me like I'm making sense. I understand what I mean. S: Does she take over completely? And you're not there? That's impossible, or you wouldn't know that she was there. G: Yeah. Do you know what trilene is? It's an anesthetic, and they give it to you when you're having childbirth pains, and you still have the pain, but it's like you're off looking at it. O.K. It's like that. It never happens with Bill. She's not interested in Bill. She thinks Bill's an ass. I know the type of man she likes. Good-natured, with a good sense of humor, who appreciates her particular style of teasing and . . . S: So, now we know why she takes over. A certain kind of man comes along and he appeals to her and so she begins reacting to him. She goes to bed with him; she has sexual relations with him; she enjoys it. But somehow or other it's made clear to you that you are to back away and to watch from a distance. In other words, you don't really experience it. G: No. It's because I don't know about men like that. It's because I don't know men like that. I don't understand how to talk to a man like that. S: Do you have a right to a man like that? G: Who's to say whether I have a right or not? S: I'm asking you to answer me. Do you have a right? G: No. S: Do you like me? G: Sometimes. S: Does she differ in her likes of me? G: Well... She likes you as a man. That's a bad thing. S: But she thinks about it all the time, doesn't she? G: Not all the time. S: A lot? G: I don't know. Why don't you ask her?

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Why are you blushing, huh? What is it to you? Just shut up! Why are you blushing? Well, because it's embarrassing for me. Why is it for you? It's embarrassing for her. You don't care. . . . She's not embarrassed about anything. Well, you don't have any feelings about it. It's her business. Well, you're embarrassing me nevertheless. Yeah. You know why? Why? Because you're her.

Somewhere in the subject of multiple personality lie potentials for new ideas. In these people (hysterical personality, hysterical psychosis, multiple personality, impostors, actors and artists), although the fracture lines are more visible, an observing ego remains to communicate with us. The metapsychology built on ego, superego, and id has produced fine results, but seems pretty well mined out. And so we move on to "self or "identity," attempts to fill out parts missing in the theory that were nonetheless observed in the real person. Now, if rigorous thinking can be applied to the observations that focus in the word "identity," we may understand psychic functions better (and even stop using a fraudulent word like "identity" [see Leites3]). Who are all the different people inside us; how and why did they get there; what forms do they take; how and when do they continue developing, and how and when are they laid down, frozen, and left unchanged throughout life; when and why do they coalesce into an identity or several identities; how are they related to the people in dreams, in auditory and visual hallucinations, and in plays and fiction? Freud's first reported discoveries were on patients we now consider hysterical personalities, several of whom had hysterical psychoses. They still seem among the best subjects for investigation. He also started with hypnosis. Perhaps, as some suggest, we should learn to use hypnosis more and better as an investigative technique. Thus, enthusiastic about the thought of looking in upon Mrs. G's earliest experiences, I suggested we both learn about hypnosis as a research tool. She responded to the suggestion with fear—and in time with the emergence of the other personality. I was not looking to uncover it. Months had passed since the idea that we try hypnosis (we never did) had arisen when Mrs. G remarked —to my anger—that she had taken LSD a few times. Later, I asked:

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S: When you take acid, what happens? . . . I don't know how to ask this because I don't know enough about it. I want to ask you something about amnesia and multiple personalities. What happens in regard to any of that? Are there any clues that come up with LSD that are of use to us? G: No, but I think I was on acid when I called D and told him about P. [P is Mrs. G's given name. For months she had felt herself to be P, and so this was an odd way for her to be speaking.] He said that I talked to him in a different tone of voice. S: I've never met the other one. If we're going to get into this . . . should I? G: Of course. That's a ridiculous question. S: You don't mind? G: No. S: Does she? G: I don't know. S: Tell me about her. Let me get our ground rules straight. Yesterday, you said that when I suggested to you before I went away that we get into this business about multiple personality and hypnosis, you thought to yourself: Fuck you! I'm never going to have anything to do with it. Right? G: Right. S: And then you proceeded to really bring her up more to the surface while I was away and recently. Right? G: Right. S: Now which is it? It sounds to me like you have been getting ready for that next phase at the same time that you were saying, "I refuse to do it." G: I'm frightened by it. ... There's not much I can tell you about it because there's not much I know about it. I know it's happened because I've heard about it, you know, from people who have run into me when I have been in that state. My mother—I talked to my mother yesterday, and she talked to me like I had just talked to her. She said, "But I explained all that . . ." and she went on and on telling me about all these things I had told her, and I don't remember ever having talked to her. S: What's the girl inside of you like? You don't know much about her? G: No, I don't know . . . just from what I've heard. She's more aggressive than I am and more honest than I am. And that's a funny thing because I try to be honest, I really do. I remember one time I told you I was a liar. . . . She frightens me, because I don't know what kind of a situation she's going to get me into.

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S: Is she showing up more than she used to since I made the suggestion? G: Yes. S: How will she and I get along? G: Probably very well. S: Better than you and I. G: Probably. S: Will you be jealous? G: No. S: Does that sound funny? G: No. It doesn't sound funny. It sounds like a question you would ask. And you ask a lot of funny questions. [Chuckles] I'm not sure if I would be jealous or not. I have my feelings for you and I don't know what her feelings for you would be. ... You know, she thinks skinny, too. S: I think you told me that's why you really don't fundamentally care whether you're fat. And also I think you told me she didn't have a penis. .. . G: And she's not a homosexual; she's not interested. S: She's a promiscuous heterosexual. The word "promiscuous" would be the wrong word to use about her attitude. G: Because she's selective. S: Has this girl been laid? G: Had sexual intercourse? Yes. I discovered evidences of it. Semen. S: You, your body had intercourse, but you have no memory of it? G: No, but the guy that she had intercourse with asked me if he could again. I knew him, but it never occurred to me to have intercourse with him because he just didn't seem the type. S: Does she want a baby? G: No. S: Has she ever been pregnant? G: No. S: Why does she take your body? G: I think she just wants to be me ... you know, to be . . . I think getting inside of my body is like taking over my mind; and when she has them both, then she'll be a complete person.4 S: What happens to this woman when you're crazy? G: Nothing. S: Have you ever sensed her there when you were crazy? G: I don't know . . . I was thinking about a little boy . . . just thinking about how little boys grow up. I think it's very unfair that I wasn't a little boy. I think I'll punish my mother for that. She tried to make

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me a little boy. She didn't do a very good job. I just wished I was a little boy instead of a little girl. S: Then why is the person inside a normal—in a biological sense— feminine woman who likes men? G: Well, that's not me. Why talk about somebody you don't even know? What gives you the right to question me about that person? S: Who else am I going to ask? G: Ask her. S: O.K. Can you assist me in that? G: Yes. S: O.K. What does she say? G: I don't hear her. S: Do you ever hear her? G: Do I ever hear her! You mean like Charlie? S: Yes. G: I don't know. S: Where is she now? G: I don't know. S: Why did you tell me to ask her? G: I was just being a smartass. S: When she comes out and shows herself to me—if it ever happens— she's got to go back when I ask her to, or there's no deal. G: She's got to go back? If you asked her to come out, that would be giving her permission to stay, wouldn't it? S: No, that's what I'm saying. There's no deal if that's what it means— then I'm not interested. G: Maybe . . . maybe it would be better if she did come out and stay. S: You mean you would disappear? G: Yeah. S: I won't have any more to do with it if that could happen. What are you doing? G: What? S: What are you doing? G: I was just trying to ... separate myself, get her out. I'm just trying to give you what you want. S: But I don't want her; I want to know about her. G: How are you going to know about her if you don't ask her? [Next hour] G: I had an unusual weekend. I had an amnesia Saturday. I don't remember getting out of bed; and I called E, and she came over, and I don't know what time she got there but ... But then she came back on Sunday to see how I was because she said I acted very strange on Saturday, and she thought I had dropped acid and ...

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S: I wonder whether your friend inside took over. G: I don't know. . . . And she said I talked a lot about my father— that's what I seemed to be primarily interested in, my father . . . and she didn't know my father was dead . . . and I talked about him like he was living right around the corner and ... S: Have you had any—even dim—communication with that other part of you? G: No. Wait a minute. Remember I told you—I don't know when we were talking about this—but I told you that I can put myself into a state where I'm not quite asleep and it's like being asleep and dreaming but still being aware of everything that's going on around you. Well, I don't know that I'm in contact with this other person, but I can be two people. First of all I have to lie down to do it, and I have had to have slept all night; and I lay down and relax and just . . . it's like going to sleep, but I'm not really asleep because I'm aware of everything that's around me ... although I don't open my eyes, I don't think. I don't know if I do or not. And I can lose my thoughts and have her thoughts. S: How do you know they're hers? G: Because they're not mine. I don't hear it outside of my head. S: What are the thoughts like? Give me an example. G: Well, I think like I'm capable of a great deal. S: You said they're somebody else's thoughts. How can that be that you feel you are capable when they're somebody else's thoughts? G: What do you want me to say? She thinks? It's my head. The thought in my head is that I'm capable of a great deal. S: The thought is: You are capable, P [her own name]? G: No, "I am capable," but not P. S: I, the other person? G: Yes. One of these days I'm going to get up and hit you right in the mouth. S: Tell me why you're more irritable with me today. I'm not doing anything to make it less, but what is it? ... Is it because of all this that we're going to be doing? G: No, that doesn't make me angry. It makes me curious and it makes me scared a little bit and it makes me apprehensive about . . . you know. S: But maybe I'm not doing it the way you want. Maybe I'm obtuse. Maybe I'm not certain. I am, actually, all of those things. Maybe I'm not as sharp as you'd like me to be. G: No, if that's what I'm thinking, I'm not aware of it. You think I'm anxious to get started? S: Yes. But I'm guessing about all that—I don't know if that's right.

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G: Yeah, you must be guessing. S: When I'm wrong, you usually let me know. G: Yeah, that's not really true. I'm not anxious to get into it. I'm very apprehensive about it. And I'm not sure I want to get into it at all. S: Are you angry at me that I want to go into it? G: No. S: Why not? I make you run risks. . . . Your friend wants to come out and talk to me. That's the real complication, or so I would guess. Does that sound possible? G: Yes. S: She wants to cause trouble on the way—to raise a little bit of impish hell and embarrass you, not let you know what's going to happen, tease me. And then what really fatigues me is thinking: We have to go through the same thing we did with Charlie, you know—the not trusting, and finally Charlie learning that he really feels close to me and that he feels safe with me and all of that. And now we have to do the same thing with her. G: Do you really think so? S: I think so, but I don't know. You know, I say so many things that are really questions. . . . G: I don't think so. I don't think so. S: She's not that way, huh? G: No, she's not Charlie. No, she's not like Charlie. Not what I've heard of her from other people. Then, over the weekend that followed, Mrs. G was frightened, so frightened that she again was tempted to end the pain with suicide. The episode reached a peak when she relived—not just remembered— the paralysis and suffocation she had experienced years before when given succinyl choline for electroshock treatment. The reaction cooled after I explained what I thought was happening in her, whereupon she said, "You might just get a call from somebody." I did, and thus for the first time "met" the other personality. "Do you know who this is?"—no preamble, abrupt as P (Mrs. G) is, but more lively. Her voice and style were not a dramatic shift from P's, but this person was decidedly happier, wiser, and with no memory defects.5 We talked for a half hour, openly, pleasantly, informatively. She thought P was staid and a fool, an occasional liar, manipulator, exaggerator, unwilling to see reality unadorned as she herself could. She began taking P over many times a day; and she called me regularly, at least once a day, for a few weeks. At first this was without

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P's knowledge, but P became puzzled, and then frightened, about the many gaps in her memory and the conversations or activities which others said she had participated in but about which she had no awareness. The second personality surfaced so often and so quickly that P was finally beginning to experience her. (All this took place as if she had never told me what I have recounted in this chapter, page 149, about her familiarity with the other.) I must admit it was an anxious time for me. For years I had been working hard, trying to understand and having to press against Mrs. G's need to keep me puzzled. Our rapport was such that if I permitted myself to be teased and visibly frustrated, and if I was imaginative enough, I would learn about her. Now that changed: The other personality had instant insight, a keen memory reaching to earliest childhood, and immediate cooperation with me without teasing or manipulation (except that, on a different level, the whole business of having another personality is a massive manipulation). But Mrs. G was frantic as she kept losing herself (in amnesias). This made her "crazy/9 and her exhaustion from this confusion made her suicidal—hence my anxiety. Whereas the other personality had taken over in earlier years for her own pleasure (so she told me), with consequences that put P at risk, now she surfaced only to help P: when P was exhausted or frightened, or when P had to face responsibilities—at work, with friends, or with debtors—that were too much for her. My task was to get to know the other one, to enlist her help, and to have her manifest herself to P, instead of being so split off, so that both would eventually be P. Here is how I first met her in person: S: O.K. Bring me up to date. G: Well, I just talked to you not twenty-four hours ago. Nothing. I went to bed and went to sleep and got up this morning.... S: And in the middle of the afternoon? G: Did I call you in the middle of the afternoon? S: There were a lot of calls, more than ever before. They were alternating. First it would be you, then her, then you, and then her and a lot of it. Does she have a name? G: Well, she says she does. But I don't know. I didn't ask her. When I ask her, she says it isn't her name. S: Is that her moving your foot or you? No, don't stop it; I really want to know.

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It's me; I'm nervous. About what? About whatever is going to happen. What are you planning? I'm not planning anything. Yes. What do you want? I want her to present herself in this room and let me know what's going on. But she did begin to yesterday . . . [when she spoke to me on the phone for the first time]. Yes . . . I don't remember. There's so much I don't remember about this weekend; you wouldn't believe it. ... Well, she's not against me. She doesn't approve of me. She's not dangerous. O.K. How should we go about it? Try. She'll be ready to speak, won't she? It's only you who prevent her. All right, let me be quiet for a few minutes, and you ... It won't work. Why are you stopping? Because I'm here? Yes. I'm not afraid of her. That's a start, isn't it? That's a change too. I told you [on the phone yesterday] that I liked her, got along well with her; she and I were in great agreement. That made it easier for you. I pick up the phone, and there's a cheery voice. So I know right away which of you it is, and she says, "Hello, Santa Claus ..." Santa Claus! Oh God! How appropriate! [Laughs] I would like her to come. Fine, go on. She'll start making noises, and you . . . What I would like is, let her come and let her talk to me as she often has on the phone; but you, either* one, watch—usually it's she watching while you do the action, right? Let it be the other way around, but you be there. I just don't feel like I can let it happen. How close is it? I feel excited. Did you tell her you would give her something? Did she just tell that to you? Yes. How did she say it? She said, "Ask him if he has what he owes me yet." Well, let me remind her, and you be in on it, that I said that I would give her something, but that she and I would have to talk about it and find out what it was. She wanted something real, none of this Fll-make-you-feel-better stuff, which is important, but it's not the same thing. She wanted a gift in her hand, but she and I will

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have to talk about it. Are you there yet? [Long pause. Patient glazes over, then in a few minutes smiles and turns toward me.] Who is it now? Don't be so naive. What's your name? What's yours? Santa Claus. That's a very appropriate name. What's your name? It's such a silly name. What is it? Well, it's not that it's silly; it's just that it's a very old-fashioned name. What is it? Carrie. From where? From my mother. She called you Carrie? That's what she wanted to name P . . . . And ... And ... . . . your grandmother said . . . [Her grandmother had told her mother to name her P, which is Mrs. G's father's name.] Is that the rest of the story? Yeah. She had a girl. Why didn't she call you a girl's name? Why did she let them talk her into that unless she had some question? Is P still there now observing? She can hear. First time ever she's with us. So it's happened. Good! It's the first time I've seen you. You know, I'm just as big and fat and ugly as P. Yes, you are. I knew I was going to say that, and that's the tough part of it. You know, you're thin and you are different from her, but the trouble with doing it [appearing] in here with me (even if you take off your glasses in order to make a difference) is that you know now that I will see P. And your problem (but don't do it) is to try and not let me see P. Don't try and force it or make an act out of it. It's enough that you're different. There's nothing you can do about the body part. Well, there is something I can do. What? I mean at this moment. Put her on a diet.

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S: [Laughs] Is she there? Is she listening? C: Yeah. I wonder how she'd feel about being on a diet. You know, she likes to be fat. I told her that no matter how long she stays in that condition, she wasn't going to have a baby. She didn't like that very much. It gave her the same security as pregnancy. S: You started to look around the room, and I was going to say, "Go on, look around since you've never been here before." But that wouldn't be right, would it? C: It looks different to me. It looks more real. P's here every day, and she sees your office but never sees it. And she sees the fish because somehow she relates to the fish, but she never sees your office. It would be a good experience for her to get up and go around and take a look.... I see you. S: I can tell you do. Once in a while she looks at me that way, but not very often, not very often. C: Well, we ... we have different feelings about you—not really different though. She thinks that she's incapable of feeling about you. It's kind of pointless to distort [one's view of] people—actually it's a pleasure to experience feelings, no matter what the feelings. . . . S: Tell her. I'm glad to hear it, but tell her. I want her to say it, too. She's still there with us? C: I'm sure she can hear what's going on. S: How come? How do you know? Because she never could before. C: How come I'm sure? Because I'm telling her to listen. S: Do you have any feeling of her inside of you? C: I have a feeling of her presence. S: Yes. How about telling her some of the things she doesn't know about things that you've done? Would that be appropriate now? It's relatively easy. C: But pointless. It's not going to help her. S: Yes, it might. Do you know why? Because then she . . . see, she has never believed you existed in the subjective sense. Do you know what I mean by "subjective"? Experienced it. She figured out that you existed O.K.? And now recently on the phone, when I talked to her, she believes me when I say that you and I talked together; but she hasn't experienced it subjectively. Do you get what I'm saying? C: Yes. So ... S: For example, tell me—you've already told me on the phone, but now she's listening; she didn't listen when you told me on the phone —over all these years, you have taken off every once in a while. How many times, would you say? C: Well, once . . . the only time that she knew or may have been aware

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that it wasn*t her that had done it, was when I took off with Chris. Do you remember my disappearing with Chris? Was that the time you called me up ready to kill yourself? No. Her husband said, "Go to the drugstore and get something"— I don't remember what—and she took off and ended up in R [where she had once been hospitalized]. I drove to R. I knew there was something wrong with that baby, and I wanted to find out what it was. But she didn't know there was anything wrong with him. At this time he was about seventeen months old, but he wasn't walking or talking or anything, and . . . so when she woke up, she found herself with what's his name, Dr. L . . . . Why did she wake up then? Because she had to know herself that there was something wrong with the baby. You woke her? Oh, yes. She learned her baby was probably retarded. She thought he [the doctor] was a liar; she thought she couldn't trust him any longer—he had been a friend of hers for years—and so she went on from there to another psychologist that she knew in San Francisco; and he told her the same thing. And so she hid, she hid out with friends; and the friends would indicate to her that the baby was slow, but they didn't think he was retarded, and she heard things she wanted to hear. So the whole thing was kind of pointless, or would have been pointless if she really didn't believe it; but she did believe it. She did believe it. She believed that there was something wrong. Yes. That's the first time—so you did accomplish something. Yes. All right. Is she still listening? Yes. O.K. Then she knows that you're on her side, that she's her own enemy, not you. Yeah. Well, I think she's known that all along. There's hope for her. For her? Yes. Or for me? No, for her. I'm not worried about you. You're not worried about me. [Laughs] If anything happens to you, let me know. But generally speaking, you seem to be the more sensible of the two of you. O.K. I want her

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to know more about the times when you're gone away for a period of time, not just the flashing in and out like this weekend, where every few minutes it was one or the other of you. When you've gone for fun, tell me and tell her what you've done . . . you know, for example, she's told me, "I don't know where the money has gone. I've spent a few hundred dollars." Her husband took out a credit card for her and told her she was allowed to spend so much of it, and I took it and went to San Francisco and had a $500 weekend—and that's not easy. But when bills come back, they say where you were. How come he didn't know it and tell her? Well, because that was the kind of person he was. That wouldn't make sense. You know what I mean; you get a receipt and it says: such and such hotel, San Francisco. Do you mean he doesn't look at it? Yeah, he looked at it. But he wouldn't say that to her? No. He knew she was gone. He knew she was in San Francisco? Yeah. But he didn't tell her? But he didn't say anything to her about it. You don't believe that! He wouldn't even mention it to her. I was just thinking: Jesus Christ! And I was about to say to you, "Why did you let her live with him?" I did everything possible to get her out of there. I set the garage on fire. Oh, you smiling bastard! Tell me about it. He had all his politics crap in this garage, and I thought: What would be more upsetting to him, what would really force him out of the picture faster than burning up his whole life? . . . So I set the garage on fire. Do you remember it? Do I remember it? Definitely. Tell me the whole thing. Do you know why I'm asking? Why? Do I know about it? Yes. Do I know all the details? Or not all of them, but you know . . . Do you remember my getting this material from her? Yes. How did I get it from her? That was the first time I ever was able to get stuff in an amnesia. [See pp. 141 ff.]

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C: Because I wanted you to know. S: Why that time? C: Because I didn't want you to think she was crazily going around setting fires that she wasn't aware of. Every time a fire has been set, there has been a reason for it. Fires are a very powerful . . . I want to say weapon, but that isn't what 1 mean. S: Signal. Communication to someone who won't listen any other way. C: Yes. You couldn't make him listen to any of them. He was incapable of... S: Why did she stay with him? C: She stayed with him because every time she was hospitalized he took care of the children; he paid the bills; he cleaned the house; he did all these things. And she felt indebted to him just like she feels indebted to you. If you were to tell her to polish your shoes twice a day every day for a year, she'd do the same thing for you. She has a terrific feeling of responsibility. You may not believe that, but that's true. So she felt this responsibility for him, and that was just her way to stay with him and let him destroy her and letting him have what she thought she owed him. . . . I was just looking at the notebooks [Mrs. G typescripts in a bookcase]. Because I know what's in them, and I was just surprised to see them there. S: You mean to see them, or the business of the reality of the office? C: Yeah. S: There's a lot of them. C: Yeah . . . a lot of crap. She can tell you a lot of her experience without really telling you. I think the only time that she ever related an experience to you where she felt enough emotion to really express it to you was the time she was telling you about her brain rotting. Or another time when she offered herself to you, her insides. S: And there was another one where she was going into a dark place that was terrifying and I said, "I'll go along with you." Do you remember that? C: No. S: And there was a time when she felt like a baby. C: Oh, that's happened before. S: Is she still here with us? How does she feel about what is happening? C: She's frightened. S: Of what? C: O f . . . I don't know what. S: We've got to get that, because I don't want her calling me all afternoon saying that she's going crazy or ... C: I don't think that will happen. I don't think she goes crazy any more. You know, she has . . . She's insane, and she enjoys -that.

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Yes. She has been insane, hasn't she, all her life? Insane. You mean, completely out of touch with reality? No. Then I don't understand what you mean by insane. Well, as soon as you say completely ... but pretty much, you know, where things are so confusing, hallucinating ... C. Oh, well, I don't call that insanity. S: What the hell do you call it? You have been on these wards; you've seen people who have been insane—they weren't completely out of touch. C: Well, I never thought any of the people 1 saw in the wards were insane. S: Is there anybody in the world who is? C: Maybe her mother. [Laughs] S: But by your definition, practically nobody is if there's a little bit of sanity left. Well, I agree. There's a little b i t . . . C: I've seen people insane in state hospitals. S: But even those people, unless they've got brain damage, even they have a little, tiny remnant that you can talk to. ... But it's very hard. C: Why doesn't somebody talk to them? You never talked to her like she was insane. S: I do the same thing with her that I do with the really insane. My feeling has always been: "O.K., granted that you're terrified, granted that you're panicky, granted that you're insane, granted that the blood is running from the walls, granted that you think you're going to die, don't think you can get away with that: You're not going to terrify me. You're not going to make me think that there's no hope. You're not going to make me think that there's no sane part of you." That's the way I always felt. You got that? C: Yeah, it always amazes . . . amazed me that you were able to put up with her delusions and hallucinations and so on and so forth in this office with her sitting crouching in that chair like a toad. S: [Laughs, horrified] God! C: Well, she's a lot stronger now; but she still has her moments. S: You called me up on Saturday; you thought she was suicidal. C: Yes. S: Was she? C: Yes. S: She kind of said no. You heard her on the phone. C: She lied to you. Because she didn't want you to scream and holler. S: Would she have killed herself? C: She might have.

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S: At this late date? You said she has her moments, but she's not the way she used to be. C: Well, suicide is something else. 1 don't think suicide has anything to do with her sanity or her insanity. S: She still hasn't completely learned that it's worth staying alive. What's missing from her life? What do 1 have to do? C: What do you have to do? S: Or what do we have to do—if I can get you to help me? I don't know whether I can or not. What do we have to do to convince her that as terrible as these things are, she can work them out and go on? Or don't you believe that? C: Oh, I believe that she can go on for so long; but when terrible things keep happening over and over and over again, there's only so much any individual can tolerate. S: Yeah. C: And she had shit happening to her for centuries. S: Yes, I know that. You know I know that. And she knows I know it. So if I keep saying that she can hold on, now either I'm not understanding it or don't recognize how awful it is—or I'm right. C: Well, sometimes you're right, and sometimes you don't realize how awful it is. S: No, that's not true. C: I think it's true. S: No, no, what I'm saying is: "Suppose I do know how awful it is and I still think that she shouldn't die and give up." C: Oh, well... S: That's what I'm saying. It isn't that I don't understand. What I think is: If she can hold on, we can work it out . . . we, you, her and me. She'll be thrilled if you start helping her. Do you understand that? Is she there to hear my saying that? C: Yes. S: Before you go, let's just try one little thing. Can you listen and hear her now? C: I always hear. S: I mean her now when she knows that you have been taking over. She's never known that before. C: You mean you want me to listen to what her thoughts are? S: Yes. What does she think of what happened now? C: WehYshe's frightened and she's concerned about what. . . she's concerned about what I'm going to say next. S: That will give her away? C: Yeah. S: Let her know that I can be trusted. The worst that I would do would

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be to be a little bit crude, that is, not to sense things well enough. I would never really endanger her. Well, 1 would never tell you any of her big secrets, I don't think. I don't think 1 could do that. Not without her permission. I don't want them without her permission. She knows that. You know, I'm practically insatiable for information, but not that way. Either she gives it to me because I deserve it, or she doesn't give it to me. I want to get every goddamn thing out of her; but I shall have to work for it, I know. O.K. You'd better let her come back. Is that all you have to say? What should I say more? That isn't all! I could go on for hours. [Pause. Carrie fades out of Mrs. G's eyes.] Speak to me. You think you're so fucking smart. Why? Huh? I need a cigarette. Why did you say I think I'm so fucking smart? Oh, because you just manage to do whatever your little ole heart desires. Ohhhh, do you really? . . . No, I don't believe you. No, come on. I'm just upset with the whole situation, that's all. Do you think I took advantage of you? No, I ... otherwise it wouldn't have happened; I wouldn't have let it happen. I think you could take advantage if you wanted to. Oh, no. You heard the last thing I said about the secrets? Yes. Did you believe me? Yes. Well, then, what can I do that would be worse than that? Huh? I don't know. Come on. Well, she ... she feels differently about you than I do ... I don't know. I don't know what's going to happen. Are you scared because of this? Am I scared? Yeah, I'm scared. Scared of what? Scared . . . scared of what's going on. I don't understand it. But you will. Don't you think you're closer to some understanding now because she's out in the open? Yes. Why don't you feel happy? Why don't you feel relieved? Or do you? Maybe I do a little bit. Well, don't forget that you do.

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G: Don't forget. 1 don't forget anything. S: [Laughs] Tell me what you meant by that . . . besides pulling my leg. G: That I don't forget anything? Well, I thought you would appreciate that. S: Is there some truth in it? G: Sure. S: Tell me what you mean. G: If I don't remember, she does. S: So there's hope. . . . What did you think of her telling about her part in the amnesias, the going away and the business with Chris? G: You know, I don't remember the business with Chris. I remember leaving with Chris, but I thought I was leaving Bill; it didn't seem to me I was going to find out anything about Chris. It doesn't seem to me that I realized that there was anything wrong with him until he was three. S: But she said you woke up* in the middle of this interview with Dr.whatever-his-name is. Do you remember that? G: Yes. S: That he was saying that there was something wrong with him, and you didn't believe it. G: Yeah, I just rejected it. S: But isn't it helpful to you to get part of that filled in? G: Yeah. [Next hour] S: Your balance is what she needs so that she can ... What are you smiling at? C: [Laughs] That sounds a bit funny . . . my balance. I'm sorry, but that just strikes me as funny. Here I am, according to you another part of her personality, which is a sickness, and you're talking about my balance. S: What were you like before you were balanced? C: Well, I guess I was pretty bad, especially in the years when she was trying to be so good. S: After she married Bill? C: Yes. S: Is that when you really came into your own? C: Yes. S: Because it was too much for her to be a middle-class housewife? C: Yes. S: When did you first appear? C: You mean when was the first time I came out? I don't know. Do you believe that?

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S: I did until you smiled. C: I'm smiling . . . 1 don't know why I'm smiling. I really don't know. I'm smiling because that question is so ... Would it make a difference to you when I came out? Would it make a difference in how you would treat me or...? S: Oh, no. C: No. Well, it was when she was very young. S: Ten, five? C: Closer to five than ten. You can probably ask her mother. Her mother would probably know. S: How? Her mother doesn't know you exist. C: No, but she knows there's a part of P that she doesn't know. S: Oh. Her mother said: "P, sometimes I don't understand you. There's a part of you I don't understand." Isn't that what she would have said? C: Yes. S: And then you take that to mean literally that it's you. C: Well, it was the truth. S: I don't understand, if you were there for a long time but hadn't come out at all, how you influenced her behavior. C: The same way Charlie did, except I was inside of her head and Charlie was outside of her body. S: But she knew Charlie was Charlie. C: Yes. S: So how could it be the same way if she didn't know you were you? C: Well . . . but she knew there was something that made her behave differently. I think if you think back you can remember her saying, "I ditched school when I was in kindergarten." That was my influence on her. She knew what she was doing was wrong, but she felt she had to do it. You don't believe that. S: I'm confused. I can't tell what is the form that you take when she doesn't know that you're there, but she does know it. When she did all these things, the check-writing, the marriages, the gas stations, the dope, I don't know what—now, allegedly, that was you behind the scenes. Is that right? C: Not necessarily. She did a lot of that on her own. S: Oh. That's why I said "allegedly"—because I wasn't ready to buy it. C: No. S: So then how is she so different from you if she could do those things herself? C: How is she so different from me! Well, for one thing, if I were to

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do something criminal, I would feel very guilty about it. Can you believe that? S: Now that you say it, I can. It was kind of shocking when you said it. C: Yes, I would feel very guilty and feel a need to be punished. She never felt guilty about anything she did. Never! She never did, and yet I made her aware that she had a need to be punished. S: She seems guilty about her kids. C: Well, that's something I don't even understand. Her whole relationship with her children has nothing to do with me, nothing at all. Carrie told more about imaginary companions and how they led to separate personalities. She also told me (not reproduced below) that Charlie's name had really always been David, named for a masculine, loving, older man whom Mrs. G had admired unreservedly before becoming masculine herself. C: I was born in Sacramento. P was a very difficult baby, you know; she made life difficult for everybody. She wouldn't eat, and when she did eat, she'd puke; and she cried a lot. I remember the vomiting. Around two. I guess P was difficult because she felt she was all alone and this was her way of getting attention. You know, her mother would beg her to eat and promise her things if she would eat. S: That loneliness reminds me of what I was talking to her about before, about imaginary companions. Do you know anything of that? C: Oh, yes. She had a leprechaun. I can't remember his name, but she had a leprechaun because her uncle told her about a leprechaun and she loved that old man [her uncle]. He was a silversmith from Spain, and he made her a little tiny pair of silver spurs, and he told her about leprechauns because he had a friend who was a leprechaun, and she used to talk to him. And he would go everywhere with her and comfort her. She needed a lot of comfort, but there wasn't anybody there to do it except her grandmother; and her grandmother is a mean, vicious, old lady; but she was never that way with P. Like her grandmother hated her sister and wasn't too crazy about her older brother, but when P was born . . . she only weighed four pounds . . . her grandmother made all kinds of special little clothes for her because they had to be a special size. As for imaginary companions, except for David I don't know of anybody else. David was what she wanted to be; she wanted to be David. I don't know if I'm making this clear to you. I get a little confused myself sometimes. She wanted to be a big, strong boy, and to her David meant strength. And then David got sick. He was . . . he would create trouble.

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You mean he got sick in the head. Sick in the head, yes. When did David first appear? Probably when she moved from Sacramento to Los Angeles and didn't have her grandmother any more. I'm guessing. Wasn't that when the leprechaun was invented? No, she had the leprechaun before she moved from Sacramento. Why wasn't that enough? Oh, the leprechaun is something that's not real. My first recollection is ... God, they had just moved to Los Angeles; and her sister was just born, and the baby—her sister the baby—got whooping cough and pneumonia, and she wanted the baby to die, and she told Charlie [David] about it; and Charlie agreed with her that the baby ought to die. That's the earliest thing I can remember, and she must have been three years old. I never remember David being an imaginary companion. Did the leprechaun disappear then? Yes. She didn't bother with him any more. When David came? [Shakes head yes.] As far back as you can remember, which goes back to about three, David spoke to P in a voice that was outside of her—that is, a hallucination? Yes. Yes. When did he get sick? You mean how old was P when he got sick? Well, if you want my opinion, he was sick from the beginning. I said, "Then he got sick" because I was thinking of the peculiar, bad things he made P do, which he didn't do at first. Probably not for months. What caused David to get sick? I don't know. Did she get sick? Did P get sick? P was born sick. No.

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and maybe that's what she is trying to do to me, torment me. Maybe she's trying to drive me crazy. That's when she's the happiest, when she's crazy. Of course, she can't do it any more. She's lost the technique. But when she's hallucinating and feeling her body floating around the room, and all this other kind of BS, then she's . . . "They'll take care of me, somebody's going to take care of me, and somebody's going to love me, and I'll be all right." But when she's just P, who cares? Who cares? Her sons don't care. Her mother doesn't care. Her brothers don't care. Who cares? . . . You care. And I am really an outsider. She's meeting people slowly but surely. It's hard for her to relate to people on a real level, because she's never done it before. She always thought: Well, here I am. I'm crazy; take me like I am or don't take me at all—you know. Then she would do some crazy thing so they couldn't take her. I don't know how to explain her . . . the way she relates to people. She gives them a lot of herself, you know, as much as she thinks she can afford; and then she cuts it off. And people don't understand that. They think: Oh boy, here's somebody I can really respond to and be warm with; and then all of a sudden P's walking away, and people don't understand that. She pulled this on one guy a couple of times, and he says, "Don't pull that bullshit on me. I'm not going for it. You're not crazy. You just sit here and talk to me and finish the conversation; and when I'm through, then you can go." So she's been avoiding him for the last two weeks. Well, I'm here to help. I can't control her behavior. . . . Oh, I can . . . but I don't like to. I think she can control it more than she used to be able to. Are you going to become her? [Laughs] Am I going to become her? That's a very hard question to answer. Sure, she has a lot of hassles that I don't have to be bothered with. She's got to be ready for it; and when she's pushing me away with everything she's got, she's not ready for it. I think one of the things I'm going to do is to come out tonight when she goes home and tell those little bastard children of hers just exactly where they stand and where she stands and tell them either put up, shut up and get out, or something. Wouldn't it be the wrong thing to do if she doesn't know about it? Oh, she'll know about it. What if she wakes up tomorrow and has amnesia and doesn't know why the kids are the way they are? She'll know about it. You couldn't do it unless she would let you? No, I could do it without her letting me.

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S: When you say, "I will do this," it's because she is ready to do it, but can't do it herself, so she calls on you to do it. And she's becoming more close to being aware of it; that's more nearly you being her. She still has to use you, you know, in order to cop out so she's not responsible. C. Like she used the penis. S: Yeah. O.K. I've got to interrupt. Good-bye. C. Good-bye. S: No, I mean "Good-bye, Carrie; come back, P." C: Oh, maybe P doesn't want to come back. S: She knows what she's doing. Before Carrie showed up, she put out her cigarette because Carrie doesn't smoke. C. Did she really? S: She was nonetheless being Carrie. So she knocked off the head of the cigarette so it wouldn't burn [to save it for when she again was P], and then she began the business of bringing Carrie out. So already Carrie was there although P wasn't alert to it. C: Maybe it is a game. S: Yes. And you're Carrie and you're P, sitting right there now. G: Yes. S: You don't have to lie down there and flash your eyes and go into a fog and bring up P. G: No. S: P's right there now. It's very hard and very hopeful. G: Hopeful? S: Yes. G: I'll take that under consideration. Good-bye. [Next hour]

G: I was trying to do some work. She [Carrie] kept putting me out of it. I would be working, and then I would not be working and would not know what had happened in between times. It was maybe just fifteen minutes. And this went on all afternoon long. Well, maybe she's playing games with me. I don't appreciate it. I don't see anything funny in it. I have a job to do, and I have just so much time to do it in, and I wanted to get it done. I did no work at all. So then . . . it was something I heard in my head like "We're going to have to get together on this" and "I'm going to be you." She was just trying to show me that there doesn't have to be a separation, that we both could have been doing it as one person. And that I'm the one that made us separate; it wasn't her; it was me. . . . I don't know why I would make myself go out [amnesia]. S: But you do, you know that. It's never been Carrie. There's a P. There's a P who is frightened, and there's a P who is not frightened.

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There is a P who is stupid, and there's a P who is smart. There's a P who is inept, and there's a P who is quite good at things. There's a P who is fat; there's a P who is thin. There's a P who enjoys other people and can be friends with them, and there's a P who is too shy and who is scared. But you have to make up a name and a separate personality. You don't want those two to come together, because it throws a tremendous responsibility onto your life. You decide to black out. That's what the Carrie part, which is P, is beginning to see. I just can't do it. I just can't be like that. Whole? Yeah. Why are you smiling? Because you smiled. Why did I smile? Because you don't believe that. No. I really .. . You can't do it, but you've been doing it. As long as you've made a beginning . . . I have been playing games for so long. You know that. . . . Do you know why the games started? I was never allowed to be what I wanted to be, you know; I suppose I have a sense of humor, you know, and it's my style to tease people. Well, my mother couldn't tolerate that; and every time I did it, she would slap me in the face. So I didn't have to do it any more. I guess I got the teasing from my father—he was a great one for teasing. No matter what the situation was, he had a joke for it; and I guess I learned it from him, if you learn something like that. But I didn't know . . . You know, at first it was a game; and then I lost control of it, you know, just like being psychotic. I can make myself hallucinate, but after a while I lose control of it, and then I'm crazy. It's the same idea with whatever-her-name-is. [Laughs] See, that's you, kidding [i.e., not remembering Carrie's name]. Right? Right. That was a Carrie trick, right? Right [Straightforward] That's you. Nice. It wasn't so I wouldn't be lonely. You know, that's what I had Charlie for. It was so I could act out my own feelings. I called my mother at noon today; she's coming to dinner Sunday. And she said, "Just fix something simple. Don't go to a lot of trouble." And I

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said, "Don't tell me what to do. It's my house, and I'll do what 1 want. I'm not your little girl any more.*' And she said, "Oh, pardon me"; she said, "I didn't realize that," being very sarcastic. But it made me feel good to say that to her. I do want to be a whole person. I want to be a person that, you know, that . . . I don't know, I haven't got a descriptive word for it But I would like to be the kind of person that people like and that can like people not just for selfish reasons, not just because . . . Not homosexual men because I know I'm safe with them, and not psychologists that I can drive crazy, people like that. I would like to have friends, and 1 don't know how to do it, though . . . you know . . . Well, I guess I do know how to do it. It might be fun to be a whole person, you know; she [Carrie] has a lot of fun, from what I hear. Remember once I told you that I can wake up in the morning and be wide awake and lay there and kind of put myself in a trance and do anything I want to do in my head? Well, that's something of what I do when I put myself out. I'm admitting to you that I do it myself. Uh huh. Do you know that? I suppose yesterday when you did it, it was at a point at which you were feeling some pain or concern or you didn't feel adequate to the job you were doing. Just as you think that, you put yourself in a trance . . . to escape. Or isn't that right? I don't know. I think I was experimenting to see how far I could go with the whole business, to see if it could take me over completely, to see if 1 could bring myself back. I think I was just playing a game. When you called me last night, you didn't know that though? No. You'd forgotten it. Forgotten it. Yes. When 1 do it in the morning, where . . . I don't know what you'd call it, what 1 do ... but I can always bring myself right out of that. But this other thing of putting myself out and letting another part of me take over, I can't control that. I did yesterday; that's the first time 1 tried it, but for years I didn't. I had no idea what was going on. Maybe I did. Maybe I did know. Like spending the money, for instance. The only time I did that with Bill was when he had done something to me, not always but sometimes. It's kind of a waste of energy. That might be what helps me feel tired all the time. And then there's the sex. I have to think about that too. Sex. That's a dirty word. Do you know, sexually there are a lot of things I want to do, like just give in and let somebody love me once; and when I put myself out, I could do that. But I have to say that I must have known that. I couldn't have been completely

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oblivious to everything that went on. You know, people have got to say to me, "Well, you did this and you did that'* when I was P. I guess I'm just chicken-shit. And profanity, which is kind of funny: I've used profanity since 1 was old enough to talk. You know, my mother told me how when I was a little baby, I used swear words; and they thought it was so cute, and they encouraged me to use profanity. And I've always been able to outswear anybody I came up against, and I can do it in two languages. But I don't like it; and when you swear back at me, I don't like that at all. I really don't. It really irritates me that you would talk to me like that when I'm a woman, and yet / can tell you to go fuck off. But I don't want you to tell me that. Does that make any sense? S: Yes. I never talk to women that way [outside of treatment]. I don't talk to men that way either. I talk to you that way. I don't mean that I don't know the words—obviously I do. I do it with you. In Carrie's place, Mrs. G, more whole, now feels freer to have fun; and—a bonus for the research—her memory of childhood events has been expanded. She remembers earlier times, more experiences, and many more details of memories that were formerly fragmentary. She can now, at will, fill in the gaps of the former amnesias that resulted when Carrie took over.

9 Murder

Not only could Mrs. G split off pieces of herself but she was equally skilled at splitting off affects from her awareness. For many years she felt nothing in situations that should have caused intense emotions, so that these emotions, cut loose from the appropriate situation for which they were created, would explode into dangerous behavior—murderous and suicidal behavior. And so long as these feelings or their proper connections to the precipitating situation were unconscious, she was a walking bomb. Only when the affects were made conscious and their reasons for arising discovered did she become safer. Before that, threats, punishment, appeals to morality, attempts to make her feel guilty, and all the other devices society uses to suppress wild behavior had only the slightest effect on her. Mrs. G often had powerful impulses to murder people which she didn't act upon, and murderous fantasies behind which there was little conscious impulse. But from age seven she actually tried to murder a number of people: a little boy, whose head she hit repeatedly with a rock; a policeman, whom she shot; a male acquaintance, whom she shot five times (not shot at, but shot)\ two of her sons, whom she gassed and drugged in a murder-suicide attempt; an unknown man, whom she tried to kill (and in fact injured) when she swerved her car suddenly in front of his car; and her husband, whom she once tried to stab and whom she poisoned with arsenic in his food on another occasion. In addition, she drew a loaded gun on one of the residents treating her; another time, she placed a loaded pistol against a policeman friend's head, with the intent to kill him; and during a confused state of despair, she was prevented from shooting her adopted son and herself only by hospitalization. Finally, there were three incidents with guns; one in which the gun she had prepared for shooting the school principal was discovered, another involving a move toward shooting her husband. And, I finally learned, me too. 176

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The following episode exemplifies these murder attempts and the underlying psychodynamics: G: S: G: S: G: S: G: S: G: S: G: S: G: S: G: S: G: S: G: S: G:

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There was a boy 1 tried to hurt. I hit him on the head with a rock. How old were you? Maybe seven. How many men have you almost killed? Boys? 1 don't know. One, two, three? Four, five, six, seven? Lois. Eight? More. Nine? Ten? Twenty? I don't know. When I say "almost killed," I mean that literally, like when you're seven, you pick up a rock. You shot a policeman in the ass. I shot another guy, too. Did you hit him? Yeah. Five times. Who was he? He was just a guy. Have you ever tried to shoot anybody else? When I was about twelve or thirteen, 1 stole a gun from my grandfather and I tried to kill the principal of my school. What happened? My grandfather missed the gun, and he knew I took it. I had it hidden in the house, and when I left the house to kill the principal of the school, he came . . . my grandfather came to the house, and my brother caught me with the gun. Why did you want to kill the principal? Because he wouldn't let me smoke. Anybody else? That I tried to shoot? I tried to shoot Bill once. What happened? I just couldn't do it. Did you have a gun? Yeah. Anybody else, male, that you tried to kill other than by shooting? I was going to kill Dr. J once by shooting him. But? I brought the gun and I showed it to him. And? I just didn't do it.

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S: You just mentioned somebody whom I never heard of before whom you tried to kill; you shot him. Tell me about him. G: He wasn't important to me. He was a great, big, stupid, ignorant... he was a dope peddler for one thing, and he was ugly and mean. I don't remember what he did to me. He wasn't really ugly—he was really pretty good-looking. It was a funny thing: I just decided to kill him. I stole the gun that I shot him with. I was living with T [a woman] at the time; and I shot him with a .22 rifle, which wouldn't really have killed him unless I hit him in a vital spot. I shot him and I shot his car up and I shot all the windows out. S: Was he in it? G: No. S: Where was he? G: In his apartment. I just opened the door and he was sitting there and I shot him, in both thighs, in the side and in the shoulder and in the arm. I'm not a very good shot. S: But you fired . . . G: Five times. S: Five times. You hit him five times. You must have been very angry. G: Then I went home and I went to bed.. . . S: What did he do? G: He just laid there screaming, and I closed the door and I left. And I went home and I went to bed and I went to sleep; and in the morning the police came, two policemen; and one of them said [Chuckles] . . . it was really pretty funny . . . one of them said, "You're going to have to come down to the police station every Wednesday afternoon for the next six months at two o'clock." And I said, "What for?" And he said, "For target practice." They didn't arrest me. They didn't do anything to me. They arrested him. S: For what? For being in the way of a bullet? G: For grand theft. He had a bunch of stuff in his apartment that he had stolen. S: How did you meet him? G: There's a place in Venice [California] where all the queers and addicts congregate, and I used to go there. S: Which were you? G: Neither one. S: Why were you there? G: Because I enjoyed the company. And I met him there, and he joined the same motorcycle club that I belonged to. S: But he had done something that enraged you. G: Yes. I remember being angry.

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How long after that did you leave T? Right afterwards. Why did you leave T? I don't know. Because 1 didn't like her any more. I don't know why. Don't ask me why. What's Charlie saying? Nothing. . . . He trusts you. He just wants you to be careful. He just said it was, that it was because I thought T liked to neck; but that's not true, because 1 didn't care who she liked. She liked lots of men. Maybe he's teasing me. Yeah. I didn't know before that you can turn to Charlie any time and he will sound off—that is, actually be heard, almost at will. Do you get what I mean? That if you ask him to speak, he speaks; and you hear his voice clearly, just as clearly as anyone. I just don't think that's a good idea, to ask Charlie things like that. He answers, but he doesn't always tell the truth. Before you shot him, what was'the last time you had seen him? The same night. In my apartment. You're remembering it now, aren't you? Yeah. I remember he was there. My kids were there. T was there. K [the man] had a bottle of wine, and he just came to visit. People walked in and out of there like it was a hotel. So it was just a visit. And what happened? I left. No, no. What happened that got you angry! I don't remember. They woke the kids up. T and K. Why? I don't know. They went in and woke them up. That made me angry. But that wouldn't have been enough. No. Did he ever sleep with T? I don't think that would have been enough either. No. There were guys sleeping with her? That didn't bother you at all? What are you thinking now? I was thinking I almost threw up. When? When you said were other guys sleeping with her. Why? [Laughs] I don't know. It just made me sick to my stomach . . . to think about guys sleeping with her.

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S: So K wakes your kids and T wakes your kids. Then what? G: I don't know because I left. They made me angry, and I left. Then 1 went and got the gun, and I went to K's place and shot him. S: What did he say that got you angry? G: I don't remember. Maybe he called me a queer. S: Why would he have called you a queer? G: Maybe because T preferred to go to bed with me instead of him. Or maybe because 1 preferred to go to bed with T instead of him. S: Did he want to go to bed with you? G: Yeah. S: Had he ever? G: No. S: Why didn't you? G: Because he disgusted me. S: Why? G: I don't know why! S: Come on. G: Because he was such an animal. S: What do you mean? G: I don't know—he was a big, stupid man. S: By animal, you mean masculine? G: Yeah. S: That bothers you? G: No. S: What did he think of you and T living together? G: Well, in that particular group of people, it wasn't unusual for two women to be living together. S: But he would have thought that two women living together were queer, wouldn't he? G: Yeah. S: Why did you leave T? You left right after that. G: Why did I leave T? I don't know. I don't know why I left T; I just left her. Besides, it wasn't a good idea for me to live there any more. Do you know what I did with the gun I stole? I sold it to a policeman. [Laughs] S: Let me remind you: A few months ago you suddenly remembered why you had left T. The reason you had left T, you said, was that someone, not T, had said you were a queer. And I think now the chances are very great that we know who the someone was. G: It would have been typical of K to say something like that. S: He may have said it just as a joking thing—not that he didn't mean it, but he wasn't even thinking of the implication of it. Isn't that right?

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Yeah. In the middle of a conversation ... I changed my mind. I'm going to have another cigarette. He might have said, "Ah, you two queers . . ." or something of that sort. Yeah. You don't remember it, though? No, but that's the way he talked. I think if K had called me a queer I may have wanted to kill him, because 1 had a certain amount of respect for him. He was vulgar and he was mean and he was stupid and everything else, but 1 did have a ... because he was strong and he took women and he did what he wanted to do; and nobody stopped him, no cops or nothing; nobody stopped him from doing what he wanted to do. Did Charlie tell you to shoot him, or did you do that on your own? No, I did that on my own. Charlie told me not to shoot him. Charlie didn't like me to kill people. But you told me last week that Charlie was the one that told you to kill people. No, I didn't. I didn't say that. All right, I misunderstood. Charlie started [i.e., first manifested himself] right after you wanted to kill the little boy [at age four]. Yeah. You went to hit him with a rock? Yeah. I don't know that I tried to do anything to him. I don't know if it was him or another boy I hit on the head with a rock. One of them I did. But Charlie didn't tell me to do it.* Charlie never ...? What about the policeman? Charlie didn't tell you to do that one? No. That was an accident. How did that one happen? There was a big drunken hassle, and he started shooting, and another boy started shooting, and I started shooting, and I shot him in the ass. You weren't shooting at each other? Yeah. All of you were? Yeah. And you were all within one room, and you didn't hit each other?

But during another hour: G: We were hiding in the hole—you know how kids do—and Charlie told me to kill him.

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[Laughs] No. Why did the cop start shooting? The cop got shot three times. Why did he start the shooting? You said ... Oh, because this kid threatened him with a shotgun. In fact, he hit him with the shotgun. . . . No, the cop grabbed the shotgun, and when he pulled it, it went off; and it shot the cop right in the stomach. He pulled the barrel of the gun, and when he did, it went off and shot him in the stomach. The kid didn't get shot at all. And then when did you shoot? While they were shooting at each other, because I thought they were going to kill me. It started in my apartment, and then we moved upstairs to another apartment. It was very confusing. Everybody was drunk except me—I was the only one that was sober because I had just come home. They had been there all day drinking. There were two cops there, and they were drunk. And this boy wanted to get them out of the apartment—I don't know why, it wasn't any of his business—and he threatened them. And everybody started shooting. And I came in, and I got scared, and I thought they were going to kill me, so I shot him. But he was already shot. So I shot him again. Because I wanted to kill him. Because I didn't want him to kill me. So you shot him in the ass. You weren't aiming at his ass? [Shakes head no] It's hard to believe. I can show you the newspaper story. . . .* They took the cop to the hospital, and the other cop got hit in the head by a third cop with a gun. [Laughs] The two cops that were in my apartment were in plain clothes, and when the third cop came to see what all the shooting was about, he didn't know they were policemen; and one cop was aiming a gun at him, and he told him to put the gun down; and this cop was so drunk he didn't understand, and he didn't do it; and this cop hit him over the head with his gun and knocked him cold. We had to go to Superior Court and testify, and it was a big mess. Were there more? No. What are you thinking? I was just trying to think if there were more. The first one was the little boy. Would you tell me again, Why did you want to kill him?

* Years later I got a copy of it from the newspaper files. It was a frontpage headline story; Mrs. G is mentioned only as an "informant."

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G: 1 don't remember why. 1 don't remember doing anything to him. I just wanted to kill him. S: The second ... G: That's when I was about seven. That's when 1 hit the boy on the head with the rock. I'm sure he's the one I hit on the head with the rock. 1 remember him bleeding and screaming. I don't know if I hit him to kill him. I really don't know. I used to think about killing him; I used to think about where 1 could bury his body and everything. I used to have murderous thoughts about him quite often, and he never did anything to me. He was a very nice little boy, you know, just a regular neighborhood little boy; and I used to think of all different ways I could kill him. I think I didn't really want to kill him; I wanted to kill somebody else, but he was handy. It would have been easier for me to kill him rather than kill my brother. I probably thought about killing my brother, whom I hated so much; and yet my brother was seven years older than I was, and he was six feet tall; and he was a big man, and I couldn't kill him; but I could kill this other little boy. I used to torment him something awful—just tease him, you know. S: What was the third? G: I didn't do anything to him. There was this boy at school I wanted to kill. I was in the sixth or seventh grade. I was in junior high school. He showed me his penis. He was just a nasty boy; and I was on detention as usual, and I had to stay after school this one night, and so did he; and he asked me if I wanted to see something cute, and I said yes, and so he showed it to me. It wasn't cute. I've never seen a cute one. I guess the bigger they are, the uglier they are. S: Murder and penises. G: It's funny that you should say that about murder and penises, because it seems like the two times I shot a man that was the area I shot in—like shooting the cop in the ass; and I shot K in both thighs. S: Were you aiming? G: I didn't think about that until just this minute. Maybe I was. S: Not maybe; you've got the gun in your hand. Are you aiming, or are you not? It only takes a quarter of a second to aim. G: Did I tell you about my dream about my penis? S: No. G: It was the other day. I woke up, and then I went back to sleep; and I dreamt I had a penis, a big penis. And everybody laughed at me; and I would walk down the street and show people, and they would laugh at me; so I decided to have it cut off. So I went to the doctor, and the doctor put me in the hospital; and they put me to sleep, and they cut it off. And when I woke up, I was in such terrible pain,

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and oh my God, the pain. And when I woke up, I was still in pain. I had a pain right there just like they cut it off. Who was the doctor who put you in the hospital? You did. And was I the one that cut it off? I don't know. 1 was asleep when it was cut off. Who was responsible for having it cut off? You were. Yeah, me. Isn't that really what's happened? Isn't it true that I have been trying to cut off your penis in this treatment? Yeah. There hasn't been any secret about it. I've told you I want you to be a woman. I don't want to be a man! We've been talking all hour about your losing your penis. Did you know that? About men's penises and your envy of them and your shooting them and at their penises and .. . Well, I won't shoot anybody else because of their penis. How's that? If you wouldn't shoot them because of their penis, you probably would never shoot anybody. My hunch at this point is that that's the only reason that you shot or wanted to shoot. I'm going to kill Bill. Cute. Why? Just because. When? But it has nothing to do with his penis. I don't think Bill has an ugly penis. Why are you going to kill him? I'm not going to kill him right away. Why are you going to kill him? Oh, because he made me come back [to live with him], and he didn't live up to his part of the bargain . . . [to get help]. So, he's got to die? It's a big price to pay. Yeah, he has to die. It will ruin our research. I'll wait until you're done. And I'm going to try to keep you from doing it, do you know that? What difference will it make when you're done? It will make a difference. I'm not just seeing you because of my research. Why did you lie to me? About what? About doing all the things he was going to do?

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Oh, come on. What things was he going to do that I lied about? Not you, him. I thought you said why did I lie to you? No, why did he lie? Oh, I'm sorry. Now you understand why I was confused. Why did he lie to you? Because he wanted you back. That's not fair. Didn't you expect it? No. Not a bit? The thought never occurred to you? No. Because Bill doesn't lie. He must have really needed you. I've never known him to lie about anything. So maybe he'll come through. He'd better. Is it time for me to go? Yes.

Talk of murder subsided immediately; and after a couple of uneventful weeks, there was a two-week interruption at Christmas time. The first session afterward, a further probing of Mrs. G's sexual relations with women, was interesting and enlightening, but not remarkable; still, an excerpt from that hour exemplifies the kind of attack that, as the years passed, had ground away her resilience. I mistakenly thought at the time that this suffering was due to the struggle against labeling herself a homosexual. Only in the material reproduced below did I learn the truth. G: Constant fear—like I'll be in the house, and I'm afraid someone is going to break in and kill me; and I go to sleep, and I'm afraid I'm going to die before I wake up. And I get in the car, and I'm scared the car is going to crash. And I got in the elevator, and I was afraid the elevator was going to fall or the door wouldn't open, and I'd be in there and I'd suffocate. I can't go in the grocery store, because I'm afraid all those people are going to crush me. And I'm scared to go out of the house at night because, I don't know why—I don't even know why. I'm just scared all the time. I've been scared before. Like I've been scared to drive the car before, but not in the same way . . . I was scared to drive the car because I was afraid I'd drive it over a cliff. I've been scared before when driving the car because I was afraid I might drive into a brick wall or something, but this time it's different. Well, maybe this time it's really the same, only I'm feeling different about it.

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That night she called and, in a flat, nonpsychotic, and frighteningly calm and gentle manner, said she was now going to kill herself. How Mrs. G acts and what remedies I take in such an emergency are described in the chapter on suicide. Suffice it to say here that she was hospitalized. There followed a week of my seeing her up to two hours daily, thinking I was getting at the cause of the suicide drive: guilt about homosexuality. Then, far into a treatment hour, came the following: G: Do you want to know why I wanted to commit suicide? Will it make you angry? Because I tried to kill Bill. I tried to poison him, with some stuff I got at the store. It didn't even make him sick . . . yeah it made him sick. He thought he had the flu, but it didn't kill him. Some ant paste that you get in a little round tin [arsenic]. S: And you hoped he would in fact die? G: I was at the time, but afterwards, after I did it, it just scared the living shit out of me. 1 thought: My God, how crazy am I that I would do a thing like that! I knew he'd have to be the one that would have to go because I have my kids; I couldn't go, but he was going to have to go. S: Of course you know if you kill him and you're found out, you won't be around to take care of your kids. G: They'd put me in jail? S: Sure. For what is called murder. Did you ever hear of it? You hadn't thought of that? What did you think they were going to do? G: Nothing. S: You thought they'd do nothing after you killed your husband? Why? G: Because he was the bad one.

Only then, with respect to that particular episode, did the suicidal threat disappear; for it had been stimulated not by fears of homosexuality (as had been the case so often in the past), but by the terrible guilt generated by her desire to kill Bill. Once that was out in the open, the need for suicide receded. By the age of four, Mrs. G had a sense of being of little worth to her parents: her mother had made her believe that only boys were valuable and that she was not lovable in any case; and her father, who openly loved her, was scarcely ever home. A lonely and despairing child faced with the task of raising massive defenses in order to survive, she invented a hallucinated male voice and a penis. These two constructions and the first remembered impulse to murder all focus in her first clear memory at age four.

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G: There was no reason for me to be alive. Nobody was interested in whether I was alive or not. Nobody wanted me to be alive, and I didn't want to be alive until 1 had Charlie. There was no reason for me to live, and Charlie needed me. . . . I remember when Charlie came to me. I was about four. It was just before 1 started school, because I had him when I started school. Do you know I ditched school, in kindergarten? I just remembered that. I'd stay in the park all day by myself. S: Was Charlie with you? G: Yeah. S: Do you recall his first appearance? G: I don't know if it was his first appearance—if I tell you, you won't get mad? S: No. G: I do remember. We lived on the corner, you know; and the street that went beside the house where it crossed and went down, that was a dirt road; and there were only two houses on it, and in the second house there lived a little boy that was my same age. And he was real mean; and I was playing with him one day in the field behind the house, and we had dug a hole and we were hiding in the hole—you know how kids do—-and Charlie told me to kill him. S: Did you want to kill the little boy? G: Yeah. I hated him. Because he did mean things. He was stronger than I was. He didn't have a mother. . . . He had a penis, and I didn't. I know he did, because I saw it ... when his grandmother gave him his bath; and I saw it when he went to the bathroom. S: Did you want his penis? G: Yeah.

But that was long ago. Although valuable for treatment, hearing it stirred my scientific interest, but not the more primitive emotions that murder reaches. The following cuts deeper. G: I had a busy weekend. I went to my mother Saturday. I was going to go home, and then I changed my mind. Maybe I should have gone home. And I called Bill, and he said he'd bring the boys and come out Sunday. I went out Saturday night with some friends and had a few drinks and enjoyed myself. Bill came Sunday. I had an automobile accident, got arrested. Bill and I had dinner together. He did something very unusual. He talked to me and talked to me, and he cried and a little bit of everything. And that was my weekend. S: Could you fill in some of the details for me? G: I had the accident. I pulled in front of a car; I sat and watched him

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come down the road, and I thought he's either nuts or drunk, and he'll kill somebody; and I pulled in front of him. He was coming down the street going this way, and I was on a street going this way. I had pulled into the left-hand turn lane, and I could see down the road the way he was coming, and I just watched him come. Could you have avoided it? [/ am beginning to get anxious and angry.] I pulled in front of him. I don't know what that means. You mean you tried to get into an accident? Yeah. Why? Just to see what would happen. What happened? Nothing. It wrecked the car. Whose? Mine. What do you mean nothing happened? You wrecked the car. No big thing happened. Could you have been hurt? The police were very surprised that I wasn't hurt or killed, the way he hit me. Did you want to be killed? I wasn't thinking about dying when I did it. What were you thinking about? Maybe I was thinking about dying, because I remember thinking: The way he's driving, he's going to kill somebody—just before I pulled in front of him. I'm still not clear about this "pulled in front of him." Did pulling in front of him mean that you put the car in the way so that he would have to hit you? How was he driving? Very erratically and fast. They arrested him for felony, hit-and-run and drunken driving and drunk in public. You mean after the accident he tried to drive away? Yeah. His car wasn't hurt bad? Yeah, it was. But it was still moving. The woman who was with him broke her arm and . . . banged up her head. He wasn't hurt; drunks are never hurt. He couldn't walk—he had to drive; he was in no shape to walk. So we've got real trouble, you and I. Because I got in an accident? No, because you want to kill yourself. [/ am now very angry.]

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G: I wasn't thinking about dying. S: That's the trouble, that you can do it without even thinking about it. What is the matter with life now if you don't care if you live? This was when? Remind me again. G: About 1:30 yesterday afternoon. S: After you talked to Bill? G: Before. S: Before. G: It scared the shit out of him. S: Was he in the car with you? G: No, he was in another car behind me. S: Did he know what you were trying? Was it obvious that you were trying to cause trouble? G: I guess it was to him. It wasn't to anybody else. S: Why were you arrested? G: Oh, because I had a traffic warrant for my arrest. S: What is that? G: I had a ticket that I didn't pay, and they swear out a warrant for my arrest. S: You mean some time ago. Why didn't you pay it? G: I don't know. S: Do you ever pay them? G: No. S: I don't like that. G: Neither does Bill. S: I don't like you when you do that. You have obligations. G: I know it. S: No, you don't. G: Yes, I do. S: Then why don't you pay your tickets? And what right have you got to kill people? That's the one thing that I don't... G: What right have I got to do what? S: To kill people. G: Kill people? S: [I am enraged.] Kill people! Put your car in front of a drunk driver with a woman in the car so that it could be three of you dead. You know, that's quite a whim. That's cute. And you don't give a shit— you don't give a shit now. You don't think there's anything wrong with that. Look, I'll understand you; I'll do everything I possibly can; I'll get as close to you as I can; but I cannot make myself over to forgive that kind of business. I can understand it, but your killing other people and killing yourself—don't expect me to sit and smile and joke about that. You have no right to decide when somebody

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else is going to have had enough of this life—that's not your decision to make. I don't care whether he's drunk or he's not drunk. What right have you got to decide when somebody else is going to no longer have an opportunity to breathe or walk down the street or make love or get angry? Who the hell are you? Then some time next week, when we're talking together, you're going to say, "Gee, 1 don't know if I should tell you this or not because you may get angry at me" and blackmail me in the treatment. This is the only thing that I get angry at you about. You go on bullshitting all day long: "Oh, I'm bad, I sleep with women. Oh, am I terrible!" Why don't you take those kinds of feelings and put them where they belong! Why don't you say, "Oh, my God, I kill people!" All this horseshit about homosexuality. Big deal—it hurts nobody. But you go on year after year about what a filthy, rotten person you are. Why in hell don't you go after yourself about the fact that you want to kill yourself or kill other people? G:. I don't want to kill other people. S: Then why did you try to kill him? G: I didn't try to kill him. S: The hell you didn't! Come on, now. Did you put your car in front of him, and did you know that he could get killed if he hit you? G: No. S: The hell you didn't. You did too. You thought it would be fun. You thought: Won't this be a great little crack-up—-didn't you? Well, somewhere within you . . . look you may be crazy, but I'm not going to give you credit any more: "I don't see Thelma [my secretary] when I come in because I'm so preoccupied." That's tough shit. You get away with too much when you're crazy. G: What am I supposed to say? S: You're supposed to say whatever you want to, but you're not to sit there like a great big fat ass. G: Oh, it's tough. [Sarcastic] What can I say? There's nothing I can say. O.K. I'll say I'm sorry. S: No, that's no good—not until you mean it. G: I don't feel anything about those other people. I don't know why. S: Why don't you ask yourself why? Why are you so damn . . . G: I'm asking myself. S: No, you're not; you never do. You never ask why you do these nutty things. Your biggest answer to me is "I don't know." G: Well, I don't know. S: How about asking some questions instead of waiting for me to ask the questions? How about you being responsible for some of the

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curiosity and concern in here? Why the hell don't you start asking questions when you try to kill people? I didn't think about anybody else. Don't say it in that tone of voice—meaning, "That's not my fault; I didn't think about anybody." I'm telling you that it's time that you began thinking about somebody else. You're not that sick any more. You're asking me for something that I don't have. Well, you better start finding it. I don't feel anything about that man and that woman. I'm not sorry. You don't feel that there is anything wrong about not feeling anything about them, do you? No. It doesn't even occur to you that there's something missing inside of you because of that. That's very possible. Yeah. But all this horseshit about things that don't harm anybody. Doesn't that seem curious to you? My God, you're ready to kill yourself because you go down on some girl. Can you see what I'm saying? Can you see that there's a difference between going down on a girl, which makes her happy, and putting your car in front of somebody and killing them? Yes. Yes . . . yes. [Sarcastically] What do you want from me? I want some decent humanity from you. Well, that's tough. What do you feel when I talk to you this way? Nothing. What's the matter with you? Why don't you feel anything? I don't know. Or are you lying to me? Do you really feel nothing? Well, then you ought to question it. If I'm chewing your ass out, then you goddamn well should be feeling something, shouldn't you? I'm asking you—What am I supposed to feel? Goddamn it, I don't know. I don't know what to do. I just don't know what you want from me. You said, "What do you feel?" I said, "Nothing." I don't feel a thing; nothing. I didn't want to leave the ward Saturday. I didn't want to go out on pass. And everybody kept saying, "When are you going to leave? When are you going to leave?" And I kept putting it off and putting it off, and I put it of! until one o'clock. Then I left. I didn't have anywhere to go, anywhere I wanted to go. I didn't want to go home, and I didn't want to go to my mother's.

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I went out with people who are supposed to be my friends, and I didn't feel like 1 was really there. I drank a lot and got drunk, and I knew I was drunk, but it was an unreal thing. When I pulled in front of that man, I didn't think about his getting killed. Had I thought about him and that woman getting killed, I certainly wouldn't have done it. I don't know why I did it. I wasn't thinking about anybody getting killed. 1 don't want to die. And then Bill . . . He talked to me about the times when 1 get angry, and he said I'm vicious when I'm being hostile. He talked about going to bed with me, about whatever it is I do to him—I make him feel inadequate. He's afraid to go to bed with me. We talked about dying. . . . I don't feel like talking to you. I'm not angry because you chewed my ass off. It's just I ... That was the thing to do, to chew my ass off. It means I did something very stupid and very dangerous and I should ... It should be worse than having my ass chewed off. I don't want to talk to anybody. I just . . . I have this thing in front of me. I don't know what it is. Have you ever been in a cave? And you talk, and your voice sounds different; it doesn't sound normal. It's like somebody else could be using your voice. That's the way I feel. I keep going to sleep; I mean my body keeps going to sleep. S: What does it do to you? All these feelings? Is it from craziness? G: If it is, if it is from being crazy, then I'm crazy all the time. S: You told me that last week. G: Yeah, but I didn't believe it. Why would it surprise me when it's something that I've lived with for thirty-three years? [Next hour (same day)] G: I was thinking about what 1 did yesterday. I still don't feel anything about it—I'm very sorry about that. I tried very hard to muster up some feelings, something appropriate like guilt or something, but I just can't do it. But I was thinking about why I did it. Just before . . . we were in a restaurant, and Bill said, "Don't you think it's about time that we talk about this divorce thing?" And I said yes. He said, "Suppose the boys go over to your mom's, and you and I go back to the hospital and sit and talk"; and I said O.K., and the boys left, and I got into my car and drove out into the middle of the street. Maybe I really didn't want to talk to Bill about it. Do you think that's possible? S: Ask Charlie. G: Charlie's not talking with me. Charlie's angry with me. S: Why? G: Because of what I did. [Long pause] What? S: When I'm reincarnated, I'm going to be something different. I'm not going to be a psychiatrist. . . . This morning, although you didn't

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feel anything, by means of Charlie you have opinions and have feelings. And my frustration comes from the fact that you split off those feelings from yourself, and they're in Charlie instead; and I'm so anxious for you to get joined back together into one piece. You're telling me that you want me to feel the things Charlie feels? Yeah. Shit, no. ... Do you want me to tell you how scared he was? . . . You spare yourself by letting it be Charlie, don't you? It doesn't hurt you as much, does it? You don't feel it—Charlie does. And that certainly is sparing you the pain; but it puts your life in jeopardy. God, I don't know how to get to you; and it's my problem, not yours. You're the one who is sick—it's my job. I'm going to go, O.K.? No. I'll talk to you tomorrow. Boy, wouldn't you be up shit creek if I said O.K.? Wouldn't you have a rough night? I don't know. Answer me. Would you, or would you not? Probably. Is there any chance that you wouldn't? No. No. Then why do you do that? Can't you think ten seconds ahead?* About what I'm going to say before I say it? No, to what the consequences are of what you do. Charlie can. Would Charlie say that and get up and go? No. What did you say about Charlie? I didn't hear, I really didn't. I said, "Fuck Charlie!" Charlie was scared? Yeah. How do you know? Because he told me not to do it. Before you did it? Good. Is there anything that you did—try to remember carefully what happened—that saved you so that although the car was smashed, you were not hurt? What? I threw the car in reverse after I had pulled back in the street. So as a result of that, what happened? He hit more forward on the car and less on me. Instead of hitting me directly, he hit ... he kind of slid along the side of the car. He

* Pan of her always does: She knows how to manipulate me—as one can see throughout these interviews.

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hit the car; but the way I had pulled out, if I had stayed where I was, he would have hit that door directly. Where you were? Yeah. What made you go into reve;se? Thank God you did! I guess because I was told not to do it. By Charlie? Yeah, but it was already too late. I was already out there. 1 couldn't get out fast enough. This guy was coming too fast. I'm frustrated. What I'm thinking is: How am I going to get you to see that if you had Charlie's thoughts that your life would be better? I don't know how I can convince you because you've got a very powerful argument. The argument is you don't have to feel the bad things . . . and I can't argue with you. Apparently I haven't been able to reach you that life is worth living—you're really not convinced of that—and the way your life has gone, I can't fully blame you. And I'm missing some crucial way to convince you. I think . . . I think the reason that you can't convince me is because Charlie's crazy sometimes, too; and do 1 want to be crazy like me, or do I want to be crazy like Charlie? I don't want to be crazy either way. Today [this morning] when I left you, Charlie was screaming. Screaming isn't necessarily crazy. I got the impression he was crazy. 1 know if 1 screamed, I'd be crazy. Why? But can you imagine people screaming in agony who are not crazy? Isn't agony craziness? No. It is for me. No, no, not necessarily. Now to go back to Charlie: Was Charlie crazy in my sense, or was he just in anguish because of what you had done and what I had said? Yeah. I'm trying to think of a time when Charlie was crazy, and I can't think of that. 1 think of a lot of times when he ... Like just before I came in the hospital—he cried for three weeks without stopping; and I had to listen to that for three weeks.

When I consider the mix of dynamics that would have made it so easy for Mrs. G to pull the trigger on any particular day, I recall the following, to which anyone would doubtless be able to add. First, there is the "natural" propensity of mankind for murder and the primeval pleasure in watching the miracle of death unfold. However, this issue, which many readers will consider the most important,

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I leave to people with a more philosophic bent; I have not yet been able to collect, as others seem to have, the data necessary to maintain with confidence either the position that hostility is innate1 or that it is produced by the frustrations of being born and bred. To say that I believe it is a mixture of both is to say little. Let us go on to less cosmic problems. When Mrs. G was born, she had a brother, seven years old, physically big, active and forceful, ready for cruelty toward a baby sister. Her father was not present much during her childhood (he was in the army); but when he was home, he was a most appealing father indeed for a little girl: he loved her very much. She was his first child, the boy being Mrs. G's half brother. Her father had no difficulty in recognizing his daughter as a female or in expressing his pleasure in her femaleness. This may sound obvious, but I want to emphasize a most valuable condition for the development of normal femininity— a father's inhibited heterosexual pleasure in his daughter. Unfortunately, this healthy trend was thwarted by war, which took her father away, and by his personality, which caused him, when the war ended, not to be able to stand his family for more than a few days or weeks at a time. During his visits home, he would renew the tender and fervent feelings between his daughter and himself, raising her hopes that he would stay and love her; and then he would leave without warning. Perhaps his lovingness would not have been so complete if it had not been intermittent; but certainly, had he stayed home, he might have protected Mrs. G somewhat from the then unshielded energy of her mother's ambivalence (and from the unrelenting pounding she took from what she considered to be her brother's masculinity). An odd but relevant fact should be noted: the little girl was given her father's first name. It is an unusual name, and with different spelling is either male or female. Whether it was due to coincidence or the unconscious plans parents have for their infants, no more apt name could have been chosen to reflect bisexuality. However, Mrs. G's parents could not leave it at that: they added more names. From earliest childhood (perhaps from birth on), although she officially bore her father's name, she was called by an endearing, more feminine nickname, "Sugar." Then, when she started kindergarten, the teachers chose to call her by her middle name, an unquestionably feminine name, but to the child an alien sound to which she did not respond with the feeling that it was she who had been addressed. All of this is to say that without a name one lacks an essential part

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of oneself. How can one feel whole if one doesn't know what to call oneself? In this regard, during all the years I have known Mrs. G, I never until recently felt any of her given names to be hers, only her married name. She has always been only "Mrs. G." Let us look briefly at Mrs. G's mother, whom we shall consider in detail later. G: She was always saying, "Your father's a son-of-a-bitch, and you are just like him/1 G: When she said I was bad, it was important to be bad, because she was not a liar. . . . If she was wrong, I'd want to die. . . . I could have died, and she wouldn't even have known it. ... Because I didn't eat . . . I couldn't eat. When 1 was little, I couldn't eat because I had to cry. She wanted me to be a boy. She said. "I never wanted a girl. I always wanted boys." G: You know, 1 was supposed to be born in X. This is one of the family jokes. My mother was all prepared to go. She had her trunks sent and everything. My father was stationed there. And I was born two months early. She never forgave me for that. S: I bet she really does blame you. G: Oh, you better believe she does.

So where are we in trying to understand Mrs. G and her need to murder? I see it this way (though I realize my interpretation leaves a lot to be explained, such as the difference between the person who imagines committing murder and the person who, with the trigger under his finger, squeezes): A little girl, tormented from birth on by hopes of closeness and love from each of her parents but forever repeating disappointments in this hope, either becomes unhinged or never quite has the hinges in place in the first place, i.e., is already using psychotic mechanisms such as hallucinations by age four. In addition, while knowing she is a female, she observes her older brother's success because of his maleness. Already confused in the development of her gender identity by parents who have given her a bisexual name, she sees her mother openly preferring boys. So she creates masculinity by imitation and identification, and maleness (a penis) by hallucination, her mother permitting this masculine development to progress unnoticed. But this masculinity does not assuage the child's anguish; she still suffers a raging envy and hatred of maleness, poorly damped by what in other children are ego functions that drive murderous wishes into the unconscious and bind them there for better use.

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If one is to rid a person like Mrs. G of her need to murder, one has to give her something better. The psychoanalyst's best route for helping his patient find something better, even when he is not practicing analysis, is via insight. I suppose a technique of treatment different from mfoe might also have rid Mrs. G of her need for murder, so my treatment is not offered as a model for all treatment.2 However, as a combination of treatment and research, I believe it has value that successful "non-insight" treatments would not have had. To make Mrs. G want to give up murder, I did a number of things. First, I always expressed my rage and disgust at her murderous acts. Second, I let her know, in her dealings with me, that I felt no significant, hidden, murderous desires of my own (though she saw plenty of irritation, sarcasm, disgust, and even rage on my part—all of which are relatives of murder). Third, whenever necessary, I locked her up when her murderous or suicidal impulses were too strong; and she came to rely on that control.3 Fourth, I mobilized the parts of her that wanted to stay alive and tried to get her to use those parts to tell herself about other humans and their sufferings; I worked to create a conscious sense of guilt in her about depriving others of life. Bit by bit, rummaging around, I found remnants of happiness and creativity; after some years, there was a large enough store of such information available to enable me to remind her that, although it was fragmented, it still made a significant mass inside her. Fifth, I liked her, enjoyed being with her, was interested in her, was never repelled by her, and expressed my selfish desire for her to get well. This foundation—supportive psychotherapy4—was, I believe, necessary for the search ("research," "insight") for causes and dynamics. Uninhibited by a need to maintain a classically analytic stance (because the patient was so crazy, so unpredictable, so dangerous), I was free to do whatever I wanted in treatment. I believe that the discipline of psychoanalysis, at least as I practice analysis, would have led to her death. Perhaps the first step in helping Mrs. G to gain insight, a step that required many years, was getting her to recognize her own emotions, to make conscious formerly unfelt experiences. This process mobilized gu»lt, hope, aad desires for enjoyment that required her staying alive and did not call for revenge. Then there was the equally long and involved process of recovering memories from the recent past and from early childhood (the growth and development of a penis, of Charlie, of the reality of her mother and father, replacing much that was "mythology," of early femininity covered over by masculinity and homo-

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sexuality, and parthenogenesis—for it was hatred of males more than any other single force that gave rise to Mrs. G's impulses to murder). Of most immediate importance was Mrs. G's belief that when people die, they do not really disappear forever. As we shall see in the next chapter, on suicide, she felt that death was a state of suspended animation followed by life going on more or less as it had before.5 Four clinical moments stand out in my mind as exemplifying Mrs. G's finally grasping the insights about death that were necessary to cure her of its hold. The first came during the struggle to break up the symbiosis between the child Chris and herself. The second was when I expressed my rage at her deliberately placing her car in the path of another car. What impressed her most at this time was that my expressions of disgust about her absence of feelings regarding murder and suicide over the years were sincere and that I really was horrified at what she had done. The third was the final breakthrough into awareness that after death one doesn't come back (see "Suicide"). The fourth insight, that a dead body is infinitely vulnerable, came at the time when all the threads of treatment were finally meshing together. Let us look at this last insightful moment more closely. Late in treatment, Mrs. G got a job in a hospital. For the first time in her life she was steadily employed; not only did she start off beautifully, impressing her employers, as she had done in the past, but also, this time, she stayed at the job, not failing because of her employers' praise. Then one day the following came up, as usual without warning, in the middle of a conversation: G: I just want to cry. I don't know. I'm not confused. S: That's interesting. Usually in a situation like this, you get confused. G: I'm scared of things that I think about. I'm scared of things that I might do; and I'm . . . I'm still working, and I still like my job. S: Don't use the word "things." It's too vague. You're scared of "things," you said. G: I'm scared about killing somebody. You remember, when I talked to you on the phone the other day, I told you I found a dead person at work? It was really quite an experience, because I've never seen a dead person, never in my whole life. She hadn't been dead very long. She was lying on her stomach with her face in the pillow. And I thought: Jesus, she's so old. If I don't turn her over, she's going to suffocate. I turned her over, and she had already suffocated. Her face was so horrible, God, it was so awful. It was all distorted and blue and everything. S: You had never seen anything like that?

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G: No. It made me vomit to begin with. The nurse came in and said, 44 As soon as you've cleaned that up, you can clean her up." And I thought: Jesus, I can't touch her. And the nurse straightened her face out a little bit. Then I did touch her. She was still warm. She hadn't been dead very long, I guess. I don't know how long it would take someone to get cold, but I thought they were cold and hard when you touched them when they were dead. But she wasn't. And I took her nightgown off, and she was completely nude, and she was so defenseless, so ... something—there's some word I want, but I don't know what it is—she was so dead—but more than that, she was something else. You know, I could have done anything with her. S: It's not more than that. I know what you mean and I want to add to your insight. It's not more than that; it's that you discovered what being dead is like. It's more than what you had thought being dead is like. You didn't know how defenseless a dead person is in the sense that they have no resistance to what you do, psychologically or physically. G: No. S: No resistance, especially when they're still soft before that stiffness sets in. Even then they're defenseless, but it's a different kind. But they're still a person. But you didn't know that dead is dead. G: I ... then I had a very terrible thought, a very bad thought. Not about her. [Long pause] I don't have anything to say to you. . . . I thought. . . I'll tell you what I'm thinking, and then you're going to holler; and then I'm going to get angry, and then you're going to holler some more; and there's just no point to it. I thought to myself, when I was looking at that woman, that I'd like to see a man dead, just one man; I'd just like to see him really dead . . . to see a man just completely defenseless. S: Talk to me about why you have to kill men, why you have to hate men, why you have to revenge yourself, what you have suffered from. G: Are we going to be here three days? Do you know the first thing that came into my mind was the little boy I hit in the head with the rock? But it must have started before that or I wouldn't have wanted to kill him, because he didn't do anything but pull his pants down and pee in the hole, or unzip his pants or whatever he did. That's all he did, was show me his penis; so it had to start before that. When I was four, my brother was eleven. I don't know. The only thing I can think of is that my mother made a penis seem so delightful, and made it seem like it was such a ... I want to say strong, but that isn't what I mean, so powerful maybe.

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That makes me think of something that has nothing to do with what we're talking about. Yesterday 1 was in a neighbor's house who I enjoy very much, and she was babysitting with a little girl, a real cute little girl. And I said, "She's a sweet little girl, but with those two brothers of hers, she is really going to get roughnecked." And the neighbor said, "Well, I told her mother that she should always treat her like a lady, ever since she was born, that if she treats her feminine and treats her like a lady, she'll always be a lady." She said, "When I had my little girl, I was so impressed with her being feminine and wanted to keep her feminine .. ." and she went on and on and on about the different ways she would keep her feminine; and then she talked about her son and how she made him masculine. And I said, "How did you know that? How did you know to do that?" And she said, "Well, that's the way my mother raised me." And I said, "How do you know that?" And she said, "Well, it must have been . . . my mother must have been that way with me or I wouldn't know it." All mothers should know that, and my mother didn't know that. When mothers talk to their babies, they'll say, "Aren't you a nice, good-looking little boy?" or, "Aren't you a pretty little girl?" or something like that. I don't think my mother ever did that, and I don't know what makes me think that, because I can't remember it; I can't remember being a baby, but I don't think my mother ever talked to me as though I were a little girl. I think she used the same tone of voice with me as she did with my brother and, see, that doesn't make any sense. What has the tone of voice got to do with . . . ? My mother still does that to me. This little girl yesterday—I guess she's about eighteen months old—and she came over and she sat on my lap and she put her hands on my face and she kissed me and everything; and my friend said that's so unusual, because she doesn't generally go to strangers; and she was so warm. . . . You . . . of all people in the world to love a little girl—and obviously you loved her, didn't you? Yeah. You've changed, haven't you? God damn, would you have believed two or three years ago that you would have loved to have a feminine...? I couldn't have had her on my lap. Look. Do you see what I mean by freedom? You don't have it yet about men; but do you see now, do you see what you get when you're free? You've got little girls that you can hold. Terrific. You never dared. You wanted that all your life, didn't you? Do you want to cry?

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G: No. [Is crying silently] I was trying to think of something specific about a man. I was trying to say, "Well, this is why I hate men. This is it." S: But there is no one thing. The penis is the obvious thing. You feel relieved about the murder business? G: Yeah. S: Why? We're not done with it, you know. We didn't get to the bottom of it. G: Yeah, I know. Because I'm not thinking about murder, I suppose. I guess that's why I'm relieved. S: It just stopped while we were talking? G: Yes. S: But you haven't gotten all the way yet. You still can't believe that a man could be defenseless. Let's go back, though, for a minute. There's something that's a little bit different, and that is about a person being dead. You know with all your fantasies—about killing yourself, and then rising a week later, and if you had killed somebody they wouldn't be dead, they'd just be removed from the scene, and they'd come back and on and on like that—I wonder what did seeing a dead body do to those beliefs, which are pretty weak now anyway. A year ago you suddenly were hit with the idea that you might be dead when you committed suicide—and it changed your life [see next chapter]. Now you've seen a dead person. What did that do to your beliefs about what it's like to be dead? G: Well, it just reinforced the new idea that I've had about being dead: that dead is really dead. S: You saw her, didn't you? She doesn't come back, does she? G: No. S: Not with that face. G: And her body, just like—fluid came out of her mouth, and her bowels opened up, and there was nothing to her, and she turned blue; even her blood didn't flow any more; there was just nothing. And the man from the mortuary came in, and he flopped her over, and he put this rubber sheet under her, and he flopped her back. She was nothing, you know, just . . . there was just no life there. S: Right, that's what you give up if you die. That's what you are if you're dead. G: Nothing. S: Do you want to be dead? G: No. S: On the other hand, now that you've seen what it's like, if you did that to a man, that's what would happen to him. G: Yeah.

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S: Now let me ask you something that isn't obvious. Is that what you want? G: No. S: No, that isn't what you want. Your idea of killing him and his being dead were different. He's got to be alive enough to know that he was killed. G: Yes. [Next hour] S: Do you remember our talking last time about death, murder? Is there anything more? G: I don't know if I've thought about it. I've dreamed about it. I can't tell you what I dreamed, but 1 know that I dreamed about it and I don't think I'll ever kill anybody. If I ever kill anybody, it's because I want them dead, you know, really . . . but I can't think of any reason why I would want anybody that dead. Before, when I thought about shooting a man, it would be like an insult, that he would have to know he was being insulted; and if he was that dead, as dead as that woman was, he wouldn't know. I feel relieved, very much relieved, because I was scared I was going to kill somebody. And nobody seemed to mind, nobody seemed to be impressed with the fact that I might want to kill somebody. I told Bill about it, and he said, "Yeah." . . . Nobody believed me.

10 Suicide

Let us now look at the other side of the coin of murder. G: Then there's the time that I took the sleeping pills The only reason I didn't die that time was just dumb luck. I took fifty Nembutal. I had taken the pills and gone to bed and gone to sleep; and the phone rang, and I forgot that I had taken the pills . . . I actually forgot that I had taken them . . . and I got up and I answered the phone. And this guy who I had gone out with quite a bit said— he was a cop, and he was just coming off duty, and he wanted to know if I wanted to go out and have a drink with him. And I was talking to him on the phone and telling him that I really didn't want to go, and I lost consciousness. And the first thing he did was to radio a police car to come to the house, and they called an ambulance. When I woke up in the hospital after taking the pills, I thought: Jesus Christ, I almost died. S: Why must you die? G: It isn't a matter of "must." It's something I want to do. It seems like a good idea to me. I don't want to play games with you any more; I don't want to be in the hospital any more; I don't want to be scared any more; I don't want to be lonely any more; I don't want to be queer any more; I don't want to be a housewife any more; I don't want to do anything any more. S: Death isn't rewarding. Death's only the end of pain. G: And that's a reward. G: I know why I feel about Chris like I do: because we're the same thing. He's something that won't ever be any different, and I'm something that won't ever be any different. And my coming here week after week after week and year after year is just ridiculous. It's using your valuable time, and it does nothing but hassle me. And I don't want any more of it. And I don't want to be confused any more, and I don't want to see things any more, and I don't want 203

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to hear shit any more. And you . . . you don't say, "O.K. Here is something else you can do [i.e., advice]." You just say, "Well, give it a little more time." I don't have any more time. You know, a long time ago, I was in Q State Hospital; and the doctors told my mother that she might as well forget it because there was no hope: I'd always be the same as I was then. And there was a psychologist at the hospital that didn't believe that; and he said, "If you ever get out of here, go and find yourself a doctor who is interested in kids, and in no time at all you'll be all right." And I believed him. I really did. . . . I don't believe anybody. I don't believe you, and I don't believe him, and I don't believe anybody. I am so sad and so ... and I am alone even when I have my kids, even when I have Chris, because nobody knows about. .. Oh, I'm sure somebody else knows . . . but people who are close to me don't know about being scared and having the walls come in on you and listening to the shit all the time—how could they know? I'm just tired. I'm so tired I'd just like to go to bed and sleep forever, and I can't do that. I tried it, and it doesn't work. Even you don't know what it's like at any time. I don't have anything more to say. . . . You know, I thought . . . I thought when Dr. Y said, "Why don't you come in the hospital because there's plenty of beds available?" I thought maybe that's what I should do. Maybe I should go in the hospital, because last time I was in, so many things got straightened out, so many good things happened the last time I was in the hospital. And then I thought: I can't do that all the time. How many times have I been in the hospital? A dozen times? Jesus Christ! That's sickening. S: What are you thinking? G: I was thinking: Where's Charlie? S: Where is he? G: I don't know. He's all right—maybe because he knows it's all right for me to die, so he doesn't have anything to say. S: Is he there but just silent? G: Yeah. S: You can feel him there? Is he going to die? G: I don't know. S: Because he dies when you do. G: What did you say? S: He dies when you die. G: Why is that? S: That's the way it is. He's you. What are you thinking? G: I was thinking it wouldn't be very nice to kill Charlie. [Long pause] S: Now what are you thinking?

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I was thinking how long it would take me to die. What are your plans? What do you mean? About dying. Oh, I'm going to take an overdose of pills. What kind? I don't know yet. Where did you get them? Where did I get them? I bought them. Where? From a guy. You mean illegal? Yeah. Does Bill know you have them? I don't think so. When do you think you're going to do it? I don't know. Give me an idea. Probably tonight after everybody is asleep. Suppose I were to tell you that I'm not going to let you. There you go again. Yeah. O.K. You tell me that. I'm telling you. And what do you expect to do to prevent it? Whatever is necessary. Well, you can't put me in the hospital. You promised me you wouldn't. S: I can. G: You told me that you wouldn't. But of course I did. This was the hospitalization during which, after two weeks, she told me she had poisoned Bill, and since he had not died, she had to. For some people, suicide is a possession, a secret, a prize kept in a pocket and secretly fondled. Knowing it is there, they can bear life. So it serves as a life-preserver. Unfortunately, it is also a temptation; and for those who play at it, it becomes more and more a possibility. So was it for Mrs. G. She always carried the thought of suicide around with her: egosyntonic and routinized, it served both to help her cope and to produce pleasure. It was the greatest of all threats to the treatment; and more than anything else, it could make me frantic.

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How is one to avoid suicide if she feels unwanted by her mother and if the father with whom she has so strongly identified commits suicide? This thought pattern perhaps began when Mrs. G was four, at that same crucial time when murder, Charlie, and her penis appeared. She recalls that at just this time, after being a chronic vomiter and not eating, she simply had to go living, right after which, according to her memory, Charlie and her penis appeared. Screened behind her first memory were earlier experiences of infancy and childhood, which from then on would be repressed and distorted but which would still survive. At any rate, that is where Mrs. G's memory begins. I saw evidence of earlier experiences only when she was in a fugue-psychosis, at which times she seemed to regress to early infantile experiences, mostly feelings almost impossible to verbalize (see Chapter 7). Today she relates her weakness for suicide to events earlier than age four. She feels her mother did not want her and that in early childhood she felt hopeless, abandoned, and unable to influence those who could ease her despair and frustration. Then three changes brought hope (we are now talking about her subjective experiences, not the knowledge beneath the surface): Charlie, who ended her loneliness; her penis, which made her feel valuable and protected against people; and murder—the restitution, the gratification of rage. What precipitated suicidal crises during the years I treated Mrs. G? Exhaustion from fighting psychic pain (panic, hallucinations, phobias, etc.) and loss of hope that the agony would end; approaching insight that she was homosexual; insoluble reality problems, all apparent possibilities seeming bad (e.g., no money, no job, no welfare, no husband, no employable skills, no car, overdue bills, and sick children— all at the same time); terror about special tests for diagnosing physical illness (e.g., spinal tap); retribution for murderous impulses or attempted murder; genuine praise; acquiescence with her husband's communications that she would be better off dead, or his ignoring her signals of suicidal intent; murder-suicide acts with her children to merge with them in painless peace. We know that repeated suicide attempts must be taken seriously and that failure to die on one occasion is far from a guarantee that success will not come the next time. In even the most histrionic wristslashers the habit can grow. With Mrs. G we are dealing not with wrist-slashing (at least after age nine), but rather with vehicles moving at great speed, actually ingested lethal doses of drugs known to kill, or guns loaded and at hand. I have always been grateful that she

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has not succeeded in her suicide attempts, but also puzzled. She seems like many others who have attempted suicide: in contrast to those who use mild but dramatic means or whose efforts are so massive they must succeed instantly, there are many would-be suicides who leave it in the balance of fate whether they die or not. They may think this as they enter their suicide experience: they are not sure of rescue, but it is possible. Sometimes they die, sometimes not. With Mrs. G there was always the question of exaggeration when she described previous suicide attempts. It has preoccupied me throughout treatment, not because I have found any evidence of exaggeration, but because so much has happened to her that it is difficult to accept that any human could have experienced all she has recounted. How can one have the luck to survive accidents occurring at great speeds, or the ingestion of barbiturates that render one unconscious for several days, or the armed robbery of gas stations in which one knows the attendants can defend themselves with their own weapons? One has to believe that Mrs. G has helped her luck by leaving at least a slight possibility of escape—else she would have long since been dead. That conviction (strengthened by my knowing that there are parts of her personality that enjoy living) made me presume that in the episode reported earlier, when she put her car in front of an approaching drunk's car, she must have done something at least to introduce the chance she would not die. That is what she finally reported had happened. In retrospect, I presume Mrs. G has continued to live because she has been lucky and because she has not been unalterably committed to being dead at the moment she has arranged a suicide attempt. Although the groundwork for her actions was laid in childhood, the use of frank suicide (not disguised suicide, as exemplified in her style of impulsivity) surfaced at about the same time, and for about the same reasons, as the switchover from psychopathy to psychosis, in her twenties. Giving up "mindless" impulsivity was terribly dangerous for her, and what insight it brought was almost fatal (see Chapter 6). In each hospitalization during which I treated Mrs. G, the crisis had resulted from homicidal-suicidal impulses so much more severe than the ones she carried with her every day that immediate hospitalization was necessary to prevent death. Unfortunately for our present purpose, these crises did not peak in my office, where they could have been taped, but rather in phone calls, usually late at night when I was at home. And I find my dictated reports after the event quite bland

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compared with the searing reality of the emergencies. Sometimes these would build up over several days, during which I saw Mrs. G in my office as the crisis mounted; but more often, the episode exploded unexpectedly in my face. On several occasions, for instance, I would have seen Mrs. G the same day or a day or two before and would have found her no more or less upset than in dozens of other hours that had led to no similar difficulties. But on these special occasions, the phone would ring, and within a few moments I would know we were in real trouble. More often than not, I recognized this not because Mrs. G was confused, but because she was not. It was when she seemed clear-headed and stated that she was going to commit murder or suicide that I really sweated. The one powerful aid in all this was that we both knew that the act of calling me was an admission that she would stop her violence if I tried hard enough. Ultimately, trying hard enough amounted to my getting her promise to come to the hospital. Once that had been agreed to, the worst was over, though I never felt very comfortable until I knew she had arrived at the hospital. Here is an excerpt from my notes: Last night Mrs. G called me up with a steady, noncrazy, and rather cheerful voice and said, "Now, Dr. Stoller, I don't want you to laugh at me for what I'm going to say"; and I said, "I won't." And she said then, "I've decided I'm going to kill myself now." She described that she had promised the voice that she would, and that she has never gone back on any promises either to it or to me. At first, because of the nonpsychotic quality of her speech and the sound of her voice, I was not concerned; but as we talked, I became more and more concerned. We talked for about half an hour, by which time I was not at all convinced that she would not kill herself. One of the things that impressed me was her saying that in the past I had always cleared up her attacks of craziness, but that this time nothing helpful was happening. That was exactly right; nothing was happening. First, she was not confused, distraught, panicky; and, second, her desire to die was not an attack of conscience where she had done something worthwhile and then felt that she had to die. This time she felt impossibly torn between the demands of the voice and my demands that she get well, that she change. The voice is convinced that to change is for it to disappear, and there is no way around it. I was unable to abort the reaction on the phone because this is true;* there's no way that I could * As we have seen, when I came to know the voice better, I was able to reassure Mrs. G about not destroying Charlie.

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lie about it, for she would know that I was lying anyway. It is clear 1 have been trying to get her to change and that were I successful, the voice would change into just an aspect of her identity, rather than as a separate person, identity, object inside of her. And since she knows this so clearly, she wants to put an end to this conflict. There is the additional crazy idea, which she can't be argued out of, that if she kills herself, the voice is then free to live. While she knows realistically this can't happen, the realistic is not very powerful when confronted with the inner reality of this fantasy. There is a question whether I should ever have started dealing with the inner voice as if it had such separate dimensions. I'm not certain that the treatment itself has not created its [the voice's] clear form where before it was not so clear. That is, have I revealed what was there, or has treatment in part suggested it? I don't think it's the latter, and the patient says that it isn't the latter—but I'm not sure. At any rate, on the phone I was unable to get her to promise not to kill herself; and in view of our talking in the last few days about her previous suicidal attempts and the capacity she has to react to the voice, I felt very uneasy. At no point during the conversation was I able to swing things around so that I would suddenly feel a release in the tension. Instead, at the end of the conversation, things were just as dangerously uncertain. I told her I would call back in a half hour, because she had given me that much of a concession. Had she not, I would have called the police to go after her. Frightened, I called her back after fifteen minutes. She was unchanged. She hadn't changed at all, and she continued not to change as I talked with her, argued with her, and pointed out the hopefulness of the situation. I asked her to bear with this pain so that we could work it out, tried to convince her that I was not the enemy of the voice and that my idea of change was not to kill it. All such subjects in the past in recent weeks had calmed her down. All now failed. So I asked her whether she shouldn't come into the hospital. She immediately said yes. So I told her I would arrange that. She then broke the calm definiteness of her voice and, pleading, asked me to call her mother. Her two boys were out at the time, and she wanted her mother to help arrange things. I called her mother, who was very irritated, feeling the whole thing is a fraud. Her mother's only reaction was that doesn't Mrs. G know she's got two children to be taken care of. I said that the patient was very concerned about this but that I felt that she should be in the hospital. I also was unable to tell the patient's mother specifically what the situation was so that the woman couldn't know there was adequate reason for bringing her daughter in. This is always difficult because Mrs. G can be so clear and charming and cheerful and full

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of humor at the same time she talks of suicide. Then 1 called the patient back, told her I had talked with her mother—no, that's not the right order—I tried to call the patient back but couldn't reach her because her mother was then on the phone—mother had said she would call. Eventually I got the patient; we arranged to meet at the NPI* immediately and did so. I presume that she will do all right and be able to go out in the next day or so [it turned out to be a much longer stay], which will confuse the ward personnel, because they won't understand how someone can be so acutely suicidal and then do fine a few hours later. They will undoubtedly feel, as I do a little bit myself, that I've been manipulated. However, I can't afford to test her manipulation by giving her the opportunity to kill herself. I don't have enough hope that during these crises she will not in fact kill herself, and so I can't give her the test I might another patient, saying "Well, it's up to you," or hanging up the phone and not calling back, or something of that sort. [Next day] S: I won't let you go home. G: I know that. S: What's Charlie saying? G: Nothing. S: Not speaking at all? What's he planning? G: I don't know. S: Is he going to insist that you die? G: No. S: Why are you confused? G: I don't know why. S: About what? G: I'm just confused about what's happening. I don't know why I'm here. S: Do you remember coming in last night? G: No. S: Was there anything wrong last night? G: Yeah, I was going to kill myself. S: I'm not clear, then, about a moment ago, when you didn't remember why you came in and what happened. Do you remember wanting to kill yourself? G: Yeah. S: Do you remember calling me? G: Yes. Neuropsychiatric Institute, UCLA.

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Do you remember talking to your mother? No. Not at all? Why did you want to kill yourself? Because I promised I would. Why did you promise? I don't know. It just seemed to be the thing to do. Why? It just seemed easier than a lot of hassle. Hassle about what? Oh, about you and what was happening. I understand and know that you don't want to kill Charlie; and he was thinking that I did, and he was just hassling me about it. That I was ungrateful to him. You mean because he thought you were going to abandon him? Yeah. By getting well? Yeah. And getting well would mean that he would have to disappear? Yeah. Now, have you any more clues why he demanded your death last night? Probably because I told him I was going to kill him. Why were you going to kill him? Because sometimes I get so tired With him? Oh God. I get tired of being told what to do and how to act and what to think and what to feel. Sometimes I'd like to do it [think and feel] myself.

About a year after the above episode, Mrs. G had been in the hospital two months. She had been acutely suicidal when admitted, but I did not know why until she revealed, after two weeks, that she had poisoned her husband (noted in the previous chapter). The hour reported below was the end product of these two months of treatment, which were aimed at getting to the bottom of the suicidal impulse. The treatment had been punctuated by psychotic episodes and suicidal impulses, a full account of which would be too tiresome; just bear in mind that the insights below did not come easily, though reading them may give that impression. G: Do you know that we used to have chickens in our house, but Bill killed them, the son-of-a-bitch. That was a mean thing to do. S: Life and death!

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G: Do you know about death? I don't. I just thought it was something t h a t . . . that wasn't real but just passed. I never found out it was real. I never thought about that. I never thought about death as being anything permanent. I thought it was just something you could do and it would go away. I always thought about suicide as being something t o . . . I always thought about suicide a s . . . like sneezing, you know, it just comes on you. Suicide just came on me. And I thought: Well, I'll die, but next week I'm going to wake up, and everything is going to be all right—all the bills are going to be paid, and Bill's going to talk to me, and the kids are going to be happy, and my mother's going to go away, and all the good things are going to happen if I just die for a little while. I just found out you can't die for a little while. S: How did you find out? G: I guess it was because I was thinking about my father. Did you know my father's dead? S: Yes. Did you just find out?* G: Yeah. S: Good. G: Huh? S: Good that you found out. G: He's really dead. He killed himself. S: Yes. G: Do you think he knew what he was doing? S: Not completely. G: Oh God! S: He may have made a mistake. Don't ever kill yourself. G: No. S: Are you over it? G: I don't want to die! S: Are you over it, the killing yourself? G: Yes. S: Forever? G: Yes. S: Do you want to cry? G: Yes . . . I'm really thirsty. I wonder why Charlie didn't tell me. Why didn't Charlie know? He knows everything. He should have known that. Jesus Christ, I could have died. I could have died! That just * She had known for years, but the reality had never quite penetrated. For instance, the previous year: G: Do you know when he [father] died, they didn't find his body for two weeks? That fascinates me ... I'll probably die the same way.

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scares the shit out of me. I could have really died. They could have buried me in a box in the ground. Do you want a cigarette? [She knows I do not smoke.] S: No. G: Can I give you something? I want to give you something. S: I don't know. Your health, I guess. G: You know, a lot of people want that for me. S: Yes. But when are you going to stop shitting on all of us? G: Is that something like being dead? S: Is that something like being dead? Shitting on us? G: No. Being well. [Later that day—the only hypomanic episode I've ever seen Mrs. G. experience] G: I'm trying to sit still, and I'm so frantic inside. I felt fine when I went to bed, and I did go to sleep. I woke up some time during the night and felt like I had to get up, but I didn't do that. I lay there and . . . I wish you could give me some Benzedrine.* There have been so many comments made about it that I'm making a double effort to control myself, but I am just as excited as I was this morning. Well, things keep coming out of my mouth without my thinking them in my head—I'm saying all kinds of wild—I mean the nurses seem to think they're wild—things coming out. I told the nurse it wouldn't do any good for me to put my hand over my mouth because all these words would come out my ears. S: I'm not going to encourage you to blow up, don't worry. But let your screws loose a little bit. If we have to, we'll tighten them up. G: You know what I thought it [the intense excitement] might be? The way I was preoccupied with thinking about death the last couple of days. I was thinking about... Remember I told you about the time I took all the pills, and I went to bed and went to sleep, and this man called me up, and I lost consciousness and went to the hospital? Well, when I woke up after I had been asleep for seven days, I thought: See, I died, and everything's all right. I never thought about that until today, and that must have really been in my mind all the times I thought about dying. I could just wake up and say: "See, it's all right." S: Why don't you want to die now? G: Oh, Jesus, what . . . who would want to die? I don't want to die. There's things I want to do. There's books I want to read. I want to see my kids grow up. Oh, Jesus, there are so many things. Seeing Which, paradoxically, she would take to calm her.

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my kids grow up, seeing my kids graduate from-school, having grandchildren, reading good books, making love to a man or a woman, eating good foods, everything, it's all good. None of it's bad. My son came home from school, and he grabbed me and he kissed me and he hugged me and he said, "God, Mom, I'm sure glad you're home. We really need you." That's really important—he really needs me. They never said that before. Nobody ever said that to me before. Think about all the people that I almost killed. Think about Chris! I wanted to kill him. I wanted to kill him. I wanted to put him to sleep so all that bad stuff would go away and then he'd wake up and everything would be all better. How many times did I tell you that? S: Yes, I know. Did you mean it? G: Yes.

S: Did you have a gun at home? G: Yeah.

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Was it loaded? Yeah. What were you going to do with the gun? I wasn't going to shoot Chris. Who were you going to shoot? Nobody. Why did you have it? I don't know. Are you sure you weren't going to shoot anybody? Yeah. I don't think so anyway. O.K. How were you going to kill Chris? I was going to give him sleeping pills and put him to sleep. But you wouldn't hurt him? No, I wasn't going to hurt him. I never tried to hurt anybody. You tried to kill Bill. That was a little different. Bill was killing me. Yes, that's different. You wanted to hurt him. I didn't want to hurt him. All right—what? I wanted him to go away for a while so he couldn't hurt me any more. But you thought he'd come back? Yes. You thought your father would come back? Yes. When I read that paper, I couldn't believe it. The paper that said what cemetery he was in and where he was buried. . . . I read it

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just the other day. I was going through letters and papers and things, and it was there, and I thought: Jesus Christ, my father is dead. I just couldn't believe it. I sat down, and I really thought about it. He's really dead—whatever that is. That's nothing! . . . he's not even . . . he's nothing. He doesn't feel anything or say anything . . . nothing. Oh, Jesus Christ... What about three or four weeks ago . . . you're home on pass, you put your car in front of a drunken fool? That was just a man, and I just wanted to hurt him. But he might have died, and the lady next to him might have died. Yeah. And you might have died. Yeah. O.K. What do you think of that now? I think it really scares the shit out of me. How could I want to kill anybody? How many people have you wanted to kill? Tell me about them. Hundreds. My mother. My father. Lots of little boys when I was a child—all of them were bigger and stronger than I was. Men that I've screwed—I can't even think of their names. I was killing them . . . I was killing them. Every time I stabbed my prick into them, I was killing them. I don't know. I don't know what to tell you. I'm just so ... Jesus Christ, that's so awful, just so awful. You're terrified, aren't you? Yeah. [Shaking severely] What's the matter with me? How could I do such a terrible thing? You've discovered something. Look, suppose you didn't find this out? I guess I'd go on killing people. Yeah. Would you ever finally kill somebody, really? Probably. Isn't it a miracle that you haven't killed somebody? Yeah. You've shot people with guns; you've poisoned them with real poison; you've taken pills and tried to kill yourself; you have tried to kill people with an automobile, literally. You could have killed somebody. You never knew that, did you? I should be locked up somewhere. [She is shaking violently, which she has never done before.] I would expect-you to be crying at how close you have come to disaster. I'm crying inside.

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S: Why don't you cry outside? G: I just can't do it. ... I'm just terrified. S: But don't you have any relief at the discovery? Do you see what you can do with your life now that you know that you can die and kill other people? Do you see that you finally have your life? Don't you see that? Well, then, tell me about it. I want to hear it. It's very important. G: Not only . . . not only do I have my life, but I'm responsible for my life. I have to decide what I'm going to do with it. It was never important before. You know, it never made any difference. Not just my life, but people around me who I influence—what am I going to do about their lives: my kids and B i l l . . . S: You thought it would all take care of itself, didn't you? G: Yes. S: It won't. And you don't have forever. G: A life is a terrible responsibility. S: Yes—it's also a wonderful thing. Do you know that yet? G: No, I don't know. I know all the good things that can come from it.... S: But you haven't had them. You couldn't have had them as long as you thought there was no death. Do you know that? Because it wasn't worth anything, and you could do it some other time. See, you've got time, but you don't have forever. And your kids have time, but they don't have forever. G: How come you never told me that? S: I told you many times. G: How come I never listened? S: That I don't know. Because you were crazy. That's not an answer. Talk to me, please. G: I was going to say—did I tell you this this morning?—I . . . this was like when I was thirteen, and I screwed all those boys because nobody ever told me it was a bad thing to do to screw boys, and I got pregnant. Maybe teachers and friends and my mother did tell me that. Maybe they told me that it was the wrong thing to do, but I never heard it. You must have told me that it's a bad thing to die, but I never heard it. Now I know why you got so angry. I never understood what you were screaming about. When I had that accident, you terrified me. I didn't understand what you were so angry about. Nobody got hurt. What had I done that was so terrible? I just couldn't understand that. Can you believe that? . . . I'm so tired I could just collapse. I'm so ... I'm so overcome by this whole thing. I can't even think of a word that fits what's happening to me. Jesus Christ, I almost died. Remember when I told you I used to

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think I was a gun and I'd say "Bang, bang, you're dead" to somebody I didn't like or somebody who annoyed me or somebody who just . . . anything. Teachers, friends, anybody that I really didn't appreciate at the moment, I did that to ... since I was a little child, I've been killing people. I hit that boy, and I hit him with a rock, and blood came out of his head. That could have been his life's blood. Jesus Christ Almighty. Do you feel guilty? Do I feel guilty? How can you say that? Jesus Christ! If this is what guilty is, / feel guilty. I just . . . I don't know what to do. What can I do to make it up? You know, I don't know what to do to make it better! How can I make something like that better? To whom do you owe things? I owe something to you. That's the least. You haven't harmed me. I didn't harm you when I called you up and told you I was going to kill myself? No, not harm the way you try to kill people. You scared me. . . . There's nothing I can do about those people; they're all gone. Yes, but they . . . Look, you were lucky; you didn't kill the little boy with the rock. See, so ... Or K when I shot him in the stomach, or the cop that I shot in the ass... Well, that's different; but they didn't die, thank God. Those were terrible things—they could have died; then there's nothing you can do; you can't go back and do anything. But probably you don't have to go back to them. But there are people that you haven't literally shot or clobbered on the head, but you have things that you have to do for them. Now who are they, and what do you have to do? There's Bill. I have to understand why he's alive and make his life good and keep him alive . . . not keep him alive, but not kill him. When I'm angry with him, I'm going to have to say, "Fuck you, Bill G; I'm so angry at you I'm going to throw a dish at you, but I'm not going to put poison in your food; I'm not going to take a gun and shoot you through the head." Oh, my God! You know when I put poison in his food that was only one of many times I tried to kill him. He can come in here and tell you about the time I took a knife to him and tried to stab him. I went wild one time when we were in M—I did everything I could to kill him. I don't even remember why. And every time he made me angry and I couldn't holler at him or I couldn't throw something at him, every time he did something to me and I couldn't accuse him, I wished him dead. He didn't deserve that kind of punishment. He's never done any-

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thing to me that's been that bad. He never tried to kill me, and you never tried to kill me. I don't think anybody has ever tried to kill me. Why . . . why would anybody want to do that? Other people must know. Other people must know about death. . . . And they don't want to kill anybody, do they? Bill must know about that sort of thing. He wouldn't want to kill me. Maybe he hurts me because I hurt him; in fact, I know that's true; but I don't think he wants to kill me. [Long pause] One time I put my kids in the bedroom and put the gas on—those kids who were . . . who haven't even grown up yet, who haven't even lived yet. .. . I wonder if my father thought about dying. I wonder if he knew what he was doing when he was taking those pills. I wonder if he knew what death was. Maybe nobody ever told him either, or maybe he didn't hear what people told him. He killed people himself [in the war]. I wonder if he knew what that meant. And he's really dead! He's really, truly, honest-to-God dead! You never had to grieve for him, did you? No. You never had to grieve for anybody who was dead, did you? No. Because nobody ever died—except in some very special, technical way. He's really dead now. Do you know that nobody in my family since the day I was born has ever died? I have grandparents and grandaunts and uncles, and nobody in my family has ever died except my father. It's going to mean something for me [now]. I'm going to feel it inside of me. I'm going to say, "Thank God, it wasn't me." If there's any answer in me [about inviting death], it just won't come out. It's like I know it. It's like a word that I want to say, and it's on the tip of my tongue, and I can't think of what it is. Let's talk about my mother. My mother's an actress. My mother pretends to be pleased and pretends to be happy and pretends to be angry . . . I'm having trouble talking. She pretends all kinds of things. There's a reason for it. I knew what that reason was when I was little, and it was necessary for me to do the same thing. I can't remember what it was. I know about feelings . . . I really do. I even know about good feelings; they're not all bad. But I know them all. I don't know all their names. I don't know why I can't . . . why I can't just feel those good ones and bad ones and let them be a real thing. That would be the honest thing to do. Tell me about her ... as an actress. What do you really mean by that? I'm thinking about V. When I lived with V, and we went to bed

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together and had sex. Do you know that was the only time in my life that sex was real to me? Do you know that I was so wild and so full of it, it was just like my whole body exploded. I can remember that. And I laughed and I really laughed because I was happy, and I cried and I loved my kids; and then a bad thing happened. I don't know why [see Chapter 14.] But I had that for about seven months, and I always remember that. Sometimes I dream about that. I don't even know what made it possible for me to have that seven months. Do you know how I met V? It was just an accident. I was pregnant with F, and before he was born my mother came home and told me tliere was going to be a New Year's Eve thing—can you imagine that many months in advance? Anyway, there was going to be this New Year's Eve party, and there was going to be a dance and a breakfast and a dinner and the whole thing, champagne and everything; and only couples could go, and she wanted me to go, and she told me to invite some man. I didn't want to take J or somebody like that, and I didn't know any men. And how could I go out and find a man when I was nine months pregnant? Anyway, there was this doctor named B—I can't remember his last name—who was really a nut. And he had a roommate, who was V, and B was always saying, "Well, you're really a doll tonight with that big belly. I think I'll fix you up with V." And I was always curious about who V was. So anyway, B was at the house, and he said, "Why don't you ask V to go to this dance with you?" So I said I would. And I called him up, with my big belly and everything; and I talked to him on the phone for a long time; and I just liked him, just talking to him on the phone. Can you believe that? I just liked him. I didn't let him see me until about three weeks later, after F was born. But that's how I met V, and it was a good thing right from the very first day. It was a good thing. And he really was a bum. I guess if I thought about it, if I listened to other people's opinions, I'd call him a bum; but he really wasn't. He was really beautiful. Not really beautiful to look at. Yeah, I guess he was beautiful. He had a beautiful body. I used to like to look at him when he didn't have any clothes on because he had such a beautiful body. And I liked to touch him because he was nice and hard and warm. I didn't know that. I didn't know that. I just threw that in to see how you'd appreciate that. Was it right? I don't know. That just came out of my mouth. Why couldn't you marry V?

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G: Oh, my mother disapproved of the whole situation. S: I mean inside of you. G: I don't know. I don't even remember. I remember that day. I remember closing all the windows and turning on the gas, and bringing those babies in the cribs. I remember that feeling.* I sure remember. The same feeling I get every time—it seems frantic, just that awful . . . I want to say desperation, but I don't even know what that means. I just can't think of a word for it. Jesus God, what am I going to do if it happens again? How am I going to handle it? What am I going to do? You better bet your sweet ass I'm not going to try to kill myself. S: If you appreciate life and have your feelings as they really are, maybe you won't have to go crazy. Maybe going crazy is because you can't stand knowing what you're feeling. I would guess that it was either V or your mother. G: V or my mother that what? S: That was the choice you had. So you went crazy. Or maybe it was that you couldn't have V because of your mother. G: I don't know. Maybe it was too good. S: Too good for whom? G: For me. S: No. G: For who? S: For your mother. G: I don't understand that. S: Try. G: You mean that would have been a real thing for her, and she couldn't stand it? S: That's one meaning that I had. I had a second meaning, and that is that as you perceive your mother, she doesn't even have to be there. She would—inside of you—have said, "You can't have that." G: Maybe she thought it was too good for me. * Here is a different version from a different time in treatment: G: I don't remember it clearly. I locked myself up in the house and took an overdose of pills and gave the kids pills. I was nineteen, eighteen. I think it was Seconal, two bottles of it. It was enough to kill us, whatever it was. S: Did you think it would be? G: Yeah. S: You used all of them in both bottles? G: Yes. I gave it to them in baby food, I think.

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Yes.* You know my mother really doesn't like me. Are you telling me something new? Did I ever tell it to you before? You told it to me a thousand times before, but it may be new this time. What do you mean? I was just thinking a b o u t . . . my mother just doesn't like me. From the very beginning, the day I was born, I wasn't what my mother wanted. I just . . . that was a disappointment to her, and then later I lied and I did all the things she accused me of doing which made her right, and she never liked me for it. My mother just never liked me. She likes me now. Did she like you better in some crazy way because her predictions were right when you did the things that she didn't like? That's what I was thinking. No, she doesn't like me now, not really, or she couldn't call me up and say the things to me that she does. When H [son] ran away, she called me up and told me what a bitch I was and a pig and how incapable of being a decent mother I was and how I provided such an unhealthy home life for him. Is she losing you? I don't know if she's losing me, but I lost her. Is this something new—this going after you like that? Yeah, she hasn't done this in years. The last time she did this to me was when I married Bill. She called me up the other day and told me she was taking H away from me. And I told her, "I'm very sorry, but you can't do that to me again—in no way, in no way." I told her, "I know you love him, and I know you're concerned about him; but he's not your son, he's mine; and I intend to keep him for himself, not for what you want," whatever that is. I told her, "You're an old lady now. You don't need a teen-age child around the house." This time, this time when she said these things to me, I was angry with her for imposing her sickness on me when I'm in a hospital

* Not a bad theory. However, at another time the patient said the following, which strikes me as a more likely precipitant to the murder-suicide attempt. (See Chapter 14.) She had been talking at length about her excitement when making love with a woman: G: When I was living with V, I went to bed with a girl . . . because I was lonely, because he had left and taken a trip somewhere. We almost got caught—there was a chance that her husband would walk in at any time. It was just shortly after that [the next day] that I went to the hospital. S: Did that help make you feel suicidal? G: I think so.

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trying to get rid of my own sickness. That's what I thought about her this time. [Pause] You know, I told everybody on the ward I'm going home Monday? They just said, "No, you're not. No, you're not. You're just crazy, Mrs. G." I just thought I'd shake them up a little bit; want them to know I'm still around. I don't think anybody noticed me today. S: [Laughs] How do you feel right now? G: Oh, a little less tense, still excited inside. I'm not shaking as bad. I'm so goddamn tired, and I'm really hungry.

Mrs. G had been free to read the typed transcripts of our interviews when, almost a year later, she said the following toward the end of two months' hospitalization, during which she learned what a dead body is (see Chapter 9): G: It [typescript] had a lot to do with me killing Chris and my desire to kill Chris, and it just horrified me. If I think about that period when I would have killed Chris, I have to think about all the other things that I was feeling—just so confused and desperate. I had a frantic kid on my hands, and as time progressed he just got more frantic; and I was so involved with him that the more frantic he got, the more frantic I got. And I just couldn't separate us. And we weren't sleeping or eating or doing anything, just screaming at each other. I guess I got so tired . . . I don't know, just so frustrated and so tired and then when they told me here [UCLA Child Inpatient Service] they couldn't take him, I just . . . I just couldn't think about anything else. But at that time I . . . I don't know what I thought, I just thought that was a good idea. [In the past year] G: You know when I was little I can remember thinking: I'm going to kill that boy, and I'm going to bury him someplace; and nobody's going to know, but he's going to know; he's going to know I killed him. And then I used to think about: I wonder what it's like to be dead. And while dead doesn't really mean anything, it means you go to sleep and then you wake up and everything's all right. There was a patient on the ward once who wanted to know what it felt like to be dead because his mother had just died. So he put plastic bags on his head and he jumped out a window, and he did things so he could see what it felt like to be dead. I'm not curious about what it feels like to be dead. I know what it feels like to be dead. Just nothing. If I gave you reasons for wanting to kill myself, I could say, "Well, I'm bad, and I want to be punished. I'm tired, and I want relief." But there's something else, too. I don't know how to tell you about it. I have a fascination for death, it's really . . .

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Last night I dreamed that I put a gun in my mouth and blew my brains out, and I could feel it; I could feel my brain exploding. It was the most fantastic thing in the world, the sensations of the gun going off in my mouth. When I think about the things I feel every day, every single solitary fucking day, wouldn't it be fantastic to have it just that once, that one fantastic thing, just once? .. . S: In the dream it was slow motion, wasn't it? [That is, no longer really suicide.] G: Yeah.

11 Identity

What shall we say about "identity"? It has become almost too sacred a word to attack these days, for all kinds of unscientific causes have gotten their sanctions from its scientific aura. On the other side, some analysts condemn it because it overflows the supposed precision of words like "ego,"1 "superego," and "id." I am both attracted to and put off by "identity": attracted because it denotes qualities of being (on which analysts previously did not focus 2 ) and put off by its facileness, corruptibility, and propaganda value (see Leites3). If "identity" is to be scorned, one might want to examine how many of the reasons for such scorn also apply to the modest words that are the corpus of metapsychology—words such as "ego," "superego," and "id." What has this to do with Mrs. G? First, there is the business of her names. Her given name was "P."* It was suggested by her maternal grandmother to her mother, who accepted it. Then, she was given the middle name "Jane." For some years, neither name was used much—her first name not at all, and her middle name by one relative only. Instead, she was called "Sugar," this nickname having been given to her by her father and accepted by others. Nonetheless, when she started school, the teachers insisted on calling her "Jane." That was too feminine for her by then, so she adopted the name "Whitey" (from her blond hair) because it had a more masculine quality. Not until she was twelve did anyone call her "P." In her teens, this profusion of names was compounded by her marriages, each of which gave her a new name every few years. Perhaps too many names do not disturb a child who lives in one, stable family; but Mrs. G was living in turmoil. She could not be certain when her * It is, as I have already said, an unusual and bisexual name, her father's name, but with "i" and "e" exchanged. 224

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father would be there and when he would be gone; she was shipped off to her grandparents for months; at the rare times when the family was intact, she still felt she was the wrong person, of the wrong sex, for her parents. So the multiple naming fit all too well with her uncertainty about who she was. Thus for Mrs. G a crucial identity theme was: "I do not know who I am," if "I" is defined as a unitary whole. If she could have articulated this, she would have said, "I am a number of parts; I am not a whole. If I have any identity as a unitary whole, it is that I am unlike all other people in that I am a collection of fragments/1 Unfortunately, each of these fragments took on a life of its own because, I think, when she was expressing a particular aspect of her personality, it was reacted to, especially by her mother, as if it were all there was to her. So that aspect became split of!, and its independence rewarded. Later, Mrs. G herself came to thrust only part of herself forward on any given occasion, this inducing everyone to react to that part as if it were all there were to her. It was in this fashion that she made people respond to her as "Sugar/* feminine and cute; or as "Whitey," tough and fearless; or as one expected to be hallucinating and delusional; or as a mother; or as a murderer; or as a suicide; and on and on. Each fragment drew from a different part of her personality, and each had its own role. The grossest forms of this splitting were, first, Charlie, whom she experienced as a different person entirely; second, herself (whatever that means) during fugue states; and, third, the impish psychopath Carrie. There was the heterosexual-married-woman-mother, and there was the butch-homosexual-penis-possessing-female, the two more or less patched together with the terribly vulnerable rationalization that she could not be a homosexual if married to a man or, when having sexual relations with a woman, if she had a penis. There was the identity (as with some of her other aspects, adopted in the hope of pleasing her mother) that she was bad and a liar—for had she been good, she imagined, she would not be recognized by her mother as mother's daughter. As a teenager and adult, Mrs. G sensed herself as a "nut," as anatomically unique (with a bit of the sense of being a freak), and as having sanction—more than that, demand—from her mother to be bad. So she slid comfortably into an underground of the mentally ill, sexually perverse, addicted, and criminal. There she felt tranquil; there she came closer to feeling herself whole than in any other milieu in her life. The attempt finally failed, for reasons that have been re-

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vealed in the transcripts; but it was at this time that she felt her most comfortable. However, life would not let her survive even with this "negative identity": bit by bit Mrs. G removed herself from the only environment—the underground—that held her together, first by her decision to raise her sons, next by falling in love with a man, and then—most difficult of all—through psychotherapy. Thereupon she collapsed into psychosis and almost uncontrolled homicidal and suicidal impulses. When that happened, she had a further identity to help her—that of the insane patient; and this identity (perceived by many who helped treat her as partaking not only of psychosis but also of manipulation and artifice) may have made psychosis bearable because it was a bit under her own control—a phenomenon seen in the hysterical psychoses. We have noted another theme earlier (in Chapter 4): so long as Mrs. G could be and do what she felt her mother defined her as, i.e., bad, she suffered no guilt. She was herself when doing bad things; her conscience was clear, and her "voice" left her alone. One can imagine, then, how terrified she became of me and my treatment, with the conventional standards I tried to force on her (murder is bad; her suicide is bad; love is good). But she already knew those standards, and she fully accepted them as being the immutable moral laws of the universe. She did not need me to teach them to her. What I did not understand was that in order to survive, she had to be sure not to obey those laws. We noted earlier that psychopaths, according to earlier views, are moral imbeciles. Perhaps; but Mrs. G was not. She had the keenest intelligence for morality. She had to: if she did not know good from bad so she could adhere to the wrong and refrain from the right, she would lose her mother. And that was too much for her. As with other therapies undertaken especially by psychoanalysts, the goal of Mrs. G's treatment was for her to find herself and then be herself. I suppose there are people so evil that should they learn to be themselves, they would be obliged to commit suicide. Mrs. G might have been one of these. I would have thought so had someone told me about her before we met; but there was that sadness in her eyes during our first interview, that suggested she knew of parts of herself, beyond reach, that were worthwhile. She did finally find them, and they are her self. Moreover, she not only likes these parts of herself

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now but likes the satisfactions—physical, emotional, intellectual, and creative—these parts can bring to her.4 Mrs. G talks of identity issues: G: My mother wanted me to be a man. When I was little, she dressed me like a boy, and she kept me like a boy, and she wanted me to be a boy. I remember her saying more than once, "I wish I had little boys. I never wanted a little girl!1' She still has the same attitude. She even today says, "If I had it to do over again, I'd have all boys. I wouldn't have a daughter." S: Yet she likes you now the way you are, you said. She's a little bit puzzled by you. G: Yeah. Well, she's accepted the fact that I'm a woman. S: Did your father want a girl? G: Yeah, my father wanted a girl. S: But he wasn't there. G: No, he wasn't there. G: I had dinner at my mother's yesterday, and there was something on television that said something about a little girl. And my mother said, "Well, that was something I never had." I said, "Yes you did; I was a dainty little girl." [Laughs] You don't know why I said that, but I resented her saying that she never had me. S: What did she say? G: "Yeah, until you were four." She has always called me Sugar since I was born. S: It's not a boy's name. G: That's why my father named me Sugar because I was tiny, and I was sweet. I only weighed four pounds when I was born [premature by two months]. I cannot believe that now. [Laughs] G: I've been called different names by different people. My friends call me Whitey, and my family call me Sugar, and my husband calls me P. S: And what did you think you were? G: I didn't know. S: The name that was given to you when you were born? Have you ever felt you were P? G: No. S: What did you feel you were? . . . I thought you felt you were Whitey. G: Yeah, mostly I felt I was Whitey; but I was never sure. I didn't even

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know my name was P until I was twelve years old. When they put me in school, the teachers called me Jane. S: Jane is a very feminine name. G: Yeah. I hated it. I didn't want to be anything.

The following emerged only later in treatment: S: G: S: G: S: G: S: G: S: G: S: G:

Was your father there when you were born? Yes. Who chose your name? My mother. Did your father have anything to do with it? I don't think so. He nicknamed me Sugar. Why did she name you with your father's name? I don't know. Why did she change the spelling? To make it more feminine. Why would it be more feminine with an "i"? I don't know. Francis and names like that, they're all spelled with an "i" if they're feminine.*

G: If I'm not Sugar and I'm not P and I'm not Mrs. G, what am I? Sometimes I can see a little bit of what I am—sometimes I remember a little bit. Sometimes—like sometimes with you, not very often, but sometimes with you; sometimes when I'm with another woman; sometimes when I'm feeling for other people, when I have a real feeling for other people—nothing that I've tried to have because that's the thing to do, but when I have a real . . . then there's some part of me that's real. All over. S: You are a person with a body when you are you. When you're not you, you are a person who inhabits a body over which you have more or less control. Is that correct? G: Actually very little control. Don't you . . . don't you remember the times when I told you that I don't feel real? That's when I'm aware of what . . . that's when I've been real for a minute and I knew it. G: I read in the book about the history of medical psychology: "Where is your soul?" and I used to think maybe it was in your stomach, and maybe it was in various parts of the body. I don't even know what a soul is, but I was thinking about that this morning; and maybe that's what makes me want to live, because it isn't thought that makes me want to live, and it's not my health, and it's not what * In fact, of course, it is the opposite. She has confused the masculine and feminine.

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I eat or anything like that; maybe that's what your soul is, that makes you want to survive. I have the feeling that because of the rottenness inside of me, my body is rejecting my soul. Do you think I'm being crazy? S: No. G: O.K. I don't want you to think that. That doesn't mean I have a ... G: I wonder if my mother ever thought of me as a person. You know . . . I've gotten the impression that at different times in my life she thought of me as different things, you know, as a little girl who should have been a little boy, and as a mischievous child she was concerned about controlling, and a delinquent that she didn't want any part of, and a sick person that she didn't want any part of. I just wonder if she ever wanted any part of me . . . or if she just did her duty. G: I'm so excited. Dr. P has arranged for the dermatologist to see me. To take the tattoos off [tattoos on her fingers and legs that identified her as a gang member]. I'm too old for that. I'm just not that kind of person any more. I'm a mother and wife. As Mrs. G became more whole, this exchange took place: G: All this time that I've been thinking about men as being strong, I've been thinking about women as being weak and thinking men weren't weak like women, but I don't know what . . . I don't know how they're particularly strong. S: The Charlie part of you—what does it know about all this? G: That men can be just as weak and vulnerable as anybody else; but they have their strengths and their weaknesses, and they're not any different than anybody else. Charlie thinks women have a strength men don't have. I don't understand that. He's not telling me anything. He gives me little things and then expects me to figure it out for myself, and I can't do that. I guess what it is with men and women is they complement each other. A woman helps a man be strong, and a man helps a woman be strong. If men aren't strong, God-like creatures . . . if men aren't the most intelligent, the most all-knowing and all-giving and all the good things, if men don't have all those good qualities, if all men don't have all those good qualities, then why do I have a penis? G: Remember last week when I was here, and you said, "You take a secret pride in being crazy," and I left here and I went to my mother; and I had dinner with my mother, and she said, "How are you getting along with Dr. Stoller?" All of a sudden she is really

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interested in everything that is happening. And I said, "Do you know what he said to me today? That I'm proud of being a nut." And she said, "Boy, he sure hit that right on the head. If you weren't proud of being a nut, you wouldn't have an excuse for all those things you do." [Laughs] G: I like to think that I'm a tourist—you know when you're a tourist, you go to a place and you stay a little while and you meet people and you can give them as much as you want, but it doesn't make any difference how much you give them because you're going to move on. G: When I was married to Bill I really wasn't anything, and when I left Bill I had to find out who I was. G: When I was little, I was sad. Always. You know one time when I was in reform school and I had to be a butch to survive—and that's really what it was—they would have beat the shit out of me, do you know that? If you had been there then, I could have become a female. Because that's what I wanted to be, and I used to cry about it. That's why they thought I was crazy. Then later when I was older, after the kids were born, and I went to jail, the same thing was expected of me again; and I figured what the hell, that must be what I'm supposed to be. Until recently, starting immediately after the next exchange, Mrs. G needed to play at being stupid. This served to make her fit her mother's expectation, to relieve her of responsibilities, to play a perpetual joke, and to resist treatment—to resist me personally, and to permit the emergence of insight moving toward awareness in herself. At this late date, the session that follows, she is much less crippled by pseudostupidity. G: Somehow, my boss is very impressed with my work on the project she assigned me. She keeps bringing people to sec it. I was working on it [for many hours] last night, because she's got to have it today, and she didn't tell me until five o'clock last night. She asked me to do it because she knew I would do a good job of it. She more or less assured me yesterday that I was in no danger of losing my job. [Mrs. G was hired on a probationary basis.] S: How does she know that she can give you a job that can take hours at night and that you'll do it without being paid for it? G: I don't know what you're asking me. S: What's in it for you to play stupid?

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G: You know for sure that I'm not stupid? Oh, God! [Disgust with me] S: Did you do this with your mother? G: I'm not even going to answer that asshole question. I don't think so. You know when I was a little kid going to school, I got good marks in the beginning; and then the higher up in the grades I got, they used to say to me, "Your big brother did this, and he did that, and we expect this from you." So I failed every class. S: What were you trying to say? G: "I'm not my big brother." S: You didn't want to be him, and you wanted them to know you weren't. Isn't there some of that going on even now when you play stupid? G: I don't know. S: What does that ["I don't know"] mean? G: Do you know this is my lunch hour? I could be feeding my belly instead of putting up with your bullshit. S: It's not bullshit. I'm being the district attorney. G: You do very well at it. You should have been a lawyer. S: Uh huh. G: I don't know that I play stupid—sometimes I do; sometimes it's necessary for me to play stupid. I don't want to be my brother. I would like to be like him in some ways. . . . Oh God, go talk to somebody else! Twenty-five minutes. And what have we accomplished? Maybe I don't want to change that aspect of my personality. So why bother with it? Maybe people demand too much from me. Did you ever think of that? Maybe when I'm Carrie, people think: well, and then they start making demands. Like this project that I'm doing, for instance. Now, I didn't have to do it, but I did some other work for her that showed her I was capable of doing it. Had I played stupid, I wouldn't have to be doing the fucking thing, and I hate doing the goddamn thing. It's a hassle. O.K. If I play stupid, then people don't make demands on me. Playing stupid in school didn't do anything except that they called in a psychologist to test me because they didn't think that I was stupid because I had done so well in the beginning that they thought that maybe there was something, that possibly I was emotionally disturbed. But I . . . and the psychologist demanded that I behave in a certain way and accomplish certain things; so I just quit, you know. Fuck it! My mother made demands on me, you know, like, "It's too embarrassing for me to talk to your sister. You tell her what to expect when she's going to have her period and about babies and things like

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that. You know about it; you've already had one." So I told her I didn't know where babies came from. G: When I wear levis I'm a different person, and when my mother calls me Sugar, I'm a different person. I have to be whatever is expected of me. If I'm going to be what I really am, then all those other people have to walk away. S: All those other people inside, you mean? G: Yeah. S: Do you think you'll miss them? G: Yeah.

12 Mrs. G's Father

G: My father was a natural born fuck-up. S: Could he have done more with his life? Let's not even think for the moment about the suicide, which is in you as it was in him. What did he do? G: Like going to Korea. He didn't have to go to Korea; they didn't want him to go; they wanted him to stay in California and be a recruiting officer. He demanded that they let him go, and he went all the way to Washington, I guess; and they finally let him go, and he got wounded and he got captured. I don't know what they did to his mind. It didn't help him to go to Korea; and when they brought him back, they put him in an institution, because he was nuttier than a fruitcake. He never drank much before that, and then he became an alcoholic. My father was a hero. I thought that he was a hero to fight the war; I also thought that he was a chicken-shit to go off and leave me. S: Did you feel that he was someone who screwed himself, not just this one time, which certainly seems like it, but was this a way that he was—you know, like you're so tall, or you weigh so much, or you wear such-and-such a size shoe? Was he this way? G: Yes. Like stealing things—he could have gone to prison. He used to steal things just for the fun of it. He never used anything he stole. He never stole anything that was useful or that he could make money with—you know, he just stole things. The main purpose of my research is to find sources of masculinity and femininity. Now, after fourteen years of study, I believe that in humans the primary force (but not the only or a sufficient one) is the influence of parents' wishes on their child. You can imagine how distressed I am when, on arriving at a discussion of Mrs. G's father and mother, I cannot claim that the evidence confirms my hypothesis. But such confirmation is difficult to achieve. A problem common to all research on human development is that it requires reports from sub-

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jects, be they reports such as the extensive ones that comprise a psychoanalysis or skimpy ones of the questionnaire type; and the difficulties in establishing what really occurred on the basis of such reports are great. The psychoanalyst may argue that he can see early experiences in his patient's reliving them in his relationship with his analyst, which is true up to a point. Still, transference does not tell us precisely what happened; at best, we may see dim outlines of what the infant's version of the experience was. Yet the situation is not hopeless. The study of parents and infants helps correct some of the defects, and changes in psychoanalytic technique may also help—some day. Perhaps even the uncertain and contaminating technique of hypnosis may, in the future, be harnessed to help us; and undoubtedly, unknown techniques, such as might be provided by future neurophysiologists or psychopharmacologists, may give the researcher a more reliable picture of the experiences of earliest childhood. If I had had ample time to talk with Mrs. G's mother and father, I might have quite different interpretations from those now possible (but would still be haunted by the fear that the additional information might not make the end view more accurate). For an inevitable flaw in this study is that almost all we have to go by is Mrs. G's story, filtered through my head. Mrs. G almost had a good relationship with her father—and that is perhaps the most optimistic statement one could make about any of her childhood relationships. Her father was a career soldier and thus was away from his family for years at a time. In addition, Mrs. G believes that even when he could have lived with them, he could not stand it for more than a few days. Given those short periods, he managed intense and loving relationships with his family; but these would end without warning when he simply (from the child's point of view) was not there one morning. For years this shocked Mrs. G, because while he was there, he was so loving; thus his open pleasure in his daughter seemed to promise he would stay with her. And then he would be gone. It was only after she was ten or eleven years old that she finally faced the knowledge that her father's love was not trustworthy. I believe her father played an essential part in the development of Mrs. G's penis; something in the relationship between father and daughter promoted her desire to be male like him, as the following quotation from the filmed interview the first time we met might suggest:

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He is in the army, and he has always been gone. They are divorced; and when they were married, he was never there anyway. He is a pretty nice guy . . . I guess. He is an alcoholic. My mother says he's crazy too, and I am just like him . . . it used to bother me a whole lot because my mother would go around calling me different names, saying he was a skunk, and he did this and he did that, and you are exactly like him; and it made me feel a little bit bad, but it didn't bother me for very long . . . if she didn't like him, she didn't deserve to have him. . . . He may have been a little irresponsible, but he wasn't bad. This is not to say that aspiring to masculinity was simply the result of Mrs. G's relationship with her father, which would leave out the crucial contribution her mother made. Probably, her mother's not wanting a girl helped draw Mrs. G to her father as a source for identification, just as her mother's rejection pushed her toward her father. Another factor in this masculine identification may have been the intensity of her (heterosexual) love for her father and its frustration. The mothers of transsexual boys are in some ways like Mrs. G (see Appendix 3). As children these women also may have had an intense and loving relationship with their fathers coupled with a cold and hopeless one with their mothers. Many have a period of some years in childhood when they are beloved by their fathers; and then between six and twelve years old, they are "rejected" by their fathers, either by their fathers' leaving the family through divorce or death, or by their turning away from the particular daughter to another child. Necessary for Mrs. G to have survived were the several isolated islands of femininity present in her (though they never coalesced into anything one could call a feminine identity). This, too, is found in the mothers of very feminine boys; and in both instances I believe it is due to the periods these women spent as girls being loved as girls by their fathers. Femininity thrives on an appreciative father, or at least one who recognizes his daughter's femininity and demonstrates that it has value in his eyes. So it seems that Mrs. G's father contributed significantly to what femininity she has; augmented the process of her yearning for masculinity and maleness; increased her sense of being an aberrant member of the family, as he was; and finally, by his suicide, gave her permission and incentive to be suicidal (i.e., made it egosyntonic, a pleasure, even a merging with this lost father). Among other things, saving her life and otherwise succeeding in therapy required that treatment help Mrs. G to extrude three inner objects: mother, father, and Chris. In overly simplified terms, her

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mother existed within her as a series of commands, disapprovals, and an announcer of ideals beyond Mrs. G's ability to reach; Chris-inside was herself, a freak in appearance and, because of his broken mind, inarticulate, uncontrolled, frenzied, unable to reach other humans; her father represented impulsivity—love of life of the sort that leads only to death, with a disjointed love of others that is transient, poignant, and doomed. The process by which these three stopped being inner objects and instead became realistic people in the outside world was in each case preceded by a psychotic crisis, hospitalization for months, and a working through of the relationship (with mother, father, or Chris) that brought an end to the inner object as persecutor or seducer toward tranquillity-death. The following is from a letter before formal treatment began: Hamburgers often remind me of my Dad. Or a particular time with my Dad. When I was very small, during a time when my father was at home, we would go to the beach. My mother can't swim and is deathly afraid of the water and so were the other kids, so he and I would swim. He taught me to skin dive and body surf and he and I would spend what may have been hours together in the water. I was very happy, and I loved him very much. He was a "hamburger lover" and he and I would eat dozens of them at the beach. Now, hamburgers make me vomit. Another time he came home and I was pregnant for the first time, and it was pretty obvious. My mother made me swear not to tell him. He took me to see some radio programs, and I can distinctly picture myself sitting there waiting for someone in the audience to tell him the terrible truth. I got very terribly ill, fever and all and he had to take me home. I went to bed and when I got up he was gone and I didn't see him again for almost five years. He had gone to Korea, been wounded, taken prisoner, returned, divorced and remarried and I never was told. I just knew my Mom had told him I was pregnant and he hated me. The next time I saw him he had a new wife and baby girl, was drunk 3/4 of the time—I have to stop this now as I'm making myself sick. And this is from a letter three days later: Did I ever tell you about my father's death? An Aunt I hadn't seen in fifteen years called me and wondered if I'd be interested to know he'd died. I called my stepmother and she very calmly told me he had committed suicide but his body wasn't found for three weeks [sic]. It was a closed casket funeral and believe it or not, I can't make myself believe he was in that box. They gave him a very impressive military

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funeral with soldiers and guns and flags and about 130 so-called friends. His own father couldn't make the funeral as he was in Europe, probably screwing all the ten year old kids he could get his filthy hands on. Nevertheless, I keep thinking my Dad's going to come back and get me just like he promised about a million times. He spent a lot of time in mental hospitals too, but he wasn't afraid of anything. S: I'm not just bugging you in general, but bugging you about your father. G: You have no business bugging me about my father. S: My hunch is that you're going to have to admit that your father is dead. G: I admit that he is dead. S: But you have never grieved for him, have you? G: No. S: Start wherever you like, with whatever thoughts come to your mind about your father. G: My father was a very dependable person. When my father was home, if he said, "If you do that again, then I'll spank you," we knew that if we did it again, he was going to spank us. If he said, "Tomorrow night I promise I'll be here," he was there. We knew that he was going to be there. If he said, "Next week I have to go away," we knew he was going away. He was very dependable in that respect. Sometimes he wasn't able to keep his word, but it wasn't his fault. There's only one time he ever lied to me. He came home once and he said, "I'm working in a mental hospital, and I'm doing something with mental patients"; and he wasn't actually working there; he was a patient then. That's the only time . . . no, one other time I caught him lying; and he lied about this woman that he married—but that wasn't important. It was when he came back from Korea in 1951 [?]. I think it was in 1951 they put him there. I don't know what for. I don't know how long he was there, but I know it was close to a year. He got married. So I have a half sister. She looks a lot like my oldest boy. She and my oldest boy can pass for twins. I was pregnant when she was pregnant. S: That's a burden for a daughter to have to carry. G: I don't understand that. S: I mean that people ponder, think about, wonder over, compare themselves with their parents when their parents were having a baby at the same time that they are. There's kind of a jumbling up of the generations. You know, you try to put your father in his place of being so old and being a father, and then suddenly he's not just a father; he's a husband who is a contemporary of yours in the sense

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that he's just as capable of getting a woman pregnant right now, this month, as that man over here who got you pregnant this month. So that your father is having a child by a woman your age. O.K. That's disturbing for girls, and you know that. No, I didn't know it until you told me. You look like the cat that ate the canary and then got indigestion. Well, he had no business getting her pregnant in the first place. He couldn't take care of the kids that he had. What business did he have having more? Are you angry at him for that? No. Maybe I was a little bit angry. . . . He wasn't dependable. He was a stupid ass. He never took care of his responsibilities, and he never cared anything about his kids, and he went off and he joined the army so he wouldn't have to have any responsibilities, and he went to wars where he had no business fighting. He asked to go to Korea—he wasn't sent there. He asked to go, and he had no business going. He got shot in the ass. He could have been killed. He had no business doing things like that. He didn't give a shit for any of us. How come you said all this? I've never heard you say that before. I don't know why I said it. Because I'm tired of defending him. That wasn't a very good thing to do.* I feel like a little girl that has just lost something. I needed my father. I always thought that he was the only one in the family that cared for me, but he didn't really. I don't want to talk about it any more. I really don't. I should have cried a long time ago. I remember the first time I was pregnant and I was so scared, and my mother kept me locked up so that nobody could see me; and my father came home, and she wouldn't let me tell him; and I wanted to tell him so bad, because I thought maybe he could help me make it go away or something. And he took me to see some radio programs or something . . . I remember he took me out all by myself . . . and I did tell him, and he said it didn't make any difference. When it was all over, he would come and get me, and he would take me with him. But he never did. That's all—that's enough. All the times he promised to get me—over and over again he did that to me—and over and over again I believed him. Like when I was in detention, and he promised that he would take me away so that I wouldn't have to live with my mother any more; and

* I.e., to open up the anger against him. I pushed her to do so at this time because in recent weeks we had finally gotten to her feelings about Chris, and she had not only survived without being annihilated in an attack upon herself but had ended up with Chris no longer inside herself, destroying her.

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when I was in R State Hospital, it was him that signed the papers so that they could sterilize me. I didn't know that. Every time you told me about that, it was always your mother. It wasn't. He wasn't dependable—he was a liar. He lied all the time. Every time he told me something, it was a lie; and my mother says I'm just like him. Why does she keep saying that? She has been saying that ever since I was little. "God, your father, what a stupid son-of-a-bitch he is, and you're just like him." Why does she say that to me? And then I think—I thought about it, and I thought: This is really wonderful, because my mother loved my father; and if I'm just like him, then she must love me too. Were you like your father in any way? [Shakes head no; shakes head yes] What do you mean? Well, I used to lie a lot. I used to drink a lot—my father was an alcoholic. But I never treated my kids the way he treated his. She said you look like him. Did you? No. Do you know my father had blond hair? [She has.] Did I tell you my father committed suicide? You've told me many times. Why would he do a thing like that? Maybe he was lonely. And it's his fault. He deserves every bit of it. I am glad he was lonely. Because he made me lonely. I don't really mean that. I don't really mean that. He shouldn't have done that. I don't know why he did that. After he promised—he promised to come to me. I'd just got a letter from him where he promised. I don't know why he did that. After he promised—he promised to come to me. I'd just got a letter from him where he promised. I don't know why he did that. The stupid son-of-a-bitch. He knew what he was doing. Then he wasn't stupid. No. From your point of view as a little girl and as his daughter and as somebody who was just aching for him all your life, what he did was: he abandoned you.... Permanently . . . I always asked him to take me with him, and he never could. You always asked me that when I went away on vacation. And you never grieve for h i m . . . . And you never feel anything. Why should I grieve for him? He never grieved for me. I don't feel a thing. Is that true? Yes, it is.

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S: It's so true that you're going to go down to that ward and you're going to start hallucinating again. You don't feel anything—you just lose your mind every time. [One week later] G: Look, we've talked about my father. There isn't anything else to tell. I've told you all there is to tell about him. I don't know what you want me to tell about my father. S: I don't know what either. But I want to hear about how it really was when you were a child. G: I don't remember. S: You did last week. And you told me about disappointment. G: Well, if I've already told you, what more is there to say? S: Do you remember it? G: No. S: Then let's do it again. G: Maybe I don't want to remember it. You're a bastard today, aren't you? S: Every time we talk about this, I'm going to be a bastard. G: My father was a very warm . . . I don't know what my father was. My father let everybody walk over him. My father wanted to be with his children. Don't you laugh at me, or I'm going to hit you. Why do you want me to say these things? I don't want to say them. I need my father to be what he was. I always needed him. I didn't have anybody else except my father. And now you're trying to take that away from me. I'm not going to cry either. S: You are crying. G: [Long pause] It doesn't make any difference what my father was. No, it doesn't. He could have been the biggest son-of-a-bitch in the world, and it doesn't make any difference. S: It does if you have both ideas inside of you: one, what he really was and, two, what you wish he could be. G: Why does that make a difference? S: Because that means that one side of you will always be calling the other side a liar. And because if you're no longer a liar, then you're going to have to weep. You have to grieve, but at least you'll be clean and free. Then you'll be done with it. G: My father was a son-of-a-bitch. You already know that. My father didn't give a shit about anybody but himself—you know that too. I want him—I don't care what he was. S: You can't just remember him. You've got to have him alive? He's still got to sit inside of you. You can't say the man was a good man and he was also a son-of-a-bitch, and the man was a kind man and he was also a selfish man? You can't say he was all the things that

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he really was which were good things and bad things? You can't say that and then you can't say, "And the poor son-of-a-bitch died. He killed himself while I'm still alive"? You can't say that? I know he's dead. You're not even sure when you say it. I can't . . . I just can't understand what difference it makes. What difference does it make? I'm not hurting anybody. It's not hurting me! No, it's not. Yes, it has you crazy today, so we might talk about it. . . .* Well, then, let's don't talk about it. And then I won't be crazy. . . . . . . today. Why do we have to talk about it at all? What difference does it make what I want? Why don't you leave me alone? What do you want me to do? I don't understand what you're after. Do you want me to know my father's dead? I know it Not completely. There's still enough remnants flying around. Well, what can that hurt? He's driving you crazy. Not unless you bug me about it. Oh yes, it will still be there next month or next year. What difference did it make whether we talked about Chris or not? It made a lot of difference. That was different. . . . Do you know how I was with my father? Whenever a bad thing happened to me, my father always made me feel good. Yes, he did. But he wasn't there. He was there some of the time. A part of you inside knows that he wasn't there when you needed him! Don't you know that? He couldn't be there. Maybe he didn't know. Because if he knew I was suffering, he would have been there. My father wouldn't have l e t . . . he wouldn't hurt me. You're so close to telling me the truth. I am telling you the truth. No. You don't even look it. You look like you're trying to tell a fairy tale. [Long pause] Why didn't he stop your uncle from sleeping with you? What makes you think it was my father? I did, finally. How long did it take?

* I.e., she was psychotic earlier in the day and early in this hour because of her attempts to repress her growing insight about her ambivalence toward her father.

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G: Oh, I was sent to live with them, and I was there about a month. And I told him if he didn't stop that I would tell my father. S: You say your father always protected you. When did he? G: He never did. He used to let my mother do bad things to me. She never did anything bad to me. My mother never did anything bad to me. I must have had it coming. You're confusing me. You're making these things come into my head, and when I say them, they don't make sense. I think the worst things my mother did was she wouldn't let me have my father. She didn't want him to hold me and things like that. I probably used to like to do crazy things like go to the beach and buy a watermelon and just sit on the beach and eat a whole watermelon and things like that. My mother wouldn't let him do things like that, and he always took me with him when he did those crazy things; and she wouldn't want him to do that, and those were good things. Because my mother doesn't like me. Because I was just like him. She told him once to take me. When I was about fifteen, she said "She's all yours"; but he didn't want me either. What could I do? Nobody wanted me. I didn't do anything. What was there for me to do? Cry? I screwed my psychiatrist. [This was the first mention of this episode, described in Chapter 5.] S: [Laughing with disbelief, then surprise] Is that true? G: You asked me what I did, and that's what I did. That's the only thing that I can think of that I did at that particular time. S: You have a good sense of humor. I'm not convinced that that's what you did.* Why would you have screwed your psychiatrist if your mother said "Take her" and your father didn't want you? G: Because I had to prove somebody wanted me. S: Is that the way it was, or is t h a t . . . you got it from books? G: I don't know. My grandparents wanted me. They took me. Do you know what my grandmother told me here not long ago? That my mother used to get tired of me when I was a baby, and she would send me to my grandmother, and my grandmother would keep me a couple of months. And when they would send me back to my mother, I would vomit all the time, so my mother would send me back to my grandmother because I would vomit all the time. But I never vomited with my grandmother. And one time they were in Sacramento, and my mother was in Los Angeles, and I was two and a half years old, and I puked all the way from Sacramento to Los Angeles. My uncle was taking me back to my mother. My uncle still remembers the time I threw up all the way from Sacramento to Los Angeles. * By now the reader undoubtedly realizes that Mrs. G had told me so many dramatic stories that I chronically felt a mix of gullibility and suspicion.

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S: Is this the same uncle? G: Uh uh. [Laughs] This uncle screwed me when I was about eighteen years old to prove to me I wasn't homosexual; that's what he said. 5: I'm lost. The uncle that brought you down from Sacramento? G: Yes. S: That's different from the uncle that screwed you when you were thirteen? G: Yeah. Yeah. My mother's brother. S: How come you were such a cooperative little piece of ass? G: Because that's all I had to give. You don't know what this does to me inside. S: How do you know I don't? Why do you keep pulling that crap on me? G: How could you know? S: I know well enough, and you know that. G: When you talk about my father, I hurt inside. S: I know. G: And it's awful! S: O.K., O.K. It's a big deal. If you think that I'm going to get so sympathetic that it's awful, that I'm going to lay off . . . I don't think it's that awful. Just because you go crazy and hallucinate that's no big deal. Huh? Come on. G: Yeah, you're right. No big deal. S: Now, look. Arc you going to misunderstand me? G: No. S: Do you know what I mean when I say that? G: Yeah. S: All right. You try to pull that game on me: that I don't understand, I can't appreciate what you feel... G: What are you going to start on then when you get done with my father? S: Your mother. G: Oh, good. I'll love that. S: You wait. And then when I get done with your mother, who are you going to start on? What are you going to do when you've run out of people to talk about and you've run out of things to be crazy about and you start getting scared that maybe your treatment is going to come to an end, then what arc you going to cook up so that you can stay in treatment here? G: I don't know. S: You'd better start thinking, because you're running out of people. What are you going to do when you can't be crazy any more? G: I don't know.

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S: Doesn't that scare you? G: Yeah. Don't think I don't think about that. S: Oh, I know you think about it. I know you're thinking about it when you're not thinking about it. And you've got to pace this thing pretty well so that ^ou can stretch it out over fifty years. G: Do you really think I like to be crazy that much? S: No; but if that's the only way you can get me, you're going to do it. What has your mother said about your father when they first met? What sort of a man was he when he was young? G: That he was a lot of fun, that's all. My mother loved him very much. I remember when they called me and told me he was dead, I called my mother and told her. And I said, "I'll be going to the funeral"; and she said, "What for? What did that son-of-a-bitch ever do for you?" S: Tell me about the good. G: First of all, there was my father. I can't think of any good things he ever did to me. I can't even remember an incident where he did something good for me. He was always laughing and singing and joking and when he was around, everyone was happy. My father preferred girls to boys. A simpleminded, silly, drunken son-of-abitch, that's what my father was. Whom I loved very much. One time I went to Berkeley to see him, and he had a little girl about two and a half years old. And I went out and I got drunk with him, and I forgot he was my father. I felt sorry for him because he was so lonely. S: What did he seem like to you, then, if he wasn't your father? G: Like a man I wanted to do bad things to. I wanted to hurt him. I wrote bad checks and went to jail. And do you know what that son-of-a-bitch did? He sold my car and ran off with my money. I knew that it would hurt him that I would do a bad thing like that. I got arrested right in the police station. He had a luncheon date with the chief of police, and I was to meet him at the police station; and one of the men said I wrote a check that just came in, and I got arrested right in the police station. S: What did your father do? G: I don't know. He didn't come to see me. He just came one time, and that was for me to sign the pink slip to sign my car over to him so he could sell it so I would have money while I was . . . Because they thought I was going to the penitentiary, and he was going to sell it so I would have money. And he sold it and took the money. And I never saw him again. I don't feel anything. Nothing. S: You look like you're going to cry. G: Well, I'm not.

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S: You mean, you're not going to permit it. Why do you lie to me and tell me that you don't feel anything? G: Because I don't. S: You really don't feel anything? You don't feel like crying? You didn't feel like crying? G: Are you sleepy? S: O.K. I closed my eyes in pain—it's fatigue, but not falling asleep. I'm always frustrated when I feel I'm so close . . . G: Do you know when he died, they didn't find his body for two weeks? That fascinates me. Nobody cared about him. S: That's nothing to be carrying inside of you either, is it? G: What? S: A two-weeks-old dead body. It scares me to say it. G: I'll probably die the same way. S: You'd just better not, or I'll kick the shit out of you. Boy, you're really going to get crazy, aren't you? G: There's another thing I should have told you about, and it really hurts me to think about it. I feel so guilty about it. Remember your saying, when I was telling you about the last time I saw him, and we went out and got drunk together? It hurts me to tell you this. When he took me back to the motel room, I wanted him to take me to bed—that's really a terrible thing. It frightened me so bad that I never wanted to see him again. I didn't. Do you know what I was thinking at the time? And I remember this incident so vividly. Here I had slept with so many men, why wasn't that enough? Why would I want to sleep with my father too? What's wrong with me that I would want to do something like that? Where were you when I was twelve? Do you know why I wish my father was alive? Because I want to apologize to him. [Later] S:* What about your father during the early years? Did he treat you like a little girl? G: My father was very feminine. I was thinking about him not being in the army. He wore an apron, and he did the cooking, and he did the housework, and he bathed the babies. I can just picture him doing those things. He was just always the one that we played with and had a good time with. S: Why was he home? Didn't he work? G: Yeah, he must have worked. I'm sure he did work. I don't know. I can just remember . . . I can remember him giving me a bath and cooking and doing things like that. S: Did you ever have thoughts about his being a woman in some way? G: I don't know. I can remember once waking up at night, and there

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was a noise that scared me; and I got up and I went into my mother's room, and I thought they were both women. And I thought he was hurting my mother. This was just a vague recollection. And they sent me back to bed. They sat up when I came in. She sounded like she was being hurt. S: Why did you think your father was a woman? G: I just got that impression when I first went in the room. They had kind of a red light on or something because there was a baby in the room in a crib. I must have been about live and . . . four or five, somewhere around there . . . and I went in and I was quiet . . . I don't know. [One year later] G: I was thinking about my father dying. It seemed like I always knew that no matter where my father went, he'd always come back; and when he went to live in A, I started to go see him many times, but I never did. But I always knew he'd come to me if I really needed him. And then he died, and that was a big loss. And I guess I was thinking about that because you said my mother will die; and I was thinking: How big of a loss is that going to be? Will it be equal to that of my father? Because that was really a big loss for me. And then I thought: No, I really don't think it will be as big a loss, because I really don't have as much of my mother as I had of my father. Although my father was never there . . . when I had him there, I had all of him. S: When did you finally permit him to be dead? G: The last time I was in the hospital. I think the reason 1 didn't want him to be dead was because I felt so terribly guilty at his dying. I always felt that he wouldn't have died if he hadn't been turned away when he asked for help. And I could have helped him—I was in a position where I could have helped him, and I didn't do that. I kept thinking that he has to come to me. He's left me many times; now I'm doing it to him. And then he killed himself. . . . Jesus Christ, if I had just . . . you know, maybe if I had gone to him and given him whatever he was looking for, maybe I could have prevented that. I don't feel guilty about that any more. S: What put him in the position of killing himself? G: Well, he was an alcoholic. He had spent thirty years in the army, and they retired him. His wife had left him; in fact, he killed himself the day she left him. That's all I know. S: That's quite a bit. G: Yeah. You know, my brother-in-law called me the other night and he said something about how did I feel about divorcing Bill. And I told him I was feeling kind of guilty about it; and he said maybe

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it was about time that I put some of the guilt where the guilt belonged, that it wasn't just me who was divorcing Bill, it was Bill who had done things to make me want to divorce him, so pan of the guilt was his. And then maybe my father was guilty, too. Her father has never again haunted Mrs. G.

13 Mrs. G's Mother

G: My mother's an old woman who wants me to die, and I hate her guts. She never said, "I wish you were dead." She always said, "I think you'd be better off dead." She really said that. I felt like I should go home and take fifty sleeping pills and die. S: But you didn't. G: Yes, I did. I didn't die, but I took fifty sleeping pills. Only one time I went to her. And I told her, "Look at me. Look at me, I'm crazy. Help me!" She didn't know what to do, so she turned the television on. I never talked to my mother. My mother never had time. It is generally accepted that one's mother has the greatest influence on personality development in the early years of life. Both parents are essential, and so are other people—and other phases of life besides infancy and early childhood. But the early years are crucial and establish the permanent structure of personality (which may be overlain and then difficult to see). However, it must be borne in mind that this belief, though shared by many, is not proven: a research method sophisticated enough to establish the conviction as fact has not yet been developed. I am all too keenly aware of such research inadequacies as I try to assemble my thoughts about Mrs. G's mother. Despite all Mrs. G has told me about her mother, I know that she has, of necessity, given me only her views, in direct historical material, in affects, in displays of her relationships with other women, and in the transference relationship with me. Such data are more or less valuable depending on the observer's ability, on the patient's articulateness (not just in words, of course), and, perhaps, more on luck than the literature admits. Additionally, one's impressions are likely to be incisively modified if one meets a patient's parents. Mrs. G's parents were in love when they married, and their affection for each other continued for a while after marriage. Mrs. G, born 248

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two months prematurely, weighed only four pounds at birth. This uncertain start was compounded by eating difficulties. After a month of breast-feeding, she was shifted over to a formula because she could not eat well and was "puny." Her first four years are a blank to her (except in trances), and her mother will not discuss this period with Mrs. G (or with me). Mrs. G perceived reactions in her mother that could only confuse a little child. Her mother loved her father, but cursed him in his absence. Her mother paid close attention to the little girl, but would have preferred a boy. Her mother was physically and emotionally close to Mrs. G, but the closeness was not synonymous with affection and loving. Mrs. G felt rewarded for doing things generally thought bad, because her mother found them amusing; on the other hand, other sorts of behavior, insignificant to most people, would upset her mother. Mrs. G felt that her mother was absolutely, totally, and desperately necessary for her existence—not only in infancy and childhood but right up to the time this feeling changed in treatment. But she also felt that her mother's benign attention was terribly precarious. She was in the predicament of believing that since her mother was amused by her as a liar and cheat, she could be accepted only in that role. Certainly, when Mrs. G lied and cheated, her mother did watch benignly. So Mrs. G paid the price of feeling herself acceptable only when she also felt worthless. She recalled times when she had been honorable, and, sensing her mother's disbelief and rejection, had manufactured lying and cheating, after which she again felt comfortable, oriented, back to being the familiar child her mother could accept (though not admire or love). Thus much of Mrs. G's life had been built around learning to deal with her mother, to cater to her mother. While not to displease mother was essential, to discover the proper techniques for achieving this was difficult. Both the need to satisfy her mother and the confusions and despair aroused by her attempts to do so were expressed in Mrs. G's homosexual behavior until almost the end of treatment. She loved women but had to deny that this constituted homosexuality, because her mother was repelled by homosexuals. In her relations with women's bodies (which she loved), Mrs. G had to concentrate on gratifying them, that is, disarming them and making them tranquil; her own body, despite its cravings to be touched sexually, could not be touched (until late in treatment). Her own sexual

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satisfaction could come only after her partner had been satisfied. The sensations of sex were far less important than the quiet, nonerotic embraces that followed sexual intercourse. Mrs. G could not sleep with women marked as heterosexual by being mothers; this filled her with such disgust (which we recognize as the horror of temptation) that, until treatment changed this, she could not knowingly have sexual relations with such a woman. If she learned of it after intercourse, she would vomit and beat the woman. Nor could she have sexual relations with women who labeled themselves homosexuals, because this would indicate that she, Mrs. G, was a homosexual, and thus condemned by her mother. So we are not surprised that Mrs. G's homosexuality was aimed at her mother. What I emphasize (in fact, one of the emphases in this whole report on Mrs. G) is the effect of parental attitudes on a child's personality. Mrs. G spent her childhood trying to sense what her mother wanted of her so that she could comply,* a struggle that brought her into conflict with her own drives. She came to hate her mother and the resulting need to be not what her mother wanted. The situation was further complicated by her sensing the love and hatred between her mother and father; she was driven to desperation because of her inability, as a child, to comprehend all the meanings and motives of adults.1 It will pay us to look at how Mrs. G dealt with me. Unfortunately, even after these many years, I am unsure which parts in a particular piece of behavior or feeling aimed at me derive from her early relationship with her mother and which concern her father. My guess, implausible though it seems, is that not much of what I saw was related to her father. Mrs. G was a teasing, manipulating, cute, gratifying, charming, loving, insightful, dangerous, suicidal psychotic. Those who do not know her and whom she does not wish to charm find her irritating, stubborn, and malicious. Those who know her find her sad, pliant, weird, sparkling, and yearning for closeness with others. Those whom she puzzles and who wish no further contact find her a chronic paranoid schizophrenic. My abiding response has been to a benignly teasing, sad, and lonely madwoman with reversible pathology. G: I've never been angry at my mother. S: You don't dare; if you did, you'd lose her. But she tried to get rid of you from time to time. G: She couldn't help herself. It wasn't her fault. It was my fault.

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I am puzzled that Mrs. G has had so much affection for me so rarely interrupted by her tormenting me: it is as if she has saved the best part of her relationship with her mother for me and protected me from the hatred (which would only have destroyed me for her anyway). Although she has teased me dozens of times an hour, she has always signaled that I should not become impatient. And there have been payoffs to make it worthwhile not to become impatient: flashes of insight, forgotten memories, clearing of symptoms, expressions of gratitude. Such reactions have been offered so long as I have persisted, impatiently hammered at her, come back for more teasing, showed appreciation for her gifts, never given in. The puzzle is this: Why did Mrs. G not give up on me? When she had reached the end of the rope, she would let me know; and then, in contrast to some suicidal patients, she would give me the few extra moments, or the needed piece of insight, or the promise to cooperate, or whatever else the emergency demanded, to provide for the rescue. She always gave me a chance. And I have interpreted this not as a result of my treatment, but as a part of her nature. She has since told me that her mother also used to rescue her when she was at the end of the rope. G: You know, my mother rejected me; but she always held this little sign out saying, "If it gets too bad, I'll save you." Like . . . one time I got all these tickets, traffic tickets, and I didn't pay them, because I was in another jail; I couldn't pay them. The police from down here came up and got me and brought me back to go to court; and I appeared in court. And the judge was deaf, if you can believe this, and he said, "Why didn't you pay these tickets?" And in a very quiet voice I said, "Because I was in jail"; and he said, "Oh, you have no excuse, huh, $550 or 110 days in jail." So I called my mother; and I said, "Look, I've got an income tax check coming where I'll have about that much money; take the check and bring it here and let me cash it so I don't have to go to jail for 110 days." She said, "No, you might need that money for something more important. I'm not going to bring you the check. You go to jail." And I did 110 days in the county jail because she wouldn't bring me the check. Now, that's a type of rejection, except she was thinking maybe when I got out I'd need the money for more important things, I guess. She didn't think 110 days out of my life was important. She didn't think my being subjected to jail confinement and all the things that go with jail confinement were bad enough for me for me to have to get out. She thought: Well, she just did 90 days. What's another

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110 days? It's not going to make any difference to her. And when I got arrested when I was eighteen, when I was pregnant, I said, "Mom, please bail me out of jail. I can't stand it." And she said, "I don't understand why." So I lied to her; I said, "The doctor said I might lose the baby if I'm confined." Then she bailed me out of jail. It cost her $25 to bail me out of jail. But when I was in R State Hospital, and they said, "She's got to stay here for the rest of her life," my mother said no. When they told her, "She doesn't know the meaning of love or anything else, she has no feelings," my mother said, "No, that's not true. I know that's not true. I'm not going to allow you to keep her." And so she saved me from that. You know, she always . . . she rejected me in a lot of ways, but she always held out some little thing for me to say, "Well, she does care"—you know. S: That saved your life. G: And yet she would say to me, "My God, why do you live like this? You'd be better off dead"; and that almost killed me. And yet ... Now, you know, now that my mother's not that important to me, I can think she didn't realize what she was doing to me. She couldn't have wanted to murder me. Perhaps the contradiction in her mother's behavior is the clue. In all these years, with all their tribulations, with all the hatred, with all the feeling of having been cheated and humiliated, Mrs. G never quite let go of her mother; nor did her mother quite let go of her. In the midst of their battling, it was understood without discussion that Mrs. G could spend the night with her mother; this I knew for years. But only near the end of treatment did she reveal that when she did so, they slept in the same bed. Here she was, a woman in her thirties and a grandmother; and she would still on occasion "go home" to her mother. The intensity of the two spikes of this ambivalence was fierce (as is common in psychosis), but one of those spikes was love. Much about Mrs. G's mother has already been quoted. The following treatment excerpts indicate less the pathology of the motherdaughter relationship than the resolution of their deadly symbiosis. G: She felt that I was bad. She can never accept the fact that I'm mentally ill. When I go into the hospital, I have to lie to her. I have to say I'm in there for physical reasons because she can't even comprehend anybody being mentally ill. That's something that she won't face or have anything to do with. But I have to say, "Momma, I have to go into the hospital because I gained too much weight," or "I have to go in there because there's something wrong with my

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brain.*' She can understand those kinds of things, but she can't understand me being mentally ill. You were telling me last week that the only reason that you couldn't come home from the hospital was because she wouldn't take you home. Is that right? Did she have something to do with your being in juvenile hall? Yeah, because I could have come home then, but she wouldn't take me home either. That's the reason they sent me to reform school. You were at reform school for seven months because your mother wouldn't accept you. You were in R State Hospital for ten months because your mother wouldn't accept you. Maybe she thought she was doing what was best for me. A long time ago when . . . I don't even remember when . . . when she said I was bad, it was important to be .bad because she wasn't a liar.

G: I could have died, and she wouldn't even have known it. Because I didn't eat ... I couldn't eat. When I was little, I couldn't eat, because I had to cry. S: What were you crying about? G: She wanted me to be a boy. She said, "I never wanted a girl. I always wanted boys." G: You know, I was supposed to have been born in X. This is one of the family jokes. My mother was all prepared to go. She had her trunks sent and everything. My father was stationed there. And I was born two months early. She never forgave me for that. G: I was thinking about that story you just finished telling me about the little girl who was a little girl who was not her mother's idea of a little girl. I don't think that was true of me because I think I was a little girl until I was about two. S: What makes you think that? G: Just from the way my mother talks. But my mother was afraid of me. She was afraid she'd break me or something. She told me that I was so small that my grandmother had to make special clothes for me. She was afraid to hold me. G: You know . . . when you think of all the things I've done, like being addicted and being put in jail for different things and stealing and lying and doing all these things, my mother was never disgusted with me. My mother always said, "O.K. You've done this. Now let's see what we can do about it." Where if I was in jail, she would say, "O.K. Let's get you bailed out and see what we can do about it." My mother never, never put me down for what I did ... until they told her I was queer. And then she wouldn't even look at me—she just

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walked away from me. She didn't want any part of that. I didn't understand what I did that was so terrible. She was disgusted. And I didn't know that I did anything wrong. I didn't know that what I did was bad. But I had to do it. I couldn't help doing it. It wasn't because I was in a place where it was expected of you—it was something I had to do. It was like I'd go along, and I have every day, and some days I'm confused, and some days I'm scared, and some days I'm O.K., and some days are bad, and some days are good— then I have to stop and I have to do that thing because it gives me strength to go on for more days when the days are good and the days are bad. It's like being addicted, like when you use heroin and you take a fix and you go along and you're O.K.; and sometimes you're better than O.K.: you feel real good; and sometimes you don't feel so good; sometimes it makes you vomit, and then you get to a point where your nose runs and your stomach hurts; so you go and get another fix, and you're O.K. again until the next time. Only it's different this way, because sometimes I go along and I'm O.K. for years.. .. G: I was disturbed yesterday. I fell asleep, and when I woke up, I was hallucinating, and I was crazy. About being bad and running away and stuff like that. S: What were you being bad about? G: I don't know. S: Yes, you told me the other day. You were thinking about living with another woman. What's worse for you? Is there anything in your whole category of sins that's worse than that? That is, living with a woman where you're labeled as being a woman-lover, namely, a homosexual. Isn't that supposed to be the worst one in the whole catalogue? G: Yeah. Because it's the baddest. It's dirtiest. S: Why is it dirtiest? G: The only thing that came into my mind was my mother. I was just thinking what she would say if she thought I was homosexual. I have to do what she says. I've never done anything except what she says. S: Suppose you were to do something your mother didn't approve of? G: Then she'd be angry. S: And then what would happen? What would she do? G: It scares me to think about that. Maybe she wouldn't like me any more. Then I wouldn't have a mother any more. I'd be all alone. That really doesn't make sense, does it? You know . . . Remember the last time I was in the hospital? My mother called me up one

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night, and she said, "I think its about time you came home." So I told the doctor, "Give me the paper. I'm going to sign out1* He said, "You can't do that." And I said, "Yes, I can. Call Dr. Stoller. I'm going home right now." And yet I knew that I shouldn't go, but I couldn't help it. I had to go. And I can't remember that doctor's name that talked to me; and he said, "Call her up and tell her you can't go." And I thought: Oh my God, what's going to happen if I do that? And then I thought: Well, she can't touch me because I'm here, and she can't get at me. So I called her up, and I said, "Look, Mom, I can't go. I'm crazy." And she said, "O.K. O.K. . . . when Dr. Stoller's ready for you to, go home." And it was so simple, and I was so relieved; but I was so scared. And that happens to me every day, every single day. I can't get away from her. When Bill and I went to M, I had to call her. She wrote and she told me, "You're no daughter of mine. I never want to hear from you"; and I wrote back and I said, "Sorry. It can't be that way." Because I couldn't stand that. And when I lived in W, and she lived a few miles away, I called her every day, every day, never fail. I can't do anything without her. See, I did, I did for so many years; I did what I wanted to do. ... By staying away from her and not talking to her. Remember the time I shot the cop? There was a big headline in the paper about this cop that got shot. But the story didn't mention my name. And my mother said she picked up the paper and she read the headlines, and she immediately knew it was me; but she thought it was funny, the whole thing that happened. . . . Funny, humorous, the whole situation. And when I got arrested for checks, she bailed me out of jail. And when I had illegitimate babies, she paid for my prenatal care and took care of the babies. And my car caught fire the other day, and it did a hundred dollars worth of damages, and she's paying to have it fixed. There isn't anything she wouldn't do for me. She drives me out of my mind. She makes me pay for it. I don't know that she knows she does it. I think the expression on her face changes. Maybe I don't really see that, maybe I just feel that. They committed me to R State Hospital. They said I was a psychopath. You were ten months at R because you were a psychopath? They only kept me three months when they discharged me, but nobody would come and get me, and they couldn't just let me go by myself, so I had to stay there. I was a minor. Your eyes went down with sadness. I was just wondering why nobody came to get me. My mother or somebody. Somebody should have come and gotten me.

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S: I want to hear from Charlie his impression of your mother. G: Did I tell you he thought she's scared? I think she has had so many bad things happen to her—you know, my grandmother is a bitch. What a vicious, what a vicious bitch that one is! She was never that way with me, but she is with everybody else, including my mother. And I think my mother is, you know . . . became sort of protecting herself against my grandmother and then just transferred* it to other people; and then when I started giving her trouble, she just kind of shut me off. Maybe that's why she put me in the hospital and put me in reform school and sent me to my grandmother and things like that, so I wouldn't hurt her. I was thinking about the time she put me in reform school. She kept asking me what did I want to do, did I want to come home or did I want to go to the "school." I said I wanted to do whatever she wanted me to do; and she said she only wanted to do what was best for me, and everybody had advised her that putting me in the "school" was best for me. I remember the first time I ran away from home. I was about nine, and I stayed away all night, and I hid in somebody's garage or something; and then I got scared, and I came home. And she never punished me; she just acted like I had never been gone . . . and that wasn't what 1 wanted her to do. Maybe I wanted her to come after me and take me home. And love me, I guess. S: So you come home, and she acts like you had never gone. That doesn't leave you much choice except to do something more dramatic the next time. What did you do? G: Oh, I cut my wrist once. S: How old? G: About nine. S: Was that the first suicide attempt? G: Yes. S: What did she say then? G: I don't remember. S: How did she act? G: I don't remember. S: What do you guess; what do you feel inside of yourself? G: I guess she just thought I was trying to get her attention. S: You may have done many things. In order to really be dramatic, as you progress, you've got to do more and more dangerous things, don't you? G: You know, if what you're saying is true, then the hospitalizetion could be as a result of my trying to get my mother's attention, because I was to take her out to dinner and take her to a meeting Saturday night, and it was very important to her that I'd be there;

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and yet I came into the hospital on Thursday after making the agreement to do this on Wednesday. Couldn't that very well be why I'm in the hospital now? G: I wonder why she doesn't like me. Because I'm bad. Because I do bad things. I steal things and I lie and I go to bed with women . . . but she doesn't know that. She wants me to be bad! Why wouldn't she like me when I'm bad when that's what she wants? She always told me, "You're bad." I always did what she told me to do, and she told me to be bad. I did what she told me to do. Like . . . like . . . sending me to the store to get bread, and I lost the money; and she said, "No, you stole it. You're lying." So I had to make up a lie about the money because she wanted to hear the lie. She didn't tell me what it [badness] meant. She didn't tell me ... she didn't tell me about right and . . . and to do something or not to do something. She didn't tell me there was two things to do ... not to do something and to do something; and I did things, and I didn't know that they were bad, that I wasn't supposed to do them. Nobody ever told me about that. About screwing boys. She never said you're not supposed to do that. I never knew you're not supposed to do that. Nobody told me that. S: How did you find out that you weren't? G: When I got pregnant. Then she said that's a bad thing to do. That's wrong. There's right, and there's wrong; but nobody ever told me what that means. I don't know what that means—right and wrong. Sometimes . . . sometimes something's good, and something's bad; and I do a lot of bad things. I'm a very bad person, I know that, but I don't understand it. I don't understand who decides what's bad and what's good; and I don't know why it's always her choice. Why is she always allowed to say what I do that's bad and that's good? She . . . you know what she could have done? She could have spanked me. You know, she never hit me, never once did she ever hit me; and then maybe I would have understood better. But she always said, "What have I done to deserve this?" or "What did I do wrong to make you like this?" And I didn't know. I didn't know what to tell her. And that was really confusing for me, but there were so many things she didn't tell me. Now I don't tell her anything. She doesn't want me to know, and there are things I don't want her to know, because now I know what's good and what's bad. I still don't know what's right and what's wrong—that's almost the same thing as what's good and what's bad; but maybe you could tell me what that is, what's good and what's bad and what's right and what's wrong, because you ought to know that. Like . . . like

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. . . like I'd like to see Chris dead, that would please me; but that's wrong. You told me that's wrong—to me that's right, see, so I'm confused about what that means. I hate to interrupt you. I said it was wrong for you to kill him. Yes. I didn't say it was wrong for him to be dead. Oh. See, there are so many things that you have to know, and I don't know any of those things. You can. You can. Go on ... I'm learning something about you .. . something I always knew, but didn't know quite right. I don't know. I don't know any more. She has different things to be good and bad for different people, like it was bad . . . when we ... before I married Bill, when I lived with this guy, you know, I went and lived with him for a while, that was bad, that was a bad thing to do. But when I was away from Bill, she encouraged me to go to bed with men. Now . . . see ... I don't understand, why was it bad at one time, but it's good now? I don't understand those kind of things, and they make me sick inside. They make my head all fucked up. I don't understand those kind of things, and I can't keep up with her; she's always changing what I'm supposed to do. I don't know what to do. She told me ... she told me, "If you're in financial trouble, go back and live with Bill." Now she just got through telling me it would be a good thing to get a divorce. She can't make up her mind—and how can she expect me to keep up with her all the time? It's very hard for me to do. It was all right for me to have illegitimate children—she made that all right for me. She didn't tell me not to get pregnant. She never told me that. She . . . but she took care of the babies, and she let me keep them, and then she signed papers to have me sterilized because I had illegitimate babies. Does that make sense? I don't understand that. She was saying I was bad or else she wouldn't have done that to me, and yet she made it good for me to do. So many things. The only thing that I can think of that she ever told me to do that I couldn't do ... there's only one thing that she ever told me to do that I couldn't do, and that was to dislike my father. I wasn't able to do that, and I think she knows that I feel bad about that. I do feel bad about that, but my father wasn't a bad man. "Your father really doesn't care about you or he wouldn't go away. Your father really doesn't care about you or he would come and see you." She blamed my father for signing the papers for my sterilization, and I found out that wasn't true. She lied about that. I don't know why she lies to me. She does that a lot, too. When my father died, and

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I wanted to go to the funeral, she said, "Why go to his funeral? That son-of-a-bitch never did anything for you." Oh, my God, why would she say anything like that? And he did nothing to her; he never hurt her; he never laid a hand on her. She wanted me to be crazy, too. When I was in school, there was a time when I was having a lot of trouble in school. I couldn't concentrate, and I got behind in my studies, and I was having trouble with talking to teachers . . . so I just ditched school; I didn't go to school for three months. So they told my mother that I needed a psychiatrist. I don't think that's what I ... I had rheumatic fever, and I was sick. I don't know if I needed a psychiatrist then or not; but then she would say, "Just because you're crazy doesn't mean that you're going to get away with this. Just because you're crazy, don't think you can do that." I didn't really feel crazy. I didn't know I was crazy. Do you know what bad means? I don't know what to tell you about my mother except . . . sometimes I think she's bad. I think she knows, I really think she knows, I really think she knows she can kill me; and sometimes I think she wants to. That's not very nice. I don't think she wanted to kill me. I think she just wanted me to die. She wanted to be rid of me and that's the same thing. She killed my father. He came to her, and he begged her to try and understand him and try to help him a little bit; and she sent him away; and he died. She knows she did it. She knows. She isn't going to tell anybody, but she knows; and I think she knows that I know. Maybe that's why she wants to get rid of me. When he came back, he got out of a mental hospital. Maybe she hates all crazy people. If you're supposed to hate all crazy people, I could hate her, because she's crazy, too. That's not right. I knew that didn't make sense when I said it. She thinks she's very feminine. You know she told me things like . . . I'm trying to think what she said to me about being feminine . . . act weak around men, but you're always stronger. You know like . . . she gave me an example . . . sometimes she helps out at work, and there's a cash box there that she can very easily carry; but she always has some man carry for her because that's pan of being feminine. Am I making sense? I don't sound like it. When she sent me to reform school and we were at juvenile hall, she said, "I feel very badly about this" and she cried. "I really don't want you to go away," she said; and that was a lie, because she was the one that sent me away. The court didn't want me to go to re-

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form school. I wasn't really bad then . . . yeah, I was bad, but they didn't think I was that bad. She did, but they didn't. Why does she do things like that? She lied to you when she told you that she insisted that they release me from R State Hospital. That's not true. She never went near the hospital. She visited me once the whole ten months I was there, and the only reason they discharged me was because they sterilized me. That was the understanding: if they tied my tubes, I could be discharged. Her interference had nothing to do with it. In fact, she never wrote to the hospital. She lied about that. What else? Oh, many things; a million things. She wanted me to be as good as a boy. She always said, "See, your big brother can do this and he can do that. Why can't you do it? He gets good grades in school. Why don't you get good grades in school? He can hit a baseball this far. Why can't you do it? He can beat up all the boys in the neighborhood. Why can't you do it?" So I did do it. Maybe she didn't know what I was. I was a girl. My father knew I was a girl, and Joe knew I was a girl; that was my mother's first husband. He knew I was a girl. He liked me better than he did my big brother. My grandmother knew I was a girl. Why didn't she [mother] know? I felt like a girl. I ... I was pleased that I was a girl. I don't know what to tell you any more. I felt feminine, and I was cute when I was little, and I had long curly hair, and I wanted to be a woman; 1 wanted to be a mother, and I wanted all kinds of things that you can't have if you're not a girl. I was a girl. That was before I found out she didn't want a girl. She'll tell you. If she had it to do over again, she'd have six boys. My father wanted me to be a girl. My father went away. I don't remember my father going away then. Maybe my father didn't go away. But I know . . . I remember being two. Maybe I don't remember. I remember being a baby. I remember being warm. I remember loving my mother. I remember my mother holding me, and I could put my face against her and feel her and she was warm. She wants me sometimes now. What does she want me for? Maybe she'd like me to do all the things she'd like to do but she can't do. Maybe she knows that I'll do things like that she won't. For instance, killing somebody. Going to bed with other women. The bad things. Because she punishes me when I upset her organization, but not when I do something bad . . . like . . . she put me in reform school, not because I was bad, but because the school authorities upset her system of dealing with me. She put me in R State Hospital not because I was bad, but because she wanted my kids, and she didn't want any interference from me. That's what I

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mean by ... she's never punished me for being bad. When I wrote bad checks and went to jail, she came and she bailed me out; and she thought it was funny that I got away with it. I lost my train of thought. Where did you get the feeling that your mother wanted you to do the things that she couldn't do, the bad things? Because she always protected me and seemed to be ... appeared to be pleased when I did certain things. My mother knew I was a liar. Didn't you hear her tell you that I've been lying since I was two years old? She should know. She's right, isn't she? Yeah. You have been lying. Why do you think you've been lying since you were two? I don't know. Had enough? Uhhuh. Tired? Nothing's settled, you know. I'm going to send you to the ward because you're still jumbled up. Is that all right? Let me ask you one last question—in a way, taking advantage of you. Are there other terrible things that you've done that you haven't told me about? Yeah. Would you tell me now? No. I'd just rather not tell you. How bad does it have to be? There's a lot of bad things that I haven't told you. Do you mean like something I did when I was a kid, or something I've done recently? Do you want to know why I wanted to commit suicide? Will it make you angry? Because I tried to kill Bill. I tried to poison him. [And so she announced this for the first time. And there we are into the episode reported in "Murder" about her attempt and failure to murder Bill, which led to the need to kill herself and the hospitalization in which the above interview took place.]

[And this excerpt, with Mrs. G feeling improved] G: I was really pissed at my mother last night. Goddamn, she made me mad. My son left home about noon—this was four o'clock—and I called my mother's, and he wasn't there. And I thought: Jesus Christ, he's been picked up by some goddamn queer or something, something horrible happened to him. And I was thinking of all the horrible possibilities, of course, and I was calling everybody trying to locate him; and it never occurred to me to call my brother, and . . . So finally I got hold of my mother at five o'clock, and I said,

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"Have you seen H?" And she said, "Oh, yes, he was here and had dinner . . . " And she said, "I'm sorry; I haven't got time to talk to you." And I said, "Look, I want to tell you something about the kids"; and she said, "Sorry. I'm going to a cocktail party"; and she hung up. [Laughs] It pissed me off. You got angry at your mother? Yeah. Isn't that unusual? Yeah.

G: I was just thinking about my mother. I think I like my mother. G: I wonder how I'm going to get along with my mother this weekend. Last weekend, the minute I walked in the door, she said, "You know, I'm not going to be responsible for you. I'm not going to worry about you or be concerned about you or help you in any way." She said, "I'm through with that." And what I think she meant was she's always really been through with that—this was the first time she'd been able to admit it. I talked to her on the phone last night about this lecture we went to, and she said something about being heterosexual, and I told her I was bisexual, and she said, "Everybody to their own taste." [Chuckles] That's kind of a funny thing to say. And . . . at first she didn't know what a bisexual was. So I explained that the best I could, and then I told her on Tuesday I was going to go to a lecture where they teach you how to commune with the dead. And she said [Laughs], she said, "I think that's very interesting. You should go, so that when I die I can continue to tell you what to do." I thought you'd appreciate that. And I said something like, "Jesus Christ, aren't you ever going to leave me alone, even when you're dead?" And she laughed at that; she thought that was pretty funny. G: I feel kind of excited. I was thinking about being angry with my mother, and being angry so out of proportion in relation to what happens. She called me several times this week, and I haven't been available to talk to her. So I called her, and I said, "You know if you call me at five o'clock, you're sure to get me." And she said, "I can't call you at five o'clock. That's the time I'm getting ready to have my dinner"; and that made me very angry. You know, like it couldn't be postponed for five minutes or something like that. And I don't know why that would make me angry. I guess because what she's sticking into her belly is more important than I am. [Later in treatment] G: You know, I told my mother the other night that I was homosexual.

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And she said "That's O.K. if that's what you want to be, but I prefer to be heterosexual." First she thought I was joking, and she was responding to that. But I kind of took that as permission to do what I wanted to do. G: . . . you know, when you're a little kid you think sometimes your mother found you on the doorstep; she doesn't really like you. I don't know what to tell you about my mother. My mother was cold, only not cold like I am, but unresponding. I was bad when my mother said I was bad; I lied when my mother called me a liar; I grew a penis because my mother wanted a son. S: You didn't do one thing that you might have. You didn't have the guts to do it. G: What, kill myself? [That was not what I had been thinking.] I remember one time her telling me that I'd be better off dead. G: My mother's been given a responsible job. It makes me tired because she's so childish about the whole thing, I guess, and it just kind of bores me. I have to listen to a blow-by-blow account of everything. She figures I know more than she does. S: But it sounds like she enjoys talking with you . . . respects you. Would you have thought that was possible when you were four years old? G: No. S: How did it happen? G: I don't know. It's only been in the last year or so that it's been that way. You know, one day . . . I don't know if I had come in to see you or what . . . but I was really upset, really, and I was crazy. I really was crazy. And I went to her house, and I said, "Look at me, I'm crazy. What are you going to do about it?" And she said, "Well, do you think you need to go back to the hospital?" And I said, "No. I don't need that at all. I need something else. I need you to help me." And she said, "Well, sit down, and we'll see what we can do"; and we just talked about. . . you know . . . I don't even remember; and gradually the craziness went away. And I said, "Well, thank you." But ever since that time, she's treated me differently. She had never seen me crazy before. S: She treats you as more mature after seeing you crazy! Help me with that. G: Well, I think it's the way I handled it. If I had ... I think if I had come back to the hospital, it would have been an entirely different matter. I think she would have treated me as a crazy person. I think . . . I think because I asked for help, and I did the best I could with myself, that she thought that I was more mature, more something,

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I don't know. I don't understand it, but she has treated me differently ever since then. I'm glad . . . I'm sorry about all the years though. That's what I was just thinking of. A mistake was made . . . the two of you didn't really understand each other for many, many years. She suffered mildly that her daughter wasn't available to her, and you suffered terribly; I don't mean that you felt the suffering; I mean that you were damaged as a result of it. You got the wrong idea about her, not completely wrong. You felt that she wasn't interested, and apparently she wasn't; but she had always the capacity to have enjoyed you, and it was lost. Of course, you did every possible thing that would have driven her farther away all the time you were trying to get her closer all those years. She's not the kind of a woman who would come up and be close to her daughter when her daughter was constantly in juvenile hall and all that kind of stuff. You really made a mistake. I asked my mother not long ago . . . we were talking about situations that had come up in my life, and she was talking to me about my father and her relationship with him and how she felt about him, and she was saying that she probably loved me more than any of the kids. She said that she had more feeling for me because I was so obvious to her all the time with my behavior and things like that... And the fact that I had always treated her with respect; I had never talked back to her or ... been disrespectful like the other kids had. And then she said she just doesn't know how . . . sometimes when I was at my worst, she just didn't know how she was going to be able to put up with me, but she did; and I thought it's because of the way she lives. It's her attitude about life. She just . . . she's so unreal. You know, anything I did . . . you know, if I stole a car, she could say, "Well, somebody else was responsible for that" or like she's saying this week: I was born with that in me. She always cleans things up. : Yeah. On the one hand, she ruins you in the process . .. you know, "It isn't your fault that you're poor protoplasm." She gives you two sides to it. She says: "You're really not so bad, go on doing what you're doing." And on the other side is some kind of a fundamental insult which is: "You know, you're just no good. . . . Considering that you're no good, you've really done very well" or "Considering that you're no good, you are lovable." Yeah. She has as much as said that to me recently. She's always said, "You were such a tomboy and you were such a roughneck" and things like that; but we never talked about my masculinity or

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femininity—we just. . . you know . . . I . . . maybe I was afraid of what she was going to say. Maybe I was afraid she would tell me how feminine I was. S: What would that mean if your mother told it to you? G: That would mean that a lot I had done was for nothing. When I think about her comments about,"Jesus, if 1 only didn't have any girls, I'd have six boys" or, "Jesus, if I had it to do over again, I wouldn't have any girls; they'd all be boys" and "Jesus, boys are never any trouble. How can women stand to have boys ... I mean girls?" And all this time I thought how much better it would be if I were a boy. And if she thought I was feminine . . . maybe that would just be . . . I don't know . . . I guess I wouldn't be wrong; I guess I really wouldn't object to that; that would be just reestablishing what she has been saying all along, that a girl is just not a good thing to have around. G: I think one of the things that was wrong about my method of sex was that there was so much of it that was compulsive, that it wasn't necessarily something that I wanted to do or needed . . . yeah, I needed to do it ... go out and pick up a man in a bar and go to bed with him, not because I was feeling excited or anything else, but it was kind of a compulsive thing. That was wrong. I don't know why that was true, and I don't know what stopped it, but I don't do it any more. I think about it though, but I just don't do it any more. But I did do it up until about two years ago, all the time. There was something wrong with that. My going to bed with women I always thought was wrong, but I didn't know why, not really, except that . . . I just had the idea that if one woman would go to bed with another woman, she would go to bed with her mother. I don't know where I got the idea you might go to bed with your mother unless there was a time when I wanted to go to bed with my mother, and I thought maybe by going to bed with other women that would kind of tear down my resistance to myself and then possibly I would invite my mother to bed. That's just theory—I don't know if that's true. But . . . Tonight if I wasn't going home, I'd sleep in the same bed with my mother. She's got a one-bedroom apartment now, and she's only got one bed, so if I spend the night with her, I'd sleep in the same bed with her. S: That doesn't strike you as unusual? G: No. S: Is that what women of thirty-four typically do with their mothers? G: I don't know. I suppose I could sleep on the couch... . There must be something that embarrasses me about sleeping with my mother be-

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cause I don't tell anybody else that I sleep in the same bed with my mother. It started when I was a kid. It started when I got pregnant with H, and she wanted me to sleep with her so that she'd be there if I needed her. We slept in the same room; we slept in the same bed. And then after he was born, we put his crib in there; and my sister had another room, and my brothers had another room, and I slept with my mother all through his babyhood, or as long as I was there—you know, I came and went. I slept with my mother of! and on until I married Bill, and then I only slept with my mother when I went to visit and spent the night. When H was born, when I was fourteen [sic], my mother worked so she didn't get home until two o'clock in the morning; and I would be in bed, and she would get into bed and wake me up and kiss me good night. My mother always kisses me. She knows, she knows it just irritates the shit out of me; but no matter where I am or what I'm doing, my mother kisses me. I couldn't imagine her not doing it. She's done it as long as I can remember. She leans over and kisses me on the mouth, and then puts her cheek up for me to kiss her. But she kisses all of us. It was just something that I was accustomed to. And then we'd both go to sleep. Side by side in bed. She would lay on her back and go to sleep, and I would turn on my right side, which is the way I sleep; and we would sleep so usually my back is to her, because I sleep on the left side of the bed. If I was upset or hurt or confused or any of those things, I couldn't go to my mother because my mother was too distant; and yet when I was in bed with her, it was while I was being comforted, it wasn't sexual. I'll give you an example. One day I was here to see you, I guess, and I was crazy, really crazy; and I left here and I was scared, really scared, because I didn't know what to do. ... Whatever I came here to get, I didn't get. . . . I should have gone home, but I didn't; I went to my mother's house. And I got panicky and I called my mother and asked her to come home from work; and my mother came home. And I said, "Look, I'm crazy and I don't know what's happening to me; and I want you to help me." And she said, "O.K. Tell me what to do." "Jesus, I can't tell you what to do. That's something you should know." She said, "Well, stay here tonight; spend the night here"; and I went to bed with her, and I felt relieved and comforted. I don't know how to explain it any other way. In the past, an unkind thought about her mother had to be repressed by Mrs. G, and in its place would be a micropsychotic episode (i.e., sudden, intense, and easily remitted during an hour of treatment).

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Now, late in treatment, Mrs. G handles such thoughts very differently. Her mother is rearranging her life, taking on new interests that do not include Mrs. G: G: You know, as much as my mother and I had bitterness and fighting and small-time bickering and personality differences and all that, when we were in bed together, there wasn't any of that. I don't know what it was. I don't know if I was her friend; I don't know if it was we were close friends, but. . . You know, when I left Bill, I knew then that there was something . . . when she said "Come home" and I went there; but I couldn't stay there, though, because it was too much for me to handle. I don't know if I talked to you about that at that time. I felt like I was smothering. She was . . . she was too good to me . . . it was too much; I couldn't handle it, and I had to get out of there. S: You've done that with other women. G: Yeah. That's the way it was, although I've never had any sex with my mother or even considered it. I'll have to grow up. I can just find the same thing I had with my mother with somebody else. S: Did you ever go to a girl because of something with your mother? G: Probably. S: "Probably" is a crappy answer. G: I was thinking about one time when I went to a girl. My mother was working and didn't have time for me; in fact, she was seeing a man then. . . . Do you know what came into my head? My fifthgrade teacher who I loved with all my heart and all my soul. I don't even know how old I was in the fifth grade. That's the second time today that I mentioned my fifth-grade teacher. No, it was yesterday. I was talking to one of the neighborhood little girls who lives next door to me and she was talking about her . . . she's in the .fifth grade . . . and she was talking about her teacher and how mean the teacher is, and I said, "I had a mean one in the third grade, but when I was in the fifth grade I had a beautiful teacher, and I really loved her"; and I used to want to get close to her because she smelled good, and I used to want to touch her because it made me feel good. But I don't know what that has to do with my mother. S: What does it have to do with her? Jesus Christ, your five hundred years of therapy! G: I'm trying to think if I ever went to another woman because of my mother. Don't sidetrack me. I called my mother once and asked her to send me money so I could come home. She said, "No, I can't do that right now." I went with another woman, the same day; I had something to do with another woman. But, you know, I can't re-

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member consciously: Well, my mother's rejected me so I'm going to go out and find a piece of ass. I'm thinking about a man. When I was about seven, I guess, there was this man who used to fondle me sexually; and it was hard for me to go to him because I was so young my mother wouldn't let me go alone. I'm sure I couldn't have been more than seven because I don't think my sister was in school yet. I don't know why I thought of him. He was a cab driver. I don't even remember how it started. I remember . . . I can picture myself being there in that room with him and ... and him feeling my body. It was during the summer. It had to be during the summer because my mother would send me to the ... We had a recreation department at the school where we did crafts and things during the morning, and my mother worked, so she would send me there as she went to work; and my brother would pick me up in the afternoon. And I would walk from the school down into town and be with this man in the morning and get back to the school in time to get picked up by my brother. Maybe three times, maybe thirty times, I don't know. But I can picture myself in that room with that man. Just a little girl in the room with him with his hand in my pants. I had a dress on, though. That's unusual because I didn't wear dresses. S: You think of this when you're talking about your mother. What's the connection between this man and your mother? G: The only connection I can get is you said, "Can you ever think of any reason why you might have gone to another woman because of something your mother did?" It didn't necessarily mean I had gone to another woman. I could have gone to anybody because of something my mother did. That's all it means to me. G: S: G: S: G: S: G: S: G:

There are things about me that I don't want you to know. Give me an example. Give me the easiest one you can stand. I don't want you to know why I used to go to bed with men. Now give me the hardest. You can disguise it in the way you just disguised that. I don't want you to know about me being a boy. I wanted to be a boy so that I could grow up and kill my father and have my mother. Now, see, now I'm scared. My stomach is just going up and down. Hold it, wait a minute. Is that true? Yes. When did you first know it? Probably the day I wanted to be a boy. When I was very small. Probably when I was about four or five. I was in bed, and my father was home, and my mother and father were in bed, and a light was on in their bedroom. And I slept in a little alcove off their bedroom,

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and I could see the light from their room, and the baby was in their room . . . I must have been five ... and I thought: God, if I were just a man, I could kill him. And I thought, I thought: All you need to be a boy is a penis. Then I thought: If I just get big enough, if I'm just big enough to be a man, I can kill him. But I didn't really want to kill him. I think it had to do with his going away. You know, he was always going away. And this time when he left he was going to go to war, and he would be back unless he was killed. And I don't know that I really knew what death meant because I don't think I ever had anything to do with death. I knew if he got killed in the war, he wouldn't come back. So I knew if I killed him, he wouldn't come back. But I don't know that I thought: Well, I'll take a gun and shoot him or stab him—or anything like that; because I don't think I knew enough about killing a person or ... but I just thought if he was dead, he'd be gone. I wanted him to be gone so I could have my mother. [Pause] Then I could sleep with her and . . . I don't know, just so I could have my mother. S: You're five years old. How do you want to have her? G: I want to be inside of her. . . . I still want to be inside of her. . . . That's enough. O.K.? They were laughing, I guess . . . not laughing, but they were happy; I know that. Maybe I thought they were laughing. My mother was making sounds like she felt good, you know, like she was happy. I don't know what they were doing. Even now, thirty years later, I don't know what they were doing. It's just that he had her. I called my mother. When they were in the bedroom I called my mother, and she wouldn't come to me. I don't even think she heard me. I don't know. I didn't hate him really. I didn't hate him until later. It's too late now; he's gone. As I write now, Mrs. G has drifted away from her mother, whom she visits or phones infrequently; she makes decisions without thoughts intruding about how her mother would judge the act. Most important, she has discovered that her conscience has been made of two parts, one true but quiet, the other dramatic, noisy, demanding, extreme, and corruptible. The latter is a distorted version of her mother, not in a oneto-one identification, but as caricature, loaded with sarcasm: All right, Mother, if you want me to be such-and-such, I'll comply—literally. And so a fundament of Mrs. G's behavior since childhood—even a part of her suicidal drive—has been sarcastic identification,2 a parody of what she thought her mother wanted her to be, a "joke." Mrs. G's behavior was an endless reductio ad absurdum of her

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mother's demands. Behind her sarcastic compliance, Mrs. G hated her mother, in a secret (unconscious) knowledge that she, Mrs. G, existed hi her own right. That real person, however, could go on only if unseen, unknown. She constructed Charlie and Carrie to save her true self from annihilation. She, a female, had to permit herself to have a penis to stop mother's complaining. She suffered the rituals and sacrifices of appeasement (no more accepting them as honorable than the true believer admires himself for pandering to his corruptible god). At bottom, she knew she was the victim of her false self s demand that she offer her life as a gift, in sarcasm, to her mother: Mother, you said it would have been better if I had never been born; then let me please you by murdering myself (knowing—this is the joke—that if the wish came true, Mother would not be made happy). I was exposed to these forces in the transference (but did not fully understand them till the end): Mrs. G's teasing, pseudostupidity, silences, toughness, and masculinity were directed at me as they had been at her mother. But they were also directed toward her (true) self by her later created (false) self.3 We were both interested in discovering, when this true self was revealed, that it really could murder, that it really loved women's bodies, and that it was true to itself (i.e., she was true to herself) only when Mrs. G finally accepted these impulses. Then, from other parts of herself, Mrs. G also accepted the demand that she not act on them. There are those, like Fenichel and Guntrip, 4 who feel there is no innately aggressive (meaning "hostile," uviolence-toward-an-object") instinct or drive. Guntrip maintains that man's nature is good—or good enough—before it is contaminated by anxiety and frustration. I cannot tell. In any case, it does not follow that the true self—the irreducible minimum being—is good. Rather, that self is true, i.e., unalterable. Alterations are the changes forced upon it by conflict and are known (unconsciously) to be compromises.

14 Homosexuality

Being a study of a very masculine woman who believed she had a penis, this is, especially, a work on homosexuality* And despite my having fragmented Mrs. G by describing her under various chapter headings, we must try to see her whole and realize that the theme of homosexuality has pervaded all aspects of her life and personality. For instance, her homosexuality and her rage—murderous and suicidal— are inextricable: she tried to murder because of the same conflicts that gave rise to her penis; and she was suicidal because she could not bear to think* of herself as homosexual and because she had to murder. Let us concentrate in this chapter on the roots of Mrs. G's homosexuality, bearing in mind that what is reported about Mrs. G*s childhood has come from her and been filtered through my interpretation. Another caution: although there are those who consider homosexuality a thing, that is, a diagnostic category, a number of us are not certain homosexuality is a precise entity or that the homosexual is a clear-cut personality type. I would also differentiate being a homosexual from the adjective "homosexual," choosing to think that one may have homosexual relations and still not be a homosexual, depending on what one takes oneself to be.1 I prefer for now to regard homosexuality rather, like heterosexuality, as a style of sexual behavior arrived at by many routes traveled from infancy by innumerable personality types, in which a person has a habitual preference for genital gratification with a person of the same sex. This is not to imply a belief that homosexuality is "normal." Elsewhere, concerned with this issue, I have said: There is much turmoil today whether aberrant behavior is perverse (i.e., nasty, sick) or only deviant (statistically askew); the key words have been "normal" and "healthy.** These arguments have been less than inspirational because the contenders, each with Science by his 271

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side, have ignored what the opposition meant by "normal" or "healthy." The one group says the perverse person is abnormal because the aberrant behavior can be traced back to childhood trauma and conflict. The other says the deviant is not abnormal because he manages his life, other than his personal preferences, no more peculiarly than heterosexuals, who, anyway, are not noted in the mass for their happiness and creativity. For myself, I agree with both—and with neither. I think many aberrations are perversions in the sense that they emerge as solutions to conflicts and thus secrete a burden of guilt and a sense of risktaking in their core. On the other hand, I do not believe these dynamics cripple most of their owners any more than does the conflictsolving that produces normative (heterosexual) behavior.* We may not solve these moral issues, which masquerade as scientific ones, as easily as each side hopes.2 At present I believe most homosexuals are what they are in order to preserve a nucleus of heterosexuality somewhere inside, reflecting the fact that heterosexuality is the expected as well as the normative state. This is the case not so much because it is biologically ordained (such a tendency is at best weakly sustained in humans) but rather because in all societies the styles of rearing encourage boys to be masculine and girls, feminine, making a person of the opposite sex more exciting and pleasurable. This is done via the forces that encourage identification and in the intricacies of the oedipai situation. These forces of rearing being so variable, erratic, embedded in conflict, and beyond the power of a child to control, the development to heterosexuality can be uncertain, painful, incomplete, and damaged in those who prefer people of the opposite sex (as well as in those who prefer the same sex) for their partners. I do not see, therefore, that heterosexuality is a natural, normal state, but rather, in some ways like homosexuality, a synthesis. Because we find so much variability of personality in those who prefer sex with people of the same sex, we might do better either to have several varieties within the diagnosis "homosexuality" or, if we have too much trouble categorizing, simply to be satisfied with descriptions. We can spare ourselves some semantic problems by dividing what is called homosexuality into several categories of sexual (what anatomy and physiology are engaged) and gender (masculine and feminine) behavior. If we dissect a person into these sorts of cate* This is the less true the more bizarre the aberration.

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gories each time we wonder if we should label someone a homosexual, then we may come to realize that we may never find an entity, "homosexuality," but rather that we should be studying "the homosexualities," a number of different conditions with different clinical pictures, different dynamics, and different etiologies. This might eliminate some of the obtuseness from questions such as whether homosexuals are normal or abnormal, and the fatuous yes or no answers that indicate a belief in a single entity, homosexuality, for which a yes or no answer will cover all cases. Back to Mrs. G: Her mother did not want her the way she was: a girl. She was given her father's name at birth; she was put into boys' clothes; her mother often sent her away for months at a time during infancy and early childhood; her mother made much of the advantages of maleness and gave Mrs. G no sense of worth as a female.3 There was nevertheless just enough affection, fulfillment of Mrs. G's bodily needs, and moments of intimacy between the two to torment Mrs. G with hope: the rare occasions when she and her mother were close made her continually yearn for more. Rejection by her mother was not absolute, and so the desire to get back to her mother was intensified. Mrs. G could never separate herself adequately from her mother's body, and her homosexual experiences were clearly occasions when for a moment she could recover intimacy with her mother. Unfortunately, unlike in most overt homosexuals, her conscience forbade her to be a homosexual. (Overt homosexuals may feel guilty or dirty or defiant, but not that their behavior is absolutely forbidden.) Because her mother had defined "homosexual" as obscene, Mrs. G was torn between her overwhelming need to return to her mother's body and her conviction that such a return constituted homosexuality. She solved this in a simple-minded but clever manner by redefining the world, partly through psychosis and partly through language, i.e., "If I insist I am not a homosexual, then what I am doing is not homosexuality." This required remaking the world, within and without. Heterosexuality, which her mother said was permitted, takes place between penis and vagina. This brings us to another theme: Mrs. G's penis. It closed the otherwise unbridgeable gap between being unwanted by her mother and having to get back to her mother and so permitted her to sleep with women. Before age four she had figured out that the penis be»ng the insignia of the difference between males and females, she would need a penis in order to capture her mother's attention and love. We

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shall not be wrong in calling this factor in Mrs. G's homosexuality "penis envy," for she invented her penis before discovering its use in obscuring her homosexuality. (Her hatred of people with natural penises—males—was literally of murderous proportions.) So she created a penis.4

History—Behavior and Object Choices Let us briefly examine some of Mrs. G's experiences that most people would call homosexual. G: You know what my mother told me the other day? She's O.K., she really is. You know that she told me—and she let me do it, that's something that really bugs me—she said when I was little, when I was about two, I used to lift her dress up and kiss her thighs. Isn't that sickening? She was telling me about it the other day because my little nephew, who is two, I was holding him, and he pulled my blouse back and he kissed my breast. And 1 pulled him away, and he said "I love you"—he's a real cute little shit anyway—and my mother said, "You know, you used to do that to me when you were his age." And I said, "Did what?" And she said, "You used to kiss my breast and lift my dress and kiss my thighs"; and 1 thought: Jesus Christ, you're telling me thatl . . . I don't know what you're telling me. I don't want to hear it. I don't know what she was telling me. She was making a queer out of me! She just went on and on. ... Mrs. G recalls that when a child of about four or five, she strapped a nipple from a baby bottle onto herself to simulate a penis; this was because the penis already felt inside was not visible. Similar behavior is seen in other little girls, but Mrs. G went further. She knew there was a penis inside of her. This was not play. At the age of five or six, she was playing the doctor game with other girls, always taking a male part, usually that of the doctor. G: One time when I was real little—I don't even know how old I was, five or six—we were real poor; and there was this little girl who came from . . . 1 get the impression her family was very wealthy. And she had a playhouse in her yard with all kinds of things, and I was allowed to play with her one day a week—her mother allowed me to play with her one day a week—and we were in that playhouse, and I took her clothes off. Her mother got so angry and called me dirty names. I never was allowed to go back. And she told my mother, and my mother beat the shit out of me. I just remember wondering what everybody was so angry about because I hadn't done anything bad. I didn't hurt her or anything.

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I couldn't have been more than five or six. She was probably about the same age. We were playing some kind of a game, you know, like mommy and daddy or nurse or some damn thing. Were you playing the boy's part? Yeah. Did you always? Yeah. You never played the girl? No. The penis was already there? Yeah. Did you want to see her only? Yeah. I wanted to see if she was the same way I was. I didn't know what I was. I always thought I was better than a little boy. Because I had both.

Mrs. G's first genital homosexual experiences occurred around age eleven or twelve. She was used as one of the two females in a pornographic movie. Around the same time, she joined four other girls in occasional mutual masturbation. G: You know when I was eleven and twelve, most of the girls in my class were thirteen and fourteen. When I graduated into high school from the eighth grade, I had just had my twelfth birthday. I graduated in February, and I was twelve in January. When I was in high school, I was a lot younger than most of the other girls; and the girls that I ran around with were a pretty wild bunch—you know, screwing around and drinking and this sort of thing. And I can even picture them. There were four of us, and we went to this girl's house, and it seemed to me they were using a vibrator with something attached to it on each other. I don't remember exactly, but I enjoyed it, and it was repeated. / did it. S: Did you have it done? G: No. I wish I was twelve now. Things weren't so complicated then: it didn't bother me. It didn't make me sick . . . I didn't vomit. Then, at age fifteen, while in juvenile hall for several months, Mrs. G was part of the microsociety the imprisoned girls had invented. Because so many of them were Mexican-American (as is Mrs. G), the terms for their roles were Spanish: chicks [chiquitas] for the feminine girls and vatos for the masculine girls. Because of her tough, boyish appearance, Mrs. G was instantly accepted as a vato. The chicks and vatos paired off, "married" in a ceremony in which all the girls took part, and were expected to act toward each other and toward the rest

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of the society like a happily married couple. Whether sexual relations occurred or not was not very important; what is important is that these lost girls reinvented a family, at least a husband and wife. At the top of the hierarchy were those who were there because they were "cool": they ignored the guards, the rules, and the consequences, could take or leave sex, but were nonetheless warm and loyal with their peers. The girls considered those who did not need sexual relations as the most cool, but those who did have sexual relations were not considered inferior. Mrs. G was one of the leaders. She was tough and stood up to the authorities, never showing them her emotions; but she was warm with her friends. She was even more highly regarded because she could not stand to have a girl touch her body. She was frightened and depressed most of the time, but it was essential that none of this show (a quality she has always had, which made for strong resistance in treatment). She "married" one of the girls, toward whom she felt warm and loving. Infrequently she had sexual relations, but these were not important for her; what was important was that she have the relationship with the girl. Transferred to reform school, Mrs. G was seduced by the principal, a woman. Mrs. G was willing, not because of sexual need, but because she knew she could then use blackmail to hasten her release. By her early twenties, Mrs. G's regular homosexual life had begun (though she denied it was homosexual). She wished her partner to be a feminine woman younger than herself. The girl had to be ripe, that is, transmitting a sense—even if unaware of it—of wanting sexual relations, of wanting to be loved, and to have children. She would have long hair, feminine dress and demeanor, softness and delicacy, and apparently exclusively heterosexual interests; it was essential in those days that not the slightest hint of homosexuality appear in the girl's behavior and that she never have had homosexual relations. In addition, she was not to be heterosexually promiscuous, married, or a mother. There was a special piquancy in these girls* looking as if just ready to be plucked by a man. Thus for Mrs. G to take them out of men's hands was a great victory over maleness. She had defined these girls as the most feminine and the most attractive to men, almost bursting with their heterosexuality, so that, on seducing them, she outdid men. A man, so the fantasy went, could take such girls unthinkingly, automatically; for Mrs. G to get them, to arouse and gratify them, to make

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them come back to her and choose her over men, gave her a sense of triumph that increased her sexual pleasure immeasurably. She had two sorts of relationships. The first was casual, a pickup— usually in a bar—or a friend with whom she had previously had sexual relations. The second, much more intense, would occur with an apparently completely heterosexual woman whom she had known for a long time, e.g., a woman with whom she had shared an apartment for months. After a period of no overt sexuality, there was a sudden, unexpected seduction, Mrs. G always having gotten drunk before it and not having had a conscious awareness that she would act thus. Her partners, she said, responded to the seduction with sexual excitement and pleasure and without visible remorse. Yet, within a few hours, Mrs. G would have packed and run away. On one occasion, such a seduction led her, as we have seen, to attempt suicide and the murder of her small children. Mrs. G's sexual relations were compromises between what her body and emotions wanted and what her mother (her conscience) forbade.5 To be touched on the genitals or breasts by another woman was homosexual, so she never permitted that; even in the most casual social situations she shrank from contact with women or girls. Only late in treatment did she recognize how exciting it was for a woman to caress her, especially her breasts and genitals. She also protected herself against an acknowledgment of being homosexual by having her penis move into her vagina, where it took part in the sexual relations, so that with orgasm (though with women only) she had a sensation of ejaculation ("If I have a penis, then what I am doing is not homosexuality"). Mrs. G always took what she considered to be men's sexual positions in intercourse with women. Her sexual activity was geared to her partner's satisfaction; and like many homosexual women, she became a skillful lover, priding herself on her ability to satisfy any woman far more than a man could. She was motivated not only by a conscious pleasure in being an adept sexual performer but more so by the unconscious fantasy of trying to satisfy her unsatisfiable mother, who was in every woman with whom she was intimate. Invariably, it was only after her partner had had her orgasm that Mrs. G would then have hers. As a physical experience, her orgasm was of no consequence to her (which is not to say it was not intense); rather, what counted was that she had finished her task of gratifying her partner and could now anticipate her real reason for sexual relations: to

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lie quietly cradled in the softness of her partner's body. Only at that point, after orgasm, could Mrs. G switch over from being the strong one and become the child of her partner. When with a woman, Mrs. G found a single orgasm quite enough, though if it was expected of her, she would go further, in response to her partner's wish for more. In contrast, in sexual relations with men, although she reached orgasm easily, she was always ready for more— and, of course, "more" was just one more than her male partner could manage.0 Sexual competitiveness with women, however, simply did not exist. Demeanor Mrs. G is butchy. She is tough. No one would consider her graceful or feminine, nor has she ever wanted to be (except for a couple of weeks of diligent learning following the operation for tubal repair). She almost always wears slacks, a man-styled shirt, and mannish shoes. Her hair has always been cut short. She has never used makeup. She walks with a solid, deliberate, flat-footed, slow, rolling gait. She despises showing emotions of sadness or affection. She is tough in speech, in choice of words, inflections of voice, forcefulness of voice, and the belligerent, cocky position of her head as she talks or listens. Relations with Men Mrs. G was trapped by her heterosexual impulses. She could not come to terms with them or rid herself, as do many homosexual women, of her consciously felt need for men. I think she might have had a more peaceful life if she could have resolved her heterosexual feelings by repression, uncomplicated hatred of men as sexual partners, frigidity, or a life of institutionalized abstinence (such as being a maiden aunt, dedicated asexual scholar, or nun). For Mrs. G not only wanted to be against her mother's body: she also craved her father. This must have been why she was, in fact, so often the victim of infamous assaults by men. A grandfather, two uncles, and several strangers had already had intercourse with her by the time she was eight; and without letup thereafter, boys, adolescents, adults, and aging men found her sexually compliant. More than that —she was skilled, enthusiastic, always willing, and always able (so long as it was not fellatio or anal intercourse). By the time she was a young woman in her teens, Mrs. G was only

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selectively promiscuous. Every man she has had as platonic friend, lover, or husband has been intelligent, physically fastidious, and endowed with special potentials—but a failed man. They fall into five groups. Her four husbands constitute the first group: all were "sick," i.e., visibly damaged, with marked neurotic symptoms. The men in the second group, four lovers she has known for years but never imagined marrying, are manly and warm, trustworthy and unneurotic; but with them her relationship has always been all friendship, without love or commitment. For these men only has she never felt contempt. The third group is made up of the men chosen to father her children. They have had to be especially good examples of the positive qualities already mentioned, but of the weaknesses as well. The fourth group have been strangers, whom she has usually picked up at bars when suddenly afflicted with heterosexual fever. Her purpose has been to outscrew the strangers, and she has invariably succeeded. This acute heterosexuality has usually been a flight from a particular homosexual possibility or a commando raid on maleness inspired by a need for revenge. She has a predilection among the friends and strangers for policemen (never firemen) and soldiers (never sailors).* The fifth group is composed of men with whom she has had long-lasting friendships but no sexual relations, usually homosexuals. With them there has been no anger, envy, or desire for revenge. There have been no shifts in the men in any group from one category to another. She has loved only two men: her father and V, with whom she lived in a loving, uncomplicated, unbrutal way for almost a year. She fled from him only when she felt she had ruined the "cleanness" of their relationship by having gone to bed with a woman one night. The flight consisted of a serious attempt to kill her children and herself, followed by lengthy hospitalization, as we have noted earlier. Here is an example of how Mrs. G permitted herself to be used by men. When eleven or twelve years old, she babysat for a professional photographer, who asked her to be a subject with another woman in a pornographic movie. He tried to prepare her for what she should do by giving her pornographic books and by showing her photographs and movies of women in homosexual behavior. I repeatedly asked her if she was surprised he did this, and she repeatedly said she was not, * Perhaps it is no coincidence that the grandfather with whom she lived for several years (not the one who had intercourse with her) in infancy and childhood was a policeman, and her father was a soldier.

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adding, "Look. I cannot make up something that is not true. I cannot tell you something [surprise] I did not feel." I could not understand this until it occurred to me, and I said as much to her, that it must not have surprised her because nothing men had done to her had surprised her. She confirmed this: 'That's right. Since I have been three years old. Nothing they do surprises me. This wasn't anything new. I had had [homosexual] intercourse before, just never had pictures taken of me." As we have seen, Mrs. G has tried hard to kill men, by shooting, poison, and her automobile. This murderousness came from heterosexual despair (which is at the root of so much homosexuality). She has never tried to murder a woman, or even thought of doing so (except for her mother). Late in treatment, there was this admission: G: I really don't even know what a man is; I just really never knew a man. I had all these ideas about what a man was. All a man represented to me was an enormous prick that was capable of dealing out life and death. I thought that was the greatest and the strongest and the most magnificent thing in the world; and in my lifetime I've obviously known all kinds of men, all kinds. They weren't all magnificent and strong—in fact, most of. them weren't strong; because I think if they'd really been strong, I'd probably have been scared of them. Parthenogenesis Because penis envy is such a powerful part of the makeup of many female homosexuals, they must devalue maleness. (The same is true for other women, not necessarily homosexual—those, for instance, who enjoy being only with effeminate homosexual males, because these men do not stir up the angry feelings of penis envy.) At its most sensational, this rage against men provokes manifestos from women proclaiming the biological and social uselessness of males. A milder form of this desire to rid the world of males is the fantasy of parthenogenesis. Fairly often one sees a female homosexual couple who try to simulate a married couple, setting up a bourgeois household based upon cliches abstracted from the culture. To complete the picture and to demonstrate that a happy marriage does not require a male, the couple, starting with raising dogs, may move on to babies. They may even choose to have the more feminine of the couple go to the community sperm bank, that is, they pick a suitable male7 and

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extract sperm from him by vaginal manipulation, until the woman has gotten pregnant. Then the borrowed testes and penis are discarded. The couple now go through the pregnancy, delivery, and rearing of the infant, happy a man has not been psychologically involved, but has functioned only as the syringe for insemination. Mrs. G did something like this, except she could never have lived for long with another woman, much less gone through the role-playing of the homosexual marriage (except for the experience at juvenile hall). She consciously believed herself promiscuous (that is, that she was indiscriminate) and accompanied that belief with the satisfying thought that she had slept with hundreds of men because "they're all the same." In this way she could make them out to be worthless. (Only after years of treatment, when men had come to be regarded as worthwhile, did she know she had not been promiscuous in the sense of thinking that any man would do. She finally learned that she had picked her men very precisely and that in the five categories into which she had placed them, each served a necessary function distinct from the other categories.) To have babies was very important to Mrs. G: it was her strongest act of affirmation, each pregnancy and each child (if male) an island standing solidly in her sea of confusion. But she would tell herself that, aside from picking a man of good genetic stock, it made no difference who the father was. In fact, once pregnant, she ended the relationship with the man, nastily so that he would be hurt and degraded. As an adult, when having intercourse with a man (except for the four with whom she had a real relationship, those selected for fatherhood, and her husbands), Mrs. G chose not to know the man's name or where he lived; she would not attempt to explore his personality beyond checking that he was intelligent, physically clean, white, and middle class. Making sure she saw all men as the same, she still did not know they were all the same: The Father. He ruins every woman's parthenogenesis. Transsexual Fantasies To understand what is meant by the label "homosexual," one must take note of another category: transsexual fantasies. By this I mean conscious and/or unconscious fantasies of being (anatomically) a member of the opposite sex. Transsexual fantasies are very common. In the past, they were called "homosexual." They are a prime example of the confusion that words bring to theory. One runs into such words

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over and over in the literature, and there is probably no psychoanalyst who has not heard them repeatedly: "penis envy" is an example. However much it suits some to deny there is such a condition, one repeatedly hears the fantasies of women in which they imagine themselves with a penis, that is, sexually transformed. Likewise, one hears frequently from males of their envy of women's bodies and their fantasies of taking over some of the female physical attributes. (We are now talking about people without marked problems in masculinity and femininity.) So when we encounter unusually masculine women and unusually effeminate or feminine men, we are not surprised to hear these transsexual fantasies in even more insistent and elaborated form. In addition, we see the defenses against such fantasies, e.g., the attempts some men make to create a hypermasculine-appearing body by weight-lifting, or the exhibitionism of the hysterical woman. I believe homosexuality can be roughly quantified according to the intensity of transsexual wishes/ For males, those with the least transsexual desire are the most masculine, and should they wish treatment for their homosexuality, they are the most likely to become more heterosexual (there are those who consider them to be heterosexual with a pseudohomosexual defense 9 ). Those who are most feminine (which indicates powerful transsexual wishes) do not change with treatment, and they have no heterosexual needs to speak of. They need most of all a person of the same anatomic sex because their psychologic sex (gender identity) contains so many elements of the attitudes and role of the opposite sex. Homosexuals can live with transsexual desires. Freud developed a thesis concerning those people who cannot, in what he stated was the cause of paranoia:10 this psychosis, according to him, is due to unacceptable homosexual fantasies. His thesis was elaborated by others, so that finally, ludicrously, practically every form of psychopathology was explained on the basis of "homosexual" conflicts.11 I think Freud was wrong, however, in feeling he had reached the bottom of the process when he found "latent homosexuality." It is, rather, the fear of sexual transformation that one often sees in paranoid schizophrenics; the fear of homosexuality (loving the same sex) is more superficial. Homosexuality is feared, then, because if one should have sexual relations with a person of the same sex, one may in some way be a member of the opposite sex and thus lose one's identity. In schizophrenics, "homosexual" accusations (perhaps they should be

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called transsexual accusations) are found much more commonly in men than in women (as is transsexualism). Infants spend their first, intense months of life against their mothers' bodies and in intimate contact with feminine psyches. Later in life, to reduce tension, both sexes are drawn back by that memory of the mother's flesh; and to wish to merge with her, in infancy and in adult life, is to risk becoming like her. For a girl or woman, this is no threat to gender identity; but in a boy or man, it obviously can present problems. Mrs. G is net a transsexual, but she certainly has transsexual tendencies, more than almost any other patient I have seen with gender identity problems except female transsexuals. She is not a female transsexual because she does not believe herself to be a member of the opposite sex (she only believed that she had one of the necessary anatomical features of the opposite sex); she does not ask or expect to be transformed into a member of the opposite sex (she wishes she had been born so, but does not believe it could happen no matter what surgical or other procedures were inflicted upon her); she makes no effort to pass as a member of the opposite sex. Identification "Identification" can mean either the process of identification or those products (identifications) that result, ihtraphysically, from the process. It is usually assumed that a child begins to develop gender identity by drawing from adult models, especially the parent of the same sex. As we have already seen, Mrs. G's development in this respect was not ''normal." Although she considered her mother feminine, she felt herself driven from identifying with femininity; she was not to be like her mother. S: Why couldn't you have been a female like your mother? Why wasn't it possible for you to be soft, cuddly, feminine? G: Because I would have died. I was just thinking, that makes me sad. I was thinking about when I was little. It's sad that I couldn't be a little girl. S: I believe that when you even put your life in danger holding up gas stations, riding your motorcycle too fast, that you were running away from the little girl that was inside of you. G: When I was holding up gas stations and riding my motorcycle too fast, I didn't think about whether I was male or female. Until a

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little while ago, I never gave it a thought, because I knew what I was and I didn't have to think about whether 1 was male or female. While not wanting at first to be a boy, Mrs. G felt her mother considered her having been born a girl a misfortune. On the other hand, her father always expressed his pleasure that she was a girl; unfortunately, he was rarely home. So she felt she was a female—which was unalterable and unacceptable; and she wished she were a male— which could never be. As the pull to be like her mother was thwarted, as it is not in more normal women, the urge to develop men's qualities grew. However, she was not encouraged in this to the extent that children who become transsexuals are: when these children start dressing and acting like members of the opposite sex, their parents are pleased. The parents of such children are too silent when communicating to which sex the child belongs (they do assign him to one, but then enjoy his behaving as if he belonged to the opposite sex). Mrs. G's parents did not quite do this, though her mother occasionally put her in boys' clothes. G: I don't know when my mother put pants on me, but maybe she did it because . . . maybe because I was always in the dirt or something, and it was an easier way to keep me clean than putting dresses on me. I don't know what her motive was putting pants on me. I can remember being in pants when I was four. Boys' pants. G: When I was younger, I daydreamed that I was a boy. When I was older, I daydreamed that I was a girl. When I was playing with the boys, I imagined that I was a boy; and when I thought about what I wanted to be, I thought about being a man. Like: Jesus, if I was a boy I could be a better baseball player, or they wouldn't be so careful with me when I played football—not that they were ever very careful—but, you know, there were just advantages as far as I was concerned in being a boy. .. . Defenses Against Homosexuality One can take another cross section to evaluate kind and degree of homosexuality by studying what, if any, defenses are raised against homosexual and transsexual impulses. A typical example is the dread most men have of being effeminate. They fear desires to be physically close to other men or to have sexual relations with other men not only because same-sex intercourse is forbidden by society and themselves but also because, for most men, to love a man is to be less of a man,

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which is to be inclined toward femaleness.12 I suppose the man who is feminine or effeminate because this tendency has been induced, and then encouraged, by his mother and not forbidden by his father does not feel threatened by femininity or effeminacy. The behavior having his parents* approval (which is by no means the same as society's approval), he probably at worst suffers threats and embarrassment if scorned socially.13 As we know, Mrs. G avoided believing she was homosexual by saying, in effect, "Although I would seem to be a homosexual because I have sexual relations with people whose bodies look the same as mine, I nonetheless belong to a different sex; therefore, regardless of appearances, what I do is bisexual, not homosexual/9 She was always pleased when I told her she was bisexual. S: You were saying, "They're homosexuals, and I'm not.'* G: Yes. When I was living with her, I was going to bed with men. When I was going to bed with her, we just had sex; there wasn't anything else to it; there wasn't any kind of a relationship with her. S: "It was just sex." And you probably said, "Sex is sex; it makes no difference who the person is." Right? Another thing you said was, "I like men. I'm going to bed with men.'* A third thing you said was, "I have a penis." But still you had to say these things in order to ignore what your conscience was saying. What was your conscience saying at that time? G: Nothing. I didn't have a conscience. Are you yelling at me? S: No. See, that's part of your conscience. G: What do you want me to do? S: I want you to admit that the word "homosexuality" is in fact the proper word to use for what you did with girls. And then I want you to tell me, when you've admitted it—not just admitted it for me, but that you really accept it—then I want you to tell me how important it is. And then let's see if we can find out—if it isn't too awful for you to find out—how come you like it. G: I know what it is [that is awful]. When they go to bed together, they're queer. When two women go to bed together, that's being homosexual. S: Why do you do it? G: I don't know why I do it. Because I like to. I like to go to bed with girls. Because I like to touch them and I like to hold them and things like that. That's all. [Long pause] I haven't been to bed with a woman for a long time. I don't like women to touch me. I like to hold them and touch them. I like to hurt them—not physically. T was a very small person, and she was very conscious of her weight;

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and I used to say things like, "You'd probably look better if you weren't so goddamned fat"; and that would really upset her because she really didn't want to be fat and she always thought she was, you know. Do you know why you did that? No. I always felt bad about it, that's why. And yet you had to do it—it gave you some pleasure to do it, obviously. Did you feel angry at her because she was willing to have these homosexual relations? I don't think I was angry. Did you think less of her? Yeah. Or despise her at times? Yeah. Were you disgusted ever when she was excited and obviously abandoned to this pleasure? I suppose so. I couldn't have slept with her if she had been homosexual. But here she was getting to like it more and more. So what? Maybe the reason was that since you were not a homosexual, then she was not. Is that right? I guess so. Do you have a box? Yeah. She did too? She sure did. So two boxes . . . How did you get around that? I didn't get around it. Yes you did. That's the definition of homosexuality. She never touched me. You got around it that way; it never added up to two, did it? Anybody else in the world would have added it up to two, wouldn't they? A doctor doing a physical examination would have said, "Ah ha, two boxes." Right? Uh huh. Two homosexual women possessed of the same boxes would have said "Ha, homosexuality." Right? Two men, three men, a million men, a billion women, the whole world, would have said *'Two boxes. Homosexuality." Right? But you didn't. Reason: she didn't touch yours, so she couldn't literally add it up although she knew damn well you had a box. And two: you had a penis; no box. So one plus one mustn't equal two. But you know, you are an intelli-

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gent woman and you're a logical woman and you're a woman with a conscience, and you knew that one plus one is two. You did know it. And to this day you hallucinate because of that, and to this day the fact that you know that logic underneath the surface, no matter how much you try to avoid it, that logic makes you sick. I'd love to know what you're thinking now! I was thinking about when I was fifteen. It was kind of sad. I was at reform school, and you were supposed to go to bed with girls. And I didn't. I remember it making me so sick that I went out of my head. [Years later she marks this as the first time she was "crazy."] I broke windows and I cut myself.... Yes, I heard about that before, but I never heard what it was that did it. Do you know why you did it? Because it was clearly understood by everybody to be homosexual. Isn't that right? They told my mother I was a homosexual. What's your mother's attitude about homosexuality? I don't know. I never asked her. I guess she doesn't think very much of it. She thinks it's kind of disgusting. I don't know about my mother's attitude. I don't know. I don't care what my mother's attitude is. She never said anything about it. I think if my mother came in contact with a homosexual, she'd be repelled. I ... I ... that's not true because she knows N, my friend, is homosexual, and she likes him. I just don't think she ... she just wouldn't like that. Did you breast-feed your children? Yeah. All of them? Yeah. The girl, too? No. Why didn't you breast-feed your daughter? I don't like little girls. Why didn't you breast-feed your daughter? She wasn't my daughter. I don't like that word. She was just a baby. I gave birth to her; I didn't keep her; I gave her away; I never wanted her. I didn't want nothing to do with her. I didn't like to look at her, and I never touched her. What are you thinking? Nothing. Come on. I'm screaming. What are you screaming? Just screaming loud screams. Why didn't your mother breast-feed you?

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G: Because she didn't like me. She breast-fed my sister. Because she liked her. That was her baby. She's still her baby. [Later in the hour] G: I thought about this all last week—I'm really going to find out, so I called this girl up. I really can't stand her because she bugs me every time I've called her. All I can do is call her once, and then she starts calling me, and she really drives me nuts because I don't want to be bothered. S: Is she the one with the kids? G: Yeah, she's got kids. She was available. It makes me sick to my stomach. We went out and I got turkey-ass drunk. I don't know whether I can do it sober or not—I just got drunk. And I went to a motel with her.... Anyway, I went to bed with her, and I thought: Oh, if I let her touch me ... anyway I did let her touch me [the experiment precipitated by treatment] . . . and then I got so angry I almost killed her. I wanted to kill her. I just wanted to smash her. So I beat the shit out of her and left her there. I don't even know if she got home. S: She must have thought you were some kind of a nut, not that you aren't. Tell me more. Go back over it and tell me it in detail, puking and all. G: I drank, but usually when I drink it relaxes me; but I very rarely get drunk; but I just got drunk. I can't tell you how hot it was, and she's all wrapped up in this big coat, and I'm pouring sweat We took something to drink with us, and turned the radio on, got our clothes off, and got in bed. It just seemed natural where I would do it, but I couldn't understand how she could do it. How can you sit and listen to that kind of shit? I went to bed with her. I made love to her. She wanted me to S: But then what happened? G: I got angry. I was just so very angry and I was sick to my stomach and I didn't want her to touch me; and I didn't want to be in that room, and I didn't want to have anything to do with the whole situation. And I was sick and I wanted to get out of there. I told her to get away from me. She just wanted more. So I shoved her. She told me not to shove her. And she came back again, after me again, and then I hit her. In the face. With my fist. She pushed me. I hit her again. Then she locked herself in the bathroom. S: She had to run in there. Did she cry? G: Yeah. S: Was she frightened? G: Yeah. S: Did she think you were crazy?

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G: I don't know—probably. I don't know what she thought. Then I put my clothes on and left. S: And since then? Since then you've been hallucinating? [Shakes head yes] Depressed? [Shakes head yes] Sick to your stomach? [Shakes head yes] How have you been sleeping? G: Not very well. S: O.K. You went there as an experiment. What was the experiment for? G: I'm not too clear. At first I thought (I'm going to be sick; I feel sick to my stomach) . . . at first I thought if I go there and I don't like it, then I can't be homosexual. And then I let her touch me, and I did like it. S: And you must have been heartsick. G: Just angry. S: Are you very sad right now? G: I don't know. I feel sad, yes. I don't want Bill to touch me. It just repulses me. S: Do you feel that the experiment has proven that you have homosexual impulses? G: It just proves that I'm a pig, that's all I guess it does. In the Schreber case, Freud " described how the patient tried to deny his homosexual impulses by delusions and hallucinations. Something similar occurred with Mrs. G: she became psychotic, within moments, when other devices failed to protect her from her own accusation of being a homosexual. Schreber's homosexuality was unacceptable to him also. Both Schreber and Mrs. G could consider sexual relations with a person of the same sex only if this were not "homosexuality," and both used transsexual delusion and hallucination to enable them to have such relations. Delusions, like perversions, are manic denials of traumatic conflicts (conflicts because they contain wishes desired, forbidden, and punished); at their core is the (memory of the) same experience that at first was traumatic, but has since been transformed into triumph. In the Schreber case, the steps in the transformation might be described thus: ( / ) Life-long wishes to merge with his mother, with the possibility of a transsexual metamorphosis, haunt him. (2) This is forbidden, first by a stern father who demands that his son also be stern, and then by a superego that incorporates the father's morality. (3) Nevertheless, the wish toward the mother is strong and, when released in psychosis (though not necessarily causing psychosis), can be gratified if the superego is assuaged: it is God,

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not Schreber, who demands and even produces the change of sex—so what can Schreber do but succumb voluptuously? The inner restraints on Mrs. G were less severe than those on Schreber, and so she indulged regularly and with gratification in homosexual relations. Her restriction was not that she not perform such acts, but only that she not call them homosexuality. The psychotic reactions she developed to her homosexual behavior were a response to guilt, as was the case with Schreber; but her guilt was not quite so much a response to homosexual activity as such as to (before treatment, at least) her specifically having seduced an apparently completely normal, femininely heterosexual, homosexually virginal young woman (ideal mother?). It was always the sense of having spoiled a heterosexual woman that caused the despairing guilt that blew up in psychosis. Moreover, she did not develop the complicated delusions we are used to seeing in schizophrenia, delusions that Schreber exemplifies. Instead, she would explode into a panic state, with confusion, terror, a buzzing, noisy hallucinosis (rather than clear-cut spoken language), poorly formed visual hallucinations such as blood pouring off the walls or black holes appearing in the streets, and an overpowering drive to kill herself. Except for the possibility that she might kill herself, the prognosis of her psychotic episodes was much better than in those of the typical schizophrenic reacting against homosexuality. When my relationship with Mrs. G had become strong enough, after several years of treatment, and when I understood her well enough, I began charging in upon the subject of homosexuality. For the first year or so, when I did this I could count on her becoming psychotic—sometimes right before my eyes, and sometimes after an hour or so. Initially it would happen even if homosexuality was only implied; later, each time I stated unequivocally that she was homosexual. To what extent she gradually became "used" to this subject because of growing insight, or because of growing familiarity with not being destroyed by the thought, I cannot say. It seems to have been a combination of both.1' G: Sometimes I would be in that room and I would be so frightened, I wouldn't be able to move. Literally could not move my body. I didn't even know what I was afraid of. S: Was it anything about homosexuality? G: Probably, because that was what was uppermost in my mind. It was all during that week that I kept thinking: If they find out, it's really going to be a terrible thing. I couldn't even imagine how terrible it

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was going to be. Then one of the nurses said . . . I was sitting on the ping-pong table as usual, and she came up and put her hand right here like this, and she just stood there; and then she started to laugh, and she said, "You know, that's funny: a month ago I couldn't do that." And I said, "Do what?" And she said, "You're not even aware that I've got my hands on you. A month ago you would have slapped me or casually drifted away or something." And I hadn't even thought about it.10 At any rate, Mrs. G has finally come to accept her homosexuality, and can enjoy a lasting, loving, sexual relationship with a woman. There is another aspect of defense in homosexuality. One style of homosexual behavior may be used to defend oneself against another such style. Mrs. G's "masculine," forceful, doing-all-the-work, sexual activity—her being a great lover and thus ensuring her partner's maximum gratification—was used, in part, to keep from recognizing that she wanted to be taken care of and "mothered," functions she performed for her partner. It also kept her from acknowledging what she knew—that rather than disliking to have her own body dealt with in that way, she wanted it all too much. Homosexuality as a Symptom of Conflict Here we are in most important territory; but inasmuch as analytic workers, from Freud on, have considered this subject in detail, I need not do so.17 * * * By the time we began to tape-record the treatment sessions, Mrs. G was already beginning to accept the fact that her activities were homosexual, though she still had difficulty acknowledging that she was a homosexual.

G: The only time I've come in contact with homosexuals, they kind of fascinated me, but at the same time they repulsed me. I have one friend, a man, who is a homosexual; and that doesn't bother me. I don't care about a man being homosexual, but women—that just bothers me. I know one time I was living in an apartm* u, and there was one directly behind me; and these two women moved in with four kids, and the mother of these children had left her husband to live with this lesbian. I just couldn't understand her doing a thing like that. I just disliked her. That made me angry. They were both

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attractive women. They were very friendly; and the mother of the children, I guess, could have been called a good mother. Yet how can you be a good mother and sleep with another woman? They were affectionate to each other, always putting their hands on each other and stuff like that. I just don't like to think about it. S: Try to even if you don't like it. Did you admire them? G: I think I must have because I figured . . . well, if they can do it, I can do it. And that's when I started living with T. And that was a funny thing—there I was in one apartment living with a girl, and there they were in another apartment living together, and I would get so angry with them and so disgusted by them.... [Four years ago; treatment has begun to "bite"] G: I used to wear men's pants all the time. I used to wear men's clothes all the time, between the ages of fourteen and twenty. Because I was comfortable in them. But I was called a homosexual too many times, and I don't like to be called a homosexual, so I changed into more feminine clothes. S: So what you did, you wore mannish clothes, that is, clothes that are made for homosexual women. You were homosexual. G: No, I wasn't. No, I wasn't. I've never been a homosexual. I don't want to be a homosexual. S: Why didn't you want to be known as a homosexual? G: Because what I was doing and what I was feeling was so frightening to me. Having sexual relations with another woman was a terribly frightening experience for me. I think one of the biggest things that kept me from being a homosexual was my children. I never wanted my children to know that I had homosexual feelings. I didn't want to make feminine boys or confused kids out of my children. That's part of the reason; that's not all the reason. When I was fourteen years old, I had to go to court, and while I was in court the judge said to my mother, "Do you know that she has homosexual tendencies?" And my mother came unglued. "What do you mean? What does this mean?" And my mother was repulsed by the fact that I might be homosexual, and she kept on insisting to me that I be more feminine; and even to this day, when I wear pants around my mother, she insists that I be more feminine. I have no desire to be homosexual. I just want to have a relationship with my husband and be happy in my marriage and not have homosexual contacts. I'm thinking . . . how could I have a penis and not want a female? G: Dr. A came to talk to me this morning, and when he walked in my room, I said, "I'm a privileged character. I have a private room." And immediately I thought: The reason I have a private room is

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because they're afraid I'm going to have something to do with one of the other patients. And that came into my mind . . . the minute I said that; that's the first thing that occurred to me. And yet three months ago, nobody was . . . I don't know . . . they weren't aware that I was having homosexual thoughts, and yet I always insist on a private room because I always think that's liable to happen. You knew you had homosexual feelings? Yeah. And you knew, therefore, that you were, by your standards, homosexual? No, I didn't know I was homosexual. You do now? I ...

S: Every time you had a homosexual relation with a woman, you moved out the next day. You ran away, moved to another town. G: Except once. Once I lived with a girl for eight months. S: What was different about that? G: I don't know. [Long pause] S: Are you there? G: What? [Long pause] I was just thinking about it, I guess. I just needed her. [Looks very dazed] S: Come back to me. Is the voice talking? [Nods head yes] What's it saying? G: I don't know. S: Come on, damn it. What's it saying? G: Just about how filthy it is.* S: O.K., now let's go to the girl. When was it? G: When I first left the hospital here, I went to live with a guy I know. It wasn't a sexual thing; we were just roommates. And she lived across the street. And one night I took thirty Nembutal tablets. I was just tired. [She was unconscious for four days; that this was a genuine attempt can be measured by the fact that she took all the pills in the bottle.] And I went home and she came over to see if I needed anything. This guy I was living with—his wife came after him, and he * But at all other times, she says that the voice—Charlie—never was accusatory about her homosexual affairs. G: Charlie never thought it was bad for me to go to bed with a woman. I always thought—when I was in bed with a woman, I thought "dirty queer/* But he was benign. I don't think he thought it was filthy.

S: Usually it was the other way around. Charlie would be the one to attack you whenever you did anything. G: Not when I went to bed with a woman.

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decided that he'd better go home. And she said, "What's going to happen to you now?" And I said, "I don't know. I guess 1*11 go back to my mother or something." And she said, "I like your apartment better than mine. I'll move in with you." [This girl was probably the instigator of sexual relations.] How come that relationship lasted? I don't think it had anything to do with sex. I don't know if this is going to make sense. I think it was because she took care of me. That really doesn't make sense, because I should have been the one taking care of her. This was really an unusual relationship in the sense that you were the masculine one, she was the feminine one, but she took care of you. Didn't she hold you? Come on, tell me more. I just can't. What do you want to hear? Yes, she did hold me. You know, I didn't always have the penis. When didn't you? Just with her. I felt like a baby. I don't know why I said that. I didn't always feel like a baby. I was just quieter. That's why I had to leave. That's why I married Bill. [She had never admitted this before.] I married my previous husband because my mother accused me of being homosexual. [She had never said that before, either.] And you married Bill how long after this girl? After I left her? A week.

Always before when Mrs. G had described the circumstances leading up to these two marriages, she had said each was a whim. She would give as an additional reason—now shown to be superficial— that it was to save these men from going into the army. The above exchange made it clear, finally, that she had used marriage as a flight from homosexuality, not only into heterosexuality but into the clearly labeled nonhomosexual role of wife as well. Then she covered that knowledge with amnesia, a technique at which she was most adept. G: When I go to bed with a woman, my only thought is to give her pleasure. There wouldn't be any pleasure in it for me if there wasn't pleasure in it for her. Just to be good and gentle and to do what she wants me to do so that it's good for her. No, it's like . . . it's like being rewarded for being a good girl. Why shouldn't I be rewarded for giving somebody pleasure? That's what counts. You know this woman this morning, this interviewer from the State Rehabilitation Department asked me if I ever had any homosexual problem, and I told her no. I was telliifg the truth. It's never been a problem for me. S: [Laughs] You know when you haven't had a homosexual problem?

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G: When? S: When you hadn't talked to me. Then it became a problem. What are you thinking? G: I was just thinking about homosexual problems. [Laughs] I was just trying to think when homosexuality was a problem for me, and I guess it's always been a problem for me. [She had never said this before.] S: The blood's running into my feet. I can't stand it. Apparently you mean it. G: Yeah, I do mean it. I discovered that my landlord is homosexual. Oh, what a blow that was, what a waste. That beautiful creature! Oh, God, it just broke my heart. I caught him in bed with his boyfriend. He got up out of bed and put on his pants and introduced me to his friend. No, he wasn't the least embarrassed, and he hasn't been embarrassed since then. S: Does he know that you have some familiarity with homosexuality? G: Oh, I'm sure that he does. Doesn't one homosexual know another? S: Often. G: That's what I expected you to say. [Laughs] Anyway, all last week I was thinking about: Maybe I would like to be a queer (that word just turns me cold). And then I was thinking that I really don't want to be because I want to be a mother. S: I wonder to what extent you wanted your tubes untied to be female all the way through in order to be telling yourself you're not homosexual. Why are you smiling such a wise smile? G: [Laughs] It's just funny that that would be the first time that that ever occurred to you. That thought had occurred to me before. I just wondered why it hadn't occurred to you. I was thinking that if I was really a homosexual, I would want to take care of somebody—I wouldn't just want somebody taking care of me. [Later] G: You know . . . Remember when I was in the hospital last time [after the tubal repair]? . . . I thought then that I would really like to be a feminine female, so I kind of watched the nurses to see how they behaved, the ones that were feminine. I don't think I can do it. I think if I was to be like that, it would be an act. I don't think something like that could come naturally to me. I feel sad. . . . I was feeling sad because I was thinking about my dad, and I was thinking about doing it [being feminine] for you, not for me, because that's not what I want, but doing it for you; and I don't think I can do that. And there are so many things I've had to pretend to be. I've had to pretend to be tough, and I was scared; and I've had to pretend to be a good mother when I was really a crazy one.

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S: Now suppose you were yourself. G: I don't know if I could do that. I've been doing the other for so long and it's such a habit; I don't know if I could do that. G: It doesn't seem to me that most women who were queer would even want their mother to know, let alone . . . I don't know why I say that because that doesn't make any sense to me. S: Say whatever comes to your mind. G: I can picture myself kissing my mother's breast. Only I'm not a woman, just a little girl. It's not like sex. It's just like being warm and comfortable. The only person I can picture is my mother. It would be the breast of a young woman, full, firm but soft—just a breast. I just want to feel the breast on my face. I don't picture myself as a baby though. More about four years old. If I was four years old I'd be living with my mother, I think . . . I don't know. S: When was your brother born? G: One was born . . . I think I'm four or five years older than he is. I don't remember how old he is. I can just picture her sitting in a chair and nursing him, holding him and nursing him. He was an ugly baby. When I'm talking about being small or talking about my brother being a baby, I don't feel real. I feel like I'm not here. S: When you recall watching your brother, can you recall what you felt? G: No, I don't want to. Maybe I'd be angry. My mother didn't nurse me. S: Not at all? I thought you said she nursed all of her children. G: All of them but me. S: Why didn't she nurse you? G: I don't know. Maybe she wanted me to die. Because she didn't like me. Because I was a girl. S: Yes. What did you do to your daughter? G: I didn't have one. S: I'm going to suggest to you that you missed that little girl of yours, that somewhere hidden out of sight where you've never had to feel it, she's your daughter. And that one of the things that you might have wished in this world was that you could have been normal enough to love a little girl. Look at me and answer me. Am I right? G: I didn't hear what you said. I just didn't want to hear what you said. You said I wanted her ... so I could have made a queer out of her? You said to say the first thing that comes into my mind. What time is it? Why talk about something that's gone? Yeah, it's gone. I gave it away. S: The baby's gone but "it" isn't gone, namely, the problem and the love.

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G: What love? I hated her. When they took her out of me, I told them to put her back; I didn't want it. Throw it in the garbage can. The doctor thought I was crazy. Yes ... S: I thought you told me in the past you were afraid they would never come out. G: Yeah, I was, but when they got her out, I told them to put her back. One time I was in bed with my mother [when Mrs. G was in her twenties], and I dreamed that I made love to my mother. That's a bad thing. It wasn't just loving her—it was a sexual thing. It doesn't make any difference if it's fantasy or a dream or what it is—if it's your mother, that's a bad thing. I don't know why. You can't do that with your mother. S: All right, I understand. But you can do it with somebody else? G: Yeah. S: It's O.K. because she's not your mother. G: No, it's not O.K. S: Why? G: What if your mother found out? S: In your case, considering that she said queers are bad, it would be pretty rough. I thought of something even worse. What if it turned out that they are your mother? G: I'd die. G: I was thinking about this girl I went out with Friday night. I went out with her once about three years ago, and I went to bed with her. Then Friday, when I was really scared, really scared, I called her up; and it was the first time I had talked to her in three years. And I asked her if she wanted to go out, and she was anxious to go, and I met her at a bar, and I got outrageously drunk. .. . Anyway, then I went to bed with her. Then I puked all the way home. S: What made you call her? G: I was lonely. I knew that she knew what I expected, and I didn't have to . . . I didn't have to hunt for it. She's quiet. She's a lot older than I am. Not a lot older, but she is older. S: That's not typical, is it? G: No. S: Is she the oldest of any woman you know? ... G: Yeah. Very feminine. Married, and she's got several children. She's very affectionate. She not only accepts me for what I do, but she encourages me. Like we were talking about my school, and she encouraged me to continue with the school and to do the best that I could. We were talking about my going to some classes at night, and she was encouraging me to do something along that line. And she encourages me sexually—that's what I mean.

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I was scared when I first saw her because I wanted her to take the initiative, and she didn't. Yes, she did; in a way she did. She was the one who suggested that we go to a motel and get a room—it wasn't me. And she took her clothes of! and got in bed, and I took my clothes off, which is unusual because I don't usually take my clothes pff. I wanted to be as close to her as I could be. But she spoiled it. She wanted to do things to me. I didn't want her to. I just wanted to hold her and put my face on her. But she was just interested in sex. She was pretty wrapped up in being taken care of, herself. I didn't feel anything sexually. But I did it for me. So I'd know who I was? That doesn't make sense, does it? S: It might. You'll have to tell me more. G: I don't know any more. That just came into my head. S: Did it tell you who you were? G: No. Then we just laid on the bed and talked about what I was going to do. And it was fine. S: Did you feel anxious? G: No. S: Did you feel safe? G: Yeah. S: Did you feel calm? G: Yeah. S: Was it as good as Thorazine? G: Better. S: Did you feel normal in the sense of no anxiety? G: Yeah. I guess we were there about an hour. And I just felt warm and peaceful and content—like I had just had sexual relations and was spent. That's how I felt. Then I got up and put my clothes on and went home. Because she had to go home, and I wasn't going to stay there by myself. S: If she hadn't, you would have stayed longer? G: Yes. I started to feel tense as soon as I put my clothes on, and then I got sick. As soon as I got in the car, I threw up all over the car. [When making love to a woman] G: I get kind of frantic. It's not sexual stimulation; it's kind of a ... like I want to hurry up and have it over with, and yet I want her to enjoy it so much that when she's through she's going to give herself to me—she's not giving herself to me when we're having sexual relations, she's receiving . . . and when that's done, then I get to have her for myself. Am I making myself clear? I think about being up inside of her and being warm and being tight . . . no ... being closer . . . no, how can you get any closer? It has something to do

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with why I don't want a woman to go down on me or to touch me, but I'm not clear what it is. I can't think. If what you want to do is to climb up inside of her and be warm and safe, apparently what you're saying is that you don't want her to climb inside of you so that you have to take care of her and be on the outside. Is that what you felt? That was the feeling I had. You're doing it because you're trying to crawl up in? Do you try to do that? Yeah. Yeah. Does that get you frantic? Yeah. That you can't get in? Yeah. Yeah. The best part comes after she has the orgasm and wants to hold me close. I'm just like a baby, just limp. I guess I do some of the holding too, but it's not like I'm cradling her, but like I'm holding on. Yeah, I know that. But do you ever become the mother? No. If it weren't "bad," how many times would you have been with a woman? I would hire me a woman to just lay and hold me, and I'd never get up. Forever? Yeah. Answer me honestly now. Are you absolutely convinced that it's bad? When I talk about it, like I just finished saying, I want to be inside and I want to be held and I want to feel close and feel warm, that doesn't sound bad to me. But when I'm sitting at the table reading a book about the three little bears and somebody says, "Jesus, did you see that queer?", I think, "God, that's wrong." It's not wrong when I'm doing it. It may be wrong a half hour later. Boy, you sure made that clear with your clobbering some of those women. But running away—almost invariably you run away. You know running away is kind of like holding up a gas station and not staying at the scene of the crime but removing yourself as fast and as far away as possible. Going to bed and leaving a woman is just about the same thing. But recently, in the last year and a half, I have returned to the scene of the crime. Because I feel more comfortable about it. the last year] All the girls that I've had something to do with are going through

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my mind. They've ail given me about the same thing—in different ways, I guess. You know, they give me warmth and peace and quiet. When I'm with a girl I don't think crazy—I don't think I think crazy, and it isn't necessary for me to be crazy. I don't need anything really, just that kind of nearness. I don't want to think that's a bad thing. I don't see how it can be bad. I don't either. Will you ever have to go crazy because you love a woman? I don't think so. I think it's time that you be done with that, huh? Yeah. Being crazy after being with a woman spoiled all the good things. You know when I ... like E, leaving her and vomiting all the way home. All the warmth and good feeling was just spoiled. It really isn't necessary to do that. I wonder why I thought it was necessary.

G: Sunday night they had a birthday party for four or five of the male homosexuals that had their birthday this month, you know, the friends; and there were thirty men invited to this dinner and me. And I didn't want to go, but they came over and picked me up and insisted I go; and I went, and they all gave me a Mother's Day gift. S: You're the Den Mother, huh? G: Yeah. And some of them are such cute boys, you know, really, personality-wise they are really cute kids. And some of them are really messed up. But I guess most of them know what they're doing, whatever that is. S: That's more than you ever did. G: More than I ever did? S: You never knew what you were doing. G: Yeah. And I feel freer, you know. And I think my sons know that I'm gay. But I haven't told them. I don't think there's any reason to tell them. All the time I wasted. And then I think about my relationship with Bill, and why it was so strained and unhealthily and . . . I think about the women that I have had relationships with that probably could have gone on to something bigger and better, but I killed it right in the bed. And . . . I feel like I can talk about homosexuality to straight people without getting uptight. If a straight person were to ask me if I were homosexual, I could say yes. I'm very happy about the change, and I'm glad it came about, and I'm glad I didn't wait until I was forty-five to have the change. You know, at least I have a little time left; and I think that it's unfortunate that, I'm sorry that I ... The only thing I can say is my attitude must have

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had something to do with my craziness, because it just doesn*t seem right to me now. G: W came over, and then we went to bed, and it was nice. She just started. And . . . she's willing, too willing . . . So she stayed all night, and I took her home in the morning, and . . . I enjoyed it very much. I did enjoy it, and I wasn't frightened, and I didn't beat her up, and I didn't puke on her and ... S: How come? The first time in thirty-five years. G: Well, to tell you the truth, there wasn't any question in my mind that I couldn't do it; and I never doubted for a moment, from the time that I called for her to the time I took her to bed, I never doubted for a moment that I couldn't do it. And the reason why I never doubted it was because I just felt stronger and more capable of being more receptive. And why, I don't really know, unless I'm a more complete person than I was two months ago.

Those who regard homosexuals as depraved and unnatural, or who would stamp out this supposed scourge of humanity with treatment, may give Mrs. G and me only slight credit that she is now fully able to enjoy her body with another woman, free of guilt or psychosis about homosexuality and capable of loving a woman. I disagree: If one can both lust and love generously, then he is very well off; and those rare homosexuals who are so blessed need not apologize to psychoanalytic theoreticians. Such happiness seems rare in heterosexuals, too.

15 Treatment

Can our world afford the luxury of one-to-one psychotherapy these days? I personally believe such treatment, however humane and worthy in the particular case, is wrong to the extent that it deprives many people for the sake of a perhaps fortunate few; it becomes honorable, as Freud observed, if it is used not as treatment alone, but for the study of man. The analyst has an obligation, usually ignored, to convert his therapy into scientific communications with colleagues. I must write something about Mrs. G's treatment if the reader is to be able to judge the data. The rational reasons for my reluctance to do so come from the same reservoir of distress that motivates this research: it is so hard to make clear what really happened; but even worse, I fear there are those who do not even know it is necessary, when developing ideas about psychological functions, to reveal how one collected his information. Many psychiatrists doing clinical research do not believe it useful to give extremely precise, extended, and accurate descriptions of a patient's appearance and behavior (including his exact words). They are not trained to see that without such description, discussions of treatment or of human psychology derived from treatment are mythologic. That this goes on is painful, but that it is honored is appalling. One consequence of this failure to provide detailed information is that no one knows to what extent analysis succeeds.1 When two people talk intimately, the subtleties of their communication are difficult to describe. If generalizations about human psychology are derived from such subtle data, they are questionable to the extent that descriptions are inaccurate or absent. I am thus in a predicament: treatment is the research tool. The treatment—an interweaving of my personality and Mrs. G's—is the vehicle necessary for finding out about her; the reward for good treatment is greater trust; and the product of greater trust is more information. 302

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There is nothing more controversial than how one does psychoanalysis or psychotherapy. Of one thing the reader can be sure: no matter how honorably the typescripts of Mrs. G's treatment have been edited, and even if the editing does not distort what took place (which, of course, is impossible; all one can do is minimize the distortion), he still cannot have a full picture of what happened. If one listened to the tapes, one would be surprised at how much more alive we were than can be sensed from reading the transcripts. But even listening to the sessions gives an incomplete impression: the silences, for instance, no longer "speak." One thing I will say for the treatment—Mrs. G was helped. Although that was a happy outcome, it does not confirm the correctness of my hypotheses; and it certainly does not prove mine was the correct treatment.2 We shall, of course, never know how many other techniques and styles of treatment might have helped Mrs. G. We cannot even be sure that life might not have cured her—though I rather think not, if only because she was likely to have killed herself before life's cure would have worked. In other words, it is not safe to draw conclusions about the best means of treating Mrs. G from what I did. Even less, I think, can one generalize much about treating other patients from this description of Mrs. G's treatment.3 Another warning is in order: in editing the typescript, I have removed some of what I said. This keeps the focus on Mrs. G's story and eliminates the repetitiveness of the "working through" (which may fascinate the therapist and, less often, the patient, but bore the reader). However, it also eliminates many of my interpretations, which, I must say, sounded better than they read in a typescript, since they depended so much on the atmosphere of the moment. Years later, I still think some of my interpretations were not only correct but effective; but it is amusing to read others, delivered with the same enthusiasm and sincerity—resulting in that quiet pride one feels if right— that eventually proved to be quite wrong. What actually helped Mrs. G? Although Mrs. G and I officially began the treatment years later, it actually started when we first met. As the reader will recall, I was to film interviews with patients for research in medical education and so met Mrs. G, who was alert, humorous, and very open. In that brief meeting she amused me with her intelligence, sharp perception of her situation, and a charm too intense to be considered superficial or merely manipulative. We met again before the cameras, and you have

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read what we said. My first response to her was confirmed in that interview, and an additional quality was introduced important for her future—she could be sad. Whatever rescue fantasies this sadness aroused in me, it also told me something about prognosis. Mrs. G was not what I know psychopaths to be. I do not see them sad, though they can, when it serves them, simulate sadness; the related affect they exhibit—self-pity—has a different prognosis. (Let me add that I do not attempt to rescue patients with what seems a hopeless prognosis; nor have I treated so sick a patient as Mrs. G for so long or so earnestly before or since.) The interview completed, I took the patient back to her ward and was about to leave. She stopped me, expressing diffidence and an uneasiness that she was unfairly taking my time (she did this genuinely, without exaggeration or insincerity, and it was therefore exactly the right approach to get to me). She asked if she could be transferred to UCLA (in those days the County Hospital did not have a treatment program) so as not to be returned to the state hospital from which she had run away. For the next seven years, Mrs. G was other people's patient. She was treated by many psychiatrists as both an inpatient and an outpatient; but I was always in the background of her mind. She would drop around to see me for a moment or write letters and Christmas cards. I enjoyed the few moments spent with her; I especially enjoyed her not being my responsibility. I knew that as one's patient she would really be an unmitigated pain, with her teasing, manipulation, and true crises and false. She had to act on her impulses, and her repertoire of impulsive acts was just too dangerous for my liking: life is short, and there are too many other things to do to be forever involved with a dangerous, manipulative patient. Another essential feature for treatment that I now realize I sensed when we first met was a need in Mrs. G to get well. There can be no treatment without this need, no matter what fine substitutes for it intrigue both therapist and patient; in good treatment it is the impetus for success.4 I suppose the need derives from some happy experience in earliest childhood, most likely with one's mother; no matter what dreadful experiences accompany or subsequently follow this good one, it provides an island of optimism and of courage. I have treated patients so insistent upon getting well that no mis-

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takes could overpower that drive. Mrs. G was of this sort, except for one dreadful complication: her need for peace via suicide (a need she expressed on several occasions when only luck—not the desire to get well—preserved her life) was coupled with a capacity for psychosis profound enough to wipe out temporarily her desire to survive. She had first to be cured of her attraction to death before the drive to be healthy could be depended on. Those who admire quiet, reflective therapists who listen uncowed by long silences, capable of an interpretation that hovers at just the right level between what the patient already knows and the part that is hidden, may be dismayed at my grossness with Mrs. G—my talking, interrupting, joking, anger, sarcasm, argumentativeness, disbelief, impatience, pushing. I believe I have good reason for employing such techniques. With all psychotics (except those with autism since childhood or with organic brain disease, such as a severe toxic delirium or the result of chronic LSD use) I always talk to the sane remnant of the patient, no matter how small it may be. A bit of sanity is there in the patient at least as a memory of what once was; usually it is somewhat more, a little creature (identity) all wrapped around with psychosis, hidden but peering out of the darkness and listening. As it comes to trust the therapist, it increasingly reveals itself. I think that trust depends on my having two insights: first, that I am at ease with the psychotic part, in all its crazy primary-process glory, and, second, that I do not get so swept up in the psychotic part of the patient that I do not also recognize the sane part. Only if I am familiar with the psychotic process and person—only when I truly demonstrate an understanding of its nature—can I fight against it. So long as a patient feels one disagrees, because of ignorance, insensitivity, or puritanicalness, he will not listen. But if the therapist can be trusted not to be either frightened off or seduced by the madness, the sane part will know that the therapist is safe enough and that ultimately he is its friend, not the psychotic part's.5 The main tool of much clinical research is the therapist: if he does not reveal himself, the reader is uncertain how to evaluate the reported findings. This is one reason why I write less formally than we are taught to do: I do not do so for frivolous reasons. The scientific style of objective, impersonal writing was invented for a related purpose; to emphasize that the findings (e.g., measurements) were independent

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of the scientist's or his audience's personalities. However, in psychotherapy the instrument is the self, and that cannot be ignored as can a calibrated machine. And so it does not hurt a discussion of treatment to learn what the therapist needs from treatment in order to work properly. This would include a discussion of the milieu in which he works, such as the way he would like his office furnished, with whom he prefers to eat lunch, or how he wears his clothes—but we here can leave these essentials to an author of a book on treatment and give only a few hints of what this particular therapist needed from his patient—what I needed and got from Mrs. G. Mrs. G having revealed she possessed the following attributes, I then realized I needed in her: intelligence; humor; courage and the related capacity to bear pain without wallowing in it; interest in learning about her own psychology; honesty; a desire to live; capacity to enjoy intense bodily pleasure; unusual access to primary-process thought and contents combined with an ability to recover from life in those depths; enough heterosexuality to respond to me as a woman; independence in not accepting what I said because I said it, coupled with an eagerness to examine it; motherliness toward her children; severe psychopathology alternating with episodes of normalcy; flamboyant pathology appealing to my diagnostic interests, including such unusual states as multiple personality and a voice that had its own identity; patience; raucous and outspoken language and attitude tinged with rare moments of embarrassment; respect and affection for me, despite having been born and bred in a culture so alien to that from which I come that I listened at times out of sheer curiosity and amazement; clever teasing followed by cooperativeness; hypnoid-psychotic states that were a window into the past; quick "cures" following correct interpretations; a willingness to say "Thank you" sincerely even if without words; a capacity to get well in part as a result of insight; and an undemanding faith in my ability, that nonetheless was demanding in that it made me ashamed not to do my best (e.g., at those moments when Mrs. G phoned to say she was about to kill herself and the temptation was severe, finally, this time, after having done all one could for so many years, to let go of the grasp on her and let her slip away). On the other hand, there were qualities I did not like, though surmounting them eventually led to pleasure in itself: her fatness (when

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we met, she was thin; the fatness was a symptom, not a reflection of an unalterable character trait); her homicidal and suicidal drives, which at times went to the very edge of what I could stand; her rage, terror, and frustration, which led me to moments of hopelessness; a nagging feeling I might be wrong about the prognosis, in the face of repeated failures in her treatment; a blinding, merciless process of working through°—the need to repeat over and over and over, the need to pick up the pieces when progress had been shattered, the need to respect the amnesias that would wipe out our work for a while; the inability to turn to psychoanalytic techniques in a patient who had at times seemed suitable; her extensive use of silences (which does not show up in the typescript), so that I had to talk to keep myself in contact with her and, by thinking out loud, try to find out what was going on inside her during her silences (that is, I was constantly describing to her and to myself what I saw and heard and felt during her silence, and would persist until I could get some flicker from her, like a slight flush or a smile or a darting look into my eyes). It has been remarked that one should like the patients he treats in psychotherapy and analysis; without that, technical skills fail. I do not mean I never hated Mrs. G, or was not enraged by her, or didn't want to give up on her: these feelings occurred at times, and I think appropriately; but they developed on top of a solid, unchanging base of likableness. That I felt this without having to work on it, convince myself of it, or indulge in self-analysis to permit it or improve it guaranteed to Mrs. G, wno knew somehow it was there, that she would not be abandoned. But even with the guarantees that our liking each other gave, there were several other factors without which the treatment might not have succeeded. First, the hospital. The patient's life could not have been saved if a hospital had not been immediately available and a few of the personnel familiar with me and with the patient. Being on the ward, Mrs. G could stand the intensity of the therapy I felt free to launch with twenty-four-hour control over her. It was when she was hospitalized that my own feeling of freedom from danger was sufficient to allow me to say anything that came to mind and to say it just right, without that special hesitation of searching for the politic phrase sometimes necessary with dangerous patients when they are to leave one's office and go out into the world.

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Using the hospital this way developed only gradually. In the beginning, before I was Mrs. G's therapist and for several hospitalizations thereafter, hospitalization was used only to patch over emergencies. When Mrs. G had been "cooled," by supportive means, we could let her go home, assured that she would not kill herself or others. But as I gradually became more committed to learning who she was, I was better able to cut to the bone. Under those circumstances, she needed to be hospitalized longer; and I needed her in the hospital simply to permit me to go to such depths. Despite knowing I would frequently make her psychotic and dangerous, I developed confidence that she could stand it and would survive it, that we would both learn more about her, and that a permanent, higher plateau of treatment would be reached after each such hospitalization. And so, after the emergency had passed, Mrs. G would stay in the hospital. When one does not have a hospital that is his own home, or the financial assistance that a university service provides, or the friendship that brings cooperation from other doctors and other personnel, then hospitalization is of limited value. My friends permitted me what they considered this idiosyncratic treatment, and the California Department of Mental Hygiene and the University paid Mrs. G's hospital bill—most extravagant, if one measures the end result as the salvaging of one crazy homosexual housewife. Mrs. G is an outstanding manipulator, and it was rare for her to be too psychotic to exercise this capacity. Her admissions to the hospital were enlivened by one's sense of being taken advantage of. Hospital administrators, such as admission officers and resident O.D.s, responded to the manipulation as an attack on their power to command. Whenever the patient's challenge ("I am going to kill myself," "I am going to kill Bill") was faced by a stranger who controlled the availability of beds, he would sense he was being pushed (by her and by me) and begin the process of refusal so often part of the machinery of inpatient psychiatric care. This never occurred when doctors who knew Mrs. G were those first contacted, for they had long since become familiar with both her manipulation and her great dangerousness and, like me, could see the manipulation as a last sign of ego strength and a desire to live rather than a threat to administrators1 prerogatives. The ward personnel also had difficulty if they did not know her; but as the years passed, there was almost always at least

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one nurse who knew Mrs. G, to whichever ward she was assigned. They needed help because, expecting a suicidal and/or homicidal patient, they saw at first a quiet woman who would cause them no difficulty. However, as the days passed, they would become familiar with the episodes of hallucinated confusion, amnesia, despair, silent withdrawal, and escapes from the ward (frightening because these would occur during periods when someone on the ward would know that Mrs. G was either disoriented or talking of death). In addition to the protection the hospital gave each of us, I could rely on Mrs. G's being a woman and physically weaker than I. Naturally, I am less likely to say dreadful things to a patient who is physically capable of murdering me. Mrs. G could not have done so; and since we both knew this, the possibility could be ignored. No matter how infuriating I was, I never felt she could rise up to kill me with her bare hands, an experience that has threatened with male patients. It was fortunate that I had this sublime conviction and that it never occurred to me that she might want to kill me with an equalizer, like a gun. By the time she told me she had once come in with a loaded gun in her bag prepared to shoot, the dangerous episode was only a report of what had happened several years before. Besides Mrs. G's good qualities, which were constant, the aspect of treatment that brought the greatest results were the crises precipitated by my lack of understanding. Perhaps the most important was my desire to rid her of Charlie. Without having determined the exact nature of her hallucinations (believing, more or less, that a voice is a voice), I did not realize she had two kinds of auditory hallucinations, those she herself recognized as her "craziness" and Charlie, who was unchanging and had his own identity. Only when I came to know his nature could I give up my hatred of that aspect of her and accept Charlie. Before that, Mrs. G could like me, appreciate my concern and hard work, and respect the times I was right; but I was so wrong in my comprehension of Charlie that she had to struggle with me in this regard or give up treatment. (I can become very self-righteous when I feel I am right—a luxury experienced therapists grant themselves.) We had quite a battle one day—Mrs. G crazy and trying to cope with me, sane but wrong. A fragment of that struggle is given in the transcript of the hour in which she asked me to help her get a plastic

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repair for her ligated tubes (see Chapter 5). I, without waiting for a full explanation, impatient because I knew so much about her disturbed sense of femininity, her rotten relationship with her husband, and her nutty way of doing many things—and enjoying hating her for her parthenogenetic wishes—ripped into her for saying that it was her decision alone, not also Bill's, whether she should become fertile again or not. Righteous indignation is such a fine feeling, especially for the long-suffering analyst who can rarely indulge it; and I really enjoyed hating her selfishly stupid psychosis at that moment. Fortunately, it can happen that patients are as understanding, kind, careful, and patient as therapists. Mrs. G had more of this capacity than many patients (another quality in her that made me like her), and so she bore with me until she had made it clear that I had not understood. There was another quality that helped the treatment, a compatibility between us one would not have noticed in the first years of treatment and that I recognize now only because times have changed. At the beginning one would have seen a quiet, staid, liberal therapist treating a dangerously mad woman who had lived a life almost completely alien in all of its actions to anything that had ever touched him. However, from the start we shared certain features, such as respectful familiarity with unconscious forces and a similar moral code (which I studied and lived by and she studied and opposed). Now that she owns herself, our differences are obvious enough. Neither of us will change into the other (a corrupting danger in long treatments), but certain similarities have increased: I am an old-fashioned psychiatrist; she, an old-fashioned patient; and this was an old-fashioned treatment. How we age! Despite the difference in our years, Mrs. G and 1 both belong to a generation some of whose beliefs have become quaint, but to which we both still cling. Like many others battered by the changes in the oncoming generation, we don't argue, and we don't particularly feel right. It is just that we don't feel wrong either. What we lost along the way was the sense of absoluteness that youth has and that she and I still had to some extent when the treatment started. Whatever our differences, we now share the feeling that the most important thing is life. Curiosity is another quality that can sustain a therapist during the long, hard stretches that must occur in insight therapy; it keeps one alert. Without that stimulus, practice can become bleak as the years

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pass, no matter how high the fees; and lack of curiosity may lead eventually to perfunctory treatment, such as routinized interpretations and impressions arrived at on the basis of inadequate data, and the introduction of theory and jargon into the treatment. Perhaps if therapists were more curious, there would be less theory of the sort from which we now suffer: we would demand more data and not be willing to settle for pseudo-explanations. Blunted curiosity probably also defeats empathy. Finally, the curiosity had better be infectious or the therapy will not be an insight therapy. When the patient wants to know about himself with the same intensity his therapist does, insight (not the pseudo-insight so much promoted by the noncurious therapist) will flow. Treatment can also be sustained by one's conviction that insight therapy works. When Mrs. G and I first met in the 1950s, individual psychotherapy was a highly moral, much-sought-after treatment technique. It was the best there was. Now it is an unconscionable luxury; and most psychiatrists and psychologists say it has no rationale and does not work. The touchy subject of measuring results of treatment, which has been so often and so unsuccessfully researched, is not within the scope of this report. Let me just say that those who have never successfully treated a patient by insight therapy cannot believe it will work, and that all the statistical assaults upon the problem of measuring the results of treatment cannot convince the skillful therapist that he cannot be successful or that his success is the result purely of circumstances beyond his ken. The same difficulties with which I have here struggled in trying to convey what really went on between the patient and me are difficulties that contribute to the inexperienced observer's inability to believe that insight treatment works. I must admit that I myself could not be convinced on the basis of the literature that insight is therapeutic.7 Yet therapists who, after hard work, share with patients the excitement of discovery recall those moments of insight throughout the dry periods of treatment. What except one's curiosity and one's remembrance of previous success can carry one over the long stretches when not only is the patient not learning about himself but is suffering badly and perhaps making the therapist also suffer? It is so easy to discard patients; the good reasons for doing so are almost infinite when

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the patient is a difficult one or not sufficiently "worthy." There are practically no reasons to persist in the face of an urge to unload formidable patients. The inexperienced therapist's persistence can come from his not yet knowing about the bleak periods, or from his naive exaggeration of the chances of success, or from his fear of failure— all of these not yet eroded by the exhaustion of his profession. But in time he will need better motivation, and this may be found in constant curiosity and occasional success. A final essential in treatment is honesty, which I have been learning over the years. Obviously, we do not always have to be right, and we often are not; but we must struggle to be honest, and that is a far more subtle process than it might seem.

16 Conclusions

How does Mrs. G help us understand the development of gender identity? Let me briefly review some of my earlier work, in Sex and Gender. The word "sexuality" covers a wide range of behavior, within which are, among others, two areas: one, biological—the male and female sexes; and one, psychological—masculinity and femininity. For the latter, no word is commonly used, so I have chosen the term "gender identity" to designate it.1 The word "gender" is not very convenient, for usually it has been synonymous with "sex"; therefore, somewhat uneasily, I have added "identity," which implies an organization around lifelong themes that add up to one's sense of self. Gender identity, then, is that part of oneself—a set of convictions— concerned with masculinity and femininity. At its core, the earliest part to develop, is a taken-for-granted conviction that one is a male or a female, that is, that one's assignment to the male or the female sex is anatomically and ultimately psychologically correct. I think this core gender identity—the sense of maleness or femaleness (which is not all there is to gender identity, only the beginning)—develops from the following: 1. Biological factors, including embryological anatomy and physiology, hormones, and central nervous system centers. However, in humans the effects of these factors can be reversed by learning. 2. Genital anatomy, as a signal to parents (or to any other person, such as the one who delivers the baby and thus gives the first official assignment) and as a source of sensations ("body ego") that confirm sex assignment. 3. Sex assignment and rearing, involving parents* personalities, parents* attitudes about the particular child's sex and gender, and other people's (society's) attitudes. 4. "Learning": conditioning, classical and ope rant; shaping; im313

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printing; habituation; the effect of being raised from birth by a female (mother); the encouraging of identification with the parent of the same or the opposite sex. These factors contribute in varying degrees to creating core gender identity, which seems fairly well formed by a year and half or two years of age.2 It is almost irreversible by around age five or six, no matter what attempts are made to alter it.3 (Research has yet to be done to establish these ages; this is a clinical impression derived from work with children by our research team.) I believe this core gender identity is produced by the above factors, and does not arise from defense by one part of oneself (superego or ego) against "instinctual" desire (id). Such conflicts contribute to gender identity development, but only later. I do not mean that there is no pain or trauma in the first months of life or that, when present, they do not help determine core gender identity. Painful demands do shape an infant's behavior; but these demands are forces that originate initially from people outside the infant, not from intrapsychic conflicts, such as one (inner) idea, fantasy, or object's being opposed by another. Conditioning (or a like learning process) comes earlier. Then fantasy gradually begins to dominate, conditioning per se changing behavior only in unusual circumstances (e.g., traumatic neuroses). That the potential for such change remains in adult life is proven in the experimental laboratory and by some behavior therapies. According to classical analytic theory, femininity in females arises only in response to intrapsychic conflicts. Although such psychic events do shape masculinity and femininity, I think they play their part only after such capacities as memory, fantasy, and recognition of self and objects have developed. Then conflict begins to have increasing importance in shaping gender identity—but mostly after the core gender identity has formed. Given this core, one then builds on it from one's happy experiences and from conflicts that end in mastery, in compromise formations, and in failure to develop a particular piece of masculinity or femininity. We are far more familiar with this later developing gender identity; it has been the subject of psychoanalytic study since Freud first began his work. We are especially familiar with it as a product of fantasy used to solve conflict, and much of what we study in Mrs. G (e.g., her penis) exemplifies how such fantasy becomes character. But I think we can also see in Mrs. G the results of some of the factors

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listed above for the creation of the core gender identity; these are the qualities in her that are unchanging, at least that I found unchangeable—a feminine aspect with a sense of worth in being female (concretized in Carrie), and an equivalent of masculinity and maleness (as seen in Charlie, her penis, and her homosexuality).4 In the rest of us, too, the psychic elements first created (core gender identity) are untouched by life experience or intensive treatment such as analysis. Whatever else shifts in the way of masculinity and femininity, even under the onslaught of deteriorating psychosis or organic brain disease, one's sense of being a male or of being a female remains stable if it was fixed in infancy. However, this aspect of identity will be bisexual from the beginning of life on if parents encourage too much intimacy with, or behavior like that of the parent of the opposite sex" or act unsure of their infant's sex (as we find in certain anatomical hermaphrodites whose parents are uncertain from birth on to which sex their child should be assigned0). And what if a female is raised, as was Mrs. G by her mother, with the baby's genitals correctly perceived but unacceptable? This, too, may induce from earliest days a bisexual split in a little girl's sense of femaleness.7 Some nontraumatic, early, parental factors that contribute to the development of femininity in females are: 1. Parents' unequivocal conviction that their infant is a biologically normal female, which is confirmed in the infant by the sensations she receives from her genitals plus her seeing her genitals. 2. However, it is not inevitable (though it always happens) that the infant is aware that her particular genitals (of sensed dimensions and capacities) are those of the class "female." This takes a year or so to learn from her parents, by their unquestioned acceptance of her and her anatomy as female. Only then do the observations "I have these genitals" and "I am a girl" become fused into the conviction "These are female genitals, which prove I am a girl." 3. The physical and psychological intimacy of the mother-infant symbiosis, which encourages the most primitive sense of being like, being part of, mother ("feminine identification"). 4. Encouragement of phase-adequate separation from mother's body, mother not only feeling but also expressing her pleasure at her infant's capacity to separate from her body.8 5. Encouragement of phase-adequate individuation—development of the knowledge that one is a unique individual with precise, valu-

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able, and permanent attributes, with mother and father feeling and expressing pleasure at their infant's capacity to become a distinct individual.9 6. Encouragement by mother at the appropriate time to do things mother feels are feminine, mother's capacity to accept femininity as a worthy quality in herself and other females, and her relatively unambivalent pleasure in her daughter's femaleness and femininity. 7. A masculine father who is present physically and psychologically, who appreciates his wife's femaleness and femininity, and whose maleness and masculinity are appreciated by his wife. 8. Mild seduction (too much can contribute to the pseudofemininity of hysterics) by the child's father, which makes it clear she is a female he likes (wants?) but does not need to possess (chooses to refrain from possessing?). This not only reinforces the infant girl's sense of worthwhile individuality but also makes her susceptible to heterosexuality. If we can accept the concept that these parental influences play an essential part in the development of femininity, then we have displaced, as have so many other workers using different data, the oedipal situation and its anxieties as the crucial force introducing femininity. I do believe that conflict also contributes essentially to the development of femininity—but, as was noted earlier, so that we can here focus on the more egosyntonic forces—defensive factors need not be reviewed now. This is not a classical analytic hypothesis about the development of femininity in feminine women; it stresses nonconflictual learning. I am not bothering to discuss material with which I agree—the effects of conflict and the contribution of various libidinal stages to the "coloring" of femininity. If the above nonconflictual parental influences are essential to creating a sense of femaleness and, later, a sense of worth in femininity, then femininity is not just a defense against envy of maleness and masculinity.10 I quite diagree with Freud in his conviction that women are fundamentally inferior,11 as I have indicated elsewhere.12 The crux of Freud's argument is that little girls do not develop femininity until after the oedipal stage (around five, six, or seven) and that before that time they develop in the same manner—masculine—as little boys. He say this is because girls wish to be boys, masculinity being the naturally superior state and the possession of a penis the evidence of that superiority. So all little girls from the start of their lives feel

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robbed and yearn for a penis; only with the final, bitter acceptance of the fact that they can never have a penis do they settle down to their defeated state, the common name for which is ''femininity." This made a coherent theory, but there are data that contradict Freud's argument—just look at little girls. Another influential myth for years was that the balance of a woman's femininity and masculinity was expressed in its most succinct form in her genital sexual pleasure. If she had come to terms with her penis envy and had achieved femininity, she gave up her hypercathected clitoris and, in accepting her vagina, developed the full, more loving, feminine, vaginal orgasm. By now the knowledge that a capacity for vaginal orgasm is found in women with all degrees and diagnoses of mental illness (such as Mrs. G) rather diminishes this theory, as do observations that feminine or masculine appearance and behavior need not correlate with capacity for or sites of sexual pleasure.13 The argument fails also in the face of the fact that some masculine women with teeth-grinding penis envy, a desire to dress as men, athletic interests, and hatred of appearing feminine have vaginal orgasms in intercourse with a man. I have known a few such women, who hated their bodies for so betraying them. Knowing what we do about the development of Mrs. G's gender identity and comparing it with the more normal development of femininity, we quickly see how different was hers. If we accept her story as essentially accurate, we may even surmise that not much femininity could have resulted. She never established a firm sense of being female; for although assigned to the female sex at birth, she was not appreciated as a female. From the moment she was given her father's name, she was invaded by the idea that her femaleness had no value in her mother's eyes. In addition to having little worth as a female—and in fact almost no worth as a creature, regardless of sex— Mrs. G had a powerful brother who was held up as an example of the way to be, both by her mother and, later, by teachers in school; and she had all too many opportunities to observe the insignia of his superiority and to absorb the knowledge of her own inadequacies. Her father, who might have restored some dignity to her sense of femaleness, was rarely present, and perhaps even in his leaving relayed to his daughter a message that her femaleness was not good enough to keep him close to her. If a girl does not develop a solid core gender identity, then how

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can she later build an adequate sense of femininity around the defective core? At best the result is patchwork, and the seams may loosen or break apart under stress. What follows are simply some brief, random observations, many long since stressed by others, on which this research touches: 1. To say a person is "homosexual" tells us as much and as little as to note that he is "heterosexual." It would be better at present to describe the preference called homosexuality in as varied a way as possible rather than to imply that all homosexual people have much in common other than preferring a partner of the same sex. In time perhaps we shall be able to group certain personality types as "the homosexualities" and differentiate them clinically, psychodynamically, and etiologically. (Might we do this to discriminate "the heterosexualities" as well?) I am not hinting here at a belief that homosexuality is merely a variant practice without psychodynamic significance or without onset in conflict and defense. Rather, I am saying that I dp not know if we should even use the phrase "homosexuality is," much less pontificate about the subject, until we determine the varieties and etiologies of homosexuality. 2. Certain behavior fixed early in life is unalterable, even by psychoanalysis. Not all immutable behavior is of biological ("instinctual") origin, however; early parental influences, or lack of an expected habitual parental influence, can produce immutable effects (including lacunae) in personality development. It follows from this thesis that when one encounters an immutable or universal human behavior, he is not obliged to invent a biological "explanation," though he is free to develop scientific tests to prove or disprove the possibility. 3. Discussions of psychological treatments of schizophrenia require that the descriptions of the patients be adequate to differentiate the disorders currently called schizophreniform or reactive schizophrenia or hysterical psychosis—all of which are known to have a good prognosis—from the fixed and usually incurable "schizophrenias." 4. Belief that all mental disorders are organic or "learned" (in the behavioristic sense), beliefs that are spreading (especially because of the—at best—only modest success of psychoanalysis as a therapy), can obstruct progress in psychiatry. 5. Theory is not research; to elaborate theory is not research; however, research needs theory. 6. Psychoanalysis is the most powerful tool yet devised for exploring the dynamics of human behavior and for reconstructing a person's

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past life. However, to use it alone for these tasks is to fail: it must be augmented by other research techniques, e.g., infant observation. 7. Most fantasies are not hallucinations, though most hallucinations are fantasies. Whatever the similarities, a fatal mistake in logic is made if one sees no difference between a hallucinated penis and the wish for a penis. When one has found manifestations of a psychodynamic, he cannot yet assume he knows the part that dynamic plays in its owner's life. One must not ignore ego strengths by giving equal weight to all dynamics, conscious and unconscious, continually present and active or silent and unused, just to suit an argument. Finally, let me underline a major question of this research on the earliest origins of masculinity and femininity: To what degree are we the products of our parents* conscious and unconscious fantasies?14 When we are those products, we may not know it. Analysis of the transference cannot reveal exactly what parents felt about or did to their infant, much less why they did it. Ideally, if one wishes to find out about nonbiological influences on infant development, one should observe parent-infant interactions in the most minute detail (love is expressed more by skin temperature, muscle pillowing, style of breathing, and other psychophysiological events than by words), analyze both parents, longitudinally study the family and the infant-becoming-adult, and psychoanalyze the infant-now-adult. It is too much even to attempt, but what data we could collect! Some analysts are familiar with the impossibility of analyzing egosyntonic, nonconflictual areas;15 analysis is energized by the tensions conflict creates. How, then, can analysis be the tool for discovering the origins of those large sweeps of character that are not the result of conflict or that, starting in conflict, have become egosyntonic and work unnoticed in making life bearable or enjoyable?16 Consider, for instance, the personality of the Israeli sabra; sturdy, reality oriented, and remarkably well suited to the environment that produced it. Some of the attributes of this personality—stubbornness, impoliteness, directness—look to the outsider like a defensive toughness (reaction formation), in our culture known to be an attempted solution to intrapsychic stress. But that is not the etiology of such traits in the sabra. His traits, too, have developed from conflict, but not his own: they are the result of his forefathers' conflicts and restitutive fantasies, though the sabra might be the last to know it. He feels he grew by spontaneous generation out of his native soil and cannot comprehend the ghetto-Jewish Tearfulness of his parents or grandparents. He is what

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they dared not be in Central Europe. This again reminds us that not all historical forces act through neurotic mechanisms. Closer to our subject, recall that most feminine of males, the transsexual, who feels he is a woman and wishes his body changed to female. His femininity derives from the way he is handled by his mother, who has wished him to be her beautiful, graceful, idealized, feminized phallus. And that is what he becomes, starting with the first behavior one can reckon as gender behavior. The transsexual's mother uses her son this way because, in her neurosis, she suffers endless anguish, for which he, the marvelous phallus, is to serve as the cure. But her son's femininity, the result of her influence, causes the boy no suffering (unless he is punished for showing it). i: The end results of parental fantasies are often not congenial in children. Some parents wish to destroy their children, and the wish can become reality if transmitted to the children (perhaps a common source of suicidal impulses18): they comply with their parents' wish that they disappear. We saw that motive in Mrs. G. Some parental fantasies produce a child whose living out of those fantasies causes conflict within himself or, as we saw in Mrs. G, with society—either because the bearer of the fantasies is fought by society, or because the fantasy has ambivalent elements. In the happier situation—probably the one in which the greatest part of one's culture is passed on from generation to generation—parental fantasies result in children who are in touch with themselves and their society. "Interpersonal schemas" become "intrapersonal schemas."19 I think such parental fantasies can be emplaced by two processes. The first is exemplified in conditioning or imprinting, in which the central nervous system is modified without the interposition of psychic processes in the infant. What the transsexual's mother does with her body as she holds her infant is an example of such communication from psyche (mother's motivated action) to unresisting neurophysiology (infant's brain). 20 And like modes of communication—though different messages are transmitted—pass from all mothers who hold their infants. The second process, this time cognitive on the infant's part, is so familiar to analysts that we too often ignore the silent, earlier, noncognitive process. Only with this second process do we have memory and fantasy: the infant senses his mother's impingement on his tissues and makes something of it—that is, he has now advanced enough so that he has the capacity to perceive it, judge it, interpret it, and believe it has meaning for his mother and for him.

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Although psychoanalysis has toppled the mechanical models used by psychologists, it has paid a price in that it has hesitated to let any mechanics (nonmotivated behavior) back into its theory: in living organisms, what is not motivated (i.e., "instinctual," drive-oriented, goal-directed) does not exist; creatures are pressing for (desiring) either life (Eros) or the absolute peace of inanimateness (Thanatos).21 But analytic workers have recognized that there are other learning processes at work. Thus leaks in theory have gradually been plugged by such concepts as conflict-free ego spheres,2- basic faults,23 and lacunae.24 From outside psychoanalysis, quite different theoretical schemes and data have been permitted entree into analysis: the theories of Piaget, general systems theorizers, cyberneticists, ethologists, neurophysiologists, and even academic psychologists, with their work on conditioning, reinforcement, shaping, reward, and punishment.25 Sometimes the parents' fantasies make a happy child; unfortunately, this generally requires happy parents. Often, on the other hand, the child is the object of fantasies of revenge or hatred, an especially poignant version being the child who is shaped by a parent's self-hatred, the child being regarded as part of that parent's self. One sees this, for instance, in the effeminate homosexual boy. Often he has been saddled with his mother's hatred of maleness and masculinity, originating in her self-hatred for not having been a boy; under his mother's alternating malice and overprotectiveness, the boy must shape himself as unmanly and act unaggressively26 in order to retain closeness with his mother. The results may be happy or unhappy, but the examples are endless, because, I believe, this element of parental fantasy is present in the development of all children. Let us look briefly at Mrs. G in the light of "identity themes" inflicted on her by her mother: You are a female, but males are better; if you were a male and had a penis, I would admire you as I do your older brother. It would have been better had you never been born; you would be better off dead. You are just like your father; he's no good (though I loved him intermittently). You are just like your father; he is crazy. You are a liar. You are a bad child, but that's the way you are; you will never change. But you will always be my daughter even if you are bad ("bad" meaning being in trouble with society or being mentally ill—

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hence the child's reaction "If I am good, I am bad; but if I am bad, I am good [acceptable to mother]"). Our beliefs about our children are apt to be self-fulfilling prophecies. Sometimes the task parents assign a child is simply too great for the child's capacities; he may be biologically incapable of performing it because, for example, of a low I.Q., or unsuitable physical appearance, or a too intense biological drive that precludes living out the parental fantasy. Sometimes the task cannot be accomplished because it is made up of a parent's conflicting fantasies. The child must respond to all the orders, even to sorting out which are to be dominant or conscious themes and which hidden or unconscious; conflicts with or within the superego will be prominent in this category. To what extent is Mrs. G's impulsivity the vicarious expression of her mother's forbidden impulses? On the other hand, to what extent is Mrs. G not just acting out her mother's unacceptable impulses but rather performing these acts because her mother has set the child's role as being mother's bad girl, and if Mrs. G is not mother's bad girl, then she isn't mother's girl at all? Greene'-7 says, "The *psychotic's' supergo is the internalization of the actual aggression of the parents against the child, even if refracted through the child's fantasy." May this not be more generally true than just with psychotics? And may this not also be related to many other aspects of normal and abnormal personality development that heretofore have been ascribed in the analytic literature to infant fantasy rather than also to reality incorporated? So that there is no misunderstanding, let it be said that of course not everything is attributable to direct parental influences: one also creates his own neuroses. An explanation based only on learning theories, ethological concepts, or a theory of parental influences cannot account for repression, for splitting, for most of psychopathology —such as phobias, conversion reactions, hallucinations, compulsions, perversions, psychoses, addictions, depressions, panic, psychosomatic disorders, multiple personality—or the unending variety of defense mechanisms. In the case of Mrs. G, certain symptoms were created not only in response to her mother's demands, but arose because one part of her was under attack by another part. My presentation may have made it seem that a child is unable to resist the force of his parents' wishes. But I do not quite believe that— though it is, I think, somewhat true for the infant, it is less so for the

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child. First, there is a biological endowment that may permit (or force) the infant to withstand such pressures. Second, in later infancy, a child's own development (especially his advancing fantasy life, conscious and unconscious) makes him reshape the parental demands. Third, parents are changed even by their child; parents' messages can be diluted, die away, or be reversed (e.g., "I no longer want you, my daughter, to die"). Last, the child misinterprets his parents' wishes. Seen through Mrs. G's eyes, especially when she was a child and when she was psychotic, her mother was a monster. Yet I know her mother is not—and so, now, does Mrs. G.

17 Epilogue: Roots of Evil That is all I want to say now, but Mrs. G and I are still at work. The quotations that follow are in chronological order, taken from a few months of therapy after this book was written. What I said has been removed, and Mrs. G's remarks have been run together as if all spoken in a day. They have been selected so as to amplify, clarify, and fill in more clues needed to understand events reported in the text. Although unreal in that they do not indicate the passage of time in treatment or what I said that at times provoked Mrs. G's remarks, these associations convey a sense of her presence better than the transcripts heretofore presented. By this point, Mrs. G had an option never hers before: she could control her mental condition. Although she might still feel suicidal or conjure up hallucinations under stress, she could choose whether to let the reaction proceed or to turn around and face reality. The latter was often grim: dangerous liaisons with the past had to be broken; her financial state was desperate; and severe physical illnesses not only caused her suffering but also frightened her. But she felt like a human. Relieved and pleased to find herself, she was interested in learning more. We did this by taking advantage of her peculiar capacity to free associate, by which she could not only recall but relive past experiences. This was especially facilitated by her being able to go into a trance, one more aspect of her capacity for splitting. She could go back to earliest childhood simply by letting herself drop into the past. We were both interested in the roots of evil, especially in her trying to find when and how murder became so easy for her, how her warmth for others could be so blunted that she no longer recognized that killing them would harm them. That, most of all, is the theme of the following, the content of which is particularly filled with Mrs. G's memories and feelings in regard to violence, the ease with which she could harm others, and her final awareness of her capacity to feel. As one reads, one can watch Mrs. G slide up and down levels of awareness and move from talking to me in the office to being again back in the past, talking to others whose replies only she can hear. 324

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Mrs. G: Upset my mother . . . Maybe I wanted to confuse my mother—she confused me. I didn't know if she wanted a boy or a girl. I thought she wanted a boy. I wanted to be a boy so I could kill people. And I don't know what made me say that; it just came into my head. Of course, women kill people, too; but men do it so much more effectively. My father was a killer, you know. The army took him out and gave him a gun and he killed people. I remember one time when I was a little kid and he was recruiting officer, and he brought home movies of the atrocities that showed pictures of people being killed in masses and shoved into pits and set on fire. Jewish people. Bodies of babies that had been mutilated. I don't know why he showed them to me. I used to get sick every time he showed them . . . and frightened. They used to frighten me to death. I guess he thought we'd be interested to see ... maybe because that was his life, he thought it ought to be our life too. Death and destruction. I think he showed them to us so that if we ever had a need to kill people, we'd know how. He had been there. No ... not like killing the Jews . . . it was the Germans who did that; but he had been somewhere where American soldiers killed people. And he had funny films about killing people, too. Then there was a movie about Snafu, whatever that was, when the government made a mistake or something, and that was an animated cartoon about killing. My murdering was a little bit different than most murdering because I never wanted to hurt anybody; I just wanted to kill them. Charlie was not my friend. In the beginning he wasn't my friend . . . just a distorted character or a policeman. Towards the end he was my friend. I don't know if Carrie was my friend. I don't know that much about her. The penis wasn't my friend. It made me hurt people, and it made me hurt myself; and I thought it was for my protection. What it was doing was exposing me to all sorts of dangerous situations. [Long pause] You know what you told me once? You told me that there's no point in committing suicide because all you have to do is wait. And I never really understood that before; and I was thinking about that the other night . . . it's really not a long wait, you know, for some people. You just have to be patient—impatience, I think, is a sign of fear, which maybe . . . you know, you're afraid you're not going to make it. Why did I have to die, and why did I have to kill anybody else? Well, I don't know what I was feeling at the time. I mean, I can't

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say, "Well, I hit that little boy on the head with the rock because he was peeing in the hole," you know. I have to say that what I really felt was rage; really I was furious because here was a boy with a penis pissing in my private place. It was my place to be a boy. It was a place / went to be a boy, and I didn't even have a penis. And then here conies this bastardly little boy who had no right there at all, and he . . . he just ruined the whole thing. If he were here right now, I'd kill him. I used to dream about killing him. Sure, I knew him for w h a t . . . thirteen years? And for thirteen years I wanted to kill him. All because of that one incident. Not because he was a real bad boy, you know, or because he could do things better than me, because I always outdid anything he could do; but he was such a little . . . I can't think of a word . . . just a little boy. I remember, I used to come home from school; and, of course, our town—when I was a kid—was a very small town, and a lot of the roads were unpaved; and I used to walk up the dirt road—his house was right there and mine was on a paved road—and I used to think: I'll kill him and I'll bury him in the road. And then they're going to pour pavement over the road, and they'll never find him. I used to think of all the different ways I could kill him. You know by chopping . . . horrible ways . . . by cutting his head off, slowly, not in a hurry, but just slowly cutting his head off. And I think the thing that cured me from wanting to kill him was . . . There was a man who I admired, very close to ... who .. . They had a big strike, and the families were going hungry. And this man had been laid off, and he went berserk; and he was in his garage, and he cut his wrist, and his wife saw him. And I was in my hole, and he ran, and he jumped in my hole, and he cut his throat. When I saw him coming towards me, I got up to run, because I thought he was after me; and he cut his throat. I was nine. . . . I was hiding, and I heard people screaming, you know. I guess it was his wife screaming for him to come back. And I got up, and he was running toward me with blood on his arms; and I thought maybe he had killed somebody or maybe he had done something terrible, and yet I couldn't really equate that in my mind with the man that I knew, so I wasn't really frightened, just astonished or something— I wasn't frightened of him. And he jumped in the hole, and he took this razor, and he cut his throat, and he made this gurgling sound; and there was a lot of blood squirted all over. I got blood on my legs. And I ran home, screaming at the top of my lungs. Oh, yes.

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He died! In my hole. If you cut your throat, you'll die. I don't know what to tell you. I know if there's a lot of blood, you'll die. No . . . I know they took him away in an ambulance, and I never saw him again. I don't know where they took him or what they did with him. When you're sad and when you're lonely and when you're crazy, you cut your throat and you die. But he never came back. No, that puzzled me, that he didn't come back. Because by then I believed that if people died, they came back. I'm thinking about that woman in the nursing home where I worked—when we turned her over, and she was so horrible; and then washing her and dressing her and changing her sheets . . . I could have shoved a broomstick up her twat; I could have cut off her arm; I could have done anything to her, anything. And she was totally and utterly defenseless; she was completely inanimate, under the jurisdiction of the living, you know. They dug a hole, and they put her in the hole, and they covered her up with dirt. And that's all there is—that's the end; there's nothing left. She can't even prove she was alive. I don't want to die. That's not really true, that I don't want to die. Sometimes I want to die. Sometimes I think maybe I should find out what it really is and—[Chuckles] this must sound stupid, because it's so unreal—and then I can come back and tell my sons. You know, that's the old stuff. Sometimes I still think that way. I think, I'll just die and then . . . Yeah, well, I know about destruction. If you have warm feelings for people and you have some capability and you have a desire to learn and to be educated and to do all these things, you don't have any desire to kill yourself. That's a lie. That's a ... way of manipulating somebody to give you something. Most suicides are manipulators anyway. Now what would I want? Maybe I want you to tell m e . . . I don't know. When I get so angry that I'm filled with rage, I become very calm and very quiet and very diabolical. I want revenge, and I think of the most horrendous ways of getting revenge. Let's use K as an example. He did something that upset me—it wasn't anything too terrible . . . He threw F [son] across the room. He fucked my friend T. What else did he do? He did several things. Now each one is making me angry. The first time I ever saw K . . . there was a hot dog stand in Venice—it's still there, I guess—where the motorcycle gang I rode with hung out and where you could purchase dope or

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anything like that, anything illegal you wanted. And K took this boy's . . . this boy had a German shepherd, just a young boy about fifteen years old . . . K was one of the first long-haired people I knew; he had long hair—which is kind of funny, in 195—, it must have been '58—K took the dog by the leash and threw the dog up over the lamppost; the extension was coming out from it and hung the dog, and that made me violently ill. This boy was so disturbed and everybody . . . I think everybody was upset by his doing this— it was just so cruel and inhuman a thing to do. And as I got to know him better, I knew that he was just a vicious person, just vicious. They arrested him on a traffic warrant once, and he bit a cop's ear off. I knew the entire Venice Police Department hated his guts, that they were constantly looking for some reason to arrest him so they could send him to the penitentiary—not to the county jail, but to the penitentiary. I started riding with a guy named Jack—you know, I was his buddy, bike buddy, you know, when you ride on the back, you're bike buddies—and Jack and K were friends; and K could come to T's and my apartment to see Jack, so we got to know K quite well. I remember one time K got drunk and passed out; and a friend, a cop, walked in with this guy passed out on the floor; and he picked him up by the hair, and he said, "Who is this?" and his head bounced off the floor. But he was just a repulsive . . . even his appearance was repulsive. He was short and stocky and swarthy and greasy-looking. One time I had the boys home for the weekend, at my place for the weekend—you know, they stayed with my mother—and F came out of the bedroom and asked for something, and K picked him up and threw him across the room, which frightened F. And F was hurt. And I said something about, "You son-of-a-bitch, don't do things like that to my kids or I'll kill you!" And he said, "I'll do the same thing to you if you like," or something to that effect. And I told him to get out, and he wouldn't leave; and I put the kids to bed, and I left. And when I came back, T had been to bed with K, and I didn't say anything; and K was gone. . . . I left the apartment and walked two blocks over to where I knew this boy lived who had a gun, and I broke into his apartment and took his gun, which was a repeater rifle, a twenty-two I think. And I got in Ts car, and I go to K's apartment; and I knocked on the door, and he hollered, "Come in"; and I opened the door and I shot him. I

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didn't feel rage, I just wanted to ... I didn't want to kill him; I wanted to hurt him. . . . I wanted to hurt him enough he'd be gone, you know, without actually killing him. . . . I don't know how to explain that. I shot him in both thighs trying to shoot him between the legs. I wanted to shoot his balls off. Anyway, he fell down. And I went outside to his car, which was his pride and joy, and I shot the windows out and I shot the radio . . . I just shot crazy. I just wasn't even thinking of what I was doing. And I went . . . I didn't go home . . . I went to this guy's house who I had been living with before I moved in with T and asked him if I could spend the night, and he said yes. . . . And I put the gun under the mattress, and I stayed there until about six o'clock in the morning. And then I went home—I left the gun there— I went home, and I was so tired; so I laid down. And a policeman came to the door, a very big, huge cop, just as sweet as he could be; and he asked me if I shot K, and I told him no. And he said, "If you lie to me, I'm going to put you in jail." He said, "I'm just going to ask you one more time, did you shoot K?" And I said yes; and he said, "O.K. You have to be at the Police Department at three o'clock"—I think he said every day or every other day or something. And I said, "How can you put me on probation when you haven't even arrested me yet?" And he said, "Oh, we're not putting you on probation. We're going to give you target practice. You did a piss-poor job!" And that's all he said—that's all he said about K; he didn't say . . . Oh, K . . . after the ambulance had come and taken K to the hospital, they arrested K for having stolen property—they found his house full of stolen property. They finally got their charge to send him to the penitentiary, and he asked for police protection against . . . from me ... and they just laughed at him. You know, no policeman who has had his ear bitten off is going to protect an animal, because that's what he was; he was an animal. When I was shooting him, I was excited. When I was actually pulling the trigger, it was . . . it was . . . like eating something good. I felt it in my throat. I felt it in my guts. It was a good feeling. And I hurt him too. . . . He was on the floor and he was crying; he was hurt and he was bleeding; and I just closed the door on him. I didn't call an ambulance. The person that called the ambulance was . . . when I was shooting at the car, I missed once, and it went through somebody's bedroom window and missed their head by about that far, and they called the police. They thought there was some maniac

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on the loose on the street with a gun. It would have really been . . . it was such an insane thing to do because I could have really hurt somebody. I mean somebody who was innocent. I didn't feel the gun. I felt the trigger; I don't know if the gun was heavy or light or what. I didn't think of it as a gun. I just thought of it as a method to destroy something that was evil to me, you know. It was just like . . . it was like it was coming out of me. It was like . .. I'm going to destroy this man; he's an animal, and I'm going to do it. The gun was something that was superficial; it had no part of me, you know. It was like the trigger was an extension of my finger. Like I was pointing my finger at him. I'm going to shoot your balls off. And when I was done, I was completely relaxed. You know . . . when I went to get the gun, I felt tight—I don't know a better word for that—and driving over there . . . but when I was shooting at him, I was excited, I was (snaps fingers). I was I-don't-know-what. I don't remember seeing his face until after he fell. All I saw of him was from the waist down. I felt excitement in my chest, you know, like you're on a high diving board and you look down and you get that feeling in your chest, my God, that's a long ways down, you know—not fear, because you know you can dive. Do you know what I mean? O.K. I felt that, and all my stomach muscles were relaxed, whereas before they had been tight. You know, I could have shit in my pants, everything was so relaxed. And when I looked in his face—and he was terrified of me, he was terrified— all I could do was close the door on him; I felt powerful. I never thought about his dying; I didn't care. I thought I had gotten his balls. I can shoot a gun better now. I wasn't even aware of my penis. I wasn't a man shooting a man; I was a woman shooting a man. I was a woman who was infuriated by the humiliation of this man's animal character. I was . . . everything he did repulsed me, and when he threw my son across the room, you know, that was an attack on me as a woman, as a mother. He didn't do it because he didn't like the kid. He just did it because he was vicious, you know. One time he grabbed me; he was going to kiss me. And I said, "God, no"—I was so repulsed—and he dug his fingers into my back, and I had black and blue marks on my back for weeks where he had dug his fingers into my back. If he were standing in front of me right now, I'd do the same thing again, only I would be more careful about where I aimed. I'm serious. You don't believe me. No thought about the consequences, no thought about anybody else

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who might be in the area witnessing it, no thought about police, no thought about T, no thought about the boy whose gun I stole, which I later sold to a policeman—that was the icing on the cake, to sell the gun that I shot K with to a policeman, that just tickled the shit out of me. He had no more respect for me than he did that dog he hung. He came into my house, and he ate my food.... Because I was scared of him. I was scared to death of him. He was so vicious, so inhuman, and . . . in all my travels I never met anybody like that before. He knew I was a woman; he didn't know I had a penis; he didn't know that I had been to bed with other girls; I was twenty-one years old, or twenty-two—something like that. He treated me like an animal. You know, he just. .. He never spoke directly to me ... I don't even know what I'm saying. He never knocked on the door before he came in the house; he just walked in. Because he wanted T. I felt like he was taking something away from me, like when he threw F across the room, the same feelings. And T and I had a funny relationship. We took care of each other and we protected each other and . . . I had strong feelings for her. How could that animal defile her like that . . . with his filthy body? After I shot K there was something I had to be concerned about. It was that his friends would come after me. And yet they were scared of me. Can you believe that? Grown men, Hell's Angels, who wore chains to hold their pants up, you know—they were scared of me. And nobody was more scared than I was. I had a reputation for people to be sure enough not to make me mad because I had an uncontrollable temper, and the whole fallacy of that is I didn't lose my temper. I never lost my temper. I didn't have a temper to lose. I wasn't . . . I wasn't angry. My mother tells me that even when I was three years old and my sister was six months old and crawling, my sister used to love to grab me by the hair and pull my hair; and my mother would say, "Slap her hands" and I'd say, "No, I can't hurt the baby." And she said, "You never got angry at anything the kids used to do to you." So even before I remember, I guess I didn't get angry. You know, one of the hardest things it's going to be to talk about is killing the kids . . . or not killing the kids, or attempting to kill the kids . . . because I love them so much. You know, sometimes I didn't kill or attempt to kill to hurt somebody: sometimes I attempted to kill to save them. You know there's a big difference.

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And when I wanted to save somebody, I never wanted to hurt them. I can see the difference between me and K. K was just a vicious person. I wasn't vicious; I was diabolical. [Laughs] Did we ever talk about the Hell's Angels? Did you know that all the men and women who were Hell's Angels by the time they were thirty they were housewives and husbands and had children? Very few of them are on motorcycles any more. And all the people who smoked pot when I was a kid grew up and got married and had children, and they didn't smoke pot any more. I feel my treatment has just been helping me to grow up, so I don't need to be crazy any more. And sometimes I wonder, had I not been suicidal, if I couldn't have accomplished that myself— which doesn't give you very much credit. And then again I know that isn't true because I would never have figured out why my brain was rotting and I would have never figured out why I wandered around not knowing who I was or where I was. The treatment, I feel, at times was very beneficial, and at other times I feel it was very detrimental. I think there were times that you pushed me into craziness that wasn't necessary, and I suffered a lot because of that. God! When we were discussing homosexuality, for instance, and you would make me say things that you knew would upset me and you knew were disturbing and you knew would drive me crazy, but you insisted on my saying it; and I would go home and I'd be out of my mind and I'd be frantic and sick to my stomach and the whole works. But maybe that was necessary for you to accomplish whatever you were trying to accomplish; I don't know. I think maybe I could have been spared that. I think we could have maybe started out by discussing my body. Since I've been a little girl, I've never been sure of what my body consisted of. I always thought I had a penis and I always thought I was different than everybody else. And that it didn't make any difference how many other girls' bodies I saw, I always thought mine was different. Just like not being able to stand having my breasts touched. I thought my breasts were different, and I didn't want anybody to touch them to find out. And I think had we discussed my body, part by part, that I would have understood my body better. Then maybe we could have worked into the homosexuality and . . . my liking other women's bodies. 1 don't know what I'm talking about. It was never necessary for me to sit in that chair and say "I am a homosexual" . . . because I always knew what I

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was; I always knew it. But I didn't want to believe that I was a homosexual. I don't know if it speeded treatment up because I was . . . because I was crazy half the time. And that was wasting time because I didn't accomplish that much by being crazy. I thought you were a cruel and inhuman bastard, and I could never understand your purpose in doing it. It never occurred to me that it was for you to make me better. I thought. . . you know, he's got his research and now he's got somebody to play with; he's just going to play. I thought I had given you myself to play with so there wasn't anything wrong in what you were doing. Like my mother. I was thinking about being in the County Hospital and Dr. M coming in to talk to me and I'm asking him if he wants to get laid. . . . And he looks at me kind of funny, and I said, "Just pull the shade down on the window"; and he turned around and looked at the window, and there wasn't any shade. [Laughs] I was thinking about how many times I did that to you. I had to do it to you because I never wanted you to own all of me; and as long as I could say, you know, "Pull the shade down" . . . What did I do to my mother? Why, by never being disrespectful, by never answering her back, never telling her no, and always smiling at her and agreeing with her, and all that time I was thinking: Fuck you, lady. Yeah. "I don't disrespect you, but I'm going to shoot a policeman in the ass. How does that make you feel, Mother dear? This is the daughter who you raised so carefully. ..." If she hadn't been crazy, we could have had a good relationship, but her craziness didn't match mine, and we just couldn't . . . we just weren't on the same wave length. Maybe I love my mother more than most daughters love their mothers. She always gave me just enough, just enough to make me hungry and to want more. Enough of what, I don't know. Maybe enough love or enough attention or enough discipline or ... no, she never disciplined me. I don't know. You know, you see these dogs . . . have you ever been to the dog races and seen the electric rabbit? I always felt like that dog chasing the rabbit... I never could quite catch up to it. She has a real thing about feeding babies. My sister-in-law's kids and my sister's kids and my various sisters-in-law . . . she was always concerned about the way they fed their babies, whether they breast-fed or bottle-fed and that sort of thing . . . and I don't know what she did with her

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own babies. She told me when my big brother was a baby, she was working, and my mother used to bring him to work on her break and her lunch hour so she could breast-feed him . . . like a kid. I know my mother has always been scared of me. She is even today, but she was scared of me when 1 was a baby. She's told me a million times of how frightened she was . . . maybe because I was so small. It kind of built into something else because I was so diabolical when I started to walk and talk that she was just frightened of me. Tell me, what's diabolical? Diabolical means sinister. I was always a tease. I think I learned that from my father. I don't think I learned that from my mother, and yet my mother is quite a tease, but she teases sexually. I didn't tease sexually. [Laughs] Not really. You know, I had a dream the other night that I was inside my mother. [Laughs] I was wet and warm—that's what I always wanted to be when I was a baby, wet and warm—I was always wet and cold. I remember that. You think I don't remember that, but I do. Because I can feel it. When I go to bed at night, I feel it—wet and cold, just like a goddam lizard. My grandmother said, "If you put mittens on her hands, she won't suck her thumb." And my mother pulled on the sleeves on my neck and tied them shut and I couldn't get my thumb in my mouth. And there was nothing to put in my mouth . . . so I just screamed and screamed, and nobody ever heard me scream. Maybe I didn't really scream—maybe I just thought I was screaming; because sometimes now I feel like I'm screaming and screaming, and nobody hears me, and I'm not really screaming, just screaming inside. I didn't... I didn't want to be a difficult baby, but they didn't understand the things I needed. I needed not to be cold and I needed not to be in a cage. If they were to just listen . . . [Sighs] . . . nobody ever hears me but my grandmother, and she doesn't live there. If I don't eat, they pay attention. If I vomit, they have to clean up the mess and then I'm a difficult baby. I don't know what the word "difficult" means. I just need to be warm and I need something in my mouth. He doesn't touch me because he's scared of me. My brother is so big; he's got such big hands, and he likes to grab my arms and hurt me. He always did. My grandmother doesn't want a baby; she wants a doll. Nobody wanted a baby. And I don't want to be a baby. I remember the first day of school. I was a year younger than everybody in my class, and the teacher said, "You're the baby";

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and I knew she was wrong because I was already so old. When I was four, I had already lived and died. If she left me cold, I just puked on her. I don't understand. I don't throw up because I'm bad. I don't understand any of it. I don't understand why she hates me so much. Sometimes she holds me and . . . I don't mean to hurt her so I'm not going to hurt her any more; I'll hurt the person that deserves to be hurt. They just didn't know I didn't mean to be bad. [Sighs] She gets mad if I don't eat, and she slaps me; and she gets mad if I eat and throw up, and she slaps me—nothing I do is right. So if I could just die ... and I try so hard and they won't even let me do that. Nothing I do is right. Don't cry. [Long pause] Well. . . well. . . well. He wraps me all up and takes me home. I'll throw up on Bud. He forgets that one. I wonder if he remembered that when he died. I ate the soap. My mother thought that was very strange that I would eat soap. Somebody'd better help me. Don't cry. How come nobody ever comes and I need help so bad? I can't hear you. That's just what I need, somebody to be with me. I'm not going to cry. No. No. Oh God, don't cry! Be careful. Why doesn't someone come help me? No. I can't do that. Don't cry. He says I shouldn't because if I do then I give him everything. He says I shouldn't. Be careful. I'll give him everything. David [original name for the "voice" we dubbed Charlie]. [Long pause] David. He's angry. I guess that was because of the fire. It sure was a big fire. My father said, "If you do that one more time, I'm going to spank you." And my father never spanks me, and I didn't believe him; so I did it again. And he said, "O.K. Go out to the garage and wait for me." And I went out to the garage, and I waited, and I set the garage on fire. If he wanted to spank me, he had to come in and get me. David got so mad! My dad came in and got me, but he didn't spank me. I knew he wouldn't spank me. My dad didn't like to hit me. My mother liked to hit me, but my dad didn't like to hit me. Did you see the fire? It was before my dad went away to war, the big war. It was a big war, and my dad wanted to go. Every time there was a war he wanted to go. He wouldn't have gone if he had got burned up in the fire. He wouldn't have gone anywhere. [Sighs] I'm not sorry. She can't make me sorry. She's having another baby; I didn't want another baby. God, babies . . . baby boys, always baby boys. That was the best baby of them all. My grandmother thought he was an idiot because he

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was the best baby of them all. So she took me home with her. Don't cry. No. 1 cried all the way back, all five hundred miles, cried and puked. He said, "It's the last time Til ever take that kid any place." From my grandmother's house to my mother's house. I didn't want to leave. I had a coat and shoes and my grandfather never went away except to his job; he was a policeman, too, a big policeman. He was a big, big man. I don't know why she kept doing that to me. She did it over and over and over again. God! Sending me there. If I was bad, I got sent there. If I was good, I got sent home. It was like . . . your badness will last for three months and then you may go home. Or your badness may last for six months, and then you may go home. I never knew what I did that was so bad except to miss school. But when I did go, I was good in school. I guess that's a lie. I wasn't good in school. I hated school. I liked to read and paint and do arithmetic and read history books, but I hated the teachers and the kids. And I said, "God, please don't make me go to school. Please make me sick so that I don't have to go to school." And then I got sick and I didn't have to go to school for a whole year. David said, "You've got to read; you have to know. How are you going to find out if you don't read?" And then there was another baby, another baby boy. How could she do it? I wonder how . . . I wonder how she could do that. She wanted a baby boy, so she got a baby boy. I guess I was the only mistake she made. It would be O.K. . . . it would be O.K. to cry if you don't let them see you; don't tell anybody. When my dad came, they told him I had a kidney infection—that was a lie. They lied to him every time I did something. They never wanted my father to know what I did. It wasn't a kidney infection—I had a baby in my belly, a real live one; and it was a boy, too. It had to be a boy—it couldn't be anything else. God only loves boys. I tried to kill it. This man that I was babysitting for—I told him I was pregnant—and he said, "Well, if you take quinine, sometimes that makes the baby go away"; and I bought quinine and I took quinine, and all it did was make my ears ring; I still had a baby inside of me, and I did everything to get rid of it. Because she would have destroyed it ... like she did the rest of them. She destroyed them all. She wasn't a mother. And yet she wouldn't want me to keep it, oh God forbid. What could a stupid, ignorant, ugly fourteen-yearold do with a baby?

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I don't know where the baby came from. I don't know. [Sighs] I went to the doctor because ... I went to the doctor... David told me to go to the doctor. And I said to the doctor, "Don't tell anybody"; and he said, "I won't." He lied. He lied; everybody lied. And he said, "You'll be fine. You'll be fine." He didn't tell me I had a baby in my belly. And I went home, and my mother screamed and hollered and said, "Why did you do this? What are you trying to do to me?" I wasn't doing anything to her. "What a rotten thing you are." I already knew that, so she wasn't telling me anything new. I knew it was going to be a boy. That's when I went to sleep for three days. They showed me that boy, and it came out of my body. Don't cry. Just go to sleep. You can't cry, don't you understand that? I don't know why you can't understand that. You can't cry. The baby weighed eleven pounds. A big baby boy. She said, "If you don't give him up, I'll send you to reform school." [Sighs] She sent me to reform school anyway. What a bitch! I don't mean that. She took them all away, all the babies. I had one that was my own; and he . . . I don't know why, I don't know why he had to be sick; I just don't understand that. If you don't cry, maybe you can make him better. He's never going to get any better. No, it's too late to cry. If I could have just had one baby for myself, one baby boy. But I don't need baby boys, and I definitely don't need baby girls. I don't need anybody. I don't need anything or anybody. You can do anything you want to me. I know what you're saying. [Sighs] Just drive that car and just get all smashed. It didn't even hurt. There's something . . . something just hurt a little bit. Now I know you. Dr. Stoller. How do I know him? He talked to me nice and he didn't tell me any lies. He told me some lies. Everybody lies sometimes. But I don't have to cry about that, that's nothing to cry about. I know her, too. Carrie. It's so painful. All that screaming didn't do any good. All that just . . . Nobody ever heard me. It's just like when I was four. I . . . I . . . I have to tell them about the pains. I'm finally alone now. I ... I just need to be alone for a little while. So there are things I have to do. It's time to do all the right things now. David would know. If somebody would just help me a little bit with the understanding part. Nobody's going to help me. I didn't do that. I didn't tell a lie. I don't want her to leave me here. I'm scared. Mother . . . I wish you'd just hit me and not lock

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me up. They weren't. If you don't cry, she won't know you're scared, and that will be a joke. I'm scared. I don't cry. It's much worse this time. This time it's not jail; this time she's going to leave me in juvenile hall after all those jails, after all those dirty places; this time she's really going to leave me there. Please don't leave me. I'm scared. David. Kill her; she's going to kill me. I've got such a pain in my head. So they come up and they say, "Kid, get us. Kid, get us." They dropped him. David, I need to cry. It hurts so bad. She'll take care of you. She sure takes good care of you. I guess that's the way it's supposed to be. I don't understand any of it. They don't even hear me. They'll hear me this time. They're really going to hear me this time. They're all the same. Every fucking one of them's the same. Those men. You know about them. You saw it. They always say, "We're not going to hurt you." He's just like they are. My father's just like all the rest of them. "I'm not going to hurt you," and V, yeah, even V: "I'm not going to hurt you." He didn't either. Not one of them hurt me. They hurt her, but they didn't hurt me. She's . . . how can I tell you when she doesn't even know? Just a little girl. She was a little girl. She really was. Don't you remember . . . don't you remember the yellow dress? Three years old. I have to go to San Francisco, and my aunt buys me a yellow dress, a pretty yellow dress that's all mine; and I look like a girl, and I talk like a girl, and my grandmother knew I was a girl. She wouldn't let my grandfather do that to me. But when it was gone, they all did it. When the dress was gone. I had . . . I had to show them . . . it's a little confusing. What did they do? I had to show them I was a girl so I showed them I was a girl and then they hurt me because I was a girl. I didn't know it was a bad thing to be a girl. I just thought my mother wanted boys because boys were better, but I didn't know ... I didn't know to be a girl you had to be hurt. You remember that man. That first time. Oh God! He was fixing his car, and he said, "Come here and I want to show you something"; and he took me in that room and he hurt me. He said, "I'm not going to hurt you." They all said that: "I'm not going to hurt you." Liars! Pricks! There isn't one man in this whole world who wouldn't hurt you if he had the opportunity. They and their big pricks. They all look alike too. Did you ever notice that about men? They all look alike. I needed a . . . I needed a ... the pain, but I didn't need the lies. I didn't lie. David said that's not necessary.

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The pain. Because I didn't do anything wrong. David said it wasn't wrong. David . . . David is part of me and I thought... no, David is a thought and ... [Sighs]... that's too much. I didn't know that when I was three or four. Not when I was a big-time vato. Not when she was taking care of me like the court said, rehabilitating me, making a better person out of me—she did a good job. I wonder how she rehabilitated her house when I got through. The principal of the school. I broke all the windows. Because I didn't want to be rehabilitated. She made me touch her ugly body. She was so skinny and so ugly and she stunk. I should have told somebody something. In the beginning, in the beginning I was just a baby, just a little baby; and then it was gone, and then it was back again, and then it was gone, and then it was back again . . . it didn't know who it belonged to. It was very confusing; and then they said it was a boy, and then they said it was a girl, and then it did bad things like . . . vomit on it, vomit. . . God, I've got to get that food out of there. How are you going to die if you've got food in there? And eat the soap. But I didn't die. And then the new baby came, and the new baby was a girl, and everybody knew it was a girl, but I didn't know it was a girl. So I took its diaper off to see that it was a girl, and I got a beating. I didn't know that was bad. I just wanted to see. And then . . . then the baby's six months old and she gets whooping cough; and I pray, I say, "Please, God, let it die. Please, God, let it die so I'll be a girl"; but it didn't die. And then I knew about the pain. It's a bad thing; it's a bad thing to do. Sometimes I had to make my own pain. Remember the time . . . Remember the time she locked me in the shed? Do you remember that time? It was dark in there and there were spiders in there—that's where my father kept all his books— and my mother was going to punish me because I slapped my sister. So I broke the glass and I cut myself; and there was blood all over the place. And my mother said, 'That was a stupid goddamn trick to pull," and she hit me again. I was only trying to help her because I knew I was bad. No, I didn't. No, I didn't. I never understood what I did that was bad. What did I do that was bad? I don't know what I did that was bad! I thought she hated me. I thought they all hated me, except for my grandmother, because I was dirty and because I wasn't a boy and because my father liked me best—everybody knew he was a bastard—and because I couldn't study; I didn't want to go to

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school; I didn't want to be there with those kids who were so different. They weren't different; I was different. Maybe that's why they did all those things to me, because I was so different. I wanted to kill. None of those kids ever thought about killing, and I thought about it all the time. I wanted to kill them all, Once I stole my grandfather's gun, and I was going to kill her. My mother. I ran away until it was dark, and then I knew she'd be home, and I came home with the gun. And my grandfather knew that I took it, and he came to the house and told my mother I took it; and I had to give it back, But I could have killed her; I could have killed her. I begged David to kill her. He could have done it. He said, "No, we'll just torment her; we'll just do everything she wants us to do." How can you be wrong, how can you be bad, when you do everything your mother wants you to do? What could be more aggravating to a mother than to have a child who wants . . . who does just what they want them to do? That's right, that's bad. Sure, it's a game. It's a game to kill her with. Because when the game doesn't work any more, I'll just kill her. I had the pain. She . . . it didn't work right. I was always the one that got hurt; and she just went on and said, "Well, I think it's a good idea for you to go to reform school. I think it's in your best interests. I think it's a good idea for you to go to R State Hospital. I think it will do you a lot of good. I think it's a good idea for you to go to jail. I'm not going to pay your fine. It's a good idea for you to go to jail for a year. It will teach you a lesson." And I said, "Yes, Mama. Yes, Mama." And I learned lots of things in jail, and I learned lots of things in R State Hospital, and I learned lots of things in reform school; and some day I'm going to hold out this book and I'm going to say, "Here, mama. Here's all the things that you taught me. Here's all the good things that you did for me." And then I'm going to kill her. I can't cry. I can't cry in this room. Don't cry ... I want my mother. I want my mother. I don't want to cry. Help me. Help me. . . . I don't want to cry! . . . Help me! . . . Where's my mother? . . . [Cries] No ... [Cries] I can't. God, no ... [Cries] David . . . Oh ... Help me ... I am so bad. I'm sorry. I'm so sorry I don't want to hurt anybody. I don't want to hurt anybody. [Continues crying] Just help me a little bit. Don't let me hurt anbody. . . . Oh, God! . . . I can't do it. I never did want to hurt anybody. I had to

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do it. If I cry, it will all come outside. . . . Then I have to start all over again. That feels good. Having a baby inside of you. Just imagine. . . . It's growing and growing. . . . And you stole it, that's what makes it exciting, that you can steal it and keep it and it's yours; and how is anybody going to get it? And the person you stole it from doesn't even know it was stolen. The first one . . . the first one, I don't know where it came from. I didn't steal that one. It just came to me; but the second one, I stole that one from . . . from . . . from what's his name? We were mixed up. He had a girl's name, and I had a boy's name. I stole it from him. It took so long, and it was so hard to do. ... I don't know what I'm doing here. There's nothing wrong with me. I just came here because the court sent me. We could be friends. Then there's . . . then there's all those little things. I didn't mean to hurt him. I ... I had to do what I had to do. I had to have that baby, and he was the only way I could get it. I told him I was sorry and would never bother him and I wouldn't tell anybody; and I never did tell anybody. Yeah, I told somebody. That doesn't count. There wasn't any pain, just warm feelings in my stomach. Take your time. Call the doctor and count the days. This has got to be the day. This is the day. He's afraid of me. I can see it now. Didn't you? . . . It would be nice to go for a ride. It's so beautiful here. If you don't hurt me, I'm not going to hurt you. I don't hurt people that don't hurt me. I did hurt him though, and he never hurt me. It really wasn't fair. I forgot what I was talking about. Just tell him—don't be so chickenshit—just tell him that I'm pregnant, and you don't know how I got pregnant and . . . that I should go home and have my baby. And call my mother and tell her that I have to have this baby. Tell her that she can't take this one away from me. Tell her it will crack me up. That's the only time I didn't cry to go home. I didn't even throw up, not once. And I never saw him. Now I see him every day [in her son]. Do you remember when . . . I don't know if I remember . . . they said "It's time for your X-ray." The room was all lit up ... and they don't have an X-ray. What are they going to do to me? That's a lie—my mother wouldn't sign a paper like that. Please don't do it. David, tell them what they're doing. Well. .. you know

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what I think? I think he can't make me any better, so this is your way out. You're just a bunch of chicken-shit bastards. How can I talk to that man? I've been here ten months, and he's never said a word to me, and he's my doctor. All he said was, "Bend over so I can put this needle in your back so you won't feel anything." I did feel it. They were taking all my female away from me. They didn't even try to make me well. I guess psychopaths don't get well. I guess they just lock them up and sterilize them and turn* them loose. Every time I ask for something I get punished, so I learned not to ask for anything. Once they locked me up in a back ward. Of God! It's time to go home now. What am I going to do with these babies? Mom says, "Bring them home. We'll take care of them." Lying bitch. So I go home with the babies; and she says, "I don't know what we're going to do with all these babies. You're just going to have to get rid of them." They're mine, and I'm not going to get rid of them. The girl's got blond hair and green eyes that are almost blue and her hair is curly . . . and they both have a dimple. I've got to get her away from my mother. I came home that day and F had his hair all in curls. God, it was so disgusting! There's a lady that would take the twins. I'll call her right away and ask her. What's her name? What's her name? She'll be glad to take the babies for as long as I want. I don't want to let go of my babies. I can't let her do to my girl what she did to me. She wants to, I know it; I can see it. She hates that baby girl. "Oh, look at the boy, he's a nice big boy." My mother never held the girl, never gave her a bottle, never changed her diapers to see if she was a girl. She was scared to find out. I know her. I know that bitch. Well, now they're safe, both of them. I can still see that baby girl. I remember when she came out of my body, and they held her up and they said, "It's a girl." God, I was so frightened! What could I do with a girl baby? "Put her back." Yeah, I'm just kidding. Not really. I'm not kidding, not really. Bring her to me and let me see her. I want to take her clothes off. Don't tell me what I can't do with my own baby. She is a girl. She's a little girl. Now she's a big girl. Sometimes . . . sometimes I want to call and say, "How are my babies?" But they're not mine any more. And if I do call, they get frightened. So I don't call. Everything . . . everything is about crying. Crying . . . crying is for people who have been hurt. But maybe I deserve the hurt. I ntver stop hurting. I have a pain inside of me that never goes away.

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It came a long time ago. I don't even remember when it came, but I know when I feel it the worst is when I do bad things. Not after I do bad things—it's not a guilt pain. It's a pain that's like something eating inside of me, that's biting me and chewing me. And I do bad things sometimes ^ maybe the pain is ... you know . . . will be relieved. But that doesn't relieve it, not really. Then I think maybe if something else hurts, I won't feel that pain as much, so I cut myself or I burn myself. But I feel it while I'm working, and I feel it when I'm sleeping. Sometimes it wakes me up at night, it hurts so bad. Sometimes I think it's in my head, and sometimes I think it's in my stomach, and sometimes I think it's in my heart. One time I had the pain so hard, I thought I was having a heart attack; and they took me to the hospital, and the doctor said it's hysteria. And I felt just as calm as anybody else, or at least I thought I did. Someday I'll tell Dr. Stoller about the pain that makes me hurt myself; it makes me go out and fuck dirty old men and . . . It's just a strange pain; it's like a migraine headache. David knows what it's like. David feels the same kind of pain sometimes, and he screams and screams. I can hear him screaming, and I can't help him. And sometimes I scream and scream, but it doesn't help. And I think maybe . . . maybe there really is a God, and maybe he has put this pain here for some reason that I ... I'm confused. But if I hurt myself or if I let somebody hurt me or if somebody is good to me, or, you know, if somebody shows me that they love me, then the pain goes away for a little while; but it always comes back. [Long pause] They never ask me what's the bad part of it. They ask me what was the advantage of some of it, but they never asked me what was the bad part of it. Of being crazy. And I told them all the advantages, but they didn't give me a chance to tell them what the disadvantages were. A complete loss of freedom. You're not free to do anything. You're not free to think straight; you're not free to go where you want; you're not free to do what you want because there's all these things happening around you and all this confusion and all these loud sounds and everything looks strange. I'm cold. I'm scared to be cold. They were just a bunch of smart bastards anyway. Those doctors. I can't get rid of the pain. I've tried everything. I make the pain because I live the bad things over and over and over again. Every

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time my mother slapped me in the face, every time they locked me up some place, every time they cut me open, every time they kept one of my babies, every time the teacher told me I was stupid, every time David punished me, every time Carrie went away, every time my father went away, every time Dr. Stoller went away . . . I can go on and on and on. When I'm quiet, one of those things comes into my head. See, when it happens, when it happens like . . . like when they cut me open and tied my tubes, I wanted to scream at them, "Don't do this to me. Don't! You're killing me!" But I didn't say anything. Now, if I see a baby or my brother brings his children over or something, I'm quiet; and when they go home and I'm alone, I think: Please don't do this to me; you're killing me—and the pain starts, and I need to be punished for not saying it then. And Dr. Stoller goes away, and I say, "Don't go" or "Take me with you"; and he knows, he knows what he's doing, and then he goes. And I wrote him a letter every day telling him about the pain. . . . I never mail them, though, because he wouldn't understand. Every time my brother beat me and I didn't fight back, every time my father left me and promised to come and get me—and the thing I remember most is the last promise, the big promise, that lying son-of-a-bitch! He lied and lied and lied! To come and get me and the boys so ... so I could . . . live and be happy and be with my father where I wanted to be, so I'd never have to go back to my mother no matter what happened; if I was broke or if I got sick or something, I wouldn't have to go back to my mother, and my mother couldn't make girls out of my sons. I have a terrible pain now. It's in my back and it's in my stomach. What am 1 going to do? It's in my stomach. It burns and bites and squeezes and pushes. It knows if I'm bad I have to hurt myself. Fm going way back. I'm cold! Nobody's going to come and get me. They're just going to leave me here to die. In a box. I can't walk, I can't get out of the box. That's where they keep me. What did I do? Maybe I screamed too much. Oh, God, my stomach hurts! I'm going to throw up. I'm in a box. I can't get out of the box. It's too big. I'm too little. But I can think. I think with pain. My mother used to keep me in the box. I remember the box. I was two. I never told you about the pain because I kept thinking that as we were working it would go away. Everywhere I go, she goes. I can't go anywhere without her. I even have to take her to the field with me. Well, she's your little

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sister; you should take care of ... And I hate her so much. I can't take her to the birthday party because she wasn't invited. / was the one that was invited; don't make me take her. I can't go to the birthday party, I'm sick. I am sick. Remember what happened last time when you believed I wasn't sick? It's so beautiful, just riding. How will they find out I didn't go to school; they'll just come to do something . . . who cares? I don't care. And Joe said, "Ride the blue horse." He's running away, but I'm not scared. I can hold on. I'll stop at the fence. Oh, God! My feet! My gut hurts. I thought he was going to stop. I hope he's not hurt too bad. Joe, look at my feet. What am I going to tell my mother? I got caught in the barbed wire. Mom! I hurt my feet, and my gut hurts too. I fell down. Please take me to the doctor. That's a laugh—my mother wouldn't take me to the doctor. Never! Not in a million years. Not if I had one of my feet cut off, she wouldn't take me to the doctor. O.K. I'll go to school. The pain is so bad. Somebody better come help me. I can't get up. I forgot your name. No, don't take me to the hospital. My mother will be mad. Oh, I can't stay here. What are you going to do to me? She's sure going to be mad. Well, the horse fell on me. Now she's going to know I was ditching school again. If my pelvis is broken, does that mean I can't have babies? Yes, Mother, I know. I promise I'll go to school. No, I don't promise. I don't promise . . . I'll teach her how to ride a horse. You're never satisfied with anything, always wanting more and more. I want to go see Uncle Pete. Gram, see what he made for me. Don't lose them. We're going to Los Angeles now. Oh, God, I don't want to go! I'm sick; I can't go. Please don't make me go. I'm sick. You have to take care of me when I'm sick. You'd better stop; I have to throw up. O.K., bastard; I'll throw up on you. I told you I was sick. I don't want another brother; one's enough. One brother and one sister is enough. No, he's not beautiful—he's ugly. He looks like a little old man. I love him, though. I didn't want another brother, but I got one and I love him. Where are you going, Dad? Promise me you'll be back right away. Please don't go. No, I won't be bad, just don't go. I'll be so good! David! Oh, he's not my real father. He's just somebody that my mother likes. If he hits me again, I'm going to kill him. You know I can do it. When my father comes home, he'll be mad. He'll come home; he always comes home.

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Do we have to have another baby? Please, God, let it be a girl, not another boy. It's a boy, another boy. She did it again. This one's mine. This one's my baby. That's O.K.; I'll change it. That's O.K.; I'll feed him. Now it's my turn to have a baby. Not yet. Not time yet. David, stop it! Stop yelling at me. He says not to do that, you know, not to pretend all the time. He's saying, you have to live in a real world with real people, and you can't say "Bang, bang, you're dead" and they're dead, because they're not dead, and they're going to come right back and do it to you again. That's a game for babies, and you're not a baby; you never were a baby. I remember I was a baby. A little baby; I was a little baby. The pain in my stomach . . . It's dark and I'm scared! They're right there—why can't they hear me? Mama! Oh ... That's the right word. No, I don't want him [brother] to come in here—he'll do something to hurt me. I'm so cold. It hurts so bad. What did I do? Yeah, I know. You don't have to tell me, I know. I couldn't help it. I was in the box and I couldn't get out. And I called and called and nobody came, and I just went in my pants. And then they spanked me for it. I didn't mean to do it in my pants. It was bad to dirty my pants. I couldn't get out of the box. They say I'm bad when I'm not. And they don't say I'm bad when I am. They don't know the difference. They really don't know the difference. David knows what bad is. I'm going to kill them all someday. Because they try to kill me. They wouldn't feed me when I was hungry; they wouldn't make me warm . . . He ran over my kitten and killed it. Don't leave now; it's bleeding. Stay here and help me. I don't want it to die. Dad, you always . . . you don't care about anything except your stupid job. I'm sure you're sorry! I don't want to touch it. I want to kill you. Maybe I'll run over you with a truck or maybe I'll cut your throat. . . . I'm going to do a bad, bad thing. It's going to be so bad that I'm not going to feel anything. I'm going to kill all of you. I don't care about that. She has her kitten—that was my kitten—that was all I had. If you tie me up again . . . you'd better not tie me up again. I'm going to tell my dad. I don't want to go to school. I'm not old enough to go to school —you have to be five to go to school, and I'm only four. Please don't make me go to school. This is so silly, being with these children, and thsy don't understand anything. They don't know how to kill

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and they don't know . . . yeah, they don't know about David. David can play tricks on them. That teacher! I like the teacher. 1 wonder . . . 1 wonder if she'd take me home with her. Maybe if 1 know all the answers, she'll take me home with her. Til hide so I don't have to go to school. I don't even know what a psychologist is. [Long pause] You have to pay me for it. David . . . 1 know it's a bad thing. What that man's doing . . . but I'm not going to tell anybody. That man in the corner in the little house that answers the telephone. Right . . . right on the corner. If he wants to touch me, that's O.K. He has to pay for it. That makes me bad and makes him disgusting. David says, "Don't do it." David! You don't have to do that. You don't have to be bad. That man didn't do anything to you. You . . . It's your own fault. He knew what he was going to do. Don't come crying to me when your belly aches. The badness, like the man, and doing that, that's my secret. That's a secret nobody knows of. See, my mother wants me to be bad. I'm never bad where my mother can see me. That's a joke. Do you understand that? She doesn't know I'm bad. I know that I've done what she wants me to do, but I'm not going to tell her. What's the baddest thing I ever did? I've done so many bad things; I don't know which was the baddest. Not stealing, that's not too bad. Maybe scaring somebody. Maybe shooting K was the baddest thing I ever did. Because I wasn't going to kill him. I was going to shoot his balls off. I just didn't shoot straight. No, that's not true. I missed on purpose, but he knew what I wanted to do; he knew what I was there for, and he was terrified. That animal! But K never lied. That's what made what I did bad—K said, "You're nothing but a goddamn queer"; and it was the truth, it was the truth. It didn't make any difference how many men I went to bed with. And I went over there and he said, "What are you going to do? Are you crazy?" Are you crazy? Yeah, yeah. "I'm going to shoot your fucking balls off." Did you call me a queer? Look at the blood. That's your blood, you bastard! Now his prized possession, his beautiful car, his car that makes him a man because that's all he's got that makes him a man, all his hurting and his dope and his beating up policemen doesn't make him a man, and his prick doesn't make him a man, but his car makes him a man. So just shoot his car up. I'll kill it. T, take me over to ... what's his name, oh yeah . . . take me over to John's; I'm going to sleep at John's tonight. You don't want

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me to sleep at John's. Well, I have something I have to leave there. No, this is Herbie's gun; I'll leave it at John's. Let's go to bed; I'm tired. There's no pain. I don't need the pills tonight; there's no pain. T, who's here? O.K. Let me put my clothes on. No, I didn't shoot K. Yeah, I shot him. [Laughs] That's nice. . . . They're pleased they have somebody to do their dirty work. They couldn't shoot him— they wanted to, but they couldn't do it—and I did it for them, and now they say I need target practice, and he's in jail. Oh, he's in the hospital in the jail ward, you know on the 13th floor. . . . Oh yes, I'm queer. Being queer is such a bad thing. I don't want anybody to know. He was going to tell everybody. I should have killed him. He was going to tell everybody that I was queer. Maybe he was only guessing. Maybe he was calling me a queer like I called him a bastard. I don't know if he was a bastard. His parents could have been married for all I know. Maybe that was just a dirty word to him, but I didn't think about those things until afterwards. All I knew was the minute he called me queer, my head got red, inside it was red. He slept with T. She was so beautiful to me mauled by that animal. Big, greasy, stinking animal. Did K lie when he called me a queer? Do you remember that little girl that lived on the hill in the rich house? And I was allowed to play with her Wednesdays and in the back of the yard they had a ... I don't know . . . a party room like with a bar and glasses and bottle. So we were going to play doctor, and I made her take her clothes off because I wanted to see her; I wanted to see her with no clothes on. I wanted to see everything. I wanted to see if she was the same as I was, because I had a penis, but you couldn't see it; and I wanted to look up inside of her and see if she had one. And her mother caught me, and she said, "You goddamn queer; I'm going to tell your mother"; and she did; she told my mother I was a queer. Oh, God! It wasn't the beating that hurt, that never hurt, but the way my mother looked at me. Don't tell, don't tell. I didn't do anything bad, I just . . . we were just playing a game. I know you don't play those kind of games. I didn't mean it to be bad. Please, Mom, you're going to make me sick. I didn't touch her. I swear I didn't touch her. Didn't you tell me to do that? You told me to do that. I never understand what you mean—God, why don't you ever explain what you want from me? What do you want from me? If I do what you say, I'm bad; if I don't do what you say, I'm bad.

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I said, "Mama, am I a boy or a girl?"; and she said "Go find out for yourself." She thought it was a joke. I really thought it was all right! I didn't do anything bad. I just took her clothes off. It is true. What could be bad about it? If she were a girl and I were a girl, what could be bad? If I were a boy, then it would be bad. This woman was saying that I was something else. I wanted to see ... I wanted to see if she had a penis. The first time it was for sex was when I was in the seventh grade. No, it must have been before that. When I slept with H. I stayed all night with H—I don't know how old I was, eleven, I guess, maybe ten—and we went to bed, and I thought she was asleep, and I was touching her, and she liked it; and she said, "Do it some more"; so I did it some more. That was sex. Because I touched her where sex is. And then E . . . when I used to babysit for the principal, she came over. I know I'm bad, you don't have to tell me anything. Nobody needs to tell me. My mother told my father. My mother told my father that I was queer, but he didn't believe it. They told her in court that I had had homosexual experiences at the school and they couldn't tolerate that type of behavior. If you're queer, you'll go to bed with your mother. I loved to touch my mother and put my face on her. My mother always smells good. I like to touch her with my mouth. If she put her breast in my mouth, I would just go to sleep, and I would sleep and sleep and have a beautiful sleep. Mama, let me sleep with you tonight. I'm scared to be in there in the dark. Yes, I promise, I'll be good. Why do I pee the bed? Because I want her to be warm. Do I know it when I'm asleep? Of course. Uh huh. And I crawl up inside of her where it's wet and warm and she loves me ... for being a little girl; but if I have to be a boy, I can do that too. I can do anything my mother wants me to. All she has to do is ask. But she asks me all the wrong things. She will be very angry if the bed was wet, so I couldn't do that any more or she wouldn't let me sleep there any more. It was nice to touch her body. I just wanted her to hold me close so I could feel her. Sometimes if it was cold and we didn't wear any clothes to bed. Ruth made me buy a nightgown. It is a horrible thing. I can't wear it to sleep in. I can wear it when I get up, but I sure can't wear it to sleep in. When I was living with V—and that friend of his, his wife—and I talked her into it, and I went to bed with her. That was a bad thing. What do you know about homosexuals? Well, they're not bad

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people. A woman can make a woman feel better than a man can because a woman knows more about a woman's body, and men just like to climb on and bang away and climb off. If you want to, I will. She's got a nice body. She's a nice girl. Don't do it. But you know you're going to do it. You'd better get out of here. Oh, God! I can't stand the pain. I just can't stand it any more. What will I do with the boys? I'll just put them to sleep. Good babies. 1 should call and find out . . . no, I'd better not. Just go to sleep, and everything will be all right, and the pain will be gone, and the girl will be gone, and V will be gone, and we'll all be gone. How are you, Mrs. G [fourth husband]? No, you're not Mrs. G. What's your name? Mrs. C [third husband]? No. Mrs. D [second husband]? Yes. Mrs. D. "Mrs. D, why did you want to kill your babies?" I wasn't going to kill the babies. I just put them to sleep. "How do you feel about committing suicide?" I don't feel. "How do you feel about always being in some sort of trouble?" I don't feel a thing. Tell them, David. Just this pain . . . Do you hear that? That's not David. That's me. You know who I am. That's me. Do you hear that, Dr. Stoller? That's me screaming. I have to get out of here. Oh, God! Let me out of here! See, the room's so small—that's just a joke, that's a joke you play on me, Dr. Stoller. I'm not going to scream for you. And the fish get bigger and bigger and the walls come down . . . and the noises, oh God, the noises. And David screaming, "You did it. You did it." It's about killing Chris. I could never make . . . I could never make Dr. Stoller understand. I tried so hard; I used up all the words I knew, but I could never make him understand. That that was something that had to be done. To kill Chris. It had to be done . . . to save my sanity. Now . . . now it's too late. I can't kill Chris, and I can't kill me, and I can't kill Dr. Stoller. I just have to live with it. I'm just stuck. That's why I'm crazy? See, Chris . . . when Chris was born it was to save me. You know all that. And Dr. Stoller took Chris away from me. Am I not crazy when I'm working? I don't know. I'm crazy when I'm sleeping. The pain is my punishment. For being alive. I have to be careful with Dr. Stoller. See . . . Dr. Stoller can do anything he wants with my mind, and I can't give him everything. The part that's wrong is that I want to give it to him; I want to try; I just can't do it. There's something in me that won't let me. I go up to her and she's just sitting there, and I pull her dress

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up, and I put my face on her legs; and she smells good; and I curl up in her lap, and I kiss her, and I kiss her on her chest, and she likes it. My father says, "What are you doing? Making a queer out of her?9' But my mother likes it, and I don't know what a queer is. That's just another one of my father's words. My father uses lots of words I don't know. But it must be bad, because my mother slaps me and pushes me away; and then a pain comes in my stomach, and I cry. Mama, it hurts. And she picks me up and puts me in bed. Mama, can I sleep with you tonight? He's gone. I'm excited. The baby's there. Put the baby in the crib. Hold me close, Mama. I have a pain in my stomach. I'll just put my face on her breast. If I could just . . . if I could just get inside of her ... It's wet and warm inside ... so I'll make it wet and warm. Now she's angry again. Oh, God, I always make her angry. Just when it's going well, I make her angry. "Goddamn little brat." I peed on her. I did it to be wet and warm. Why doesn't she know I don't mean to hurt her? I don't know if it's bad to misunderstand, but she never asked me. She never said, "Why do you want me to hold you?", you know. She never said, "Why did you wet the bed? When you haven't wet the bed in two years, why are you wetting the bed now?" I would have told her what I knew. I would have told her because I wanted to be wet and warm. She wouldn't have understood that either. My mother didn't let me talk to her. Never, since I was her . . . since I learned to talk, my mother never let me talk to her. "Shut up, get away. I don't have time for you." She had time for her job. She had time to come home and tell me how tired she was. She had time to come .home and say, "Sugar, rub my back for me. I'm so tired." Or "Sugar, change the baby"; or "Sugar, take your little sister with you" when I hated the little bitch and didn't want her with me. That was my mother's baby. My sister could pee on her— I don't know if she ever did, but she could have—and my mother would have thought it was cute. You knew, you knew all the time what was going on, and you never did anything to stop it. My father. You knew she was trying to kill me because that's what she was doing. You can't not feed a child or make a child loving or make a child have terrible pains in their stomach and terrible pains in their head and confusion all the time and everything and not want to kill it. She wanted to kill me. That's bad. I don't understand why she wanted to kill me. Be-

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cause I wasn't a boy? My sister wasn't a boy. She didn't want to kill her. What did I do? 1 don't know what I did that was so bad. What did I do when I was six months old? Why did she want to kill me? The baby can't survive the mother . . . oh, God . . . Food. Food. Don't throw up this time. "Come on, Baby. Come on, Sugar, eat this time. Goddamn it; you puked it up again. I'm going to kill you if you don't eat." She wants to kill me. She's a bad woman. Why doesn't he stop her? Because he's a bad man. Mother . . . The pain! I'm sorry. I'm sorry. Don't you know I'm sorry? I'll scream. I'll scream all day long and drive you out of your mind. You want to kill me? Well, you're not going to kill me without pain. You're bad. Go away! Go away and leave me alone. You're not my father. I can't say: bad Mama. She'll send me away soon anyway. I'm tired. My mother . . . my mother . . . You're doing it backwards. Are you Dr. Stoller? I can't do it. You know that I know she was a bad mother. She did bad things to me. . . . But I deserved them. I was a bad baby. I had had thoughts from the minute I started to have thoughts. Kill her. Because she hurt me. Do you know when Chris was born he screamed every night from eleven o'clock at night until four o'clock in the morning. Five straight hours he screamed and screamed, and I thought: Oh, my God, what have I done to this baby? And I called the doctor, and the doctor said, "There's nothing wrong with him." And he screamed and screamed; and one night I was so tired, oh, God, was so tired; and I picked him up and I threw him into his crib. was so angry and so frustrated and so tired I didn't know what 0 do with him any more. I walked the floor with him; I fed him; put a hot water bottle on his belly—I did everything, and nothing did was right. He just screamed and screamed and screamed, and threw him into his bed. Now had I thrown him a little bit harder, I could have killed him. I didn't want to kill him. Yes, I did. Yes, 1 wanted to kill him to stop the screaming because I couldn't stand it any more. He must have wanted to be bad to me. The reason I told you about Chris was because that's what happened when I was a baby. I screamed and I puked; every time they tried to feed me, I vomited; and I lost weight and I got smaller and smaller: and they thought I was going to die; and my mother wanted me to die. My mother wanted me to die! I know that. And I wanted her to die. I wanted her to die first, but there I was . . . I wasn't big enough to kill her . . . so I made my grandmother angry

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at my mother. I thought maybe my grandmother would kill her. And my father was angry with my mother. He said, you know, "What are you doing wrong?" Do you know . . . do you know what this pain is in my stomach? It's like a poison. It's a burning, hot poison. If I could have puked that up on my mother, it would have killed her. That's the worst I can be; and I puked over and over and over again, and that never came up. It hurts. Did you see what I did? I don't know which is right and which is wrong. I ... I just don't know. I just like the way she feels and the way she smells. I guess that's bad. You never think anything's bad. I don't understand why my stomach hurts if she hit me in the mouth. I don't even know what those words mean. Did you see what I did? I guess nobody has ever done anything like that before, but I didn't mean to be bad. What did she hit me so hard for? I just wanted to love her. See, she let me go so far. She lets me kiss her legs and she lets me kiss her breast, but she won't let me kiss her mouth. I just want to be like my father or my brother. I just want her to know I love her. I'd like to bite her. Mama . . . David . . . Tell her. I don't want to do anything bad. It's because of the baby. The baby's sick, and she's worried about the baby. That's a lie. It's not because she's worried about the baby; it's because she hates me. I bet she wishes that was me that was sick. I wish I were sick so she'd take care of me. I'll just tell her... Mama, I'm sick. I am sick, too. I've got a pain in my stomach. It hurts. David . . . You tell her. I'll tell my daddy. When he comes home, I'm going to tell my daddy. I hope that baby dies. Please, God, let the baby die. Help me. When I was a baby, I couldn't talk. The box ... my grandmother screaming at my mother telling her, "Why do you treat this baby like this?" I was cold. I was hungry. I can't remember being a baby. My grandmother slapped my mother. And she took me away. I don't want to leave my mother. She used to put me in bed with her, and then it would be warm, and it would smell good, and I could kiss her body, and that felt good. She didn't get mad then. Do you remember? Do you remember how it was when he was gone and . . . and she put me in bed with her and I didn't pee in the bed either? I wanted to be wet, but I knew she'd be mad and take me out of the bed. Her body was so nice. That's why. She did then, she knew it, she said "Meja," so she knew it; she knew I was a girl, and she would . . . give me a bath and put oil all over me and wrap

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me in a warm blanket and put me in bed. I could stay there all night. And that was the most beautiful thing in the whole . . . But when the baby was born, then she didn't want me any more. I told you. . . . She let me ... she was just sitting there, and I was kissing her leg, and I got on her lap and I kissed her breast; and then when I went to kiss her on the mouth, she hit me and she called me names I didn't understand. Why is it all right one time and not all right the next time? I don't understand those words. But it was a bad thing. A queer. She called me a queer. She said, "You must be even more of a boy than a girl." I was two and a half. I can't stand it. Whenever my mother takes a bath, she always smells good. She's always soft—not too soft, not like grandma. My grandma's fat and soft, but my mother's not fat. She's got a big belly, but she's got a baby in there. I wish I could have a baby in my belly. I didn't mean to do anything bad, I just wanted to love her. I wanted to go . . . I didn't want to go ... I knew I couldn't go back inside of her because there was another baby already there. And I was too big for her to just swallow me. She was . . . she was talking. She was talking to my grandmother, and I was just playing on the floor. And I thought, she's so pretty and she smells so good, I'll just love her; and so I ... I know that I was just standing by her and she had on, she had on a blue . . . don't you remember that blue thing she used to wear? . . . and I was kissing her legs, and she didn't say anything; she didn't say anything bad to me. And I got up on her lap, and I kissed her breasts; they were so soft . . . I don't remember. And they told her in court and she said, "I knew she was a goddamn queer all the time." I didn't know what it meant. She called me a queer. It was a bad word. Puto. She said . . . she used to call my father that all the time, and he didn't like to be called a queer. I guess . . . I guess . . . maybe my grandmother told me, I don't know; I don't remember. Oh, I heard it before I was two and a half. I knew that it was a bad word. I didn't know what it meant. When she hit me in the mouth, I hated her. I wanted to kill her. I wanted somebody to kill her. My grandmother was angry. My grandmother could kill her, but she didn't do it. The pain came when I cut her. You know when I cut her, right here. And I cut my hand, too. I cut her. She . . . she hit me in the mouth, and my grandmother slapped her and said, "Don't call that baby those

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names." And I went into the bathroom . . . we weren't at home ... What was that big lady's name? I can't think of her name . . . we were in her house, and I went into her bathroom, and I got a razor blade, and I went back and I cut my mother right here [thigh]. And I cut my hand. And my grandmother got scared and took me . . . took me to her house. My grandmother was scared my mother was going to kill me. My mother screamed. I wanted to kill her, but 1 wasn't big enough; I just couldn't do it. I cut her. She hit me in the mouth. She knows I'm sorry. David . . . I just wanted to love her, and I didn't mean to do anything bad. She let me ... she let me do it and then she hit me. If it was bad, why didn't she hit me when it started? I wasn't bad. She was bad. I'm going to kill you. I'm going to kill you. She laughed at me. I can't stand this. I got the razor blade, and I was going to cut her belly open and take the baby out, and then I was going to kill her. She was just standing there, and I just reached up and cut her. My grandmother got scared that my mother would kill me and she could do it, too, because she was bigger than I was. She always wanted to kill me, all along she wanted to kill me. I've got to get out of here. I've got to get out of here. I don't want to. Don't do it. I can't do it. Stop asking me. Noooo. I . . . Let me go. I might kill her. I might kill her. I'm not bad; she's the one that's bad. You know that, don't you? Don't you know she's the one that's bad? I'll get the razor blade and cut her up. Oh, God, I hurt myself. There's blood there. I did cut her, but I didn't kill her. She's too big for me. She's going to kill me now. Grandma, don't let her kill me. Why does she hate me so much? I just wanted to love her. No ... Oh, I have a pain in my head. I'm going to hurt all over. Take me back and let her beat me. Make the pain go away. I need something. I need something to help me. I don't know what it is. No ... No ... No. No. I can't. Daddy, somebody . . . help me. Don't cry. Ohhhh. Ohhhh . . . Ohhhh. Oh no. No. Ohhhhh. Ohhhhhh. Don't let that happen. I can't stand it. I don't want to kill anybody. I don't want to kill anybody; I don't want to kill anybody. Please God, don't let me kill anybody. Ohhhhh. Let me die. Ohhhhh. Ohhh. Ohhh. I can't stand the pain. I can't stand it. I can't. Oh, let me go. Let me go. I don't know how to cry. She'll kill me. In my head and my lungs and . . . I don't want to die! We just play games—who is going to kill who first. Are you stronger than she is?

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The only place I could reach was her rear end. She was facing away from me. Do you know what I feel about my mother right now? I feel like I should be there taking care of her to make sure she doesn't die. She wasn't good. She was evil too. She climbed in my belly. I didn't put her in there. Don't you understand? Then I have to get her out. I'm not crazy any more. They opened my belly up four or five times, but they never could find her. And the most fascinating thing was when they took my gallbladder out; you know, they have to take X-rays to see if there's gallstones, and the X-rays showed gallstones and then when they took my gallbladder out, there were no gallstones. I don't remember ever hurting my mother. I told you many times. I never talked back to her or did anything disrespectful to my mother. I just tried to kill her. So that's the first murder. How could I get crazy by the time I was two years old? If my mother was pregnant, I must have been . . . yeah . . . two years old. How could I be crazy by the time I'm two years old? Babies aren't crazy, are they? Yeah, Chris was crazy. I don't feel the pain right now. I think the pain should be right in the back of my head. I think it should relocate itself because I don't think it has anything to do with my stomach. It has to do with my conscience, and I don't know what my conscience is doing in my belly. But I think . . . I think it's just a terrible guilt feeling I have about something; otherwise it wouldn't go away when I punish myself. I don't feel guilty about anything. I think if this pain, as intensely as I feel it, were converted into guilt, Jesus Christ, I'd jump off the building. I was a very evil girl. It was a razor. One of these big long blades. That fold up. I'm sure my mother was pregnant. I'm sure she was talking about having a baby, so it must have been my sister; so I couldn't have been more than . . . between two and two and a half years old, because my sister was born when I was two and a half. And the only thing I can picture is being in a room with a hall going to the bathroom and the only house that was like that was my grandmother's, so we had to have been at my grandmother's house. I don't know what my mother was doing. I don't know why she was standing up, you know; she could have been ironing or washing dishes or anything. I don't know what she was doing, but she did something to me, and I don't know what, that just enraged me. Maybe she pushed me away; it could have been something simple; and I went into the

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bathroom and climbed up on the toilet and got my . . . it had to have been my grandfather's because he was the only one that ever used a straight razor, and he still does to this day . . . and got my grandfather's razor and went in and cut her. I was just angry . . . just so full of anger. I could feel that same anger right now. And it's a frightening possibility because if I'm that angry, what am I capable of? If I'm capable of stabbing my mother when I'm two years old, what am I capable of as an adult? I was capable of shooting K. I was thinking about . . . about V and the day I wanted to kill myself and the kids. That was evil. But not really evil, because I was trying to save us. And when I was going to kill Chris, I wasn't going to kill him because I hated him—maybe that's not true, maybe I did hate him —I didn't hate him; I hated what he was doing and how it was affecting me, and I hated myself because I couldn't make him better. And I felt so guilty because I just wasn't accomplishing anything; I was giving him everything I had, and nothing was enough. I couldn't love him enough. I couldn't beat him enough. There was nothing I could do that was correct, you know. But I loved him very much, and I still do, but not as much; and I'm finding that I love him less and less every day. Do I feel obligated to love him? I think that's what it is. I feel guilty because I don't have the same feelings I had for him five years ago, and yet I can't . . . he's not the same child. I feel so sad . . . you know. I remember when I used to believe in God. And what a disappointment there was for me to find out there was no God. Sometimes when the creditors call the office, and I'm standing there not wanting the whole office to know my personal business and trying to figure some way to handle the situation, I think: That son-of-a-bitch Bill, I'm going to get a gun on him and I'm going to kill him. It's always been my idea that I never wanted to kill anybody unless they threatened me. I don't think that I ever wanted to go right up and kill somebody just for the thrill of killing, because that isn't my bag. And he threatens me; he's a threat to my life; he's a threat to my sanity. And he wouldn't be a threat if he were dead, and yet I'd have to live with the guilt of having killed him, if I felt guilty. But if I really felt that he was a threat to my life and I were defending myself, I wouldn't feel guilty. I never felt

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guilty about shooting K. I never felt guilty about... oh, yes, I did. I was going to say I never felt guilty about wanting to kill Chris, but that's something entirely, different, and yet Chris was a threat to my life. But it is a little different situation. I remember I used ant poison. All I can think about is Dr. D. I don't know why, but I was thinking about the first time I screwed Dr. D with the marijuana on the ward. I think it was after I married Bill. . . . I know why I remember. Because the night before I came into the hospital, I tried to kill Bill. I remember that time. He had a gun collection, and he only had ammunition for one gun. And I didn't know how to use it, and I was thinking about killing him—when he came in through the door from work, I was going to shoot him, and I don't remember why. We'd only been married a couple of months. It was about the baby. The people next door had . . . I don't know . . . twelve or fifteen kids; and the woman just gave birth to a baby boy, and she said I could have it, and Bill wouldn't let me have it. And I thought if he's gone, I can have the baby. It was an Indian baby—these people were Indians. It must have made me crazy to want to kill him, because the next day he had to come home from work and bring me to the hospital. I didn't kill him. Because I didn't know how to work the gun. That's the only reason I didn't kill him—because I didn't know how to work the gun. Had I known how, I probably would have killed him. This one had a clip, and you had to push something before you could pull the trigger; and I wasn't strong enough or something; anyway, I couldn't fire the gun. I tried it, and I couldn't fire the gun. I needed the baby, and he couldn't understand why I needed a baby. And when he said no, I just hated him so much . . . you know, I just . . . maybe I didn't hate him; maybe I just wanted to get rid of him. I guess he was playing with my head from the minute we got married, because I can remember being so frustrated at times. I would leave the house and just go and drink until I was drunk and passed out or something, or use heroin or something, you know, just anything to get away from him. And then one day I said, "Let's go somewhere. Let's just leave, leave everything here and just go and start all over again." So we just got on the motorcycle and went to M. I don't really want to talk about Bill. I just don't. I spent twelve years with him—that's a long time. I think this time we should just leave it alone. I really don't want to talk about him. I just don't feel

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that I can handle this right this minute. I can't breathe. It seems like I've been here for hours. I feel like Fm going to go crazy. No, I'm not going to cry. I think I should go. I can't breathe. My mother called me just before I came down here to ask me how my aunt was, and I said, "Why don't you call her and ask her?" And she said, "I can't call the hospital." Which reminded me of all the times I was on the ward, the only time she called me was when she had something nasty to say. When I was in the hospital, Bill never called. Jesus. They could be identical twins. That used to bug him when I'd say that. "God, you get more like my mother every day," and that would just bug the shit out of him; he couldn't tolerate that. He gave me permission to behave in a certain way and then when I did, he punished me for it. A million things. He would bring some guy home for me to go out with, and then if I went out with him, he would . . . well, he wouldn't talk to me for days at a time, something like that, some petty shit. But whatever it was, it always freaked me out. It had to be a coincidence that we married. I didn't know him fifteen minutes before I married him. I didn't marry him the same day I met him. You know where I met him, and how I met him. And that night he took me home; and he said, "Maybe we should understand each other before we get married and know things about each other . . ." It was arranged for us. It was a bet that we wouldn't do it or something, and besides he was going to get drafted . . . I don't know. I don't know why he wanted to marry me except. . . He didn't know I was crazy until that night when I told him, "Look, I just got out of a mental institution...." He was strong and that. . . just, you know, he was a big man. I was just under the impression that he would take care of me, and I felt a need to be taken care of. And if I hadn't felt that need, I wouldn't have signed myself into Q State Hospital or Los Angeles County Hospital or UCLA Hospital. And after he told me about his mother and the care that he had given her, I was convinced that he was the one that was going to take care of me. He had my mother's style. Just a quiet, nonverbal way of accusing me and punishing me ... I don't remember the first . . . I just remember that night. I don't remember . . . I don't know. I don't remember. That day when it came up that we were going to get married, it never occurred to me that I was going to live with him. He was so

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serious. And he was warm. Warm yet rigid. He never took it as a joke. And the fact that he didn't drink or smoke or screw around or any of those things, all that was frightening to me. I didn't know how to handle that. I kill because I'm terrified for my life. When I think of that first night I went to bed with Bill my intent was to fuck his lights out. That just accurately describes it. He wouldn't let me. The only thing you can do with someone like that is to kill him. The only thing left—you can argue, you can plead, you can say, "My God, I'm dying"; you can say, "Look at the pain I'm suffering"; you can say "Look how good I've been"; you can say, "Look how bad I've been"—it makes no difference because there's only one thing that will stop them, and that's to kill them. My mother, too. And no matter . . . about fourteen years of therapy or books or anything, the same thing is true today. But, you know . . . Bill could have destroyed me and did a pretty good job of fucking me up; but if I hadn't had him, I would have died long ago. He kept me alive. He used to hold me. I would say, "Bill, I just want you to hold me." And he would hold me. I suppose I have to find somebody else, one of these days when I'm ready for it; but I'm not going to ... I'm not going to turn myself over to some . . . I can't do the same thing again. I never said I didn't like men. I tried to kill them. That doesn't mean I didn't like them. I expect more from a man than I do from a woman? Well, of course I d o . . . . The book. I know all the consequences of having a book written about me. I know even better now than I did before, and I still want to see it published. You know, I spent five years and three months in various institutions for different things—that's got to mean something, you know, it couldn't have been for nothing. That's five years out of my life that I was locked up for some reason or another. And I have to know why. I don't give a shit if anybody else knows, but / have to know why. And so when the book comes out, I'll read it again because I imagine it's a little different than what I thought. I don't know what you've added or changed or anything. I want to know why . . . of course you tell me all these things, but sometimes I listen and sometimes I don't listen; sometimes I hear you and sometimes I don't hear you at all. But if it's right in front of me, if it's printed, how can I miss it? If I read it, you know. And those are my words and your words. I actually said those things. Nobody

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reading the book will know how much pain there is in that book, but I know and I'm hoping maybe somebody will understand enough. I feel . . . I'm thinking about . . . thirty-five years of living and not really having lived, although some people wouldn't say that. And I feel the waste, the futility of a lot of the behavior; and I feel like a fat, old lady. I wonder if I'm all in one piece yet. I don't want to fall into one piece yet. You know, if I'm one whole person, then I'm totally responsible for myself. I don't even know how to say it ... being evil isn't really . . . isn't me all the time. I have evil moments, but most of the time I never want to hurt anybody, physically or verbally or any other way. And it hurts me to hurt other people; and it's hard for me, because it seems to me to be real. You have to tell the truth, and some people don't want to hear the truth, and sometimes the truth hurts people....

APPENDIX 1 Mrs. G as Textbook of Psychiatry

At one time or another, Mrs. G earned the following diagnoses: Paranoid schizophrenia Antisocial personality (psychopathic personality) Epilepsy, grand mal type, post-traumatic Organic brain disease, acute, with psychosis, due to amphetamine Drug addiction (amphetamine) Homosexuality Hysterical personality Hysterical psychosis Multiple personality Dissociative reaction (fugue states, amnesia) Depressive reaction with suicidal tendencies Psychophysiological (psychosomatic) reaction (gastrointestinal, pulmonary) Kleptomania Anxiety reaction, mixed type (depressive, phobic, conversion) Pseudocyesis

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APPENDIX 2 Physical Illnesses

By developing apparently severe illnesses, Mrs. G had still another way of keeping feelings and fantasies out of consciousness; or perhaps that hypothesis is wrong: instead, the illnesses may have arisen because she repressed feelings and fantasies; or perhaps it was all coincidental. There are more theories than data. The "mysterious** leap from the mental to physical changes in the body may someday be explained by neurophysiologists. The information Mrs. G furnishes us will not solve such problems, but the questions she raises are helpful. And since I have never before seen a patient so frequently diagnosed by competent physicians as having a gamut of physical illnesses she actually did not have, it seems worth reporting this aspect of Mrs. G's case study. The history of Mrs. G's physical illnesses was not remarkable until in her twenties, when her antisocial behavior dropped away and other reactions—especially psychosis, murder, and suicide—and physical illnesses took its place. Before that time she had had the usual childhood illnesses, pregnancies and deliveries, minor surgical procedures, broken bones, etc. Perhaps more important, at around age eleven, she was diagnosed as having rheumatic fever and was put on bed rest for a year. Whether she has had residuals from this episode is not clear; apparently not. I participated in the diagnostic efforts surrounding three experiences that indicated major medical pathology. (Others in which I was not the primary physician will not be reported.) The first episode occurred during the hospitalization precipitated by the suicide-homicide panic with Chris. Two weeks after Mrs. G had been hospitalized, and just after Chris had left her abdomen, she developed acute abdominal pain. She was seen by the surgeons in the Medical Center; the findings on physical examination and the laboratory findings were positive and typical for appendicitis. And although Mrs. G said that she had already had her appendix removed, the findings of acute abdominal disease were so unequivocal that a laparotomy was necessary. Surgery revealed that her appendix had in fact been removed, and careful search of the abdominal contents failed to reveal any pathology. She recovered from the surgery and from the acute pain without difficulty. I have no information on whether the operation permitted the fantasy that she had had Chris removed from her belly; she has had no conscious sense of this. Seven months later, over a period of several weeks, while she was still 363

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grieving over the loss of Chris from her abdomen, Mrs. G became huge. Not only did she look bloated but she could breathe only with difficulty, had a pale look about her lips and skin, which was clammy. She looked very ill. It was noted when she was admitted to the hospital for evaluation for this physical condition that she had gained about twenty pounds in four months (on top of an already moderate obesity) "associated with considerable dyspnea on exertion to the extent that she would frequently have to sit down and rest after walking a block or a flight of stairs. Furthermore, within the last two months, she has noted considerable dyspnea while at rest. Although she has awakened at night, with what she describes as a smothering sensation, she has had no frank paroxysmal, nocturnal dyspnea. ..." Other physical and laboratory findings were sufficiently suggestive so that it was necessary to do a right heart catheterization and pulmonary angiograms. The catheterization revealed no abnormalities. However, this consultation with the medical service led to a diagnosis of "pulmonary vascular disease of young women, a recently described entity... made on the basis of the abnormal pulmonary functions combined with normal right heart pressures and pulmonary vascularity on angiography and lung scan." Because of these dangerous findings, the patient was referred for an even more detailed workup to a neighboring hospital that specializes in research on, and treatment of, pulmonary disease. The study there revealed a clear-cut pulmonary disorder: "There is a marked difference between the end titre and maximal expiratory CO.. levels, indicative of poor intrapulmonary mixing. The alveolar-arterial gradient is from 2 to 13 mm, indicative of many non- or poorly perfused alveoli. She was observed to ventilate excessively at rest without lowering of arterial CO... and with a poor rate of oxygen removal..." etc. I report these findings only to demonstrate that there was a massive physiological disorder, so much so that diagnoses of "multiple pulmonary emboli or a major pulmonary vascular occlusion" were considered. Of course, the whole disorder then faded away. About a year later, during the course of a few weeks, Mrs. G developed a clinical picture so different from any I had seen before in her and so reminiscent of an expanding lesion of the central nervous system that I felt she must be hospitalized. Although she had given an occasional history of visual hallucinations when panicky, she was now having such episodes throughout the day and night. The hallucinations ranged from diffusely formed lights, colors, and smoke (typical of schizophrenics) to specific images of blood pouring from buckets onto the floor, holes opening in the street, around which she would have to swerve her car, people and animals who were not there—that is, visual hallucinations more typical of organic brain disease. She suffered a type of hallucination she had not before reported: smells of rotting or burning substances. She also had a new memory

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defect different from her familiar amnesia; that is, she did not have punched-out periods of hours or days but rather, even when she was not confused and dissociated, she had increasing difficulty in remembering names and numbers. She had also developed some slurring of speech, which became more pronounced when test phrases were attempted. She had given me a vague history of convulsions in the past, but I had never been able to make much of this because her description did not separate out these alleged episodes from all the other fugue states she had had. Now she reported that others had seen her develop grand mal convulsions. Under these circumstances, a complete neurosurgical workup was indicated. The neurological examination revealed questionable papilledema ("nasal and superior margins of discs a little indistinct1'); "slight asymmetry in the use of the left lower face; mild to moderate left hemiparesis with a questionable extensor plantar response on the left; finger to nose, heel to shin and rapid alternating movements of the hands and feet are slow and clumsy on the left; there is a mild hypalgesia and hypaesthesia with mild decreased position sense on the left side; stereognosis is mildly impaired on the left; tactile extinction on the left, no visual extinction, with some mild difficulty in carrying out some complex commands, using left side as compared to the right")—all these the findings of the neurosurgical consultant. In addition, Mrs. G was observed on the ward to have a grand mal seizure. Laboratory tests were not remarkable (those minimally equivocal can be ignored), except for the following: "EEC was considered mildly abnormal in view of shock-wave-like complexes occurring during sleep and during hyperventilation but showing no frank lateralization Visual field evaluation revealed an incomplete hemianopsia o.d. [right eye] with overall constriction with question of an increased blind spot of o.s. [left eye]. Pneumoencephalogram reveals changes interpretable as some mild cortical atrophy bilaterally, primarily in the parietal areas." These findings were compatible with an old cerebral scar (the result of a head injury in a suicide attempt with her car), but an expanding tumor was not thought to be likely. So Mrs. G was discharged. And again, all this has faded away, except for a few grand mal seizures every two years or so. There simply are no other clinical remnants of a brain disorder.

APPENDIX 3 Very Masculine Females

The interest in cross-gender problems that has recently swelled the literature has concerned feminine and effeminate men much more than masculine women. Understanding masculinity in females is complicated by our not knowing the prevalence of the various gender disturbances and by our incomplete data on etiology.* We should resist temptations to explain etiologies by extensive theorizing or extrapolating either from animals or from analyses of more normal women. A feasible next step is to advance in the description of clinical states. What follows are descriptions of the manifestations of marked masculinity in biologically normal females.

Clinical Types The descriptions here presented are only averages. Not all details hold for every patient in a particular category. There are also simplifications, e.g., positive statements would be more accurate with modifications such as "usually," "almost always," "with occasional exceptions," etc.; but such an effort at semantic accuracy would strain the reader's attention. The categories cannot be sanctified as diagnoses: they are only serviceable categories.

The "butch" homosexual woman ("dieser; "dyke") This subject began showing an interest in masculinity around age three to five, but initially not to the extent that it was considered an aberration by her family. The tendency provoked only enough tension so that her mother would ask the girl if she would not prefer to wear her boyish clothes less frequently or walk more gracefully. The little girl would more or less comply with such pressures, even to dressing like a normal girl if the occasion warranted, attending school or church in dresses, but not looking particularly feminine under any circumstances. She preferred her hair cut shorter than other girls*, but not as short as boys*. In games, preferences for TV programs, movies, and reading, her interests were likely to * This is less true of the masculinity found in more feminine women. For instance, the contributions to flaws in femininity made by penis envy and by the envies produced in women living in societies that give more manifest benefits to males are so well documented that the material need not be repeated here. 366

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be masculine. In childhood she did not openly express a desire to have her sex changed, but rather, regret or envy about not having a penis. As a schoolgirl, she turned to gentle and/or effeminate boys if she had to spend time voluntarily with males, but preferred to be with girls, with whom she took a leading, masterful role, both physically (e.g., by skill in sports) and emotionally (e.g., in giving orders about what games would be played). She began having crushes on girls or older women in latency and was not at all interested in boys or men. The crushes became consciously sexual after puberty, and homosexual fantasies accompanied the masturbation of adolescence. By early adolescence, she had begun clear though incomplete sex play with other girls, progressing rapidly to mutual genital manipulation with orgasm. Her guilt was insufficient to slow down the rapid progress of overt homosexuality. There were no fierce battles against masturbation or against homosexual relations, nor were there successful efforts at making the homosexual desires unconscious (e.g., by reaction formation into hyperfemininity, frigidity, promiscuity, prostitution, or heterosexual affairs aimed at destroying men). Rather, what she defended herself against was the heterosexuality present in her feelings for her father (one often hears—I do not know how often—that fathers of masculine homosexual women were overtly sexual with their daughters)—fragmented, incomplete, and inextricably compounded with expectations of humiliation, body damage, and loss of what she felt to be her essence. As adolescence progressed, she discovered that the correct label to describe her was "homosexual"; and although she recognized that this was a stigma, she did not fight against the assignment (either not at all or not for long). Instead, she sought others who felt homosexual and thus discovered the homosexual community. By late adolescence, she had joined this community ("coming out*'), and henceforth spent her free hours with homosexuals, frequenting the institutions of homosexuality (e.g., gay bars). She either chose work in which homosexual women were accepted and sometimes preferred, or she worked with men, doing the same work they did. As an adult, she sees herself exclusively as a homosexual. She has few or no conscious sensations of heterosexuality. She loves the appearance and feel of women's bodies and is repulsed by male bodies. She enjoys homosexual relations, and her capacity for excitement is not inhibited by guilt or anxiety (whether she suffers these affects or not). She feels uneasy with masculine men, covering this with disdain and forcefulness, ever ready to attack men's manliness. The men with whom she has social relations are effeminate and usually admittedly homosexual. She prefers feminine women for her sexual partners and dislikes intensely having to take a feminine role in social or sexual relations (in contrast to most lesbians, including fairly masculine ones, who can more comfortably switch roles).

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Her masturbatory fantasies are exclusively homosexual, and in her sexual relations she enjoys her genitals being touched as much as she enjoys touching her partner's genitals. She dresses in a very masculine manner, but no one would mistake her for a man; she makes no effort to pass as a man. Quite the reverse, she consciously considers men inferior and often disgusting creatures whose appetites, sexual and other, are crude, if not appalling. She has no question that her body is completely female, although she does not wish it to have a feminine, soft, voluptuous quality; she prefers it hard, strong, handsome, masculine. She will not try to have her body converted to a male's. In fact, to do so would represent a defeat, an open statement of envy of men; and such envy is the bane of her existence: she must be eternally vigilant against it, to keep it from leaping at her unexpectedly and humiliating her as it did in childhood. Her homosexuality, then, is not only the expression of what comes naturally and of her sensual preference but also a militant defense against having to face her envy of men. In part she gratifies her desire to be a male by identification with males, but she stops short of a need to pass as a male or to convert herself into one. In order not to feel envy of maleness, she is disposed to asserting that males are unnecessary, or necessary only for procreation.

The "unrealized" transsexual The typical representative of this group is in many ways like the "butch." The differences between this group and the first are ones of degree, there being more masculinity in the unrealized transsexuals. Both groups consider themselves very masculine, homosexual; and both live as members of the homosexual community, Until the "unrealized transsexual" begins the shift toward living as a male. Up to that point, one difference is that the butch homosexual is more anti-male, as she has a greater battle to subdue heterosexual tendencies left from childhood. Unrealized transsexuals are more benign toward men because they wish openly to be male, which the "hutches" must deny. They do not mind the company of masculine men and are not fiercely competitive with them. After several years as an accepted member of the homosexual community, and after being considered the most masculine that community can tolerate (see below regarding transsexuals, who, in contrast, are extruded from the homosexual community), the unrealized transsexual becomes less satisfied with her avowedly homosexual partners and looks for "normal" women. She herself uses the word "normal" and means by this a woman who has lived an exclusively heterosexual life up to the time of meeting our subject. The "normal" woman will have been married, will preferably have

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had children, will never have had a homosexual experience or admitted to having been aware of wanting such an experience, and will have been seduced by our subject, being astonished at how much more gratifying this first homosexual experience is than any of her previous heterosexual experiences. She will then choose to live as the "wife*1 of our subject without expressing interest in other women or assuming the mannerisms of homosexuals. The two will live together as a couple, in which one functions as the husband, the other as the wife; the two roles are never reversed or even modified from the cliches of normalcy among married couples. Although both may work, the housekeeping is clearly the "normal" woman's task. She is expected, if working, to work as a feminine woman is supposed to, while her "husband" works at a man's job. When this first major transition in living has been accomplished, further changes gradually develop over several years. The subject removes "himself* from the homosexual community. Whereas "he" formerly had a bisexual nickname (as is typical of butches: Jackie, Billie, Sonny), "he" now takes on a clearly male name. Whereas "he" formerly was comfortable in the masculine dress of the butch but nonetheless did not attempt to pass as a man, "he" now dresses in a manner indistinguishable from men and adjusts "his" external appearance so as to leave no clues that "he" is not a man. This leaves a few physical features equivocal: there is no beard; breasts are present though deemphasized, and hips are usually too round. Thus "he" has begun the process of passing to the opposite sex; but this is not undertaken rapidly, insistently, and inevitably, regardless of the dangers (in contrast to the transsexual—see below). Our subject does not demand ways of changing "his" birth certificate, driver's license, passport, etc. "He" does not begin searching the medical world for information concerning modification of "his" body to masculinize it (e.g., removal of breasts, panhysterectomy, testosterone injections). However, in "his" choice of a "normal" woman, change of name, dressing completely as a man, working as the equal of men, and cutting off contact with most of the homosexual community, including any sexual partners who are recognized as being homosexual, "he" has ceased being a butch. Nonetheless, throughout this passage, "he" admits "he" is a biologically normal female; if "he" is specifically asked (e.g., when applying for work), "he" still considers "himself a homosexual. "He" does not ask to be changed into a male, though "he" would like to live as a man; and "he" considers himself to be superior to men (e.g., as a lover of women) by virtue of the very fact of not being male. In discussing butch homosexuals in conferences, everyone unthinkingly refers to the subject as "she," reflecting the subject's unequivocal estimate

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of herself as a female and woman. When referring to the unrealized transsexual, no one knows which pronoun to use: using either "he" or "she" leaves one uncomfortable.

The transsexual female The transsexual female is a biologically normal female who knows she is, but also believes that she is truly a male and goes to great effort to get her body changed to male. At no time in her life does she show femininity. This is not only by her own report but is confirmed by her parents and, when available, by photographs in the family album. When still a child, she says she wants a penis and is going to get one by the time she grows up. (There is no evidence of psychosis in these children, unless one insists that this expectation of a penis alone is a psychosis.) Since childhood the transsexual has dressed in boys' clothes, except when forbidden, and even then manages to avoid a feminine appearance in feminine clothes. Her hair is cut as short as adults permit. The subject prefers to play with boys, in boys' games, and to be accepted as an equal with the boys, competing well with them even in athletic events. In games played with girls, the transsexual female always takes male roles. As a child, the appropriate pronoun is "she" only because society insists on it and the child is in no position to make an issue of it. However, as an adult, both the subject and the observer feel comfortable only with "he." He does not wish to join the homosexual community when, in adolescence, he is attracted exclusively to females and thus made dependent upon that community for sexual partners. If he does join it, he leaves it (in fact, is cast out of it) within months. Recognized by homosexuals as being too masculine, he is rebuffed; for homosexual women, with their distaste for maleness, sense him as a man, as he does himself, even when they find his genitals to be female. (This is an evaluation made by those who are the most discriminating because they are the most concerned: his lovers, evaluators more expert in picking up degrees of masculinity than any of us professionals who merely interview.) The female transsexual is thus likely to be cut off from sexual relations. He is as repelled by the idea of sexual relations with males as most men are by homosexuality. He is also cut off from sexual relations with most women, as he quickly learns in adolescence that the females willing to have sexual relations with him are attracted to his female body (and are then repelled by his manly behavior): what is exciting to them is the very thing he hates most, his female body. As soon as he can manage, he passes as a male. This may occur as early as adolescence, and is all the more remarkable in view of his hairless face, soft features, and female contours. In contrast to the butches, who do not try to pass as males, and the unrealized transsexuals, who with effort and over many years move toward passing, the transsexual passes the first

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time he dares. He changes his name to a masculine one even before he has passed (secretly in childhood, in fact); he changes all the legal documents he can, forging others when necessary; he attempts to get his birth certificate changed (with variable results, depending on where he was born); he leaves home and lives undetected as a male. Those who are students manage to get registered in high school or in college as males; the older transsexual works as a male in men's jobs, undetected. These people solve such problems as the use of public restrooms or living with other people without their sex being discovered, and even occasionally have sexual relations, their fcmalcness undetected by their partners. While still adolescent, transsexuals begin searching out means for "sex transformation" procedures, and as soon as possible after age twenty-one (and therefore no longer responsible to their parents), manage to get regular injections of testosterone, bilateral mastectomy, and a panhysterectomy. Most do not insist on an artificial penis—but only because they are told by the urologists that it is not possible to make a real-appearing penis that can be urinated through or has erectile capacity. In contrast to many males who seek sex transformation procedures, female transsexuals are not exhibitionistic. So, far from publicizing their condition, they make every effort to keep it secret. Their greatest hope is to become simply males; they do not wish to be the most handsome and stud-like of males, but simply to be ordinary men. In contrast to butch homosexuals and unrealized transsexuals, the female transsexual is cut off from many genital pleasures. Masturbation, although a temptation, is a mixed blessing, as it involves awareness of the femaleness of the genitals, no matter how powerful the fantasies of being a male. Likewise, sexual relations with most women are unacceptable either because, as noted above, the female transsexual knows that the woman who can accept his female genitals enjoys precisely what he loathes, or at best is not a "normal" woman. He may solve this problem by finding a "normal" woman who has been exclusively heterosexual, married, and had children, and who does not desire to touch the transsexual's genitals; she would not be permitted to do so anyway. Transsexuals show none of the scorn for men so essential for the butch; their attitudes toward maleness and masculinity are like those of comfortably masculine men. The transsexual is the limit of the continuum* with which we are dealing. However, there are two more related groups of females. * A continuum of masculinity, but, I wish to add, also a homosexual continuum. Female transsexual ism strikes me as a form of homosexuality more than as a distinct condition. See R. J. Stoller, "Etiological Factors in Female Transsexualism: A First Approximation/* Arch. Sex. Behav.,1912, 2, 47-64.

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Male transsexuals' mothers The mother of a male transsexual has had an episode of marked masculinity in her life. Although she plays a womanly role as an adult, for several years, up until adolescence, she was like the little girl who later became transsexual. So far as one can tell from her history, she had no obvious masculine traits during early childhood. All such women have described themselves as being feminine girls until latency. In contrast to what butch homosexuals, unrealized transsexuals, and transsexuals report, this girl started out more feminine than not. She told of being closer to her father than her mother. However, her tie to her mother, filled with conscious anger and painful dependence, was also intense. Then, around age six, her relationship with her father was broken (in some cases this occurred because of his open rejection of this daughter, sometimes because of his death, and sometimes because the parents separated). For several years in preadolescence, there flares up an acute, profound masculinity such as we see in those who will become transsexuals. For instance, she intensely desires a penis and needs to dress in boys' clothes and to play exclusively with boys in boys' games as an equal with the boys. This masculinity is aborted by the body changes of adolescence. In contrast to the reaction in transsexuals, the onset of the menses and the development of breasts, while they sadden and anger the girl, are reluctantly accepted by her; and her dreams of being a male fade from consciousness. She learns a feminine role. Although this may be primarily a defense against conscious feelings of homosexuality, it works, probably because these girls have had a period of femininity in their early years of life. Conscious homosexual desires, if present, are rarely acted upon. Still, genital heterosexual desires are minimal. Such women as I have observed were virgins at marriage, and none had to struggle later with adulterous impulses. Being pseudoheterosexual and wishing to seem a normal woman, the mother-to-be of the transsexual boy marries, usually in her late twenties. She wants children, enjoys her pregnancy, does not complain about childbirth, and is pleased to have her babies. She involves herself completely in her household, in raising her infants and in keeping house. Although she may have some lingering interest in participating in sports, she would not be recognizable to the casual observer as anything but a housewife who accepts that role. However, to maintain her chronically endangered cover of femininity, this woman has a special relationship with her husband and has chosen a special husband. Although he usually appears unremarkably masculine and has masculine interests, he is indecisive, distant from his family both emotionally and physically, a loner who must carve out large chunks of time

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to be spent by himself instead of with his family, continuously angry at his wife but unable to express this openly, and accepting (again, angrily) of her quiet and unremitting exposure of his weaknesses to her children. In such a family no explosions are permitted; husband and wife go on indefinitely, without divorce or separation, each depleting the family by drawing from it the strength necessary for surviving each day. Then, the son is born; he is beautiful, graceful, and all too easy to love. So the mother keeps him too close to her body and for too long, creating and maintaining for several years an intense, loving symbiosis with a minimum of frustration. This ambiance so interferes with the infant's separation from his mother's body and psyche that—I conjecture—the little boy adopts his mother's femaleness and femininity instead of having the opportunity gradually to separate from her and become masculine. At any rate, throughout her late adolescence, young adulthood, and the years of her marriage and motherhood, the mother of the transsexual male maintains a feminine appearance and an outwardly exclusively heterosexual life. Only searching below the surface will reveal her homosexual and transsexual desires and show the apparent femininity to be a defense against them. This caution, however: the capacity to play this feminine role cannot be brushed aside; it is probably due to the period, in early childhood, of acceptance of femininity by both her father and herself, in contrast to the early childhood of openly masculine women.

Women with "penises"

Now, Mrs. G. This type is the most difficult to make clear to the reader, especially the psychoanalyst, for he is likely to extrapolate from patients he has seen or heard of and presume that the women in this group are not significantly different (i.e., in unconscious mechanisms) from those familiar to us as "phallic women." Let me try to make clear what distinguishes this group. In what I believe is the prevailing use of the term, "phallic women" have both femininity and conflicts about it, with at times conscious wishes they might have a penis, as well as unconscious manifestations of this wish, and with defenses against the wish and protection of it. They are women who, with more or less reluctance, accept the roles prescribed for women and who, however much they wish they had a penis, know they do not. In one form or another, drives and defenses relating to having a phallus* are ubiquitous in women of our society. * The very fact that the word "phallic" was chosen when analysts first began exploring these events suggests that earlier workers were aware that these women do not simply want to have the anatomical structure, penis, but rather, knowing they will never have one, displace their wish onto attributes of a penis, such as intnisiveness, power, violence. If such a woman awoke one morning to find she had a penis, she would be horrified.

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On the other hand, the women we are now concerned with fully believe and openly state that they do have penises. This is bizarre. Yet, of the three patients of this kind I have seen, only one, Mrs. G, has had episodes of psychosis. The second has a borderline personality without such episodes, and the third is not even borderline. Psychotics of either sex frequently report either that parts of their bodies are changing sex or that they, in their entirety, are changing sex or have done so. But Mrs. G always believed she had a penis, even when she was in remission. As we have seen, her description of her penis, which she felt as a physical object, was independent of her degree of contact with reality, presence or absence of hallucinations, confusion or clarity of thinking, or domination by primaryor secondary-process thinking.* As far back as she can remember (age four), Mrs. G had a penis; and until recently in treatment, she has never not had a penis (except as noted). She had never seen the penis nor had she ever been able to touch it. She knows that other women do not have penises, and she knows that the rest of the world would consider her mad for believing so. But if surgically explored, she believed one could be found. When I asked her how she would respond if the surgeon were unable to find it, she answered that that would be his problem in that he had not looked carefully enough. Mrs. G was neither eager nor reluctant to discuss her penis. I learned of it only after years of talking with her and then did not hear of it either as a revelation or as the result of a particular piece of therapeutic work. When I expressed my curiosity and surprise that I hadn't learned of it before, she said, "You didn't ask." The attitude expressed in all discussions of her penis was that this was a normal organ that had no more or any less reason for coming into our conversations than any other part of her body. She talked about it openly, without embarrassment, irritation, or guardedness whenever I wished to talk about it or whenever it was appropriate for her to bring it up because she was thinking about it. She did not care whether I believed she had a penis or not. One frequently hears a woman expressing wishes to have a penis, who has daydreams of having one and occasional night dreams either of having hermaphroditic genitals or, less frequently, of being a male (though, in my experience, always with details expressing an awareness of still being herself, a female). Although these wishes and fantasies tend to become more powerful the more grossly masculine the woman is, I have not seen the fully egosyntonic conviction of having a penis in the other types of very masculine women. One would expect to find it regularly in transsexual * We can use Mrs. G's words to differentiate her from a transsexual female: "1 used to think I wanted to be a man. Not think: Jesus, I sure want to be a man; I guess Til go have my breasts cut off and have a penis hooked up to me and become a man. I didn't think like that."

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women, but I have not (though I have heard them report occasional fleeting body sensations of maleness: "Do I have a penis?1*). "Penis women" are different. One of these, like Mrs. G, considers herself bisexual, by which she means that she enjoys sexual relations with women and with men and feels herself to be at times comfortably feminine and at other times very butch. The second wants to live as a man and wishes her body would naturally transform itself to male; her belief that she had a penis was in reality powerfully confirmed by her having an intraabdominal growth, about the same dimensions as an erect penis, that was both visible and palpable beneath the abdominal wall; this patient has a thought disorder of a schizoid type (her conversation is hard to follow), but is without psychotic symptomatology. Mrs. G is the third such woman.

The above clinical descriptions should be used for orientation only. Their purpose is mainly, first, to separate out the class of very masculine women from the innumerable others who make up most of the population and who, while they dream (day or night) of having penises or of seizing power, differ in most other ways from very masculine women in the balance of their masculinity and femininity, and, second, to help us sort out the types within the class ''very masculine women.** I should like to do better than furnish these descriptions based on observations that do not get into the core of these women as analysis would. My data on the causes of masculinity in women, however, are inadequate. The only generalizations to be made for the present are that a girl is in danger of masculinity if she cannot reach her mother in infancy and childhood, if her mother does not encourage feminine behavior or show pleasure that this daughter is a female, and if the girl, on turning to her father for affection, is encouraged by him to be interested in and to spend time with him in masculine pursuits.

APPENDIX 4 Mrs. G's Dreams

Mrs. G's dreams played little pan in the treatment (although they were useful for interpretations and to emphasize insight), so they have not been alluded to in the text proper. Until recently, she had reported only about twenty dreams. Then, as personality changes occurred, she felt as if flooded with dreams each night, dreams enriched with greater numbers of people, new places, and complex plots. In addition to the dreams previously recounted, here are all the dreams Mrs. G related (up to the change in style of dreaming noted above). They are closer to the dreams of my psychotic patients than to those of (normal neurotic) analytic patients. I dreamed about this girl. She was so nice and so soft, and then I thought it really doesn't make any difference because I'm a man. I was with this girl, and she did not have any clothes on, and I was touching her body; and it felt soft to me and nice. And the whole time I was dreaming, I was thinking it really doesn't make any difference because I am a man. And then somebody turned the lights on, and I found out I wasn't a man. I had an orgasm [while touching her]. I went to bed with an angel, and I got pregnant; and I got so big that my stomach exploded, and I gave birth to a snake. And I laughed. The angel was a female. She blew me up. She put her mouth on my genitals, and she blew, and I swelled up. I had an orgasm. I exploded, and the snake came out of me, a baby snake. [This dream occurred the night after Mrs. G had her tubes insoufflated to check for patency prior to tubal repair. See Chapter 5]. I was in an apartment, and I had to go do something up the stairs, and I started up the stairs. And this man started to chase me, and he was going to rape me, and he caught me. I woke up. Nothing big happened, but it just frightened me to death. I dreamed that you were dead. I picture myself with kinky hair. That's all. One time I was in bed with my mother, and I dreamed I had 376

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sexual relations with her. I dreamed that my mother and I were in bed together, that we were holding each other, and I justed wanted . . . I kept telling her that I loved her, and I wanted to show her how much I loved her, so I kissed her breasts and I kissed her body. I didn't go down on her, but I fondled her with my hands. And she put her hands on my face, and I had an orgasm. That's all there was to it. No big thing. I dreamed about having a sexual relationship with you. I just dreamed that I came to your office to see you, and I asked you if it was all right if I could lie down, and you said yes. And I got scared when I lay down. And you said, "You don't have to be scared. I'll hold you." And you did, and I got excited, and we had relations. I didn't take my clothes off. I didn't have any pants on, but I had a top on, you know, which is really typical of ... And you didn't take anything off but your shirt. How we could have intercourse with you with nothing of! but your shirt is beyond me, but you did take your shirt off. And I don't remember ever actually having intercourse with you, or I don't remember . . . I didn't have an orgasm in my sleep or anything. . . . All I know is that I felt you against me, and it was good, and I was comfortable and warm and secure; and that was a good thing. And when I left, I was satisfied. I dreamt I was a little girl. When I was real small, when I was about three and a half or four years old, I lived across the street from these people who had this big, beautiful house; and they had fish ponds and a swimming pool and everything. They had two little girls, and my mother always... later, I don't know that she said it when I was three . . . but she said it when I was seven and eight, "Gee, those little girls are always so clean and so pretty. Why can't you be like they are?" And I had a dream last night that I was in their house,- you know, that they made me one of their family. I dreamed that Bill bought me a new car, and it was very... it was a very nice car. And I drove to my mother's house, and I visited with my mother, and I had a nice visit with my mother. And I got ready to go, and it was dark outside; and I was scared to walk out to the car, so my mother walked out to the car with me. And I got into the car, and I started the car, and I couldn't find the lights. And my mother said, "They're in that box"; and there was ... you know how sometimes die workings on a TV are in a box... the lights were in this box. And I couldn't get the box open, and I was begging my mother to help me because it was dark, and I was scared, and I just couldn't get the damn box open. It was such a stupid dream. But when I woke up I was so frustrated.

378 SPLITTING And I had the most awful dream, just awful. I dreamt that I was in bed and that my son was going down on me. And this girl came in and caught us, and she said, "Now I'm going to tell everybody"; and she did. She went out and told everybody; and all these people came in to see. That's all I remember. I dreamed that I was in the park; and I don't know how old I was, fifteen, sixteen years old, not young but not old. And this man started chasing me and throwing baseball bats at me. [Laughs] Does that make any sense? And I ran into this bathroom, and I locked the door; and he was standing outside the window waiting for me. And I was so frightened. And I hollered out the window to him. I said, "I'm a boy; I'm not a girl"; and he went away. And I climbed off the window and escaped. But God, I was scared! I don't know what I was scared of. How can you be hurt with a baseball bat unless someone bangs you over the head with it? I dreamed I was in the bathroom with my father, and he was urinating and I urinated too, and I had a penis just like his. The following dream occurred late in treatment, a month or so before she reported the shift to more abundant dreaming. I dreamed that I was at home with my mother and brothers and sisters, and I was twins. And one of me was good, and one of me was bad. And the bad one always got away with everything. And my mother always punished the good one. The bad one broke my sister's doll; we were in the house and my sister just got a new doll—it was a Negro doll—and I broke it. I smashed it. Not I, but the other—the twin smashed it. My mother came in, and my sister was crying, and the other one [twin] said, "She did it." And my mother beat me. My brother kept saying, "I know which one you are." For years, Mrs. G had had this dream repeatedly, starting before I became her therapist (first reported in a letter): I am at the beach; there are waves. I am in this wet hole trying to get out, but can't get a hold of anything because the sand slides. There is a man in a white coat standing there reaching out his hand, but I can't reach. With the recent shift to more remembered dreaming, the above changed: I am in a hole, and it's not wet or slipping and not as deep. You are there. You reach out your hand; it's warm, and you pull me out of the hole.

Notes and References Introduction 1. Department of Psychiatry and Neuropsychiatric Institute, University of California, Los Angeles Medical Center. 2. Stolter, R. J. Sex and Gender. London: Hogarth Press, 1969. 3. Freud. S. [1912] "Recommendations to Physicians Practicing PsychoAnalysis/* in The Standard Edition of the Complete Psychological Works of Sigmund Freud (hereafter abbreviated 5E). London: Hogarth Press, 1958. Vol. 12, p. 114. 4. There is no need to review here the considerable literature on the pros and cons of introducing the tape recorder into the treatment situation. I shall merely state my opinion that, as others who have used the technique have reported, one gets so used to the recorder that he no longer notices it. Although the machine is a presence in the room, the cost of that presence does not seem more prohibitive than that of many other presences, such as fees, time schedules, office furnishings, flaws in the therapist's personality, rigidity due to one's theories, etc. Perhaps some feel they would be inhibited by the observer the recorder represents—and that the recorder thus would keep them so honest they would no longer be spontaneous, and therefore less therapeutic. I have sometimes felt this, but not with Mrs. G. That, however, would seem more an individual problem than one of recording technique in general. 5. Perhaps one should be more thoughtful about recording when the main purpose is to do research on the treatment process itself, for then one cannot be so cavalier about influences that color the process. Although the better my analytic work, the better the information uncovered, I do not record to reveal technique. 6. Theodor D. Sterling wrote, in Science (20 Aug. 1971): It is obvious that we cannot, as a community of scientists, examine in detail the data collected by each individual member. It is also equally clear that testimony of experts very often must be accepted. However, as a practical procedure, published results and testimony have meaning only because we assume that, in the event the need arises, the actual data on which the investigator or the expert bases his conclusions are open to inspection. Otherwise, the claims of investigators or the testimony of experts completely lose their credence. Perhaps the matter was stated most succinctly by Bertrand Russell in his discussion of the limitations of the scientific method: ". . . it is clearly impossible that each of us should verify the facts of geography; but it is important that the opportunity for verification should exist, and that its occasional necessity should be recognized/' The transactions of the scientific community must be conducted in public. This tenet is deeply engrained in the process of scientific inquiry . . . The fundamental pillar on which science rests is the accessibility of information, observations, and data. I quote, for instance, the A A AS Committee on Science in the Promotion of Human Welfare: "Science

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gets at the truth by a continuous process of self-examination which remedies omissions and corrects errors. This process requires free disclosure of results, general dissemination of findings, interpretations, conclusions, and widespread verification and criticism of results and conclusions." Data on which scientific claims are based must be public in the sense that they are available for review. Conversely, can one give credence to any widely disseminated claims based on observations which are kept secret or confined? . . . To give credence to reports based on privileged data is to destroy the validity of the scientific method. 7. "We have art in order not to perish of Truth/' Nietzsche stated (Werke, Munchen: Musarion-Ausgabe, 1922. Vol. 19, p. 229). 8. Freud, S. [1917] "The Sense of Symptoms," in Introductory Lectures on Psycho-Analysis. Part III. General Theory of the Neuroses. SE, 1963. Vol. 16, p. 261. 9. Someone may want to invent a new printed language, an alphabet of notations for inflections and pauses, for pitch, timbre, and rhythm. Of course, there is the question, Must we always be bound by printed words? (McLuhan asks questions using the syntax of declamatory answers.) Will we who are struggling toward a science of human behavior always communicate by journals and books? 10. Wallerstein and Sampson have given us a scholarly, indispensable review of research issues in the psychoanalytic process and of the ways to mitigate problems in making data available to others. See R. S. Wallerstein and H. Sampson, "Issues in Research in the Psychoanalytic Process," Int. J. PsychoanaL, 1971, 52, 11-50. 11. I was often matching Mrs. G against other patients. How was she like or different from women who fantasied having penises; in what ways did she experience hers as compared with how they did theirs (e.g., daydream vs. hallucination)? How did she compare with transsexual females, butch homosexuals, or other very masculine women in her masculine behavior (e.g., voice inflection, carriage, job preferences, love objects, loci of genital pleasure, femininity)? How did she manage conception, pregnancy, delivery? What were her attitudes and behavior in raising her infants and at later stages, especially with regard to their developing gender identity? The list of questions for which she serves as a control, and equally for which other patients serve as controls for her, is endless. Obviously, to use controls properly, one needs not only sufficient subjects but studies of each subject in great enough depth so that one has confidence in the data's quality. Yet there are not enough hours in the day or years in my life to accomplish this. So, knowing that what I am doing is inadequate (one case is too few) but still useful (at least it is a start), I have chosen patients to treat partly because they would serve as controls. For instance, in attempting to measure and understand sources of masculinity and femininity in women, I have also analyzed or treated in psychotherapy the mother of a male transsexual, the mother of a fetishistic cross-dresser (transvestitc). the mother of an effeminate homosexual, two female transsexuals, and the wives of two transvestitcs (and in addition, of course, women not part of the research, like those in any analyst's practice). Patients with biological abnormalities that can contribute to gender disorders (e.g., hyperadrcnalism in females) are compared with those without biological abnormalities. Mothers of transvestitcs are compared with the wives of transvestites: mothers of male transsexuals, with mothers of female transsexuals: females who feel a penis inside themselves.

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with those who wish they did and imagine they do, but know they don't; mothers who encourage masculinity in their sons, with those who discourage it and encourage femininity; and so forth (not to mention fathers—no need to list here the work on males). Bit by bit, the empty spaces that represent one more possibility are filled in by a patient with that (those) attributes(s). Let us not discuss the crudity of such controls or what is necessary to make them more adequate. I can only hope the small numbers of subjects and the tremendous complexity of any piece of gender behavior (which really requires controls on each element making up the behavior) do not militate against there being some value in this method. 12. That is no longer so; in the months since this was written, the transference came, I believe, to be understood and resolved. Perhaps I shall write further about it someday. 13. Freud, S. [1938] "Splitting of the Ego in the Process of Defence.*' SE, 1964, Vol. 23, pp. 275-276. 14. Let it go with this: Authorities (on theory and therapy) with me as I write are the object relations workers—Winnicott, Fairbairn, Guntrip, Khan, Mclanie Klein and her followers, especially Racker; Sullivan, Searles, Erikson; the double-bind and other family dynamics people, especially Bateson and Lidz; learning theorists, from psychoanalytic ethologists like Bowlby, to Bandura and Sears, on out to the inorganic and fleshless Skinner; classical modern psychoanalysts such as Fenichel, Greenacre, Greenson, Hartmann, and Mahler. And always Freud. In order to keep down the clutter, I have tried to erase from these pages the imprint of my inner discussions with them, but the reader may nonetheless occasionally sense the traces.

Mrs. G9s Penis 1. See, for example, the following: Abraham, K. "Manifestations of the Female Castration Complex,** Int. J. PsychoanaL, 1922, 3, 1-29. Freud, S. [1925] "Some Psychical Consequences of the Anatomical Distinction Between the Sexes.** SE, 1961. Vol. 19, 243-258. Freud, S. [1931] "Female Sexuality.** SE, 1961. Vol. 21, pp. 224-243. Greenacre, P. "Special Problems of Early Female Sexual Development," in The Psychoanalytic Study of the Child. New York: International Universities Press, 1950. Vol. V, pp. 122-138. Kestenberg, J. S. "Outside and Inside, Male and Female,** /. Amer. Psychoanal. Ass., 1968, 16, 457-520. Levin, S. "The Depressive Core in Schizophrenia, Bull. Phila. Ass. Psychoanal., 1971,21,219-229. Rado, S. "Fear of Castration in Women,*' Psychoanal. Quart., 1933, 2, 425-475. Van Ophuijsen, J. H. W. "Contributions to the Masculinity Complex in Women,** Int. J. Psychoanal., 1924, 5, 39-49. 2. Greenacre, op. cit. 3. Kestenberg, op. cit. 4. I think that many very masculine women have older brothers they feel were bullies and ruthlessly phallic—showing their penises and physically brutal.

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5. Oddly enough, with Mrs. G it was always a penis alone, never penis and testes; never once were testes mentioned. Finally, when I was writing this book, this omission struck me. When I questioned Mrs. G., she broke into surprised laughter and said it was true—she had never had testes. And she, too, had never thought of this before. She added, "They are important to me on a man. I don't know why I never had them!" See A. I. Bell, "Some Observations on the Role of the Scrotal Sac and Testicles," /. Amer. Psychoanal. Ass., 1961,9,261-286.

Charlie 1. V. Siomopoulos considers this an anlage for hysterical psychosis as opposed to schizophrenia ("Hysterical Psychosis: Psychopathological Aspects,*' Brit. J. Med. Psychol., 1971, 44, 95-100). However, others do not. (See, for example, L. Bender and F. Vogel, "Imaginary Companions of Children," Amer. J. Orthopsychiat., 1941, 11, 56-65; and H. Nagera, "The Imaginary Companion: Its Significance for Ego Development and Conflict Solution," in The Psychoanalytic Study of the Child. New York: International Universities Press, 1969. Vol. XXIV, pp. 165-196. 2. Perhaps I should defend myself: this ignorance or confusion was often due to the outpouring of historical material, signs and symptoms, shifts in affect, and a desire to tease—aimed at keeping me off balance. For we must not forget that Mrs. G never was so confused that she did not know I was dangerous: a man, an anatomical male, and a person with power in her life. Under these circumstances, she could restore the balance between us only by keeping me confused and uneasy. 3. Now, while writing, years later, I know better the path my associations took just then and why the name "Charlie" had seemed so appropriate at the moment of naming: There was a great episode in a movie of the '50s, Dead of Night, in which a ventriloquist's dummy finally overpowered the ventriloquist, taking over his body. The ventriloquist's dummy of my childhood was Edgar Bergen's Charlie McCarthy. 4. This splitting of one's self into pieces that function independently of each other brings to mind hypnosis, somnambulism, conversion, and multiple personality. (See H. F. Ellenberger, The Discovery of the Unconscious. New York: Basic Books, 1970.) If only there were renewed study of these experiences and if they were incorporated into present-day research on identity (there is little systematic work on identity yet, N. Leites's work The New Ego [New York: Science House, 1971] being an exception), the study of identity could be greatly enriched.

Chris 1. I had not read this letter since it was sent over a decade ago, and so was intrigued by how much more it said than I could possibly have known at the time—as we shall see shortly. At this point, just let me remark that

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there is a slightly odd tone in the words "I honestly know it's a baby," which one might call cryptic if he were already suspicious. In those days, I was not, but just took for granted Mrs. G*s never saying anything quite straightforwardly. (In fact, that wording is wrong: over the years I have learned that Mrs. G usually says everything exactly right, but only she knows all the facts necessary to understand her.) 2. An additional gain was her becoming familiar with the sensation and impact of insight, of understanding that made psychotic symptoms disappear. And they never disappeared when I made a wrong interpretation, no matter how enthusiastically I believed in it or how beautifully I worded it. When I was wrong, Mrs. G would show that a part was missing in the explanation and, although she was consciously as ignorant as I, would point me in the direction for finding it. 3. In each case, the main struggle is to rid myself of "normalcy." I am talking not only about the "fluid" quality necessary for an analyst to listen well to nonpsychotic people but about an additional quality that those who regularly treat psychotics have in great degree, but I only sporadically. I find opening up my insides sufficiently to truly hear the psychotic an exhilarating experience; and yet, each time it is over, I find it unpleasant to have to go back and do it again a few hours later or the next day. I do not have the energy to do this for a lifetime.

Psychosis 1. Bleuler would also have diagnosed her thus: "All cases so diagnosed [hysterical psychosis] by others differed in no wise from other schizophrenics." Bleuler, E. [1911) Dementia Praecox or the Group of Schizophrenias. New York: International Universities Press, 1950. P. 289. 2. Mallet, B. L., and Gold, S. "A Pseudo-schizophrenic Hysterical Syndrome," Brit. J. Med. Psychol., 1964, 37, 59-70. 3. Hollender, M. C, and Hirsch, S. J. "Hysterical Psychosis,** Amer. J. Psychiat., 1964, 120, 1066-1074. Hirsch, S. J., and Hollender, M. C. "Hysterical Psychosis: Clarification of the Concept," Amer. J. Psychiat., 1969, 125, 909-915. 4. That is, if we ignore the studies differentiating schizophreniform from schizophrenia or reactive from process. 5. "Our impression is that psychotherapy of such cases [hysterical psychosis] is described too often in the literature as successful therapy for schizophrenia.** C. Astrup, et al., Prognosis in Functional Psychoses. Springfield, 111.: Charles C. Thomas, 1962. (Cited in Hollender and Hirsch, op. cit.) 6. The insights and the control of her impulsivity that resulted from treatment contributed to her developing these psychoses, as did also the banking of the fires of impulsivity that comes with growing older. 7. I do believe, having seen it, that the so-called "hysterical psychoses'* may, without proper treatment, gradually deteriorate into a chronic and untreatable state that looks essentially the same as schizophrenia, except that there are more exhibitionistic, flamboyant features. Here in Los Angeles, with Hollywood near, we are familiar with the weird, exaggerated, overacted, hysterical psychoses of

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young actresses, who age into frazzled old schizophrenics. In Mrs. G, other, more typically schizophrenic features, in contrast to those of hysterical psychosis, were that she did not sexualize our relationship, was not exhibitionistic in dress or manner, was able to murder, had bizarre attitudes even when not in an overtly psychotic episode, and had been hallucinating since childhood.

Multiple Personality 1. I knew a chronic schizophrenic who won a medal for bravery and brilliance; he simply followed the instructions a voice gave him as he led his platoon to safety from behind enemy lines. Religious heroes, generals, and other leaders have had this sort of luck with their hallucinations. But most schizophrenics do not. 2. The best review of this state is by H. F. Ellenberger, in The Discovery of the Unconscious (New York: Basic Books, 1970). In a recent paper Gruenewald describes a patient similar to Mrs. G (D. Gruenewald, "Hypnotic Techniques Without Hypnosis in the Treatment of Dual Personality: A Case Report/* J. Nerv. Ment. Dis., 1971, 153, 41-46). See also P. Morton and D. Miller, "The Etiology of Multiple Personality/' Compr. Psychiat., 1972,13, 151-159. 3. Leites, N. The New Ego. New York: Scienre House, 1971. 4. The next session, Mrs. G reported two dreams. The first was dreamed the night before: I dreamed I was lying down, and a spirit got up and left my body. The second she had dreamed a couple of weeks before: I delivered a baby girl, feminine, with a frilly dress, a nice-looking three-year-old girl; and everyone—my mother and everyone else— said, "What a monstrosity that is!" But I knew the little girl wasn't a monstrosity in any way except she was three years old. 5. Over the weeks that we talked, I often wanted to use this -person's" memory, which extended farther into early childhood than did Mrs. G's— that had earlier been the temptation to try hypnosis. However, doing so encouraged Mrs. G to stay split, which left her confused, frightened, vulnerable, and unsure if she could rely on herself at work, with friends, or with her family. So treatment won out over curiosity. Later, when Mrs. G was more stable, she went into these memories via trance states without another personality.

Murder 1. In particular, a death instinct as an explanation has no more appeal for me than the allegation that there is a gravity instinct to explain why everything desires to fall—that is too romantic. 2. It is certainly not offered as an example of the psychoanalysis of a psychotic: it was not analysis. Even the acquisition of insight took place on a massively supportive base.

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3. I resist the temptation to argue here with the fools who say that mental hospitals are unnecessary, or that it is the hospitals and the psychiatrists who create mental illness, or that keeping the patient in the hospital more than a few hours or a few days can only harm him. I share all of these sentiments in part, disagreeing with the dogmatism of the reformers. 4. See R. R. Greenson, The Technique and Practice of Psychoanalysis. New York: International Universities Press, 1967. P. 235. 5. The similarity of this belief to that of most people, whether or not they have a religious sense of reincarnation or of heaven, makes me uneasy about calling Mrs. G's belief a delusion.

Identity 1. Though, especially in the earlier days, Freud used "ego" pretty much as we now do "identity." 2. "Freud takes the whole self for granted and nowhere discusses it specifically as the one psychic phenomenon that matters most of all . . ." H. J. S. Guntrip, Psychoanalytic Theory, Therapy, and the Self. New York: Basic Books, 1971. 3. Leites, N. The New Ego. New York: Science House, 1971. 4. A review by M. M. R. Khan ("Vicissitudes of Being, Knowing and Experiencing in the Therapeutic Situation,** Brit. /. Med. Psychol., 1969, 42, 390) of Winnicott's ideas on the true and false self is to the point: THE DREAD OF BEING (THE TRUE SELF) Winnicott (1960a) has introduced the concepts of true and false self in the psychoanalytic literature. Briefly stated, his argument is that dissociation of a person into a true and false self is the result of the deficiency of primary environmental (maternal) provisions in infant-care. The chief characteristics of the false self organization are: 1. Its defensive function is to hide and protect the true self, whatever that might be. 2. The false self has as its main concern a search for conditions which will make it possible for the true self to come into its own. 3. When a false self becomes organized in an individual who has a high intellectual potential, there is a strong tendency for the mind to become the location of the false self. 4. The point of origin of the false self is in a defence against that which is unthinkable, namely the "exploitation of the true self, which would result in its annihilation.**

Mrs. G's Mother 1. The following statement by H. J. S. Guntrip (Psychoanalytic Theory, Therapy, and the Self. New York: Basic Books, 1971. P. 98) is relevant: This splitting of the object in the struggle to cope with unhappy real life experience leads to a splitting of the ego in the struggle to maintain

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relations with both the good and bad aspects of the mother and other family figures. Fairbairn reduces Klein's multiplicity of internal objects to three basic fantasied figures who can appear in many guises: (1) the tantalizing mother who excites needs without satisfying them, the exciting object', (2) the rejective, angry, authoritarian, antilibidinal mother who actively denies satisfaction, a mild form being the mother who says "Don't bother me now, I'm busy,1' the rejecting object', and (3) the emotionally neutral, morally idealized mother whom the child seeks to view without much feeling, with whom needs are avoided so as to avoid her displeasure, and with whom conformity is accepted in hope of at least approval, the ideal object. The exciting and rejecting objects are both bad and are repressed as twin foci of a troubled unconscious emotional inner world. The ideal object is projected back into the real parent in the hope of living at peace in the outer world. With this object-splitting goes a parallel ego-splitting: (1) an infantile libidinal ego unceasingly stimulated by the exciting object, hungrily craving the personal relations without which the psyche cannot grow a strong ego, but manifesting in adult life as chronic overdependency, compulsive sexuality, and craving for appreciation; (2) an infantile antilibidinal ego identified with the rejecting object, an undeveloped childish conscience, negative and hostile, self-persecuting, inducing fear and guilt, the main source of resistance to psychotherapy; (3) a central ego conforming with the idealized parents, after the emotionally disturbing aspects of both objects and ego have been split off and repressed. This seems to me the most accurate theoretical analysis I have come across, of the pattern of the split-psyche that underlies psychoneurosis and psychosis. 2. Probably, in milder form, a common mechanism. For instance, it is the form that identification with women takes in effeminate men. Below it lies despair. 3. Winnicott, D. W. "The Theory of the Parent-Infant Relationship," Int. /. PsychoanaL, 1960, 41, 585-595. Winnicott, D. W. [1960] "Ego Distortion in Terms of True and False Self," in The Maturational Processes and the Facilitating Environment. London: Hogarth Press, 1965. See also what Fairbairn calls "the antilibidinal ego," that part of one which attacks one's whole (W. R. D. Fairbairn [1944], "Endopsychic Structure Considered in Terms of Object-Relationships," in An Object-Relations Theory of the Personality. New York: Basic Books, 1952. P. 129). 4. Fenichel, O. The Psychoanalytic Theory of Neurosis. New York: Norton, 1945. H. J. S. Guntrip, op. cit.

Homosexuality 1. See R. J. Stoller, Sex and Gender, pp. 144-145. 2. Stoller, R. J. "Impact of New Advances in Sex Research on Psychoanalytic Theory." Paper read at the Auken Conference, Copenhagen, 4 May 1972. 3. Freud has written, "A mother is only brought unlimited satisfaction by her relation to a son; this is altogether the most perfect, the most free from ambivalence of all human relations." S. Freud, "Femininity," op. cit., p. 133). I do not believe that this is true: I think that is a rare mother who does not

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succumb to the temptations of having a defenseless male for her own. What did Freud think happened to all that penis envy he postulated in all women? However, Mrs. G would agree that her mother and Freud saw eye to eye on this. 4. What I do not know, and feel I cannot know, is how she was able to create a penis that she felt was really there. We are familiar with women who (consciously) daydream of having a penis or who (unconsciously) have such fantasies; but Mrs. G was not one of these. She did not just imagine having a penis, but actually had one, insofar as subjective experience was concerned. What is different in her that lifted fantasy to hallucinated reality? Our work never revealed the answer. And it is certainly no explanation to say that she accomplished the task of hallucinating by "hypercathecting the penis imago"— that only says nothing more, but in an erudite way. 5. Having heard her mother express disgust about homosexuals, Mrs. G could not admit she was a homosexual. Interestingly enough, however, although she—as she felt herself to be—could not admit to homosexuality, Charlie, that split-off, hallucinated part of her conscience, did not care. 6. Is there a clue here to understanding some of the women, reported by Masters and Johnson (W. H. Masters and V. E. Johnson, Human Sexual Response. Boston: Little, Brown, 1966), who never run out of the capacity to have orgasms—by the dozens? Perhaps in some cases "orgasm" and "satisfaction" are not synonymous—rather like a fibrillating heart that cannot manage a vigorous contraction. 7. M. Hoffman (personal communication) says that some couples pick a male who looks like the masculine one of the couple. 8. See also Ferenczi's classification of subject and object homosexuality: S. Ferenczi [1914], "The Nosology of Male Homosexuality (Homoerotism)," in Sex in Psychoanalysis. New York: Basic Books, 1950. 9. Ovesey, L. Homosexuality and Pseudohomosexuality. New York: Science House, 1969. 10. I am not quite clear what he considered paranoia and what paranoid schizophrenia He excluded what he called schizophrenia from the above formulation, but most of us would consider his "paranoia" typically paranoid schizophrenia. S. Freud [1911], "Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia." 5£, 1958. Vol. 12, pp. 9-82. 11. I do not argue that conflicts expressing flawed gender identity are ubiquitous; that they are seen is just what I am talking about here. My concern is that the logic deteriorates if one finds this same simple etiology present in all conditions. 12. I believe this is less true for women; fewer of them fear that closeness and tenderness with another woman threatens them, for instance, by making them less feminine. Mrs. G was an exception to this and was as sensitive to this issue as the average masculine man in our culture. 13. What we can note for future study is that the avowed homosexual gives us a problem in this regard, for he does not seem to have to defend himself against homosexuality (especially transsexual tendencies). But perhaps he does, and perhaps his lack of fear of being up against someone of the same sex nonetheless has in it, as with Mrs. G, hidden maneuvers against succumbing to transsexual tendencies. 14. Freud, S. Op cit. Footnote 9.

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15. This bears some resemblance to "implosion*' or "desensitization" therapy, in which one confronts fantasies of phobic situations to lose one's fear. 16. There is an apocryphal story (told to me by Frederic G. Worden,) of a ward set up for young, male, acute paranoid schizophrenics in which all the personnel were overt homosexuals; tender, overt homosexuality was encouraged among the patients and staff. The story is that the cure rate was high. 17. See the review by C. W. Socarides, "The Historical Development of Theoretical and Clinical Concepts of Overt Female Homosexuality/1 /. Amer. Psychoanal. Ass., 1963, 11, 386-414, and a most original paper by M. M. R. Khan, "The Role of Infantile Sexuality and Early Object Relations in Female Homosexuality," in I. Rosen (ed.), The Pathology and Treatment of Sexual Deviation. London: Oxford University Press, 1964.

Treatment 1. Another consequence is the purity preserved in psychoanalytic institutes when supervisors control the analyses of candidates without ever seeing the candidate's patient. This guarantees a considerable presence of fantasy when the supervisor discusses such a patient. 2. This book is not written to display successful treatment, and was not planned as a case history of treatment. It was started in 1968, when Mrs. G was still very disturbed. That the outcome at this point in the writing looks favorable is just a bonus. 3. I have in mind here the extensive and exciting reports that appear from time to time on the treatment of an individual case of psychosis by psychotherapeutic or psychoanalytic techniques, the implication being that this humane and insightful treatment demonstrates that the etiology of schizophrenia is psychodynamic and its cure also psychodynamic, as if all the schizophrenias were one in origin. ("Psychosis" in the minds of some becomes synonymous with "schizophrenia.") I often wonder after reading such works what was wrong with the patient, how profound the pathology was, and whether the balance between ego strength and illness had been clearly and correctly assessed. Was the patient described really so representative of the class "schizophrenia" that we can accept that the treament described is a guideline for us? The "schizophrenics" likely to benefit most from the psychotherapies are those who, even before treatment, look the least like process schizophrenics and the most like, let us say, Mrs. G (hysterical psychosis?). These are the patients about whom experienced psychiatrists argue. We ought not generalize much from a particular case unless the author has so described the patient's psychopathology and dynamics that we know what kind of "psychotic" has been treated. 4. This capacity to insist on getting well (which is not synonymous with the therapeutic alliance) exists, I believe, before treatment starts and persists essentially unchanged throughout the therapy. All that changes is that the capacity may become more obvious as proper treatment releases it. I would guess it can hardly be destroyed by a therapist, although a patient possessed of this quality who falls into the hands of an inept therapist may leave the

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therapist and then, if lucky, eventually find someone who can harness this courageous strength. Perhaps when a therapist responds to this impetus toward cure so that it becomes a permanent given in treatment, it accounts for success more than the method of treatment, idiosyncrasies in the therapist, school of belief, errors in technique, or diagnosis. But given the silent knowledge by both partners in therapy that this strength exists, then different techniques can become more important. I am not one of those who believes that technique is not necessary in treatment or that patients get well through their loving trust in the therapist alone. Neither do I feel that analysis of the transference via interpretation and working through is not a significant healing agent. 5. Freud told us about this (S. Freud [1938], "An Outline of PsychoAnalysis." SE, 1964. Vol. 23, pp 201-202): The problem of psychoses would be simple and perspicuous if the ego's detachment from reality could be carried through completely. But that seems to happen only rarely or perhaps never. Even in a state so far removed from the reality of the external world as one of hallucinatory confusion, one learns from patients after their recovery that at the time in some corner of their mind (as they put it) there was a normal person hidden who, like a detached spectator, watched the hubbub of illness go past him. One last thought in this regard: some therapists forget that the above remark by Freud is true also for the nonpsychotic patient. 6. Occasionally funny: I would come to understand something, interpret it, and years later say it again with the feeling that this was the first time I had realized it. Thus reading the typescripts amused me and showed that analysts must sometimes work through material much as their patients do. 7. There are analysts who in their hearts do not believe analysis works. They struggle with this sense throughout their training and the first years of their practice, pumping up their enthusiasm with the hot air of dubious theory or interpretations mechanically derived from good theory. Fighting unacceptable doubts, they beat the rest of us about the head with the purity of their technique, the superiority of their theory, and the distastefulness of our sloppy struggles to empathize. Some of their patients get better, but I cannot help thinking that their patients secretly know the authoritarian rigidity is more awesome than explanatory.

Conclusions 1. Sex and gender identity are not necessarily directly related. For instance, a biologically normal male (sex) may be as feminine (gender identity), from earliest childhood throughout life, as a feminine woman and live his life, undetected, as a woman (transsexualism). 2. Money, J., Harhpson, J. G., and Hampson, J. L. "Imprinting and the Establishment of Gender Role," Arch. Neurol. Psychiat., 1959, 77, 333-336. Sears, R. R. "Development of Gender Role/* in F. A. Beach (ed.), Sex and Behavior. New York: Wiley, 1965. 3. I think that much of what analysts have called biological is instead the result of the early postnatal external influences (see R. J. Stoller, "The

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'Bedrock' of Masculinity and Femininity: Bisexuality," Arch. Gen. Psychiat. 1972, 26, 207-212). Perhaps many limitations in changing character by analysis are due to such fixed patterns of behavior. Treatment that succeeds by insight works because it removes the need for a conflict solution, a symptom. When the symptom is no longer needed, there then appears the person's preconflict core (essence, being); that, in turn, can be changed only by active relearning, e.g. behavioristically, rather easily in children, less so in adults. 4. Although Mrs. G still has masculine and feminine qualities, the forms her bisexuality now takes are less pathological. She no longer splits herself into parts. 5. I wonder if many males are not a bit less sure of their maleness and masculinity than females of their femaleness and femininity; the greater amount of homosexual hallucination and delusion reported in male paranoid psychotics (see, for example, F. S. Klof, "Female Homosexuality and Paranoid Schizophrenia," Arch. Gen. Psychiat. [Chicago], 1961, 4, 84-86) might point to this. Perhaps this is evidence that the core gender identity is more endangered in males than in females. Females do not need, and males are unable at first, to escape from having to identify with a female (mother) from birth on. (See R. R. Greenson, "Disidentifying from Mother," Int. J. Psychoanal., 1968, 49, 370-374.) 6. Stoller, R. J. Sex and Gender. 7. But parents who are happy to have had a daughter will help create her femininity. Work by Kleeman (J. A. Kleeman, "The Establishment of Core Gender Identity in Normal Girls," Arch. Sex. Behav., 1971, 1, 103-129) gives us a nice contrast. In his reports we see how parents, especially a mother who has no question of her daughter's femaleness, will respond to the assignment of sex—"Mrs. Jones, you have just delivered a baby girl"—forever confirmed by the little girl's female genitals; her parents know she is a female and respond appropriately. The result, as Kleeman shows, is a little girl with no question that she is female—an essential beginning of femininity. 8. Greenacre, P. "The Biologic Economy of Birth," in The Psychoanalytic Study of the Child. New York: International Universities Press, 1945. Vol. 1, pp. 31-51. Greenacre, P. "On Focal Symbiosis," in L. Jessner and E. Pavenstedt (eds.), Dynamic Psychopathology in Childhood. New York: Grune & Stratton, 1959. Mahler, M. S. On Human Symbiosis and the Vicissitudes of Individ nation. New York: International Universities Press, 1968. Winnicott, D. W. "Transitional Objects and Transitional Phenomena: A Study of the First Not-Me Possession," Int. J. Psychoanal., 1953, 34, 89-97. 9. Ibid. 10. It is probably the other way around: neurotic penis envy requires a preexisting sense of femaleness and femininity. Fairbairn s?ys: "Where a physically normal woman is concerned, the position is that repression of female sexuality is a prerequisite of penis-envy, rather than that penis-envy is a primary phenomenon favouring repression of female sexuality. If this inference is correct, the classic concept of 'the female castration complex' would appear to be in need of revision." 11. Freud, S. "Femininity," op. cit. 12. Stoller, R. L. Sex and Gender. 13. I do believe, however, that many women shift to a capacity for vaginal

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orgasm after a shorter or longer exposure to heterosexual intercourse, but this need not be related to an associated increasing femininity. On the other hand, in some, the connection between developing the capacity for vaginal orgasm and an increased sense of femininity seems clear. We sometimes find this accompanying changes in femininity with treatment or when some women experience vaginal orgasm for the first time when they have intercourse with men they love—or, in some instances, hate or fear. Masters and Johnson's report (op. cit.) that vaginal orgasm does not exist has comforted women humiliated by Freud's consigning them to inferiority because they had clitoral orgasms. However, while disagreeing with Freud that the site of orgasm is necessarily related to femininity, I also disagree with Masters and Johnson that there is no vaginal orgasm. They seem to base their belief on an inability to see it (literally) in the experimental situation and on the recognition that the clitoris is involved in all orgasms. But there is no reason to think it may not be felt, just as in the case of a limb that "falls asleep" or short episodes of pain or itching without visible change of surface tissue. Women who have experienced both have not the slightest difficulty in distinguishing the two sensations—the clitoral or vaginal orgasm—in quality, intensity, and location. Masters and Johnson would agree that there are orgasms felt mainly in the clitoral area and others, more widespread, felt from the perineum on throughout the pelvis but not only in the vagina, and described as a more profound (anatomically and emotionally), though less sharp, experience. Never mind if the latter is called vaginal or not—it certainly is not just clitoral. And for many women, however ambivalent, it is experienced as a need for and acceptance of penetration, as well as an act of gratitude that penises exist. 14. Recall playwrights* and philosophers' ideas that we are characters in someone else's dream or play. 15. Freud, S. [1937] "Analysis Terminable and Interminable. 5E, 1964. Vol. 23, pp. 230-234. 16. Hartmann, H. [1939] Ego Psychology and the Problem of Adaptation. New York: International Universities Press, 1958. Hartmann, H. "The Mutual Influences in the Development of Ego and Id,'* in The Psychoanalytic Study of the Child. New York: International Universities Press, 1952. Vol. 7, pp. 9-30. 17. Stoller, R. J. "The Transsexual Boy: Mother's Feminized Phallus," Brit. J. Med. Psychol.t 1970, 43, 117-128. 18. Rosenbaum, M., and Richman, J. "Suicide: The Role of Hostility and Death Wishes from the Family and Significant Others," Amer. J. Psychiat., 1970,126, 1652-1655. 19. Loewinger, J. "Theories of Ego Development," in L. Breger (ed.), Clinical-Cognitive Psychology. Englewood Cliffs, N. J.: Prentice Hall, 1969. 20. There may be an opening here into issues underlying the mind-brain problem. 21. Psychoanalysis, as Freud devised it, is a theory of desire. Even when he recognized that there was behavior beyond desire in its libidinal sense, Freud had to invent another desire: the death instinct. Yet the work of ethologists, learning theorists, and neurophysiologists points to mechanics of function and behavior that are untouched by the "energy" of desire. 22. Hartmann, H., op. cit.

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23. Balint, M. The Basic Fault: Therapeutic Aspects of Repression. London: Tavistock, 1968. 24. Johnson, A. M., and Szurek, S. A. "The Genesis of Antisocial Acting Out in Children and Adults," Psychoanal. Quart., 1952, 21, 323-343. 25. Peterfreund (E. Peterfreund, Information Systems and Psychoanalysis: An Evolutionary Biological Approach to Psychoanalytic Theory. Psychological Issues (New York, International Universities Press, 1971, Vol. 7, pp. 82-83) says: It is generally recognized that psychoanalysis has no theory of structure formation and learning. The importance of this fact can hardly be overestimated. As Rapaport, speaking about the convergence of psychology and psychoanalysis, wrote: "The future of this convergence may hinge on the solution of the problem of structure formation and learning. If that solution should arise from the matrix of psychoanalytic theory, the latter may become the core of psychology proper. If the solution should prove relatively independent of psychoanalysis, then psychoanalysis is likely to become a relatively subordinate part of the general theory of psychology as the core of its clinical and motivational theories, but its concepts and theories will be reducible to more fundamental ones (1959, p. 134)." Unfortunately, it is very difficult to see how any adequate theory of structure formation or learning can develop out of a hydrodynamic model which has no location in time and space and is conceptually divorced from biology. Implicit in the very concepts of structure and learning are the ideas of permanence, specificity and the fixation of experience, but these are ultimately inconceivable in the absence of information storage and the structure and functions of the central nervous system. And the failure of psychoanalysis to develop an adequate theory of the psychoanalytic process is, I believe, related to its difficulties in formulating an adequate theory of learning. I think it is generally agreed that therapeutic results in psychoanalysis are characterized by structural changes. Therefore, an adequate theory of the psychoanalytic process hinges on a solution to the problem of learning and structure formation. I believe we cannot avoid the conclusion that the general conceptual framework of current psychoanalytic theory imposes great limitations on our ability to understand and conceptualize the nature of the psychoanalytic process. When the day of reckoning comes for psychoanalysis, for what shall we pay most (the following not in order of importance)? (/) believing that because metaphor equals reality in primary process, the same holds true in establishing a scientific fact; (2) bridging gaps with concepts presented as factual data and converting "it seems," "I believe," and "probably" into "we know"; (3) addiction to speculation; (4) death instinct, repetition compulsion, beyond the pleasure principle; (5) libidinal stages (which I believe do occur) as the causes (via fixation) of neurosis and the theory, presented as fact—that there is a direct relationship between a particular form of neurosis and a particular stage of libidinal development; (6) ignoring socioeconomic factors while insisting (by quoting a few speculative papers by Freud) that they are adequately considered in analytic theory;

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(7) similarly ignoring the biological laboratory sciences and cross-cultural research; (8) freely using words such as "cathexis," 'libido/1 "sublimation/* "neutralization," and "psychic energy/* which everyone knows have not been defined; (9) covering up what by now is public knowledge: the modest results of most analysts* treatment and the excessive cost of analysis. Rather than training psychoanalysts to do only therapy, why not train candidates to become either researchers and scholars who use psychoanalysis or—hopefully the majority—practitioners of psychoanalysis who will enrich the field by offering the knowledge they gain in their practice to enhance research and scholarship? To repeat, analysis can be a powerful and essential research tool, provided the therapy is good—reliable findings usually require fine treatment; and it will not die, as some insist. Nothing in the above list of "sins" is beyond redemption; for that matter, it would take very little (granting a change in attitudes) to right the wrongs in that list. We would need only (only!), as was Freud, to be more conscious of our shortcomings, less defensive, more alert to label our speculations as such, and more willing to show what we do in treatment. We shall never know what part resistance plays in the rejection of analytic ideas by the scientific community until we are sure we are offering valid data and then have them rejected. 26. The aggression is hidden in effeminacy, a word that implies caricature; femininity does not. 27. Greene, J. "Thought Disorder/* Int. J. Psychoanal, 1967, 48, 532.