Torment Me, But Don't Abandon Me: Psychoanalysis of the Severe Neuroses in a New Key (Book Review)

Author:  Wurmser, Leon
Publisher:  Jason Aronson
Reviewed By:  Harriet Basseches, Volume XXIX, No. 4, pp. 45-46

First, he thoroughly references much of the contemporary literature on perversion, sadomasochism, narcissism, and, at least within the psychoanalytic sphere, traumatization. He sees the patient’s torment as always a combination or as he calls it, a complementarity and a dialectic, between inner psychic conflict and trauma. He describes the patient as suffering always in doubles—two points of view—about all that he or she experiences, thinks, and feels. While he acknowledges what may be thought of in current parlance as "splitting," he brings the inner tension of the patient alive as not only drive and defense, but as layers of defense, conflict and levels of consciousness as well as ways of coping with the trauma making it a broader concept than splitting.

While I will describe the progression of Wurmser’s development of the book of nine chapters, references and index, I first want to discuss his closing chapter: "Technique and Relationship in the Treatment of the Severe Neuroses." To start with, the term "severe neuroses" alerts us to the way Wurmser thinks about diagnostic categorization, with an implicit invitation to drop common divisions used in diagnosis (such as borderline pathology) and, instead, rely on an understanding of a continuum from less severe to more severe.

Dr. Wurmser espouses his views about technique, which are, expectedly, based on his views about dynamics. For Wurmser, the severe neurotic, with his complementary conflicts and traumas, must be approached with a continuous oscillation between focus on insight and interpretation, on the one hand, and the relationship, on the other. This means for him that there is a requirement for the analyst to be in a relationship with the patient and at least striving for objectivity toward the patient. He speaks of distance and closeness. But also, he speaks quite movingly of the analyst as witness to the patient’s account—often of the remainders of trauma—and of having a real relationship along side a transference relationship. I believe that Dr. Wurmser’s plea for a much more complicated stance of the analyst to the patient highlights a positive advance over which way of working is "better;" Wurmser is making room for a broad and vitally authentic way to be with and work with our more seriously distressed patients, and perhaps all patients. In his "integrative approach" (p. 9), Wurmser regularly includes literary and cultural referents as useful metaphors to enhance concrete experience and understanding. In that regard, that is, the position of the analyst as embracing so many points of view, it is somewhat surprising that Wurmser does not include in his vast literature of citations the more recent work of Leo Rangell on a unitary theory of psychoanalysis (2007; 1997).

At the core of the work, for Wurmser, is analysis of superego conflicts, both intrasystemic and intersystemic, in both structures and functions. Here, the condemnations of the inner judge are often expressed through the imagery and affects of recurring fantasy constructions, that is, scenarios repeated although the cast of characters may change. Each chapter deepens the richness of Wurmser’s discussion. In the chapter "Sleeping Giant or Fossil?" Wurmser concretely explores the role of conscience and ego ideal in the severely neurotic patient. In chapter 5, "Superego as Herald of Resentment," in which he exposits on the central role of resentment in the dynamics of these patients. In "The Wall of Stone— Broken Self and Broken Reality," Wurmser develops an understanding of the many "doubles" that develop, but particularly the double between knowing and not knowing reality and the doubling of the self. In this chapter as in many, Wurmser uses clinical material, sometimes extended process quotations, to demonstrate his points. His discussion of character perversion is profound and thorough. It should be studied carefully by anyone concerned with these often-witnessed and experienced states of mind and action when working with traumatized patients. In other sections of the book he discusses the powerful combination of omnipotence and absoluteness that pervades the minds and actions of these patients as well as the critical role of envy. He lists and describes more about the core fantasies that underlie and fuel the distress and behavior of these troubled patients.

You may wonder at the intriguing title Wurmser chose for his book. In it he captures the dominant masochistic flavor of relationships for the severely traumatized patient in combination with the desperate need to maintain the attachment. In his prologue, however, Wurmser reminds us to anticipate the same dialectic coupled with the opposite dynamic: I will beat you but do not abandon me. Returning again to the final chapter, in which he talks about treatment, the idea I would like to emphasize is his contention that kind of flexible and all encompassing approach he pursues leads to great improvement in these challenging people. I cannot iterate enough how much I recommend this book, but give yourself plenty of time to read it because of the density and intensity concentrated in his writing.

References

Rangell, L. (1997) At century’s end: A unitary theory of psychoanalysis. Journal of Clinical Psychoanalysis 6: 465-484.
Rangell, L. (2007) The road to unity in psychoanalytic theory. New York: Jason Aronson.

Reviewer Note

This book is so filled with carefully collected observation, erudition, understanding, and wisdom—all of which can be of use to the psychoanalyst and psychotherapist who works with the severely traumatized—that it will be difficult for the reviewer to capture and fully convey the value of Leon Wurmser’s tour de force, Torment Me, But Don’t Abandon Me. In some ways, this opening statement reflects my awe at the richness of Dr. Wurmser’s thinking and writing. To me, he stands as a modern version of the Renaissance man: knowledgeable in many languages, steeped in the literature of mankind from the Talmud to contemporary writings, and genuinely versed in most of the psychoanalytic voices. With all that, I do not believe his work is well known to many analysts of any of the dominant strains of psychoanalysis. I say all this by way of a disclaimer: You cannot rely on my review, but rather will have to read his work first hand. Nevertheless, I will try to give you a little glimpse of his thinking, as expressed in the book under review.

Harriet I. Basseches

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