Salman Akhtar - Sources of Suffering - Fear, Guilt, Greed, Deception, Betrayal, and Revenge-Karnac Books (2014)

SOURCES OF SUFFERING
SOURCES OF SUFFERING
Fear, Greed, Guilt, Deception,
Betrayal, and Revenge
Salman Akhtar
Chapter One has previously appeared in S. Akhtar (Ed.), Fear: A Dark Shadow
Across The Life Span (pp. 3–34). London: Karnac, 2014.
Portions of Chapter Three are taken from Salman Akhtar’s paper, “Guilt: an
introductory overview”, which appeared in S. Akhtar (Ed.), Guilt: Origins,
Manifestations, and Management (pp. 1–13). Lanham, MD: Jason Aronson, 2013.
Portions of Chapter Four are taken from Salman Akhtar’s paper, “Lies, liars,
and lying: an introductory overview”, which appeared in S. Akhtar and
H. Parens (Eds.), Lying, Cheating, and Carrying On: Developmental, Clinical, and
Sociocultural Aspects of Dishonesty and Deceit (pp. 1–15). Lanham, MD: Jason
Aronson, 2009.
Chapter Five has previously appeared in S. Akhtar (Ed.), Betrayal:

Developmental, Literary, and Clinical Realms (pp. 117–134). London: Karnac, 2013.
All this material is reprinted here with the author’s and the corresponding
publishers’ explicit permission.
First published in 2014 by

Karnac Books Ltd
118 Finchley Road
London NW3 5HT
Copyright © 2014 by Salman Akhtar
The right of Salman Akhtar to be identified as the author of this work has been
asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents
Act 1988.
All rights reserved. No part of this publication may be reproduced, stored

in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the prior written
permission of the publisher.
British Library Cataloguing in Publication Data
A C.I.P. for this book is available from the British Library
ISBN-13: 978-1-78220-069-7
Typeset by V Publishing Solutions Pvt Ltd., Chennai, India
Printed in Great Britain
www.karnacbooks.com
To
RAMA RAO GOGINENI & APRIL FALLON
in friendship
CONTENTS
ACKNOWLEDGEMENTS ix
ABOUT THE AUTHOR xi
INTRODUCTION xiii
PART I: SUFFERING TOLERATED
CHAPTER ONE
Fear 3
CHAPTER TWO
Greed 35
CHAPTER THREE
Guilt 67
vii
viii CONTENTS
PART II: SUFFERING INFLICTED
CHAPTER FOUR
Deception 97
CHAPTER FIVE
Betrayal 123
CHAPTER SIX
Revenge 143
REFERENCES 163
INDEX 185
ACKNOWL EDGEMENTS
Writing a book only appears to be a solo endeavour. Behind the scenes,

the writer always has heroes, peers, and critics accompanying him in
this journey. I too have been fortunate to have had the helpful input
of many psychoanalytic colleagues, especially Drs Jennifer Bonovitz,
Ira Brenner, Ralph and Lana Fishkin, Rao Gogineni, Axel Hoffer, Henri
Parens, and Vamik Volkan. Drs Rajnish Mago and Stephen Schwartz
were helpful in subtle and, occasionally, not-so-subtle ways in reading
and reviewing some of the material contained in this book. My assist-
ant, Jan Wright, prepared the manuscript of this book with diligence and
good humour. My personal friends, especially Drs April Fallon, Naresh
Julka, Saida Koita, Harish Malhotra, Tahir Maqsood, Roomana Sheikh,
and J. Anderson Thomson kept me in good humour during easy and
difficult times. To all these individuals, my sincere thanks, indeed.
Salman Akhtar
Philadelphia, PA
ix
ABOUT THE AUTHOR
Salman Akhtar, MD, is professor of psychiatry at Jefferson Medical

College and a training and supervising analyst at the Psychoanalytic
Center of Philadelphia. He has served on the editorial boards of the
International Journal of Psychoanalysis and the Journal of the American Psy-
choanalytic Association. His more than 300 publications include fifteen
books—Broken Structures (1992), Quest for Answers (1995), Inner Torment
(1999), Immigration and Identity (1999), New Clinical Realms (2003), Objects
of Our Desire (2005), Regarding Others (2007), Turning Points in Dynamic
Psychotherapy (2009), The Damaged Core (2009), Comprehensive Dictionary
of Psychoanalysis (2009), Immigration and Acculturation (2011), Matters of
Life and Death (2011), The Book of Emotions (2012), Psychoanalytic Listening
(2013), and Good Stuff (2013)—as well as forty-two edited or co-edited
volumes in psychiatry and psychoanalysis. Dr Akhtar has delivered
many prestigious addresses and lectures including, most recently,
the inaugural address at the first IPA-Asia Congress in Beijing, China
(2010). Dr Akhtar is the recipient of the Journal of the American Psycho-
analytic Association’s Best Paper of the Year Award (1995), the Margaret
Mahler Literature Prize (1996), the American Society of Psychoanalytic
Physicians’ Sigmund Freud Award (2000), the American Psychoana-
lytic Association’s Edith Sabshin Award (2000), the American College
xi
xii A B O U T T H E AU T H O R
of Psychoanalysts’ Laughlin Award (2003), Columbia University’s

Robert Liebert Award for Distinguished Contributions to Applied
Psychoanalysis (2004), the American Psychiatric Association’s Kun Po
Soo Award (2004), the Irma Bland Award for being the Outstanding
Teacher of Psychiatric Residents in the country (2005), and the Nancy
Roeske Award (2012). Most recently, he received the Sigourney Award
(2013), which is the most prestigious honour in the field of psychoanal-
ysis. Dr Akhtar is an internationally sought speaker and teacher, and
his books have been translated in many languages, including German,
Turkish, and Romanian. His interests are wide and he has served as the
film review editor for the International Journal of Psychoanalysis, and is
currently serving as the book review editor for the International Journal
of Applied Psychoanalytic Studies. He has published seven collections
of poetry and serves as a scholar-in-residence at the InterAct Theatre
Company in Philadelphia.
INTRODUCTION
Suffering is integral to life. Alongside joy and excitement, it

permeates our existence as we pass from infancy through adulthood
to old age. It accompanies us at each developmental epoch and at
every maturational milestone. It is even there after a successful psy-
choanalytic treatment. Indeed, Freud admitted that all psychoanalysis
can do is to “transform hysterical misery into common unhappiness”
(1950a, p. 305). And, he was not alone in coming to the conclusion that
a certain amount of emotional pain is inevitable in the course of life.
Buddha’s first Noble Truth, Ghalib’s equation of qaid-e-hayat (prison of
existence) with bund-e-ghum (bondage to pain), and David Thoreau’s
declaration that all men live a life of “quiet desperation”—all speak to
this very point. This is ordinary suffering: irreducible and inherent in
life. Elsewhere, I have delineated its components under the rubric of
“burdens of sanity” (Akhtar, 2009, p. 42).
However, such suffering is not the topic of my book, which deals
with suffering that is unfortunate, unnecessary, excessive, pathological,
and is remediable. To be sure, the book is not exhaustive; the fact that it
does not address the distress emanating from envy, shame, regret, hate,
and boredom attests to its modest scope. Within that limited reach,
however, it seeks to underscore the multifaceted ways in which we
xiii
xiv INTRODUCTION
encounter suffering in clinical and social settings. The book identifies

six such “sources of suffering”. The first three, namely, fear, greed, and
guilt, cause an individual to suffer privately, though not entirely with-
out interpersonal consequences. The second three, namely, deception,
betrayal, and revenge, lead others to suffer, though not entirely without
subjective distress on the part of the individual himself.
In elucidating the intricacies of these six sources of suffering I have
attempted to deal with each emotion’s phenomenological, develop-
mental, and sociocultural aspects. Wherever possible, I have included
pertinent information from the related fields of anthropology, sociol-
ogy, ethology, and evolutionary sciences. I have included literary ref-
erences as well as clinical vignettes to highlight the nuances of fear,
greed, guilt, deception, betrayal, and revenge. My aim is to help the
clinicians empathise with these complex human experiences, recog-
nise their emergence within the transference-countertransference axis,
and facilitate ego dominance and mastery on the part of their patients.
Though not a guidebook or a therapeutic manual, my book is unabash-
edly pragmatic. Its purpose is to help psychoanalysts and psychothera-
pists become more skilful in helping their patients renounce, reduce,
or reframe their suffering. The novice in our field is my main audience
but if those who are more experienced find something of benefit in my
scribblings, I will be delighted.
PA RT I
SUFFERING TOLERATED
CHAPTER ONE
Fear
F
ear is ubiquitous. All of us experience it at one time or another.
The sound of footsteps approaching us from behind in a dark
alley, an unexpected visit to the city morgue, eye contact with a
large alligator in the zoo, and a precipitous “fall” of a rollercoaster can
all give us goose bumps of terror. We shriek, scream, or simply become
paralysed with fear. We readily recognise its dark arrival in the pit of
our stomachs and feel its movement in our blood.
But do we understand the actual nature of fear? Do we know the
purpose it serves? Do we agree upon the circumstances under which
it is “normal” to be afraid? And, when does fear become abnormal or
morbid? Is fear to be avoided at all costs or can this bitter gourd of
emotion be transformed into a sweet mango of cultural delight? Ques-
tions like these suggest that fear is simple and self-evident only on the
surface. Examined carefully, it turns out to be a complex and nuanced
phenomenon.
Fear
Webster’s dictionary defines fear as “an unpleasant, often strong
emotion caused by anticipation or awareness of danger” (Mish, 1998,
3
4 SOURCES OF SUFFERING
p. 425). While the source of the threat is not identified, the tone makes
it clear that the danger referred to resides in external reality. Fear, in other
words, is a dysphoric reaction to an actual object (e.g., a wild animal,
a knife-wielding drunkard), event (e.g., an earthquake, a stampede),
or situation (e.g., watching a horror movie, losing control of a car on an
icy road) that is felt to be threatening. The extent of dysphoria in the face
of approaching danger varies and four levels of fear’s severity are iden-
tified in the English language: (a) apprehension, which refers to a mild
anticipation of a bad occurrence; (b) dread, which blends the convic-
tion that one is facing danger with a powerful reluctance to encounter
the scary object or situation; (c) panic, which denotes an overwhelming
sense of being scared, coupled with alarmed hyperactivity (e.g., pacing,
running away) and physiological arousal (e.g., increased heartbeat,
laboured breathing); and (d) terror, which signifies an extreme degree
of consternation, a feeling of doom, “catastrophic aloneness” (Grand,
2002), and psychomotor paralysis.
The fact that fear is ubiquitous in the animal kingdom suggests that
it is a “needed emotion”, that is, one that is important for the organ-
ism’s survival and functioning. For all living beings, including humans,
the emotion of fear serves as a protective device; it warns them that
some danger is approaching and they had better undertake measures
to avoid it. This could be in the form of actively combating the “enemy”
or rapidly escaping from it, meaning the well-known “fight-or-flight”
response to threats.
Some fears are widespread over the animal kingdom and seem
“hard-wired”. Others are the result of developmentally unfolding, epi-
genetic sequence of fantasies that are specific to human beings. Among
the former are fear of loud noises, sudden and jerky movements,
looking down from heights, and animals that have fangs, claws, sharp
teeth, and can jump or move at great speed (Abraham, 1913a; Akhtar &
Brown, 2005). Present from birth onwards and persistent throughout
life (even if in attenuated forms and at a preconscious level), these
fears give testimony to man’s essential kinship with animals since their
function is self-protective and oriented towards survival. Among the
latter are the developmentally derived fears of loss of love objects, loss
of love, and castration (Freud, 1926d); fear of death joins this list some-
what later during the course of psychic development. These “hard-
wired” and developmentally derived fears exist in both sexes though
there is some evidence (Horner, 1968; Miller, 1994; Symonds, 1985) that,
FEAR 5
owing to socialisation patterns and internalised cultural biases, fear

of becoming alone and fear of success are somewhat more prevalent
among women.
Another point needs mention here. The experience of fear is medi-
ated through two different routes: a shorter, rapid, and subcortical
route which goes directly through the amygdala and a longer, slower,
and more complex route that includes hippocampal and cortical par-
ticipation (Damasio, 1999; Emanuel, 2004; Pally, 2000). Each route has
an identical output: a fear response. However, the shorter route lacks
the benefit of contextual information that the longer route provides. As
a result, the shorter route produces a direct and simple fear response
which can be tempered or even entirely inhibited by the longer route.
The profound implications of this for psychic development and for
therapeutic intervention are nowhere better illustrated than in the
“visual cliff” experiment devised by Gibson and Walk (1960).
This experiment consists of having the glass floor of a room papered,
from below, with a chequerboard design up to its midpoint. As a result,
the first half of the floor does not appear any different from ordinary
floors but, as the paper affixed from below runs out, the floor suddenly
appears threatening due to the depth perception through the transpar-
ent glass. The point at which the transparent glass begins is the “visual
cliff”. Now, a toddler is placed on the papered end of the floor and his
or her mother is asked to watch him from across the room. The toddler
begins to make his way towards her but abruptly stops at encounter-
ing the “visual cliff”. If the mother remains impassive, the child does
not move forward. However, if the mother smiles, spreads her arms,
and vocally encourages the child to come to her, the child crawls or
walks over the transparent glass. Mother’s loving support activates
the hippocampal-cortical system that dampens the fear aroused by the
amygdala-sponsored pathway mentioned above.
While this is a salutary consequence of environmental modulation of
“hard-wired” childhood fears, adverse and even sinister interplays of
childhood vulnerability and caregiver input also exist. Children (more
so than adults) need company and
… their needs for attachment experiences and even moments of

intimacy will lead them to shadow, seek out, and submissively
engage the parents who, for the most part, cause them pain and
disappointment. Their avidity for exploration and assertion will
lead them to follow a ball out into a dangerous street, climb up

an unstable support, or put fingers in electric plugs. Their love of
sensual enjoyment from fondling, kissing, and rocking will result
in their participating in sexually over-exciting play or overt seduc-
tions by older children and adults. The pleasure of social contact
will expose older children to the smiling-faced inducements of a
kidnapper, and the same desire coupled with greed leaves adults
exposed to psychopathic salesmen and con men. Thus, parents
must inculcate a sense of danger as an active educative effort.
(Lichtenberg, 1991, pp. 396–397)
Such nuanced interplay of “nature versus nurture” variables in the

genesis and modulation of fear undergirds the epigenetic unfolding
of phase-specific fears throughout childhood development. “Natural”
fears of starvation and physical injury are given specific “human”
colouring via the potential danger of anaclitic betrayal and loss during
infancy, castration and genital mutilation during early childhood, and
moral anxiety (the internalised consequence of the preceding fear)
during later childhood and adolescence (Freud, 1926d). Still later, in
the course of adult life, fear of death appears on the psychic horizon;
multiply determined and culturally variable, this fear combines fears of
physical infirmity, separation from love objects, and loss of self (Akhtar,
2010; Chadwick, 1929; Freud, 1923b; Hoffman, Johnson, Foster &
Wright, 2010; Natterson & Knudson, 1965; Zilboorg, 1943).
Anxiety
Fear and anxiety share some characteristics. Both evoke a sense that
something bad is about to happen. Both are unpleasant and undesir-
able experiences. Both can serve as alarms and thus protect us from
danger. However, in other ways, the two experiences are different. Fear
is a response to external danger; anxiety to dangers emanating from the
internal world. As early as 1895, Freud noted the relationship between
“unpleasure” (not yet delineated as anxiety) to earlier painful experi-
ences. He wrote:
If the memory image of the hostile object is in any manner freshly

cathected (e.g., by fresh perceptions), a condition arises which is
not pain but has a similarity to pain. It includes unpleasure and the
FEAR 7
inclination to discharge corresponding to the experience of pain.

Unpleasure is released from the interior of the body—is freshly
provoked—by the cathexis of memories. (1950a, p. 381)
Thirty years later, Freud (1926d) published his major work on the prob-
lem of anxiety and restated this thesis. However, this time, he linked the
cathexis of previous traumata and their memories to the specific affect
of anxiety. He stated:
Anxiety is not newly created in repression; it is reproduced as

an affective state, in accordance with an already existing mnemic
image. If we go further and enquire into the origin of that anxiety—
and of affects in general—we shall be leaving the realm of pure psy-
chology and entering the borderland of physiology. Affective states
have become incorporated in the mind as precipitates of primeval
traumatic experiences and when a similar situation occurs, they are
revived like mnemic symbols. (p. 93)
In the same contribution, Freud also delineated the seminal “danger

situations” causing anxiety. These included threats of (a) loss of a love
object, (b) loss of the love object’s love, (c) castration, and (d) moral con-
demnation from within oneself. “Each situation or danger corresponds
to a particular period of life or a particular developmental phase of the
mental apparatus and appears to be justifiable to it” (p. 146). Some “dan-
ger situations” lose their evocative power as the individual matures
while others survive by acquiring more up-to-date forms. Still others
(e.g., superego’s attack) accompany people throughout their lives. “Dan-
ger situations” mobilise anxiety and set ego defences in motion. This
is “signal anxiety”. It contrasts with “automatic anxiety” that results
from the ego being overwhelmed by threats from within. The feeling in
anxiety that something bad is about to happen is due to the ego’s sense
that one might give in to id impulses that would lead to physical harm,
others’ disapproval, or rebuke from one’s own conscience. However,
since the impulse in question is almost always repressed, the nature of
danger felt remains vague. This explanatory model, however, applies
only to what is generally called “neurotic anxiety”. It does not address
anxiety that presumably arises from the infantile era where a coherent
ego and hence a wishful intentionality is not yet in place. In such anxi-
ety, the dread is not of an instinctual breakthrough but that of psychic
“breakdown” (Winnicott, 1974). Variously termed “psychotic anxiety”

(Klein, 1932), “unthinkable anxiety” (Winnicott, 1962), and “annihila-
tion anxiety” (Hurvich, 2003), such dysphoria threatens to disorganise
mental functioning altogether. Elsewhere, I have noted the main char-
acteristics of this anxiety.
… (i) it originates in early infancy; (ii) it can, however, be reacti-

vated by later phase-specific anxieties; (iii) a combination of exces-
sive constitutional aggression and severe traumatic experiences
leads to ego weakness which, in turn, increases the vulnerability
to such anxiety; (iv) it might exist in pre-verbal forms or might
acquire retrospective fantasy content from later developmental
phases; (v) it is generally associated with propensity towards psy-
chosis but might also underlie non-psychotic conditions especially
those of addictive, psychosomatic, and perverse varieties; and,
(vi) it mobilizes defenses that are particularly recalcitrant. (Akhtar,
2009, p. 22)
Regardless of whether it is “neurotic” or “psychotic” in nature, the

intrapsychic origin of anxiety also precludes its control by physical
flight; one can run away from fear, not from anxiety. Fear and anxiety
are thus both similar and dissimilar. The phenomenological terrain is
further muddled by the fact that the two often coexist. External threats
are played up by internal vulnerabilities and intrapsychic threats can
readily be externalised. Some admixtures of fear and anxiety are com-
monplace, others curious.
Phobia
By itself, fear is a rational response and therefore poses few problems.
When it gets fuelled by anxiety in a regressive blurring of external and
internal realities, difficulties of clinical proportions begin to arise. The
most well known among these conditions is phobia. A term derived the
Greek word phobos (meaning flight, dread, and panic), phobia stands
for “marked and persistent fear that is excessive or unreasonable,
cued by the presence or anticipation of a specific object or situation”
(DSM-IV-TR, 2000, p. 449). In effect, both anxiety (internal danger) and
fear (external danger) coexist within phobia, although in their pure forms,
anxiety and fear are quite different (see Table 1). Phobia is distinct from
FEAR 9
Table 1. Fear, anxiety, and phobia.

Variables Fear Anxiety Phobia
Source External Internal Externalised

Risk Actual Unknown Imagined
Threat Clear Vague Clear
Danger Plausible Implausible Exaggerated
Avoidance Helpful Futile Helpful
Prevalence Universal Limited Limited
fear because it is out of proportion with the situation in reality. Indeed,

a fear must meet the following criteria in order to qualify as a phobia:
(i) it should not be age-specific, (ii) it should not be widely accepted as
normal within a culture or subculture, (iii) it should be noticeably out
of proportion with the plausible danger from the object or the situation,
(iv) it should result in impairment of psychosocial functioning, (v) it
should be associated with active avoidance of the dreaded stimulus,
and (vi) such avoidance should provide symptomatic relief.
Phobia also needs to be distinguished from the paranoid fear inso-
far as there is no motive assigned in phobia to the frightening object;
the statement “I am afraid of pigeons” represents phobia and the state-
ment “Pigeons are out to get me” represents paranoia. The former is the
result of displacement, the latter that of projection.
Phobias can be of many types, as is attested by the profusion of spe-
cific phobias with Greek prefixes,1 and many classifications exist. While
a bit older, the classification by the British psychiatrist, Marks (1970),
seems not only to be valid today but perhaps most sensible. According
to him, phobias can be grouped into the following categories:
• Agoraphobic syndrome: is the commonest variety, constituting about

sixty per cent of all phobias. The agoraphobic patients have fears not
only of open spaces but also of shopping, crowds, travelling, and
even of closed spaces. Other neurotic symptoms including panic
attacks, dizziness, compulsive rituals, and feelings of depersonalisa-
tion are also often present. Most agoraphobics are women and the
majority develop their symptoms after puberty.
• Animal phobia: constitutes the most clear-cut variety of phobia but,
in its pure form, is infrequently encountered in clinical practice. The
symptom usually develops at the onset of latency, that is, around six
to eight years of age. There is little tendency for its “generalisation”
and there is little tension in the absence of the phobic object.
• Social phobia: involves fear of public speaking, blushing, shak-
ing, writing, eating, drinking, vomiting, or becoming incontinent
in public. It occurs with equal frequency among men and women
and usually starts after puberty, with a peak of incidence in the late
teens.
• Miscellaneous specific phobias: start any time in life and persist fairly
consistently. The phobic situations vary from one case to another but
remain fairly specific for a given individual. The dreaded situations
include travel, heights, wind, thunderstorms, darkness, bridges, and
large bodies of water.
Of these four types, animal phobias and miscellaneous specific pho-

bias have received the most attention from psychoanalysis. Beginning
with Freud’s (1909b) widely known study of Little Hans, to numerous
subsequent contributions (e.g., Campbell & Pile, 2011; Kulish, 1996;
Lewin, 1952; Rangell, 1952; Sandler, 1989; Tyson, 1978; Wangh, 1959),
psychoanalysts have sought to discern what underlies such focal reigns
of terror upon the ego. Freud traced Little Hans’s fear of being bitten
by a horse to his dread of castration by his father; this, in turn, was
the talion punishment for the boy’s incestuous longings for his mother.
Freud’s early followers (Abraham, 1913a; Deutsch, 1933; Fenichel,
1945) fervently subscribed to this explanation and began to view all
phobias as derived from castration anxiety. However, as psychoanalytic
theory advanced and attention shifted towards the vicissitudes of pre-
Oedipal development, the “danger situation” (Freud, 1926d) of loss of
love gained explanatory ascendance.2 The centrality of castration anxi-
ety came under question and anxiety over good internal objects getting
drowned by the aggression within (in a newer rendition of the “loss of
love” hypothesis) became an equally, if not more, important motivating
force for symptom formation.
Regardless of their source, till such anxieties remained repressed,
one simply failed to see, hear, or otherwise attend to threatening inter-
nal (wishes, impulses) or external (triggers, temptations) stimuli. None-
theless, the repressed material continued to seek expression. In Freud’s
(1915e) words, “The repressed exercises a continuous pressure in the
direction of consciousness” (p. 51). This tendency becomes stronger in
FEAR 11
the face of a reactive increase in the intensity of drives. Many “simple

phobias” (Fenichel, 1945) can thus be explained.
In certain cases there is not much displacement; anxiety is simply

felt in situations where an uninhibited person would experience
either sexual excitement or rage … For such cases, a formula is
valid which would be an oversimplification in more complicated
cases: what a person fears, he unconsciously wishes for … In other
and still simple phobias, the feared situation does not represent a
feared temptation; rather, it is the threat that causes the temptation
to be feared: castration or loss of love. There are knife and scissor
phobias, the implication of which is that the touch or even the sight
of these instruments awakens the feared thought of a possible cas-
tration (and, it is true, in most cases, also an unconscious tempta-
tion for a repressed hostility). Certain persons are afraid of seeing
cripples or of witnessing accidents, which means: “I do not want
to be reminded of what might happen to me” (and again, the fear
may also arise from such sights being a temptation for unconscious
hostile wishes). (pp. 195–196)
The psychodynamics of most phobias is, however, far more compli-

cated. But before going into these details, it should be noted that many
non-analytic aetiological models of phobia also exist. Modelling, vicari-
ous learning, and observational conditioning are alternative pathways
by which animals acquire their phobic potential (Cook & Mineka, 1987;
Emde, 1984; Eysenck, 1965, 1976; Marks, 1987; Mineka, Davidson,
Cook & Keir, 1984; Solyom, Beck, Solyom & Hugel, 1974; Wolpe &
Rachman, 1960). This perspective reports cases of phobias arising after
a child observes a parent responding fearfully to an animal (Solyom,
Beck, Solyom & Hugel, 1974), or, as in Mineka, Davidson, Cook, and
Keir’s (1984) experiments, after laboratory-reared rhesus monkeys view
wild-caught monkeys reacting fearfully to snakes. More recently, learn-
ing theory has been challenged and broadened by biological research
in animal phobias (Bennett-Levy & Marteau, 1984; Davey, 1992; Davey,
Forster, & Mayhew, 1993; McNally & Steketee, 1985; Mineka, Davidson,
Cook & Keir, 1984). This view suggests that learning is “biologically pre-
pared” in that there are anatomic portions of the brain preprogrammed
to perceive specific, fear-evoking animal movements much like the non-
dominant parietal lobe perceives faces. Sudden movement and speed
are “chosen” as fearful. Some of these authors have pointed to the fact
that most animal phobias involve harmless (spider, cockroach, maggot,
snake, and rat) rather than predatory animals (lions, tigers, sharks);
they postulate that animal phobias correlate more with contamination
and disgust rather than with fear. Together, these three aetiological
perspectives, namely modelling, vicarious learning, and observational
conditioning, along with consideration of potential hereditary determi-
nants of fear and phobias (Delprato, 1980), might explain why specific
animals have remained both “chosen” phobia objects and symbols in
mythology in almost every culture.
Returning to the psychoanalytic perspective on phobias, one notes
that the complexity of their dynamics is due to the fact that repression
alone becomes incapable of keeping the threat sufficiently removed
from awareness. As a result, displacement, symbolism, and regression
come into play. Displacement, the process by which an affect or attitude
is unconsciously transferred from one object to a more acceptable sub-
stitute, is then added to repression. Now, it is not the sexual situations
but the sexualised situations that are feared. The diffuse anxiety becomes
bound to a specific object/situation. This makes life easier, since the
specificity of the fear now makes matters manageable through the
active process of avoidance. The advantage offered by displacement is
that the original offensive idea/affect does not become conscious. Also,
by binding the hostile vector of ambivalence towards one’s father, for
instance, into a fear of horses, the displacement tends to resolve con-
flicts of ambivalence. Also, as Freud (1909b) pointed out, displacement
by itself renders avoidance easier.
The feared object/situation often represents an exquisitely unique
and symbolic crystallisation of all the important determinants of the
phobia, including the predominant impulse of threat against which
the phobia is a defence. Jones (1948) emphasised the role of symbolism
in phobia, noting that there is a certain affinity between the individual
and the icons he chooses to express his instrapsychic concerns. Lewin
(1952) likened the process determining the specific phobia to the dream
work, sharing the same overdetermination and other parallel phenom-
ena, including traces of early experiences. Although universally sym-
bolic meanings for various phobias may be suggested, these are not
invariably valid. It is therefore better not to approach the patient’s pho-
bia with preconceived ideas about its meaning. The true meaning of
any symbol to an individual patient can be determined only by listen-
ing to his/her associations.
FEAR 13
A certain amount of regression is also central to all phobias. The

phobic’s cognition, in the restricted area of his neurotic symptom, is
strikingly similar to the child’s animistic perception of the world as
threatening and overwhelming. Regression also is evident insofar as
… all phobics behave like children, whose anxieties are soothed

if the mother sits by the bedside and holds their hand. Such a
demand for reassuring measures on the part of parent substitutes is
especially evident in those agoraphobics who feel protected in the
presence of a companion … in phobias in which the companion is
essential, the relationship to this companion is of basic importance.
The companion not only represents the protecting parent but also
the unconsciously-hated parent; his presence serves the purpose of
diverting the patient’s mind from unconscious fantasies to reality,
that is, of reassuring him that he has not killed this person who is
walking safely at his side. In such cases, the fear that something
may happen to the patient is often preceded by a fear for the safety
of the same person who, later on in the agoraphobia, is used as a
companion. (Fenichel, 1945, pp. 206–207)
Agoraphobia, the roots of which were traced to a repressed prostitution

fantasy by Freud (1897, cited in Masson, 1985, p. 253), is actually more
often the result of conflicts pertaining to “optimal distance” (Akhtar,
1992b; Escoll, 1992; Mahler, Pine & Bergman, 1975). In an early paper
on “locomotor anxiety”, Abraham (1913b) noted that neurotic inhibi-
tions of motility emanate not only from defences against constitution-
ally strong pleasure in movement and unconscious sexual concerns but
also from difficulty in separating from love objects. They fear going
out but also are unhappy at being left alone indoors. Speaking of such
“‘topophobia”, Abraham said that in patients with this malady:
… anxiety prevents them from becoming free from themselves and

from the objects upon which their love was fixed in childhood, and
from finding the way to objects belonging to the external world.
Every path which leads them away from the charmed circle of those
people upon whom they are fixated, is closed to them. (p. 241)
Some years later, Deutsch (1929) declared the involvement of a partner

to be the crucial determinant of the agoraphobic’s malady. However,
she felt that hostile and controlling fantasies were frequently hidden
underneath the consciously experienced need for libidinal attachment.

Following this, Mittleman (1957) observed the confinement of the agora-
phobic to a “limited circumference” (p. 289) and Weiss (1964) noted that
such patients grow more anxious the farther they go from their home.
This led him to define agoraphobia as an anxiety reaction to abandon-
ing a fixed point of support. More recently, Kohut (1980) concluded that
the agoraphobic’s consciously felt need for a reassuring companion is
the key to what lies in a psychic depth, namely, the continued search for
a maternal self object.
Clearly, all these authors regard agoraphobia as a malady of distance.
My own elucidation of the ubiquitous, though unconscious, fantasy of
a “psychic tether” (Akhtar, 1992b) lends support to such formulation.
How far can one go away from one’s objects without endangering the
cohesion of one’s self, seems to be the question.3 The opposite ques-
tion, how close can one get to another person without risking one’s
autonomy, applies to claustrophobia. And, just like in agoraphobia, in
claustrophobia, too, anxieties regarding optimal distance (from love
objects) are intermingled with psychosexual anxieties and other dreads
pertaining to Oedipal conflicts. Lewin’s (1935) declaration that there is
a close connection between claustrophobia and being inside the mother
and the fear of being buried alive is a transformed wish to return to the
womb, can be interpreted in both Oedipal and pre-Oedipal ways. The
fact is that almost all psychopathology comes from both sources. It is
rarely an “either-or” matter. A phobic symptom is derived from diverse
sources and contains tributaries from multiple phases of development.
This statement applies to monosymptomatic phobia as well as to the
diffuse agoraphobic syndrome. It is even more true when phobic con-
cerns pervade the entire character.
Phobic character
Introduced by Fenichel (1945), the designation “phobic character” is
reserved for individuals “whose reactive behavior limits itself to the
avoidance of situations originally wished-for” (p. 527). Those with
severe inhibitions of sexuality and aggressiveness also display a similar
picture of generalised apprehension and social withdrawal. Elaborat-
ing on Fenichel’s proposal, Mackinnon and Michels (1971) emphasised
that more common than ego-dystonic, monosymptomatic phobia is
the use of fearful avoidance as a character defence, adding that such
FEAR 15
an individual is “constantly imaging himself in situations of danger

while pursuing the course of greatest safety” (p. 49). More recently,
Stone (1980) recognised a “phobic-anxious” personality type that dis-
plays extremes of “fearfulness and avoidance of the most harmless
objects and situations” (p. 332). While resembling schizoid individuals
in their restricted life style, phobic characters are different in signifi-
cant ways. They are not “shy” and idiosyncratic like schizoid people.
They avoid situations (and physical objects), not people. Their avoid-
ance of certain situations (e.g., visiting an amusement park, watching
a pornographic movie, going to a new restaurant), can lead to the false
appearance of discomfort with people in general. The fact is that out-
side the dreaded situations, they can have empathic and meaningful
affective interchanges with others. Phobic characters are not associated
with “identity diffusion” (Akhtar, 1984; Kernberg, 1975) and extensive
reliance upon splitting mechanisms. They do not therefore represent a
borderline personality organisation (Kernberg, 1967); they are organ-
ised at a higher level with fears emanating from the externalisation and
symbolic reification of their internal conflicts. Their fears are imaginary.
Cowardice, in contrast, involves a recoil from plausible, if not actual,
threats. Symbolism lies at the heart of phobic character and anxiety
about object loss forms the bedrock of cowardice.
Cowardice
A habitual reaction to threat and danger, cowardice—at least on the
surface—is a response to fear of actual harm. It involves a “crippling of
the will” (Menaker, 1979, p. 93); one succumbs to fear and withdraws
from the “combat”.4 Cowardice can be evident in physical, intellectual,
and moral realms. Physical cowardice involves an inordinate fear of
injury and the resulting restriction of exploratory and playful motor
activity; one avoids athletics, amusement park rides, and any possibil-
ity of physical altercation. Intellectual cowardice results in inhibition of
mental activity; one cannot think “outside the box” and gets scared if
new insights do pop up in the mind. Moral cowardice manifests as the
inability to uphold ethical standards and speak the truth under difficult
circumstances; one lies, suddenly seems to lack words, and adopts the
“silence of the complicit” (Akhtar, 2013a).
The coward reacts to confrontation with distress. In part, this is
due to “automatic anxiety” (Freud, 1926d), the spontaneous reaction
of helpless dread in the face of a massively traumatic situation. And,

in part, this is due to projection of the coward’s own anger. Unable to
express his resentment directly, the coward attributes vicious intent
to his opponent and gets terrified. Consequently, he postpones the
“debate”, falsely concurs with his adversary, or, worse, flees the situ-
ation in reality. Recognition of his timidity fills him with shame and
self-disgust; these are often drowned in drink or covered over by the
narcissistic fantasy of having deliberately engineered his defeat. The
spineless combatant of yesterday thus transforms himself into the lofty
bestower of victory to others.
But there is more to cowardice than its narcissistic dynamic. The base
of cowardice is formed by a “thin-skinned” (Rosenfeld, 1971) psyche
which is the consequence of weak maternal containment of early infan-
tile anxieties (Bick, 1968). The cowardly individual tends to become
affectively overwhelmed while facing a narcissistic threat; withdrawal
from a full encounter with it follows. Deficient identification with the
same-sex parent also contributes to such psychic vulnerability. The most
important aetiological factor in cowardice, however, is a condensation
of body mutilation anxieties (including, of course, castration anxiety)
and a dread of separation and aloneness. An “ocnophile” (Balint, 1968)
par excellence, the coward clings to his objects and is willing to sacrifice
dignity at the altar of relatedness. All cowardice, when it comes down
to it, is the fear of being disliked and being alone. Meltzer (1973) notes:
Where dependence on good internal objects is rendered infeasi-

ble by damaging masturbatory attacks and where dependence
on a good external object is unavailable or not acknowledged, an
addictive relationship to a bad part of the self—the submission to
tyranny takes place. An illusion of safety is promulgated by the
omniscience of the destructive part … Where a dread of loss of an
addictive relation to a tyrant is found in psychic structure, the prob-
lem of terror will be found at its core, as the force behind the dread
and the submission. (p. 78)
Meltzer’s proposal has implications for the technical handling of indi-

viduals trapped in relationships with narcissistic-sadistic partners.
However, before discussing them, it is pertinent to take a few steps back
and consider the myriad ways in which fear is exploited, used, mar-
keted, and enjoyed by societal institutions created by man.
FEAR 17
A cultural digression
Although fear is ubiquitous in human existence, it does have a deep
and complex relationship with culture. Their relationship is often dia-
lectical in nature. Fear can disturb a culture’s slumber and mobilise
adaptive and maladaptive responses. Cultural narratives can embellish
existing fears, create new ones, and offer rich iconography for both. All
this becomes evident in the realms of regional concerns, prejudice, poli-
tics, literature, and even entertainment. The following passages address
these matters in brief.
Some fears (e.g., looking down from a great height, fast-moving ani-
mals) seem so widely spread across the globe as to appear independ-
ent of cultural influences. Like “universal dreams” (Freud, 1900a),5 such
“universal fears” combine phylogenetic predisposition, evolutionary
advantages, and precipitates of early childhood experiences. Other fears
are idiosyncratic, limited to some people, and, at times, restricted to
regions and eras. Fear of ghosts and evil spirits, for instance, has largely
gone from modernised societies while persisting in less educated, less
industrialised, rural and sub-rural communities of the world. Fears of
earthquakes, floods, and tornadoes are generally restricted to areas with
vulnerability to such disasters. Similarly, animal phobias are regionally
anchored; it is hardly conceivable for one living in Saudi Arabia to be
afraid of polar bears.
The phenomenology of “culture-bound psychiatric syndromes”
(Guarnaccia & Rogler, 1999; Meth, 1974; Yap, 1969) is replete with
observations that support this line of thought. Not only animals that
populate a specific region are chosen as phobic objects by people living
there, they can also become the suitable containers of projections of the
attributes of bravery and cowardice. In colloquial English, for instance,
a coward is referred to as “chicken-hearted” or merely a “chicken”
and in Spanish, as gallina (hen). In Arabic, a brave man is called an
assag (lion) while in Urdu, such a person is called sher-dil (one with a
lion’s heart); in contrast, a coward is called buz-dil (one with a goat’s
heart). What all this demonstrates is that not only are the objects of
fear but even the metaphors of bravery and cowardice often regionally
determined.
Fear plays in important role in prejudice as well. The “unmentalized
xenophobia” (Akhtar, 2007c) that results in bland indifference towards
and avoidance of those different from oneself is merely the tip of the
proverbial iceberg here. The relentless need to externalise aggression

and the deployment of paranoia as a “psychic vitamin for threatened
identity and a powerful anodyne against the pain that results from
genuine self-reflection” (ibid., p. 17) results in the creation of frighten-
ing outside figures. Since minorities are often “suitable reservoirs for
projection” (Volkan, 1988), all sorts of dread and danger are seen as
emanating from them. Blacks, homosexuals, and Muslims are frequent
targets of hostile projection and therefore objects of fear; this, in turn, is
utilised as a rationalisation for discrimination and prejudice. Mesmeris-
ing oratory of hatred by charismatic though paranoid leaders fuels the
imaginary dangers posed by the other and sanctions acts of cruelty and
violence. No wonder fear and politics are often intertwined with each
other.
Monarchies and totalitarian regimes are customarily prone to cre-
ate a “culture of fear” for their citizens. The term “terrorism” —used
these days mostly to designate the political violence of small groups—
actually originated in the context of state-sponsored intimidation. First
used in 1795, “terrorism” denoted the French Revolutionary statesman
Maximilien de Robespierre’s Reign of Terror (1785–1794). Robespierre
defended his fear-mongering, iron-fisted control, and terrorising of the
masses by claiming that the Revolution enacted the despotism of liberty
against tyranny. He was, however, not an exception. More recent times
have witnessed Adolf Hitler’s Holocaust, Joseph Stalin’s gulags and
purges, and Pol Pot’s killing fields. Government, turned mercenary, can
be a source of great fear, indeed.
Unfortunately, even democratic nations can regress and make peo-
ple tremble while expressing their opinions or, worse, become alto-
gether mute. The so-called “emergency rule” enforced by India’s prime
minister, Indira Gandhi (1917–1984), before she was assassinated, and
the unauthorised wire-tapping and “extraordinary renditions” by the
CIA during the post-9/11 era of George W. Bush’s presidency were no
less terrorising to the people of their respective nations.6 Within psy-
choanalysis itself, there have been prominent individuals and organisa-
tions that have inculcated a “culture of fear”. This ranges from Freud’s
authoritarian suppression of dissent (Rudnytsky, 2012) to the perva-
sive sense in the field that openly expressing a pro-Palestinian stance
is risky if not tantamount to professional suicide. Needless to add that
when such dread pervades the tissue of an organisation, its advance is
seriously compromised.
FEAR 19
Evoking and fuelling large group fears is a favourite strategy of

political leaders with narcissistic and paranoid tendencies (Volkan,
1997). Hitler’s pronouncement that Jews were a threat to the European
economy, Slobodan Milosevic’s poisonous reminder to the Serbs that
some of their fellow citizens were actually Turks, and the constant evo-
cation of mortal danger from Arabs by Israelis and vice versa, are some
prominent illustrations of fearmongering as a tactic for strengthening
one’s political hand. Fear then becomes a ploy for oppression, disen-
franchisement, and even genocide of hated others.
A dramatically different interaction between fear and culture occurs
when judiciously titrated and aesthetically cleansed fear forms the basis
of literature. The oral tradition of telling scary tales dates back to antiq-
uity and the written genre of fear-laced fiction has seen steady output
over centuries. Essentially such sagas belong to two categories, namely
those of supernatural horror (e.g., ghost stories, tales from beyond the
grave, satanic machinations, attacks by aliens and zombies), and of evil
lying within the human heart itself (e.g., murder stories, sadomasochis-
tic cliffhangers). Reading such novels and short stories stirs up psychic
terror; this is often accompanied by a sense of helplessness (a result of
identification with the victimised protagonist). There is also a feeling of
being immersed in the goings-on and yet experiencing a bit of uncan-
niness. Freud’s (1919h) discussion of unheimlich or the uncanny clearly
stated that it derives its terror not from something externally alien or
unknown but—on the contrary—from something strangely familiar
which defeats our effort to separate ourselves from it. There is a quality
of something “fateful and inescapable” (p. 237) being forced upon one.
Freud goes on to state that:
An uncanny effect is often easily produced when the distinction
between imagination and reality is effaced, as when something that
we have hitherto regarded as imaginary appears before us in real-
ity, or when a symbol takes over the full functions of the thing it
symbolizes, and so on. It is this factor which contributes not a little
to the uncanny effect attaching to magical practices. (p. 244)
Writers of terrifying fiction, ranging from Clara Reeves (1729–1807)

and Ann Radcliffe (1764–1823) through Edgar Allan Poe (1809–1849)
and Bram Stoker (1847–1912) to Ann Rice (b. 1941) and Stephen King
(b. 1947) are deft in evoking an uncanny response by straddling the
line between reality and unreality within the plot and the details of its
characters. They succeed in collapsing the boundary between mind and

matter, mundane and strange, and natural and diabolical.
However, for some individuals menace in print is not sufficient.
They require visual images and sound effects to experience fear. Enter
horror movies. A genre which emerged at almost the inception of com-
mercial cinema (circa 1910), horror movies exploit many ubiquitous
human tendencies, even if these are ordinarily banished from conscious
awareness. Among these are the need for excitement, novelty-seeking,
the pleasure of an adrenaline rush, counterphobic pressure to master
fear, and the vicarious gratification of repressed perverse fantasies and
impulses to defy social norms (Goldstein, 1998).7 Especially appealing
to young men, such movies become an engrossing topic of conversa-
tion and a glue for peer bonding. It must, however, be added that hor-
ror movies are not uniform and many sub-genres exist. These include
themes pertaining to:
• Demon-child, e.g., The Exorcist (1973), and The Omen (1976).
• Alien invasion, e.g., War of the Worlds (1953), and Puppet Masters
(1994).
• Dangerous animals, e.g., The Birds (1963), and Jaws (1975).
• Gory violence, e.g., Texas Chainsaw Massacre (1974), and A Clockwork
Orange (1971).
• Perverse and psychotic ruthlessness, e.g., Psycho (1960), and The
Shining (1980).
The common element in all such movies is the evocation of fear, often
to an unsettling and near-traumatic extent.8 They provide an encoun-
ter with the “uncanny” (Freud, 1919h) by disrupting routine and by
transforming the all-too-familiar into the bizarre and unpredictable.
While gratuitous throat-slitting violence can elicit tormented joy from
filmgoers, it is the helpless anticipation that truly terrifies them. The
great maestro of fear, Alfred Hitchcock (1899–1980), recognised this and
declared: “There is no excitement in the bang, only in the anticipation
of it.” Hitchcock knew that while fear is unpleasant, playing with fear,
if done artistically, can yield pleasure.
Back to the clinical realm

Having discussed the differential diagnoses in the realm of fear
(i.e., fear, anxiety, phobia, cowardice), I wish now to comment upon
the management of fear and fear-related phenomena in the clinical
FEAR 21
situation.9 That such work involves a great deal of countertransference

vigilance and can be taxing for the analyst’s ego goes without saying.
Indeed, all interventions in such work require patience, tact, and for-
bearance from the analyst (besides, of course, his or her interpretive
skill) and the categorisation of such interventions here is largely for
didactic ease. That being said, three main tasks in working with those
afflicted with fear and those capable of inducing fear in the analyst are
(i) sensing fear, assessing dangerousness, and setting limits, (ii) bear-
ing and containing the patient’s fear, and (iii) managing one’s own fear
and learning from it. My selecting these three areas to focus upon is
by no means dismissive of the customary interpretive and reconstruc-
tive work that forms the basic material of all psychoanalyses. Defence
and resistance analysis, confrontation with the repudiated precon-
scious material, linking-up of derivatives, and helping decipher what
underlies the symbolic and displaced forms of fear constitute the bread
and butter of psychoanalytic work. Such work is needed regardless of
whether the patient’s fears are neurotic, paranoid, or self-annihilatory.
The three areas chosen to be addressed are additional and not alterna-
tive to the customary work of psychoanalysis.
Sensing fear, addressing dangerousness, and setting limits

Since most analysts and psychoanalytically oriented therapists screen
their patients for possessing “a fairly reliable character” (Freud, 1905a,
p. 263) and only take into treatment those individuals who are not socio-
pathic and are not suicidal or homicidal, assessment of the patient’s
dangerousness does not figure in their usual repertoire of concerns.
Nonetheless, situations can—and do—evolve where the analyst has to
decide whether it is safe to continue working in the customary manner.
The following declaration by Hoffer (1985) is pertinent in this context.
The analyst’s neutrality with respect to conflict may be suspended

in situations the analyst feels are (a) emergencies for the patient—
e.g. suicidality, psychosis, toxic state, etc.; (b) emergencies for
someone potentially vulnerable to the patient’s destructiveness—
e.g. the analysand’s children; and, (c) emergencies for the analyst—
physical or psychological threats. (p. 786)
Under such circumstances, the analyst might feel afraid and rationally
worry about the safety of himself, others, or the patient. This might
happen in the course of an ongoing treatment or, at times, in the very

first encounter between the patient and the analyst.10
Clinical vignette: 1
Sarah Green, a forty-five-year-old librarian made an appointment
to see me upon her sister’s insistence. She appeared overwhelmed
with pain at the break-up of a romantic relationship. Having
lived alone most of her life, she found this belated attachment
profoundly significant. The man she was involved with was mar-
ried. He abruptly left her saying that he could no longer continue
cheating on his wife. She was destroyed. Heartbroken, she came to
see me.
We began the first hour of consultation in a customary history-
taking way. However, within twenty minutes of the session, she
announced that she had decided to blow her head off with a gun
which she had bought earlier that day. Alarmed by the earnestness
of her tone, I suggested that we take immediate steps to get the gun
removed from her apartment, obtain some collateral information
regarding the extent of her depression, and consider beginning our
work on an inpatient basis. The patient reacted sharply to my sug-
gestion and, refusing to let me contact her sister who could remove
the gun, got up to leave the office. At this point, I said to her, “Look,
everybody gets about ten candles’ worth of life and inside you
eight have already gone off. The wind is blowing hard and to pro-
tect the remaining two candles, you came here and put them in
my heart. Now, since you have enlisted me for this purpose, it is
my duty to keep these two candles protected from the wind. When
the storm settles, I will return them to you so that you can light the
other eight candles back with their help.” The patient broke down
in tears and after some thinking gave me the permission to contact
her sister who subsequently removed the gun from the patient’s
apartment and encouraged the patient to stay at her house for the
next few days.
Such admixture of limit-setting, supportive measures, environmen-

tal interventions, and interpretive approach might tilt in favour of
one or the other component given the seriousness and/or urgency of
threatened violence (towards self or others). Generally speaking, in
FEAR 23
psychoanalytic practices, supportive and interpretive measures carry

the day while in psychiatric clinics (especially in the Casualty Depart-
ment settings), limit-setting, hospitalisation, and medications might
become necessary to manage the patient’s aggression and the fear
induced into others by such aggression.11 Kernberg’s (1984) guidelines
for the management of hatred in severely borderline patients allow for
assuring safely by strict limit-setting. Frightening outbursts of rage in
such patients have to be met not only by holding and containment but
also by explicitly informing the patient of what he or she can and can-
not do within the clinical setting.
Bob Dolinski, a borderline young man in twice weekly psycho-
therapy, exploded with rage when I refused to comply with his
demand for painkillers. In a menacing tone, he threatened to
take my eyeballs out and crush them under his feet. Alarmed by
his emotional flooding and rapidly disintegrating reality-testing,
I firmly told him to stay put in his chair. I added that if he as much
as laid a finger on me I would terminate the treatment and never
see him again. I told him that he needed someone who could listen
to him peacefully, not someone who was afraid of him and that I
would be afraid of him if he acted even once on his impulse to hurt
me. Noticing that he was settling down, I added that the idea that
he could take my eyeballs out was both unrealistic and intriguing.
He could not do it; I would not let him. And, why did he think of
eyeballs in the first place? Could it have something to do with the
memory of his mother looking contemptuously at him? Interven-
tions along these lines calmed him down and soon the session was
progressing in a more mutually related manner.
Similar to the technical interventions in the preceding vignette, my

stance during this frightening episode, with imminent risk of physi-
cal violence, included firm limit-setting coupled with comments to
improve reality-testing. In addition, I also made an attempt to link the
content of his threat with certain memories he had reported during an
earlier phase of our work. While such active efforts were needed here,
in cases where the threat is subtle and slow, one can maintain relative
neutrality and, just by bearing the fear induced by the patient, prepare
the ground for customary interpretive work.
Bearing and containing the patient’s fear

Prominent among the analyst’s tasks is to hold and contain the fears
that the patient can feel and verbalise as well as those fears that remain
unspeakable for the patient. Discerning such “beta elements” (Bion,
1967a) through his reverie, his resonance with the patient’s projective
identification, and his empathy-driven “trial identifications” (Fliess,
1942) with the patient, the analyst senses the patient’s fears but does not
hurriedly unmask them. Instead, he allows himself to be the depository
of such affects, waiting for the process of defence analysis and for the
patient’s resulting ego-growth to permit the verbalisation of hitherto
repudiated anxieties. Stated in the language of contemporary relational
psychoanalysis, fear is an intersubjective response which, like any other
countertransference reaction, helps the analyst understand himself, his
patient, and the nature of their interaction. Moreover, since the patient
and the analyst need to feel safe, a modicum of mutual regulation is
important for the dyad in “setting and re-calibrating the danger-safety
balance in their analytic work” (Kafka, 1998, p. 102).
Such is the process in most ongoing analyses. However, there are
occasions when the dreaded fragments of the patient’s psyche burst
through the rational mind of the ego and result in a state of “emotional
flooding” (Volkan, 1976). Under such circumstances, the analyst’s con-
taining capacity acquires a greater importance; this capacity then pre-
pares the ground for an interpretive deconstruction of what just took
place.
Rebecca Cohen, twenty-six-year-old daughter of a Holocaust sur-
vivor father, was in analysis with me. The course of early treat-
ment was filled with anxiety-laden fantasies about her father’s
experience in the Nazi concentration camp. Dreaded scenarios of
ethnic hatred and violence preoccupied Rebecca and this readily
spread to the transference. She feared and hated me, regarded me
as a Jew-hating Muslim or Arab, and suspected that I supported
anti-Israeli violence by Palestinians. Projections of her own trans-
generationally given post-traumatic Jew-Nazi split of the self were
constantly active in her relatedness with me. One day, I was hated
and viciously attacked. Next day, I was deeply feared.
FEAR 25
During one session while talking of the Holocaust, she

suddenly jumped up from the couch and ran to the corner of the
office that was farthest from me, trembling and obviously shaken
by something she had just experienced internally. Rebecca stood
there crying. I remained silent. Then she found a box of tissues
on the desk nearby, cleaned her face, and began to look a bit com-
posed. I did not say anything and waited patiently for things to
unfold. Rebecca jumped up, sat on my desk, and asked me if I
knew what had happened. I shook my head, telling her that I did
not. She then revealed that she had felt that I was going to take out
a knife and stab her while she was on the couch and that’s why
she had to get away from me. As she was narrating this, I noted
that she had become much calmer. I remained quiet. Rebecca went
on to say, “You know, I have never seen your office from this end.
It looks so strange … You know, what it looks like … It looks so
still. Everything is unmoved, quiet. It is like a dust cover jacket
of a bestseller murder mystery. And you know what, sometimes
when you read the whole book, you find out that all the clues
were already shown in the photograph on the cover of the book.
Yes, your office, from this side, looks like a photograph of just that
sort, with all the clues intact.” Now I spoke. I said, “And, I guess
I would be the corpse in this murder scene.” Rebecca smiled,
stretched her arms, and aiming her clasped hands at me, made a
noise indicating that she was shooting me with a gun. I responded
by saying, “You know what, a little while ago you thought that I
was going to kill you and now that you have taken some distance
from that position, you find yourself killing me. Look, this murder
and murderer are both parts of your own self and, for the work
we have mutually undertaken, it is my hope that we hold on to
both these views and see how they are related to each other, where
they came from, and what purposes do they serve.” Rebecca got
off the desk, walked back to the couch, and lay down. The session
continued in the “usual” way.
This clinical exchange illustrates a number of interventions, includ-

ing the interpretation of splitting and projective identification. How-
ever, what I wish to emphasise here is how my unperturbed and
non-intrusive stance facilitated the unfolding of the clinical material.
My verbal interventions were important but these were possible only
because of the material that became available due to my containing her

terror by an unshaken and quiet stance.
Managing one’s own fear and learning from it

During the course of his clinical work, the psychoanalyst experiences a
vast array of emotions and fear figures prominently in that list. Poland
(cited in Mathias, 2008) has described four different ways in which
fear arises within the analyst: (i) elicited by the patient, (ii) originating
within the analyst himself, (iii) pertaining to the analytic process, and
(iv) from the realities of the human condition. Finding these categories
to be overlapping, I classify the analyst’s fear into (i) his fear of the
patient, (ii) his fear of acting out and making mistakes, (iii) his fear that
the analysis will fail, and (iv) his fear of making unusual interventions.
Acknowledging that such things cannot be neatly catalogued and one
classification might clarify some things and muddle some others, in the
following passages, I will follow my scheme.
First is the analyst’s fear of the patient. This is most marked when he
is working with paranoid or borderline individuals, especially if they
are given to outbursts of rage (see clinical vignette 2). Those who are
chronically at the verge of committing suicide can also induce fear in
the analyst. Fears of being sued and of damage to one’s professional
reputation can become quite powerful under such circumstances.
These concerns might constitute rational responses to the patient’s self-
destructiveness and be accentuated by the projection of the analyst’s
own unconscious hatred of the patient (Maltsberger & Buie, 1974). At
times the analyst is successful in bearing such fears for long periods of
time and continuing to work with the patient in a holding-interpretive
mode. His decision to not set limits but allow the process to unfold is
based upon a sense that the patient needs him to tolerate being afraid
and that this transference demand is going to become amenable to
interpretive resolution. Then something happens and the whole edifice
falls apart.
As the treatment proceeded, Sarah Green (the patient mentioned
in clinical vignette 1) recounted details of her long-term suicidal
wishes and her constant sense, while growing up, that her mother
FEAR 27
hated her and wanted her dead. She also talked about the harsh
criticism her mother directed at her; she repeatedly called Sarah a
“monster” and an “evil one”. Not surprisingly, Sarah was terrified
of her mother and made few demands on her time and attention.
As these details unfolded, Sarah stole a revolver from her
sister’s house and started sleeping with it—fully loaded—in her
hand. I was terrified and yet felt prompted to stay away, this time,
from insisting that she get rid of the gun immediately. I had a vague
sense that the fear I was experiencing was the consequence of pro-
jective identification with her frightened child-self, as well as a
direct result of her revenge-seeking fantasies. In other words, due
to the effect of her projection, I had become “scared little Sarah”
while she had adopted the role of her terrifying mother. And, at
the same time, she had transformed herself from poor little Sarah
to intimidating Sarah and I, as the mother, had to be tormented for
what I had done to her as a child.
The very fact that I could conceptualise the enactment and put
what was, most likely, going on into mental words, told me that
there was something containable and, ultimately, interpretable
here. The risk (for her) was high and the fear (in me) palpable but
session after session, we talked about the potential underlying what
was taking place—feelings, somewhere deep in our hearts, that we
did not need to rupture the enactment by behavioural limit-setting,
that she needed me to bear the anxiety. We felt that all that was
happening was in the “pretend mode” (Fonagy & Target, 1997).
Then one afternoon, Sarah called me, saying that she was feeling
truly suicidal again. I had another patient in the waiting room and
asked her if she could assure me that she would not do anything
impulsive and self-destructive for the next hour. She promised and
we agreed that I would call her as soon as the patient I was about to
see left. However, when I called, the phone kept ringing and ringing
and Sarah did not pick it up. I was horrified, and thought that she
had killed herself. Trembling with fear and cursing myself for being
unduly heroic and adventuresome in my clinical work, I called her
sister, who immediately departed for Sarah’s apartment. The next
thirty minutes were the longest thirty minutes I have ever lived.
Then, I got a call from her sister that she had found Sarah fast asleep
and that everything was fine and under control. Sarah came on the
phone and profusely apologised for what had happened. I accepted
her apology but, feeling that a certain line had been crossed (and,
that from a containing mother, I was becoming an ignoring and
destructive mother), I insisted that the sister not only take the gun
away but immediately dispose of it in a manner that Sarah would
never be able to get her hands on it again. This intervention and its
subsequent discussion in the clinical setting paved the way for the
deepening of our therapeutic work.
Second is the fear of the analyst’s own impulses to act out. If the analyst
is under great personal stress (e.g., bereavement, divorce, serious ill-
ness), his fear of acting out with his patients, using his patients to
diminish his loneliness, and venting sexual or aggressive effects (even
if in a mild and aim-inhibited manner) is plausible and worthy of atten-
tion; consultation with a trusted colleague or return to some treatment
must be considered under such circumstances. However, there are other
times when the analyst is functioning optimally and yet develops a fear
of doing something odd or strange with his patient. This is the stuff
of countertransference and restraint coupled with self-reflection often
reveals the nature of transference that is putting such pressure on the
analyst. Here is a clinical example of such an occurrence.
Melanie Wright, a boyish young woman had sought treatment
owing to feelings of anxiety and some marital tension. She had
panicked when her husband was laid off from his job and, even
though he was able to find gainful employment soon afterwards,
remained anxious; in fact, she feared that they would become des-
titute. She and her husband frequently argued over this fear of hers
and the friction between them was growing.
What struck me most when I first met her, however, was not
this undue anxiety but the fact that she—a young woman in her
mid-twenties—looked like a teenage boy. Making a mental note of
it, I proceeded with gathering some background history. It turned
out that her parents were divorced when she was six years old and
that she had been raised by a loving but industrious and busy pro-
fessional mother. Two other important facts were that the divorce
had been precipitated by her father’s announcement that he was
gay and that young Melanie had to grow up with a very difficult
FEAR 29
older brother who constantly, and, at times, physically hurt—her.

All sorts of factors, it seemed, worked in unison and led to the
compromise of her femininity. The fact that she had been married
for three years and seemed to love her husband appeared a little
out of place.
As we began an analysis, I found myself experiencing some-
thing I had never felt during a clinical hour before. With Melanie
talking—sometimes haltingly and at other times freely—about this
or that issue, I experienced a peculiar discomfort in my rib cage
and upper abdominal area. It is as if someone was tickling me very
hard (my mind went to some childhood memories that involved
my older brother). I repeatedly wanted to change my position
in the chair, as if to evade this tickling. Alongside such physical
unease, I also felt impulses to interrupt her by saying something
absurd and totally unrelated to what Melanie was talking about. If,
for instance, she was talking about her parents’ divorce, I felt like
asking her if she knew the capital of Iowa and if she ruminated on
her financial future, or I had the urge to tell her about the intricacies
of Urdu poetry.
While I kept such impulses in check, the experience was nonethe-
less unnerving. I kept wondering what it was about. What would
be the impact upon her were I to utter my passing thoughts? To be
sure, she would be shocked. She might experience me as bizarre, if
not outright mad.
A few weeks of sitting upon such impulses, waiting, allowing
the material to evolve further, and conducting piecemeal defence
analysis, led to her revealing that her father had not only become
gay but quite “crazy”: he had painted the living and dining room
ceilings purple, had started inviting his gay lovers to their home
and would have sex in front of Melanie and her brother (when the
mother was out working). Once or twice, he invited the children to
join him and his lover in the bed while they were making love. As
this material emerged—amid much distress and crying—I found a
sudden reduction in my impulses to “act crazy”!
With the countertransference tension more in control, I became better

able to think about what had transpired between the patient and
myself. My “conjecture” (C. Brenner, 1976) was that the patient had
been shocked by her father’s perverse behaviour and had internalied
this traumatic object relations scenario. It remained “unmetabolised”,

however, and needed to be deposited into me, like Bion’s (1962) beta
elements, for my containing and processing. She could retrieve it only
after her capacity to bear the trauma and to “mentalise” (Fonagy &
Target, 1997) grew. Meanwhile, I had to bear the noxious experience
alternately as the victim (e.g., my feeling mercilessly tickled) and the
perpetrator (e.g., my wishing to shock her by uttering absurdities) of
the psychic violence.
A third fear experienced by the analyst is that of analytic failure.
While exceptions exist, generally this fear reflects that the patient was
not really suitable for analysis (e.g., too concrete, too paranoid, too
lonely), and was taken into treatment by misjudgment or for the wrong
reasons (e.g., analyst’s need for money, patient’s seductiveness). Gener-
ally this becomes evident via the concreteness of thought, the unrelent-
ing inability or refusal to free associate, and/or the poverty of affective
life displayed by the patient. A different sort of scenario unfolds with
patients who flood their clinical situation with their “militant hope-
lessness” (Poland, cited in Jordan, 2002, p. 989). Session after session
they complain about how futile their lives are, how the analyst is not
helping them, and how they are certain that the analysis will fail. They
might pay lip service to recognising that the analyst is devoted and
doing his best but their way of relating remains dismissive of all his
interventions. Possessed by a sort of “daemonic force” which Freud
(1920g, p. 35) talked about in his elucidation of the death instinct, such
patients suffer greatly while making the analyst suffer as well. Antici-
pating their suicide (which seems imminent each day), the analyst feels
a bone-chilling fear at the destruction of his professional reputation and
his personal well-being. Chused also mentions the fear generated by
feeling utterly helpless as an analyst and acknowledges being haunted
by memories of failed analyses which “make [her] afraid not of these
patients but of the limited value of what we do” (cited in Jordan, 2002,
p. 992). Yet another situation where the fear of failed analysis appears
is when the patient carries a tenacious “someday …” fantasy (Akhtar,
1996). The patient keeps hoping, reflecting a state of pathological opti-
mism, that his or her longed-for wish (e.g., a deceased parent to come
back alive, for the analyst to marry the patient) will “someday” come
true. And, having worked interpretively for a very long time, the ana-
lyst begins to feel the terror that this hope will not be renounced by
the patient and the analysis will either go on forever or be abruptly
ended; in either case, it will be a failure. Under such circumstances,
FEAR 31
consultation with a colleague or supervisor is indicated. And, it might

become necessary to convert psychoanalysis to psychotherapy (see
Akhtar, 2009, pp. 57–58).
Finally, the analyst (especially the novice analyst) fears making what
for the lack of a better term might be designated as “unusual interven-
tions” (Akhtar, 2012). Here, the fear is one of attitude from supervisors,
mentors, and analytic heroes internalised into the analyst’s super-
ego, rather than his “working self” (Bolognini, 2011). “What will they
say?” becomes the driving injunction rather than what the truth of a
particular clinical moment demands. Clearly, this is a murky area and
the inexperienced analyst is safe in erring on the side of caution but
the fear of acting in an “unusual” manner has to be put aside sooner
or later if the analyst has to work with a “free-floating responsiveness”
(Sandler & Sandler, 1998) and authenticity of participation. In an edited
volume (Akhtar, 2011b), I have collated nine so-called unusual inter-
ventions, including (i) making extraordinary monetary arrangements,
(ii) conducting treatment outside the office, (iii) changing the frequency,
length, and timing of sessions, (iv) refusing to listen to certain kinds
of material, (v) giving advice, (vi) interpreting in the form of action,
(vii) talking about oneself, (viii) touching the patient, and (ix) giving
mementos and gifts to the patient. The volume also elucidates the pros
and cons of their deployment and the reader might benefit by looking
up that material.
Concluding remarks
In this chapter, I have described fear, categorised its intensities, and
traced its developmental origins. I have delineated the similarities and
differences between fear and anxiety while showing how the two coex-
ist in the state of phobia. Following this, I have made a brief foray into
the cultural realm and attempted to demonstrate how the unpleasant
emotion of fear can be turned into the excitement of horror movies,
gothic literature, and thrill-seeking games, while, on the negative side
of things, forming a part of ethno-racial prejudice and political oppres-
sion. Returning to the clinical realm, I have discussed the presence of
fear in the transference-countertransference matrix and outlined the
strategies to deal with the resulting problems.
Before concluding, however, it seems only fair to make some com-
ments about psychic states that seem to be the opposite of fear. There
are three such conditions: (i) fearlessness, (ii) counterphobia, and
(iii) courage. Fearlessness is of two varieties. Primary fearlessness

exists in infants and young children who are not aware of the dangers
that surround them; they can put potentially poisonous items in their
mouths and insert fingers in electric sockets. Being hurt a few times
and being repeatedly instructed by parents gradually curtails such
“un-fear”. Secondary fearlessness is seen among low-level operatives
in a criminal ring; they carry out nefarious and risky acts under the
protection of a powerful boss and feel that nothing can and will happen
to them.
The state of counterphobia refers to that unconscious attitude of the
ego which propels the individual to undertake, and even enjoy, the
very activities that arouse fear and anxiety in him. However, there is a
rigid and exaggerated quality to such behaviour. According to Fenichel
(1945),
The obsessive manner of the search for the once-feared situations
shows that the anxiety has not been completely overcome. The
patients continuously try to repeat the way in which in childhood
other anxieties gradually had been mastered by active repetitions
of exciting situations. The counterphobic pleasure is a repetition
of the child’s “functional” pleasure of “I do not need to be afraid
anymore” (Silberer, 1909). And, as in the child, the type of pleasure
achieved proves that the person is by no means really convinced
of his mastery, and that before engaging in any such activity, he
passes through an anxious tension of expectation, the overcoming
of which is enjoyed. (p. 480)
A common example of counterphobic attitude is the social and motoric

daredevilry of adolescents (e.g., driving at high speeds, experiment-
ing with drugs, defying social etiquette, confronting the high school
principal). Another illustration is the strikingly rapid assimilation into
the host culture on the part of some immigrants (Akhtar, 1999b). They
adopt the new local customs in a magical way in order to deflect the
social anxiety of being “different”. More examples can be given. An
individual who accepts the recommendation of a major surgical opera-
tion in the blink of an eye is most likely showing a counterphobic atti-
tude. The grotesque youthfulness of some aging narcissists (Kernberg,
1980) and the “gallows humour” of some terminally ill individuals
also belies a defensive avoidance of approaching threats. In all these
situations, there is a suspicious absence of expectable fear. The fact is
FEAR 33
that fear exists but is kept in abeyance by forceful self-assurances to the

contrary.
Finally, there is courage. Hardly synonymous with fearlessness,
courage implies that the person knows that his stance (physical, intel-
lectual, or moral) and his actions can have adverse consequences:
financial loss, social isolation, personal ridicule, physical punishment,
and so on. And yet, he braces himself to encounter their impend-
ing onslaught. Only then can he face destruction and death and not
betray the meaningful core of his existence. John Wayne, the movie
actor who personified boldness in his roles, quipped that “[C]ourage
is being scared to death and saddling up anyway” (downloaded from
www.Thinkexist.com). General William T. Sherman (after whom the
Sherman tank is named) declared courage to be “a perfect sensibility
of the measure of danger and a mental willingness to endure it” (cited
in Kidder, 2006, p. 9).
The courageous man accords great weight to his own thoughts and
perceptions. He needs no consensus and does not depend upon others’
approval. He can stand on his own even when others do not agree with
him or oppose him. Courage becomes for him “an exceptional state
of mind allowing and producing an extraordinary form of behavior”
(Coles, 1965, p. 85).
In essence, courage is a particular variety of response to fear, as are
counterphobia and cowardice. And, the fact is that we—all of us—are
capable of reacting to fear in all three ways. Which one predominates,
when, and with what consequences ultimately gives shape to our adap-
tation to inner and outer reality, our overall character, and the direction
our life takes.
Notes
1. An admittedly incomplete list includes ablutophobia (fear of wash-
ing), acrophobia (fear of heights), agoraphobia (fear of open spaces),
arachnophobia (fear of spiders), batrachophobia (fear of frogs), claustro-
phobia (fear of enclosed spaces), homophobia (fear of homosexuals),
Islamophobia (fear of Muslims), photophobia (fear of lights), and so
on. The list, frankly, can be endless; one internet site contains 530
entries!
2. This affected the later reconstructions of Little Hans’s childhood as well
(Joseph, 1990; Silverman, 1980), which gave more attention to his pre-
Oedipal development.
3. The childhood disorder commonly known as “school phobia” has little

to do with school per se; the anxiety aroused by separating from par-
ents (usually, the mother) and from the familiar environment of home
mostly contributes to such fear.
4. A curious overlap seems to exist between cowardice and procrastina-
tion. Biswas-Diener (2012) observes that not finishing a task that one
undertook is associated with a kind of “minor cowardice” (p. 7) in
many people’s minds.
5. According to Freud (1900), the following dreams were so widely preva-
lent as to be considered ‘universal’: the dreams of (i) flying, (ii) falling,
(iii) being chased, (iv) being inoptimally dressed or naked in public, (v)
the death of a loved one, (vi) having difficulty performing in an exami-
nation or test and, (vii) teeth falling out.
6. The colour-coded alert system devised by the US Homeland Security
Administration in 2003 was intended to keep the public informed about
the potential threat of terroristic attacks. At the same time, one won-
ders about the extent to which the shifts from Red (for severe) through
Orange (for high), to Yellow (elevated), etc., were utilised for keeping
people afraid and hence hesitant to question governmental surveillance
of private lives.
7. Amusement park rides, especially roller coasters with sudden and
sharp drops and turns, also gratify some of these impulses.
8. The fact is that some people do get traumatised by seeing horror mov-
ies. Relatively widespread traumatisation after the release of the movie,
Jaws, was evident in a large number of people’s avoiding swimming at
the shores.
9. My observations are limited to working with adults. Not having experi-
ence of working with children, I am not comfortable commenting upon
the vicissitudes of clinical praxis in that realm.
10. The first three of the five clinical vignettes provided in this chapter
have also appeared elsewhere (Akhtar, 2013b) with a somewhat differ-
ent slant. Some vignettes in other chapters have also been previously
published. And, all the names given to the patients reported upon are
fictitious.
11. Assessment of the risk of violence becomes a truly important meas-
ure in such work. For details on this, see Otto (2000), and Gellerman &
Suddath (2005).
CHAPTER TWO
Greed
I
t is to the gifted Greek storyteller of ancient times, Aesop (circa
620 BC), that we owe the eternally impressive tale of greed. Among
the numerous fables told by him is this story of the farmer who
found a goose that laid a golden egg each day. Initially jubilant at his
good fortune, the farmer soon felt unable to wait twenty-four hours for
the next egg to arrive. He imagined that the goose had hundreds of eggs
inside her but was stingy in doling out the wealth. The farmer grew
restless and wanted all the gold immediately. He cut the goose open but
found no gold inside it. All that happened was that the goose died and
the farmer lost the daily nugget of riches that was assured to him.
In this brief tale, Aesop elegantly addressed the coexistence of enor-
mous hunger, impatience, inconsolability, a defective sense of empa-
thy, and ingratitude towards one’s benefactors. It is this constellation of
descriptive and dynamic features that are subsumed under the rubric of
greed. Since greed—along with narcissism, paranoia, and discontent—
constitutes an important feature of severe personality disorders and has
an unmistakable impact upon their treatment, it is surprising that psy-
choanalytic literature has given inadequate attention to it.
My contribution here aims to fill this gap in our literature. In it,
I will discuss the nature of greed and highlight its phenomenological
35
components. I will describe its primary and secondary manifestations

and also the defences that are frequently deployed against it. Following
this, I will address the origins of greed in the crucible of early child-
hood experiences and the consolidation as well as regressive activation
of greed at crucial junctures during adulthood. Then, I will make a brief
foray into the sociocultural realm and attempt to demonstrate its cor-
rosive impact upon the quality of human life at large. Returning to the
clinical chamber, I will delineate the various ways in which issues per-
taining to greed impact upon the process of interactive psychotherapy
and/or psychoanalysis. That being said, allow me to begin with the
well-recognised and less-than-optimally recognised manifestations of
greed.
Descriptive aspects
Webster’s dictionary defines greed as “excessive and reprehensi-
ble acquisitiveness” (Mish, 1998, p. 511). The meaning of this phrase
seems self-evident. However, a careful look reveals its ambiguous,
even though textured, nature. The first qualifier (“excessive”) suggests
that acquisitiveness is to be termed greed only after it exceeds a certain
threshold but does not specify what that threshold is and how and by
whom it has been set up. The second qualifier (“reprehensible”) posits
that greed lacks dignity, is vulgar, perhaps even immoral, and some-
thing to be looked down upon but does not reveal why does greed
deserve such derision. Left in a phenomenological morass, we open our
eyes wider, search for more clues, and look deeper and farther. Now it
dawns upon us that what we call “greed” is actually a complex set of
affects, attitudes, and fantasies lumped together. For didactic ease and
to create epistemic order out of chaos, I divide the phenomena pertain-
ing to greed into three categories: (i) primary manifestation, (ii) second-
ary manifestations, and (iii) defensive distortions.
Primary manifestations
The best-recognised aspect of greed—to the extent that it is consid-
ered the crux of the matter—is an excessive and unrelenting desire to
acquire and possess goods. Its “excessive” nature is revealed by the fact
that the quantity of goods desired far surpasses actual need as well as
by its exaggerated quality when compared to the desires of others. Its
GREED 37
“unrelenting” nature is revealed by the fact that the individual afflicted

by it is momentarily pleased with the attainment of supplies and then
becomes unsatisfied, empty, and inconsolable. “Greed, in its nature, is
inherently insatiable, and so can not be satisfied. It wants everything,
nothing less will do” (Kaplan, 1991, p. 508). While out of proportion
with realistic need, desires associated with greed are subjectively experi-
enced as a “need”. And, since psychic “needs” (as opposed to “wishes”)
do not carry the burden of intentionality,1 experiencing greedy desires
as needs confers upon them an aura of justifiability and a guilt-free sta-
tus. Thus, entitlement comes to be a third feature of greed, along with
excessive desire and inconsolability.
The realms in which greed can manifest itself vary greatly. Food and
money are the most prominent of these. Overeating that leaves one
physically bloated but psychically unsatisfied is a telltale sign of greed.
Similarly, an insatiable desire to amass wealth, regardless of its instinc-
tual origins in oral acquisitiveness or, as Fenichel (1938) declared, in anal
retentiveness, gives evidence of greed as a character trait. Pathological
gambling, too, emanates, at least in part, from greed. Writing about this
elsewhere (Akhtar, 2009), I observed that, in pathological gambling,
… the disproportion between the amount spent (e.g., on lottery
tickets, roulette, off-track betting) and the desired reward (in thou-
sands and millions of dollars) creates the illusion that what one is
about to receive is free of charge. This constitutes a powerful allure
since it secretly gratifies the infantile wish of getting something
for nothing. After all, it is only in infancy and childhood that one
actually gets free supplies (tangible or emotional); once that period
of life has passed, all material acquisition and even all love and
respect has to be earned. Gambling, by “promising” a windfall and
a generous gift from the “mother nature”, as it were, creates the
possibility of being a carefree child again. At the same time, ignor-
ing the fact that the probability of winning is miniscule (a fact that is
pre-consciously known), prepares the ground for masochistic self-
punishment; the guilt over resorting to unfair and effortless path to
success (unconsciously equated with transgression of the oedipal
barrier which demands respect for generational boundaries and
therefore of time) is thus relieved. (p. 75, italics in the original)
Money and food are, however, not the only realms in which greed
makes its appearance. Sex is another area where the operation of greed
is frequently discernible. In the setting of narcissistic character structure

especially, the desire for sexual encounters gets out of control. “Here,
eternally youthful bodies are needed compulsively, regardless of the
face, the person, and the attitudes with which such bodies relate to the
narcissistic individual” (Kernberg, 1980, p. 144). Sexual promiscuity,
like other addictions, is often orally derived and betrays an intensifica-
tion of sensual desire due to chronic childhood frustrations. Hunger
and greed of such proportions end up cannibalising whatever good-
ness might exist in the relationship and leave the narcissistic individual
empty all over again.2
Secondary manifestations
Alongside the three “primary” features of greed (i.e., excessive desire,
inconsolability, entitlement) exist certain other manifestations. Promi-
nent among these are a constant sense of hurry, ingratitude, defects of
empathy, and corruption of superego functions. Hurrying, on which
there is a lamentable lack of psychoanalytic musing, is a frequent
accompaniment of greed, since to be able to wait means tolerating “less-
than-full” states of body and mind. Waiting for supplies also implies
taking turns, sharing with others, and believing in a less than magical
regeneration of goods. The greedy individual insists upon sustained
fullness and cannot tolerate temporal gaps in the appearance of sup-
plies; impatience is the twin sister of avarice.
Ingratitude is also a frequent accompaniment of greed. Called the
“marble-hearted fiend” by Shakespeare (King Lear, 1606, I, iv, p. 283),
ingratitude is, in essence, a refusal to acknowledge that one has received
goodness, love, and material supplies from others. No amount of indul-
gence appears enough to the one incapable of gratitude. Inwardly meas-
uring every favour against the “debt” owed to him due to childhood
deprivation, such an individual becomes incapable of enjoying what is
offered and remains thankless to his benefactors. He gobbles up what is
given, does not acknowledge others’ generosity, and keeps craving for
more (Akhtar, 2012; Bergler, 1945).
Constant yearning for supplies leads to pushing others aside and
losing contact with their needs and rights. Driven self-interest causes
blindness to others’ place in the market of libidinal supplies. This indif-
ference to fellow human beings is most likely the reason that greed
GREED 39
is deemed “reprehensible” in its dictionary definitions (see above).

Moreover, such defective empathy has a boomerang effect insofar as
others gradually begin to avoid the greedy person. He or she loses the
respect of family members and peers, is ostracised. The resulting lone-
liness increases his insatiable need for love and material goods. The
defects in empathy associated with greed also have a cause-and-effect
relationship with superego corruption; lack of concern permits exploi-
tation and cutting ethical corners gives rise to the unconscious sense of
being bad which, in turn, propels one to seek more love, more praise,
and more reassurance from others. A vicious cycle of excessive need,
exploitative taking, and unconscious guilt is thus established.
Nikelly (2006) has pooled together the studies of individuals driven
to have more and more money and yet remaining unsatisfied (Berglas,
1986; Rohrlich, 1987; Shames, 1989) and offered the following portrayal
of the greed-driven “pleonexic personality”:3
• No concern for the effects of unlimited accumulation, such as the

depletion of natural resources or the fomenting of social conflict,
deprivation, and suffering.
• Acquisitions are considered worthy in themselves and for private
luxury but poverty and the public good are ignored.
• The hunger for increasing wealth has no logical purpose; having eve-
rything is not enough, and the desire for more is like a race without a
finish.
• Living for the here and now, as if life will soon come to an end, feeds
the urge to grasp and to hold as much as possible.
• Confusion of means with ends and the distortion of priorities in life;
failure to grasp the “big picture” and to acknowledge important
human values.
• Failure to recognise ethical obligations and their impact on society;
insensitivity to the unmet basic needs of others.
• Possessions become synonymous with self-worth, freedom, and
privilege along with a sense of superiority and self-righteousness.
• Social interactions become impersonal and perfunctory, lacking
warmth and not letting others come close; personal encounters are
limited to those that enhance personal gain.
• Disdain and contempt towards those who do not take advantage of
opportunities to compete and to surpass others in wealth. (p. 72)
Such overtly greedy characters stand in sharp contrast to those

who suppress/repress their greed and develop firm characterological
defences against it.
Defensive distortions
Greed can be rendered unconscious by defensive operations of the ego
due to moral condemnation from within and/or due to the need to
safeguard a lofty self-image. Four common defences deployed against
greed are repression, reaction formation, splitting, and projective
identification. By the use of repression, all temptations and longings
felt to be “greedy” are sent into psychic exile. However, since “[T]he
repressed exercises a continuous pressure in the direction of the con-
scious” (Freud, 1915d, p. 151), hints of greed continue to appear in
parapraxes and dreams. Moreover, the individual who has repressed
his own greed feels exquisitely uncomfortable at encountering the
attitude in others and might even equate their healthy appetites with
avarice. A not infrequent accompaniment is pretended contempt for
money in real life (Jones, 1913) and “moral narcissism” (Green, 1986),
that is, yearning to be pure, free of attachment, and above ordinary
human needs.4 Disenchantment with food to the extent of develop-
ing anorexia nervosa is often the consequence of such narcissism and
repressed greed (Davies, 2004).
Reaction formation against greed can give rise to “unrelenting gener-
osity” (Akhtar, 2013a), which involves excessive and incessant giving to
others. The individual feels helpless in the face of an inward command
to provide and be helpful; such giving exceeds realistic limits both of
what one has and what others need. It cloaks and defends against greed,
envy, and the need to control the object (Seelig & Rosof, 2001).
Another distortion occurs when self-representations tinged with
greed are held in abeyance via the mechanism of vertical splitting.
A “mirror complimentarity of the self” (Bach, 1977) then develops
whereby the individual consciously experiences and alternately acts
out the contradictory attitudes of being greedy and being not greedy.
He seems rational and well regulated in his appetites and then, to eve-
ryone’s surprise, suddenly turns greedy. Sequestered avarice of this sort
can also undergo projective identification and lead to the perception of
others being greedy. When this happens, desires and demands of others
are looked at with suspicion, even if those wishes are, in fact, realistic.
GREED 41
At times, others (especially the spouse and children) are unconsciously

manipulated to “live out” one’s own repudiated greed. Scorn and con-
tempt can then be directed at them. The deposition of one’s greedy
self-representation into others can also result in uncanny empathy
with their acquisitiveness and fear of being devoured by them. Guntrip
(1969), long ago, discerned this mechanism in the fluctuating closeness-
distance patterns of schizoid personalities. More recently, Kernberg
(1995) has found that often it is the projection of greed onto the desired
love object that creates dread of relatedness in narcissistic personalities.
According to him, in such individuals:
Unconscious greed and envy tend to be projected onto the desired

sexual object and, as a consequence, fear of the possessive greed
and potential exploitation by the sexual object becomes a threat,
reinforcing the need to escape into “freedom.” For the narcissis-
tic patient, all relations are between exploiters and exploited, and
“freedom” is simply an escape from a fantasied devouring posses-
siveness. (p. 16)
The mention of dread and anxiety in the setting of hungry desire to

devour brings up the relationship of greed to hope and envy on the one
hand and to pain and despair on the other hand. To grasp such nuances,
we must turn to the developmental origins of greed.
Developmental origins
The word “greed” appears only six times in the complete corpus of
Freud’s work (Guttman, Jones & Parrish, 1980). Five of these usages are
colloquial and of little theoretical significance. The sixth, though set in
the context of his ironic view of human nature, does reveal where he
thought greed originated in the course of psychic development. Freud
stated the following:
Among the majority even of what are called “respectable” people

traces of divided behavior can easily be observed where money
and property are concerned. It may perhaps be generally true that
the primitive greed of the suckling, who wants to take possession
of every object (in order to put it into his mouth), has only been
incompletely overcome by civilization and upbringing. (1901b,
p. 158)
This unmistakable link to orality was, however, nowhere to be found

when he returned to discussing greed sixteen years later. At that time,
Freud (1917c) stated that “[A]varice, pedantry, and obstinacy spring
from anal-erotic sources” (p. 127). A careful look, however, reveals that
“avarice” was not the prime designation Freud used for the obsession-
al’s interest in money in this paper. His preferred term for the anally
fixated attitude towards money was “parsimony”. The shift from “par-
simony” to “avarice”, however, creates the possibility of viewing greed
as a two-sided phenomenon. One side pertains to excessive acquisitive-
ness (of oral determination), and the other to inordinate retentiveness
(of anal determination).
Freud’s early followers, especially Abraham (1924) and Fenichel
(1945), continued to trace the development of greed to oral phases of
psychosexual development. Fenichel’s (1938) paper on the compulsion
to amass wealth did rest upon the formulation of anal fixation and con-
stitutes an exception in this regard. By and large, though, greed became
firmly associated with early oral fixation in post-Freudian literature.
Abraham (1924) emphasised that the instinctual derivatives of the oral
phase did not require as much disguise via reaction formation and sub-
limation as did those of the anal phase. He linked oral greed with cling-
ing dependency and aggression-tinged patterns of speaking.
In their social behavior these people always seem to be asking for

something, either in the form of a modest request or of an aggres-
sive demand. The manner in which they put forward their wishes
has something in the nature of a persistent sucking about it; they
are as little to be put off by hard facts as by reasonable arguments
but continue to plead and insist. One might almost say that they
“cling like leeches” to other people. They particularly dislike being
alone even for a short time. Impatience is a marked characteristic
with them. In some cases, those in which psychoanalytic investiga-
tion reveals a regression from the oral-sadistic to the sucking stage,
their behavior has an element of cruelty in it as well, which makes
them something like vampires to other people. (pp. 158–159)
Fenichel (1945) declared that the appearance of “… intense greed, either

manifest or, after its repression, in the form of derivatives, is always
traceable to oral eroticism” (p. 63). It was, however, Abraham’s analy-
sand, Melanie Klein, who elucidated the development and metabolism
GREED 43
of greed in early infantile object relations to its fullest extent. Deftly

linking the operation of instinctual drives and the evolution of object
relations, Klein (1952) traced the earliest appearance of greed to the bed-
rock of intensified oral aggression. Although she acknowledged that
“deprivation increases greed” (1957, p. 183), her emphasis remained
upon the complex interplay of actual deprivation and innate intensity
of drives. She stated the following.
It could be conceived that in periods of freedom from hunger and

tension there is an optimal balance between libidinal and aggressive
impulses. This equilibrium is disturbed whenever, owing to priva-
tions from internal or external sources, aggressive impulses are rein-
forced. I suggest that such an alternation of balance between libido
and aggression gives rise to the emotion called greed, which is first
and foremost of an oral nature. Any increase in greed strengthens
feelings of frustration and in turn the aggressive impulse. In those
children in whom the innate aggressive component is strong, per-
secutory anxiety, frustration and greed are easily aroused and this
contributes to the infant’s difficulty in tolerating privation and in
dealing with anxiety. Accordingly, the strength of the destructive
impulses in their interaction with libidinal impulses would provide
the constitutional basis for the intensity of greed. (p. 62)
In this formulation, the origin of greed lies in the linkage between

constitutionally determined intensity of aggressive drive and actual
frustrations during early infancy. At a later occasion, Klein (1959) went
a step further and spoke of “innate greed” that, once aroused, refuses to
be mitigated by gratification.
Some babies experience strong resentment about any frustration

and show this by being unable to accept gratification when it fol-
lows on deprivation. I would suggest that such children have a
stronger innate aggressiveness and greed than those infants whose
occasional outbursts of rage are soon over. (p. 249)
Klein posited that under such circumstances only hallucinatory wish-

fulfilment brings satisfaction, since the conjured breast is inexhaust-
ible. A pathway from greed to idealisation is thus opened up; restless
search for “all-good” objects (e.g., a perfect mate, an exquisitely attuned
employer, a profoundly grateful child) then becomes a lifelong pattern.

Conversely, under the influence of a harsh superego, greed is repressed
and denied, leading to false self-reliance, stifling of love, and turning
away from dependence upon others. Klein (1957) also elucidated the
relationship between greed and envy. The former aims at sucking the
object dry. The latter does that as well but additionally strives to put bad
parts of the self into the object. In Klein’s own words, “[G]reed is mainly
bound up with introjection and envy with projection” (1959, p. 181).
However, both envy and greed diminish if hatred is renounced; the lat-
ter step can be taken if love from others is accepted and internalised.
Klein saw greed as the opposite of gratitude. If loving feelings pre-
dominate within the infant-mother dyad and in the former’s intrapsy-
chic economy, then receiving libidinal supplies leads to a feeling of
gratitude towards the giver. In contrast, if the libido-aggression bal-
ance within the dyad (and in the infant’s intrapsychic world) is tilted
towards aggression, then receiving supplies stirs up more hunger and
more anger; this angry hunger constitutes greed. In explicating this
dynamic, Roth (2008) stated the following.
The appeasement of greed, Klein insisted, cannot bring gratifica-
tion. It can bring satiation, a feeling of lack of hunger, an absence
of appetite. But gratification, according to Klein, concerns experi-
ences beyond the satisfaction of hunger: pleasure and delight from
smell and from touch, from gazing and being gazed at, from being
held comfortably and safely. It contains all the budding sensory
and psychological experiences that will gradually become what we
know as love. If greed can be understood to be about getting all the
goodness for oneself, then gratification can be seen to be about an
experience of closeness and intimacy. (pp. 15–16)
In contrast to these Kleinian ideas is Winnicott’s (1968) proposal that

the infant’s appetite has an inherently aggressive component which,
in its original intent, is actually a vehicle of powerful love. Winnicott
acknowledged that the infant has a vast capacity for destructiveness
but emphasised that the mindless robustness of his taking (breast, milk,
love) from the mother must not be mistaken for hostility. He noted
that:
… the important thing to note about this instinctual aggres-

siveness is that although it soon becomes something that can be
mobilized in the service of hate, it is originally a part of appetite,
GREED 45
or of some other form of instinctual love. It is something that

increases during excitement, and the exercise of it is highly pleasur-
able. Perhaps the word “greed” conveys more easily than any other
the idea of infantile fusion of love and aggression, though the love
here is confined to mother-love. (pp. 82–83)
While proposing such “primary greed” (in my phraseology),

Winnicott (1956a) also came to describe a “secondary” sort of greed in
his paper on “antisocial tendency”. There, Winnicott observed that child-
hood deprivation (especially if it follows some experience with gratifi-
cation) leaves the child hungry and perpetually in search of rectifying
this lack. The child then pushes the envelope of supplies, takes a lot,
steals from his caregivers, and behaves in outrageous ways. Stealing is
intended not only to compensate himself for the earlier deprivation but
also to hurt the benefactor who has come to stand for depriving primary
objects. Outrageousness is a sign of hope and a method to compel the
environment to respond (see also Casement, 1991, in this regard). The
greedy taking associated with such “antisocial” tendency is what I have
termed here as Winnicott’s concept of “secondary greed” in opposition
to “primary greed” by which he meant the inherent ruthlessness of
early infantile love.
Winnicott’s follower and exponent, Guntrip (1969) took up the “sec-
ondary greed” hypothesis with full force. He underplayed the consti-
tutional element in the genesis of greed and emphasised that greed
was healthy appetite gone awry due to the depriving and tantalising
attitudes of primary caregivers. This intensified hunger frightened one
since it could lead to cannibalistic destruction of the object or rejection
by the object which felt threatened. Consequently, one suppressed the
greed for objects and, in a protective move towards them, adopted a
solitary life style.
Putting this formulation (appetite turning into greed) upside down
on its head, Boris (1986) proposed that greed antedates appetite in the
course of development. Greed is the primary attitude from which appe-
tite might or might not emerge. In this view, the fact that the mother has
two breasts leaves the infant with having no contact with one breast no
matter how gratifying the other breast seems at the moment of nursing.
Inability to bear the “loss” of the other breast is what underlies greed.
In other words, greed reflects an unevolved state of mind in which the
infant wishes to suck on both breasts simultaneously. With acceptance
of reality and consistent if alternate availability of both breasts, so to
speak, greed can evolve into appetite. Appetite makes actual (and not
wished-for) experience for the first time a player in the developmental
process. The fact is that actual experience not only plays a role during
the formative years of childhood, when it contributes to the genesis of
greed, but also during adult life where it sustains greed and/or causes
its reactive flare-ups. This “actual experience” comes both from home
and from the society-at-large.
Sociocultural aspects
The topic of greed and culture is vast and can hardly be dealt with
comprehensively in this largely clinical essay. Nonetheless, it is impor-
tant to be addressed since neither do our children grow up in a cul-
tural void nor our patients remain unaffected by the societal currents
around them. In innumerable ways, sociocultural institutions and
practices interact with, and are affected by, the human propensity
towards greed. Such interplay is more marked in societies dominated
by capitalistic ideology and the free market economy. The monetary
ambition of producers of goods forcefully impacts on individual sub-
jectivity and seeks to turn the general population into mere “consum-
ers.5 The following scenarios highlight the interplay of capitalism and
human greed.
• Induction of false needs: Even though all human beings have the same
psychological needs (e.g., needs for safety, freedom, identity, affir-
mation, love, causality, temporal continuity, and generativity), those
living in capitalist economies are vulnerable to experiencing their
wishes also as needs (Akhtar, 1999a). For instance, food is a need
but the variety of pizza toppings offered can create a wish for them
which under the mesmerising juggernaut of advertising can be expe-
rienced as an urgent need. Respite from the daily humdrum of work
and turning to moments of leisure is certainly an emotional need but
the alluring luxuries of today’s resorts and retreats can delude one
into thinking that such accoutrements are truly needed for relaxation.
Induction of such “false needs” lies at the core of a consumer-driven
economy; the more one can make people buy things, the better off the
state of the nation, declares this mentality. Hypnotised by seductive
television commercials, the vulnerable person begins to feel needy
and, over time, turns greedy.
GREED 47
• Distortion of the parameters of success: In capitalist societies, the notion

of personal success is linked with financial status. As a result, the
bar for contentment is very high (Wachtel, 2003). How big a house
is big enough? What imported car delivers greater social prestige?
Or, conversely, what would happen if one does not wear brand-
name clothing, drives an “ordinary” car, lives in a modest home?
Such preoccupations are created, sustained, and fuelled by the cor-
porations that produce goods and these pied pipers of materialism
recruit masses to relentlessly pursue the “good life” by purchasing
more things. Satisfaction felt at every new purchase soon evaporates.
Hunger for acquisition returns and greed sets in.
• Eclipse of child care and communal bonds: The free market economy
tantalises, offers betterment of life through acquisition, and makes
people buy more and more things. It thrives on people remaining
in a state of want. A frequent result of all this is that the length of
maternal care of infants is abbreviated since the households “need”
two incomes. Employers, responding to their own financial “needs”,
curtail the length of maternity leave.6 Children are sent to “pre-
school” nurseries, and even “pre-nurseries” at an extremely young
age (often at a few weeks or months) and, not surprisingly, grow up
to be driven and ambitious adults. Another deleterious effect of the
forever escalating consumption is that people’s energy is spent on
earning, buying, and paying back loans. This leaves little actual or
mental space for communal bonds. One does little community serv-
ice and the idea of social sacrifice becomes foreign. On a local level,
the sense of neighbourhood declines; instead of being companions,
neighbours become competitors for standards of living. On a global
level, one fails to gain (or repudiates) awareness of how vast numbers
of people across this world are living in poverty and deprivation.
“Capitalist greed” (Sievers, 2012) activates ferocious competitiveness
that seeks to annihilate competitors. Pursuit of money and the things
it can buy fuels a narcissistic orientation to life.
Two caveats must be entered here. The first pertains to whether some
nations are more greed-driven than others and whether the East and
the West differ in the extent and nature of greed. The second pertains to
our selective use of the word “greed” vis-à-vis certain pursuits in life.
Regarding the first matter, it should be noted that such generalisations
are prone to error and fail to take into account that all sorts of human
beings exist in all sorts of societies. At the same time, it is possible that
some cultures might be less money-driven than others. A comparison,
for instance, of the over $60,000 annual fees for medical school tuition
in the United States with Germany, where such education is free for the
students pointedly brings this point home. Another illustration comes
in the form of socialised medicine. Nations that provide universal access
to health care create an ambiance of safety and fuel material pursuits to
a lesser extent. Less greed is in the air people breathe in such lands.
The second matter, namely, our applying the term “greedy” to some
pursuits and not to others, also reveals some interesting points for consid-
eration. For instance, if an investment banker makes a lot of money and
has little sense of civic responsibility or if a real estate mogul keeps build-
ing one high rise tower after another, we are quick to call them greedy.
But if a fiction writer churns out novel after novel or if a psychoanalyst
publishes paper after paper, we do not look upon them as “greedy”. We
readily discern greed in overeating but are reluctant to see it in vora-
cious reading. Why? Is all this a knee-jerk response to our exposure
to corrupt and scandalous entrepreneurs like Bernie Madoff? Is this a
moral recoil from Gordon Gekko’s7 celebrated declaration that “greed
is good”? Or does it express an idealised preference for aim-inhibited
discharge of instincts on our part? Have we inherited this legacy from
Freud’s stoic ethics? If that is indeed so, are we not ignoring that some
creative activities are actually “pseudo-sublimatory” (Kernberg, 1975),
that is, done in the pursuit of glory, fame, and immortality? And, worse,
by harshly judging rich businessmen, are we not overlooking that their
work itself might be about making money (sublimation in the direction
of what we deride as instinctual) and require great devotion and intel-
lectual prowess? To be sure, no clear-cut solutions exist for such concep-
tual conundrums but we must acknowledge their existence. Humility
of this sort might preclude moralising and enhance curiosity. It might
even become a stepping stone for developing poignant empathy and
“respect” for what is or seems to be greed in others. This applies to
sociopolitical views as well as to clinical work with patients.

Greed makes its appearance in the clinical situation in myriad ways.
The patient might bring greed within himself or herself, in a “one-
person psychology” manner. Or, the patient’s greed might have been
GREED 49
stirred up by the analyst’s overly depriving attitude. And, the analyst

might have his own struggles with greed. While the two types of greed
(the patient’s, the analyst’s) are often related to each other in a dialecti-
cal fashion and tearing them apart is difficult, it is didactically prudent
to consider them separately.
The patient’s greed

Manifestations of the patient’s greed can be crude or subtle. Included
in the former category are struggles over the payment of fees, sensitiv-
ity to the slightest lateness of the analyst, wishes for longer and more
frequent sessions, tenacious withholding of associative material, and
frequent contact-seeking between appointments (e.g., by phone, email).
“Malignant erotic transference” (Akhtar, 1994), with its typical coercive
quality, also is a manifestation of greed. To be sure, factors other than
greed (e.g., anxiety, mental pain, unbearable amounts of loneliness) can
play an aetiologic role in such developments but greed is often at their
centre. The same is true of the patient’s hatred of the analyst’s other
patients: the analytic breast is not allowed to feed anyone else. Need-
less to say that such gross manifestations of the patient’s greed extract
a heavy toll on the analyst’s poise and patience. The risks of moral
judgment become great under such circumstances (Kaplan, 1991). This
risk can only be avoided if the analyst holds on to the fact that lurking
behind the patient’s inconsolable hunger is the void of desperation and
feeling utterly unlovable. Waska (2002) eloquently describes the tense
ambiance of clinical work with “greedy” patients.
Patients want desperately to change and find relief from their

chronic and often debilitating anxiety. At the same time, they cling
to their demands for unrealistic change and ignore, devalue, and
attack the true potential they have. To accept the strides they do
make, within the less-than-perfect analytic relationship and the
intimacy and progress capable outside of the analytic relationship,
brings on a sense of loss too deep to bear and too confining, confus-
ing, and persecutory to allow. As one patient put it, “I want more in
life. It has to be more or nothing.” This seals their fate into an end-
less and exhausting hunt for better, ideal, and impossible states of
union with fantastic, idealized versions of the self and of the object.
(p. 508)
Waska (2003a) notes that greed destroys insights gained in analysis. The
hunger for more coupled with intense oral aggression makes internali-
sation and retention of good objects (including the analyst) difficult.
Prognosis is far better, in my experience, for patients who are con-
sciously aware of their greed and can even muster a bit of self-reflective
humour about their malady.
Phil Robertson, a highly successful businessman in his late thir-
ties, had sought analysis for being unable to establish a sustained
romantic relationship with a woman. He was tall, handsome,
wealthy, well mannered, and, generally speaking, a very likeable
person. As a result, he had no difficulty in finding women to date.
He was constantly “fixed” with women by his peers and relatives;
others sought him out spontaneously. The problem, though, was
that he could not tolerate them beyond three or four dates. Their
slightest “blemish” would lead him to become totally disenchanted,
even hateful. One had a coarse laughter. Another came to the date
wearing sandals. A third one did not know who Chaucer was. And,
a fourth one hated Boston (which Phil liked very much). And so
on. Soon each became history. Phil’s restless search for a “good”
woman (he was smart and avoided the word “perfect”) began to
appear endless.
Soon after starting analysis, Phil said, with wry laughter, “Doc,
I am the sort of guy who is never satisfied by ninety per cent of any-
thing.” Elaborating upon this, he said, “If you put all my favour-
ite food items on a boat in amounts that would last for a hundred
years and then have me sail away, I would still be worried about
the potential of scarcity. What if I wanted something and it was not
on the boat? What if it had fallen out of the boat? What will I then
do?” As this material unfolded, a childhood memory emerged. Phil
recalled that, on more than one occasion, when a dish was being
passed around during the family’s dinner, his mother reversed
the direction of the dish’s movement as it was about to reach him.
Consequently, he was unable to take that food item. The “screen
memory” (Freud, 1899a) nature of this account did not preclude
my empathy with his sense of chronic deprivation during child-
hood. Somehow, though, he had maintained a sense of humour,
GREED 51
too, about this pain. For instance, once he laughed and said, “Doc,
wouldn’t you say that life with a woman who has a big mole on her
back would be tough?”
In contrast to such self-reflective irony is the attitude of sadomasochistic

oblivion to one’s greed and its destructive impact upon clinical work.
Amira Hashmi, a Pakistani-American student of clinical social
work, was bored with her studies and wanted to drop out of the
university. However, she had no alternative plan. Nothing excited
her. She felt depressed, adrift, and utterly anhedonic. Referred by a
fellow analyst, she came to see me having tried psychotherapy as
well as antidepressant medications to no avail.
A polite, soft-spoken woman of extraordinary intelligence and
keen empathy for her “clients”, Amira filled the sessions with what
Warren Poland has called “militant hopelessness” (cited in Jordan,
2002, p. 989). She cried endlessly, declared incessantly that her
treatment with me was bound to fail. “Nothing will change, I can
tell you. Ten years will pass and I will be suffering in the same way
and to the same extent.”
The omnipotence that underlay such a seemingly hopeless (but
darkly triumphant) rant was beyond her awareness. Calling herself
weak, mindless, lifeless, inept, and stupid, Amina nonetheless dis-
played great eloquence, impressive debating capacity, and stunning
certainty regarding her dire predictions. More strikingly, she would
beseech me to speak, comment, and comfort her, but would instan-
taneously turn anything I said as meaningless; she either told me
that I was flat-out wrong or repeated my interventions in an exag-
gerated and mocking manner. Nothing I could say or do brought
her any comfort. She told me so and yet she came to her sessions
with saintly devotion and asked me to speak with greater frequency
during sessions. She was intolerant of my silence and rejecting of
my words. I was an emptied out, defiled breast from which she
nonetheless demanded the milk of therapeutic optimism.
Here the patient seems utterly incapable of accepting the feed-

ing by the analyst-mother due to the powerful infantile greed,
destructive intentions towards one’s “dead mother” (Green, 1980), and

unconscious guilt over such sadism. Analytic work in such cases has
to continually oscillate between affirmative and interpretive interven-
tions (see Killingmo, 1989, and more specifically, Waska, 2003b). On
the former front, the analyst must empathise with and validate the
patient’s agony and desperation. On the latter front, the analyst must
point out the sadomasochistic destructiveness in the patient’s reducing
his interventions to “shit”: inert, offensive, and useless. Both manoeu-
vres are ultimately aimed at helping the patient transform his greed
into appetite. However, this work is not easy. The patient often miscon-
strues overtures of validation and alliance as throwing “crumbs” and
mercilessly devalues the analyst’s efforts. Silence is found unbearable
and speaking useless. In such an environment, the potential for “nega-
tive therapeutic reaction” (Freud, 1923b) is great and the analyst might
be better off focusing upon what did not happen (in the course of the
patient’s development) than what did take place.
Discussing the technical dilemmas that clinical situations of this sort
present, Klein (1957) states:
It makes great demands (both) on the analyst and on the patient
to analyse splitting processes and the underlying hate and envy
in both the positive and negative transference. One consequence
of this difficulty is the tendency of some analysts to reinforce
the positive and avoid the negative transference, and to attempt
to strengthen feelings of love by taking over the role of the good
object which the patient had not been able to establish securely
in the past. This procedure differs essentially from the technique
which, by helping the patient to achieve a better integration of his
self, aims at a mitigation of hatred by love … We find that … the
patient’s strong desire to receive evidence of love and appreciation
from the analyst … is never completely given up … In identifica-
tion with his patient, the early need for reassurance may strongly
influence his [the analyst’s] counter-transference and therefore his
technique. This identification may also easily tempt the analyst to
take the mother’s place and give in to the urge immediately to alle-
viate his child’s (the patient’s) anxieties. (pp. 225–226)
Powerful and accurate though this statement is, it does not take into
account that the patient is not alone in bringing the hues of greed into
the clinical situation. The analyst contributes to it, too. An excessively
austere style of intervening on the analyst’s part can stoke the fires of
GREED 53
greed in the patient. Such “co-creation” needs to be acknowledged,

rectified, and only then handled in the customary interpretive manner.
And, then there are more “personal” struggles with greed that the ana-
lyst often faces.
The analyst’s greed

On a gross level, the analyst’s greed becomes evident via an exorbitant
fee, ostentatiously decorated office, overly packed clinical schedule,
and refusal to consider retirement even on becoming old and infirm.8
Sadly, none of these attributes are rare among psychoanalysts and seem
to have become more pervasive as analytic patients become scarce,
insurance companies shirk reimbursements, and the monetary well-
spring of academia dries up.
On a subtler level, the analyst’s greed is stirred up in response to
the patient’s seduction, and the idealisation of interpretive prowess.
The former can tax the countertransference experience heavily and, at
times, can lead to the breakdown of treatment.
Pamela Kasinetz, an elderly woman of extreme wealth, sought
psychotherapy for depression and anxiety of recent origin. The
apparent trigger for this was the worsening relationship with her
husband of over three decades. With their children no longer at
home, the two had become quite alienated; he was engrossed in his
business and she with her social commitments and philanthropic
work. Matters became worse when Pamela ran into an “adorable”
seven- or eight-year-old Cambodian boy in a shopping mall and
“fell in love with him”. She took it upon herself to help him and his
financially strained family. The boy gradually became her constant
companion. Paying huge sums of money to his parents, Pamela
pretty much took over his life. She would pick him up from school,
bring him home, shower him with lavish gifts, and indulge all his
whims and desires; his friends also were welcome at her house and
were treated with similar indulgence. While numerous examples
can be given, one instance should suffice, where she spent in excess
of thirty thousand dollars over a weekend entertaining her little
“friend” and his four playmates. All this led to frequent arguments
between Pamela and her husband, who insisted on putting limits
on her expenses. Seeking symptomatic relief, Pamela appeared

unprepared to look into the deeper meanings of her fascination
with this little boy. Raised in a family of means, she readily dis-
missed any enquiry into a childhood sense of feeling deprived and
thus blocked the therapist’s efforts at linking her runaway altru-
ism with potential unconscious issues pertaining to early trauma.
It was all “real” and rationalised in terms of kindness and gener-
osity towards the underprivileged, as far as she was concerned.
Soon after starting treatment, she expressed a desire to pay a much
greater fee for her sessions, quoting what appeared to be truly an
exorbitant amount. The situation was complicated by parallel prob-
lems in the therapist’s countertransference to her and to the finan-
cial glitter of the situation. Having suffered a childhood parental
loss at about the same age as the Cambodian boy Pamela so adored,
and being financially strapped himself owing to a recent personal
crisis, the therapist was made terribly uncomfortable by Pamela’s
financial seductions. Reacting defensively, he not only made pre-
mature transference interpretations but also sternly rejected her
offers. He failed to explicate and explore them in a peaceful man-
ner. Pamela soon dropped out of treatment.
This adverse outcome seems to have been the result of a number of

factors in the therapist: (i) current financial distress made it hard for him
to listen peacefully to his patient’s extravagance; it stirred up too much
greed, (ii) childhood trauma made it difficult for him to hear about his
patient’s indulgence in a little boy; it stirred up too much envy; and
(iii) not seeking a consultation in what was obviously a difficult clini-
cal situation for him, it led to defensive recoil and over-interpretation.
Flying solo under these circumstances was an inappropriate clinical
choice.
In contrast to the vignette above is the following case where the ana-
lyst was able to manage his greed (with helpful consultation from a col-
league) and, in the process, deepen his work with the patient.
In the process of writing her will, Kathleen Roberts, a wealthy
widow in her late seventies, became anxious and sought consul-
tation with me. Intellectually gifted, artistic, and good looking,
GREED 55
Kathleen was nonetheless in considerable distress. She felt torn

about how to leave her estate in an equitable manner. She had
two children and wanted to leave more money to the one with
lesser financial resources. But she felt guilty at such “unfairness”;
dividing the money and property on a fifty-fifty basis also appeared
unjust to her. She did not know what to do.
Expectedly, this contemporary scenario of fair-unfair dealing
contained echoes from her past. Kathleen was the younger of two
sisters and had been known to be “her mother’s child”. This, how-
ever, did not mean that she received more love than her sister did
from their mother. It meant that she was trapped, controlled, and
possessed by the mother. With further exploration, a history of
childhood sexual abuse by the mother came to the surface. With
great anxiety and shame, Kathleen recounted being asked to take
off all her clothes, spread her legs, and then undergo a “test”. This
consisted of her mother rubbing her genitals to make sure that there
was “no weakness there, no eczema, or anything”. This masturba-
tory ritual went on from the age of four to five till thirteen or four-
teen years of age. After that, its place was taken by the mother’s
asking Kathleen to describe her imaginary encounters with boys
and, as the years went on, by the mother’s insistence on hearing
each and every detail of Kathleen’s sexual life with her boyfriend.
But why was Kathleen and not her older sister chosen to serve the
mother’s perverse aims? Was this fair that one child was abused
and the other escaped the violation, Kathleen wondered.
As our work deepened and with Kathleen’s work in sorting
out her enormous estate getting into full swing, material began
to appear which suggested that she wanted to leave me a huge
amount of money. At times, this appeared in derivative forms, as
in parapraxes and dreams. At other times, it was explicitly verbal-
ised. Kathleen was genuinely grateful to me for helping her gather
the sequestered parts of her psychic life and feel deeper and more
meaningful as a person. Her wish to give me something ema-
nated from gratitude. She wanted my work to be available to more
women in her situation; there was thus an altruistic streak to her
generosity as well.
However, it was my countertransference experience that told
the deeper story. I felt split. At one time, I would feel omnipotent,
powerful, and entitled to millions of dollars for my work. At other
times, I felt that I was being corrupt, unethical, and greedy in my

temptation to seduce her to leave me a huge sum of money. Upon
brutally honest self-reflection and a consultation with a senior ana-
lytic colleague, I was able to connect my vulgar desire to grab her
money with an identification with her sexually abusive mother who
grabbed her genitals and my recoil from it with my becoming a
mother that she needed but did not have. It was such countertrans-
ference vigilance and working-through that allowed me to inter-
pret her oscillation between putting herself in a potentially abusive
situation and hoping that such exploitation would not happen.
Such “gross” and money-related scenarios do not exhaust the ways

an analyst has to struggle with the forces of greed. A subtler pressure
comes from what I call “interpretive greed”. Dedicated to analytic
work and idealising of interpretation as the centrepiece of his clini-
cal enterprise, the analyst might interpret excessively, too deeply, or
prematurely.
Judith Conahan, a highly intelligent lawyer with narcissistic per-
sonality disorder, was in analysis with me. For the first year or
so, all she talked about was how she felt unloved by her husband
and, during her childhood, by her mother. She never made a com-
ment about me and in effect treated me with an indifference that
was quite like what she had received from her mother. Then, in
the eighteenth month of her analysis, I announced that I had to
take a few days off at rather short notice. The patient responded to
the news with immediate acceptance and the usual lack of associa-
tions. The next day, however, she began her session by telling me
that one of her clients had cancelled an appointment that morning.
During that hour, she went through her desk drawers and found
her home insurance policy. Judith went on to tell me that she got
quite upset upon reading parts of that policy. There were too many
loopholes, too little coverage! Discerning unmistakable allusions to
my impending absence (e.g., “cancelled appointment”, “too little
coverage”) in her associations, I said: “Perhaps, you find it easier to
talk about an insurance policy with loopholes than an analysis with
interruptions.” After a long pause, she responded in a pained voice:
GREED 57
“I can see how you arrived at what you said but it hurt my feelings
because I was really worried about the policy and it seems that you
are not paying attention to my concern about it.”
Clearly, in too rapidly pointing out the deflected transference implica-

tions of her overt concern, I had succumbed to “interpretive greed”.
Issacharoff (1979), who has elucidated “the analyst’s unconscious
greed”, and Epstein (1979), who has talked about the analyst’s “com-
pulsion to interpret”, propose that withholding patients and verbally
fascinating patients elicit the analyst’s greed with remarkable inten-
sity. Both authors warn about the risks of over-interpretation which I
was guilty of in the preceding illustration. The following two clinical
vignettes, however, show greater restraint on my part.
Stephanie Brooks, an analysand with known psychosomatic sensi-
tivity to fresh paint, started to sneeze and cough badly during her
second session in my office in a brand new building. Knowing that
the hallway water fountains were not yet functional, she asked me
where she could get some water to drink. I told her that she could
step out and I would instruct my secretary, on the intercom, to give
her a paper cup, which she could take to the ladies’ room to get
some water. The patient went out and returned within a few min-
utes. She mumbled “Thanks” and resumed the chain of thought she
was pursuing earlier. I listened to the material carefully, wondering
if any overt or covert reference to my intervention would appear.
None did. During the next couple of sessions, I silently looked for
any reference to my intervention but did not find it.
In the throes of a regressive transference, Jill Schwartz entered my
office enraged and waving a finger. Approaching the couch, she
said, “I have a lot on my mind today and I want to do all the talk-
ing. I don’t want you to speak even a single word!” A little taken
aback, I mumbled, “Okay.” Jill shouted, “I said, ‘not one word’ and
you have already fucked up this session!” Now sitting on my chair
behind her, I was rattled. “Did I do wrong by speaking at all?”
I asked myself. As she lay on the couch, angrily silent and stiff,
I started to think. Perhaps she is so inconsolable today, so intent
upon forcing me into the role of a depriving person, that she found
a way to see even the gratification of her desire as its frustration.
I was, however, not entirely satisfied with this explanation and
therefore decided to wait, and think further. It then occurred to me
that maybe she was rightly angered by my saying ‘Okay’. In my
agreeing to let her have omnipotent control over me, I had asserted
my will and thus paradoxically deprived her of the omnipotence
she seemed to need. I was about to make an interpretation along
these lines, when it occurred to me that by sharing this under-
standing, I would be repeating my mistake: making my autono-
mous psychic functioning too obvious. As a result, I decided to
only say, “I am sorry,” and left the remaining thought unspoken.
Jill relaxed and the tension in the room began to lessen. After ten
minutes of further silence, she said, “Well, this session has been
messed up. I had so many things to say.” After a further pause,
she said, “Among the various things on my mind …” and thus the
session gradually “started”. By the time we ended, things were
going pretty smoothly.
In both these cases, I chose not to explore and not to interpret what was
overtly an “attractive” piece of clinical material. In the first vignette,
I did not ask what, if any, fantasies the patient had about stepping out of
my office, getting a cup from the secretary, drinking water, and coming
back. In the second case, I did not ask the patient what the patient had
been thinking during the long silence before she resumed talking. Inter-
estingly, upon hearing the presentation of both vignettes, some analytic
colleagues expressed the opinion that I had missed important data by
my lack of investigation. While I am able to see their point and even
have some “old” empathy9 with such a perspective, I believe that not
analysing or letting go of some aspects of these sessions was preferable.
To do otherwise would unnecessarily “pathologise” iatrogenic events
and betray analytic greed.
Similar restraint is needed when faced with moments of “mutual
silence” (Akhtar, 2013b) during the clinical session. Such silences feel
peaceful. The analyst and the analysand are attuned to each other but
experience little need to speak (Elson, 2001). Take a look at the follow-
ing vignette.
GREED 59
Marcy Schectman begins the last session of her nearly ten year long
analysis by saying that on her way to my office, she felt as if she
were coming to a funeral. She describes her experience of there
being an air of finality, solemnity, and loss to the afternoon. As I
remain silent, Marcy goes on to recount her experiences at a couple
of funerals she has attended. She sobs. I too feel sad, but do not say
anything. Gradually, her associations shift to her getting a doctor-
ate soon and then to graduation dinners, commencement ceremo-
nies, etc. She begins to be animated. Soon, however, she catches
herself and observes that this talk of happy endings (graduations)
is defensive against her sadness (funerals). Significantly, she adds
that while this might be the case, the two sides most likely repre-
sent the two sides of her feelings regarding parting from me for
good: “happy and sad, sad and happy”. I now say, “Yes, it does
seem like that,” and, after a momentary pause, add “but you know,
all well-timed funerals are graduations of a sort and all gradua-
tions contain funeral-like elements.” Marcy nods in agreement. She
remains silent and so do I for the next couple of minutes. The sense
of our being together in each other’s apartness is evident as the end
of the session approaches.
Here, like in the two preceding vignettes, it would have been greedy to
insist upon a verbal exploration of the patient’s silence, especially as it
occurred during the last few minutes of a long analysis. A better techni-
cal choice was to allow the non-verbal relatedness to remain intact, and
avoid succumbing to “interpretive greed”. Even outside the drama that
the very last session of an analysis presents, non-intrusive handling of
silences can form an extremely important “intervention” and a demon-
stration that the analyst has mastered his interpretive greed.
Marilyn McDonough, a very attractive architect in her fifties,
had sought help following an emotional crisis with one of her
children. Once the acute matter was settled and the treatment
began to deepen, the centrality of her own mother’s death when
Marilyn was barely five years old came to the surface. A talented
and industrious woman, Marilyn had devoted all her energies to

raising her kids (after a tumultuous marriage ended in divorce)
and to advancing in the profession she loved. She excelled at both
these endeavours and, all along, the pain of her early maternal
loss remained psychically sequestered—never repressed but not
entirely worked through either. Later, she got married again and
had since then maintained a reasonably satisfactory marital life.
Her analysis remained focused upon the lifelong effects of
early loss; it coloured transference anxieties, sensitivities to sepa-
ration, and fear of getting retraumatised by losing me. Provision
of ample psychic space, empathic validations, gentle uncovering
of defences against the awareness of the pervasive impact of the
childhood tragedy, and interpretive handling of “survivor guilt”
(Niederland, 1968) and the resulting inhibition of healthy entitle-
ment led to great improvement in her capacity to mourn. Energy
thus freed up was then directed to deepening ties with her family
and newer sublimations.
One phenomenon during this middle phase of Marilyn’s analy-
sis was outstanding. It began around the late second or early third
year of her treatment and lasted off and on for a very long time,
though with changing hues and increasing insight into its nature
on the part of both her and myself. The phenomenon consisted of
her stopping talking some five or six minutes before the end of each
session and then remaining quiet until we parted for that day.
Reflexively, I wondered whether I should interrupt Marilyn’s
silence and explore what was going on in her mind. Something,
however, told me not to do so. Then, an association occurred to me.
This pertained to the diminished pressure under which gasoline
gets pumped into the car just before the paid-for amount is to be
reached. The gas continues to go in the car but now under less pres-
sure. This cognitive allusion reflected a growing certainty in my
inner experience that Marilyn and I were not only deeply related
but still “in analysis” during those last silent minutes of each hour.
The fact that neither she nor I felt restless, dammed up, inhibited,
or in need of talking confirmed the correctness of my therapeutic
stance. Further reflection reminded me of the concept of a young
child’s “low-keyedness” (Mahler Pine & Bergman, 1975), whereby
his or her diminished interest in external reality, lesser motil-
ity, and sombreness of mood reflect the effort to inwardly hold
GREED 61
on to the image of a mother who, at that particular moment, is

unavailable. I surmised that, during these end-of-session silences,
Marilyn was keeping me inside her while simultaneously separat-
ing from me. The work of mourning (her actual mother) was as
evident in her silence as was the preparatory effort at separating
from me (in transference). I remained “non-interpretive” but emo-
tionally attuned to her throughout these moments.
Confirmation of such insights came from Marilyn, who—after
about a year or so after the beginning of these silences—one day
said, “Do you know what I am feeling and thinking during the
times we are silent towards the end of the session? I feel very peace-
ful and in no need to talk. I feel I have talked enough and now
I can be with you without speaking. And, you know, sometimes
when I am silent, I see an image of the sign infinity which is pulsat-
ing.” Contrary to my usual practice of waiting for further associa-
tions and/or asking for clarification, I felt the comfort to intervene
immediately. I said, “Infinity—like forever, pulsating—as fully
alive. There, yes, there is the mother who’s gone forever and yet
fully alive within you!” Marilyn nodded in agreement.
Restraining interpretive greed at the first few end-of-session

silences led to my ability to connect with the patient on a deeper level.
Whether it gratified an unspoken transference wish or simply acted as
“holding” (Winnicott, 1960) is open to debate. The fact that the patient
became able to talk about the potential meanings of what was going on
in her mind (and this became more developed still later in the course
of her analysis) leads me to believe that the “permission” to let her “lie
fallow” (Khan, 1983) and to be “alone in the presence of the other”
(Winnicott, 1958) advanced her treatment.
In contrast to such “non-interpretation” over a length of time, there
are sudden and sharp decisions that an analyst has to make to curtail
his interpretive greed. An example of such restraint is evident in the
following case.
Laura Klafter, a blond sixty-year-old widowed attorney, was in psy-
chotherapy with me for interpersonal difficulties that had plagued
her for a very long time. Estranged from her son, she felt bereft
and painfully alone. As our work progressed, a disastrous event

occurred. Laura was diagnosed with an especially lethal form of
intestinal malignancy. The day she learned of this diagnosis, she
had a scheduled appointment with me. As she sat on her usual
chair and talked about the tragedy amid sobs and tears, I noticed
that she had picked up a trinket from the nearby occasional table
and was caressing it, absent-mindedly, with her hand. I wondered
if I should bring this to her attention but decided not to; I restrained
my analytic greed in favour of remaining available, affirmative,
and attuned to her distress.
What all these clinical examples show is that the analyst has to make
choices of not only what to address in a session but also of what to
leave untouched. Such titration of dosage, timing, and even the very
offer of interpretation is what makes analytic work forever challeng-
ing. Limentani’s (1989) quip that “Psychoanalysis is an art and for this
reason it needs discipline” (p. 260) is pertinent in this context. Needless
to say that the “art” consists of both interpreting and not interpreting.
Interpretive appetite is good, analytic greed is not.
Concluding remarks
In this chapter, I have delineated the phenomenological aspects of greed,
clarifying its manifestations into three categories: (i) primary, (ii) sec-
ondary, and (iii) defensively altered. Following this, I have elucidated
diverse perspectives on the ontogenetic origins of greed and included
the concepts of constitutionally innate greed, developmentally-
inevitable greed, and greed as an angry intensification of appetite. After
taking a brief foray into the sociocultural realm, I returned to the clini-
cal realm and discussed how conscious and unconscious greed operate
in the matrix of transference-countertransference relatedness.
Two areas remain to be addressed: variations in nature and inten-
sity of greed that are lifespan dependent and/or gender based. As far
as the impact of the unfolding epigenetic sequence of development is
concerned, only one thing is certain, that greed originates in infancy
and early childhood. What remains unclear is whether massive dep-
rivations during late childhood (e.g., death of a parent when the child
is six or seven) can “activate” or even “cause” greed for the first time.
GREED 63
In either case—whether greed is coming from early infancy or late

childhood—manifestations of greed might vary in accordance with
developmental phases. These might include hoarding of toys and video
games during latency, inconsolable hunger for peer approval and sex-
ual contact during adolescence, pressured pursuit of home furnishings,
automobiles, and other status-rending accoutrements during young
adulthood, unending accumulation of awards and honours during
midlife, and extraordinary zeal for leaving behind a glittering “post-
self” (Shneidman, 2008), that is, an embellished and thoroughly crafted
legacy during old age. The encounter with limit that occurs during
middle age (Erikson, 1950; Kernberg, 1980) certainly triggers a greed-
asceticism dilemma. Facing limits of time and becoming aware of one’s
mortality, one gets regressively pulled towards brooding withdrawal
and cynical anhedonia on the one hand and pseudo-youthfulness and
dramatic changes in vocation and marriage on the other hand. Rework-
ing the freshly aroused greed during this time can lead to deeper con-
tact with reality and an enhanced capacity to enjoy what one possesses
and what one has become.
The second question, pertaining to greed and gender, is more dif-
ficult to answer. From an overt and behavioural perspective, the fact
that women are less prone than men to gambling, promiscuity, and
addiction (Grant, Chamberlain, Schreiber & Odlaug, 2012; Potenza
et al., 2001; Robertson, 2013; Seedat et al., 2009) can be taken to mean
that they are less “greedy” or, at least, more content and consolable.
Support for this conclusion also comes from the developmental vari-
able of the female child venturing less far away from the mother
(Akhtar, 1992b; Mahler, Pine & Bergman, 1975) and the intrapsychic
variable of women’s strong identification and intuitive closeness with
their mothers. Unlike boys who must undergo a developmentally
necessary “dis-identification with the mother” (Greenson, 1968), girls
retain an ongoing internal contact with their mothers; this, in turn,
might dampen their mother-hunger and diminish their vulnerability
to greed.
In the end, though, such lifespan related and gender based speculations
pale in front of direct clinical evidence. Our interest as psychoanalysts
remains in one individual at a time and that, too, in accordance with the
ebb and flow of drives, affects, fantasy, and levels of cognition. We
remain open to the possibility that greed might fluctuate in intensity,
get eclipsed by defences, drive the ego’s acquisitive ambitions, or

become a source of self-hatred, remorse, and guilt.
Notes
1. For a detailed discussion of the need-wish distinction and its implica-
tions for psychoanalytic technique, see Akhtar (1999a).
2. Hoarding of things and animals appears to be a consequence of greed
on the surface. At its depth, though, hoarding is mostly a result of fear
of loss, inability to let go, and profound feelings of insecurity. Forever
needing the warmth of closeness to his objects, a hoarder is an ocnophile
(Balint, 1959) par excellence.
3. The term “pleonexic personality” was coined by Nikelly (1992) to
describe a character constellation dominated by pathological greed. In
his view, such preoccupation can be traced to fixation at the anal stage,
with money and faeces being symbolically connected. It may also be
attributed to loss of gratification.
4. Green (1986) distinguishes the resulting asceticism from masochism
on two grounds. First, the moral narcissist suffers from shame over his
needs, while the moral masochist suffers from guilt over his wishes.
Second, the moral narcissist seeks to impoverish his object relations in
order to restore his infantile megalomania of self sufficiency, while the
moral masochist retains a tormented but rich tie to his objects. An illus-
tration of moral narcissism comes from Gandhi (1940) who, in attempt-
ing to become passion-free, concluded: “I must reduce myself to zero”
(pp. 504-505).
5. This is clearly not true for many societies. To begin with, the sheer fact
of poverty keeps people “uninvolved” with money matters. And, on
top of it, the values of stoicism, asceticism, and spirituality uphold dis-
interest in monetary affairs. It is therefore not infrequent to find men
and women, especially of older age, with pretty much no contact with
money and little desire to purchase things. This can come as a huge sur-
prise to those living in capitalistic societies. No wonder the publication
of The Man Who Quit Money (Sundeen, 2012), an account of a Utah man
who has survived without spending a penny since 2000, in the United
States, was received with great scepticism and curiosity.
6. The provision of maternity leave for twelve weeks (with highly variable
salary support) in the United States compares poorly to the thirty-six
weeks in Norway and twenty weeks in Estonia, Poland, and Russia (all
with 100 per cent of the salary).
GREED 65
7. The investment banker protagonist of the successful movie, Wall Street

(1987), Gordon Gekko gave a spellbinding speech on the virtues of
avarice to a hushed audience of businessmen.
8. An analytic colleague and a good friend, Ira Brenner, told me that early
on in his career, he marvelled at senior analysts who kept working well
into their eighties, and sometimes even in their nineties. With greater
maturity, he has tempered this idealisation and thinks that a combi-
nation of love of psychoanalysis, anxiety about aging, and greed for
prestige and money drives such professional longevity (personal com-
munication, November 6, 2013). This latter dynamic became especially
apparent to me during a recent visit to a North American psychoana-
lytic institute where younger training analysts confided their dismay
at their seniors’ (who were far along in their eighties) grabbing all the
attractive and well-paying applicants for training analyses.
9. I was trained in a very strict classical tradition, which put premium
upon clarification and interpretation at the cost of tactful and “permis-
sive” silences. As a result, I am able to empathise with colleagues who
express reservations about my not exploring the material that presum-
ably underlay these patients’ reticence.
CHAPTER THREE
Guilt
I
“ am sorry” is perhaps the most versatile combination of three words
in the English language. Compared to its lexical rival, “I love you,”
the expression “I am sorry” is used far more often and in much more
varied contexts. It can carry the hues of emotions that vary from flimsy
courtesy through considerable remorse to soul-wrenching contrition. It
can therefore be spoken with comparable ease at spilling coffee on the
tablecloth, forgetting to turn the cell phone off during a play, hurting
a lover’s feelings, and hearing the news of someone’s passing away.
It can also be used by a child molester seeking a lesser punishment in
a court of law, a politician caught embezzling party funds, and even a
head of state expressing “regret” for policies that led to abuses of an
ethnic minority or for a weak response to a natural disaster.
All these instances involve the experience of guilt, be it real or pre-
tended, mild or severe, fleeting or sustained. The utterance of “I am
sorry” is always motivated by guilt. But what is guilt? What gives rise
to it? How does it affect us? And, why do some people feel so much
guilt, others so little? Certainly the emotion does not result solely from
committing “bad” (i.e., hurtful) acts. If that were the case, hardened
67
criminals and psychopaths would be enormously guilt-ridden and

law-abiding citizens would be devoid of the inner naggings of con-
science. Actually the opposite is true. The one who commits crimes
and breaks the law is often free of remorse while the one who avoids
moral and ethical transgressions frequently suffers from the pangs of
guilt. The relationship between “bad” actions and guilt seems highly
tenuous. It seems best, therefore, to start our investigation by defining
the terms involved in it.
Definition
According to Webster’s dictionary, the word “guilt” stands for: “1. The
fact of having committed a breach of conduct, especially violating law
and involving a penalty; 2a. The state of one who has committed an
offense, especially consciously, and, 2b. Feelings of culpability, espe-
cially from imagined offenses or from a sense of inadequacy” (Mish,
1998, p. 517). The scope of this definition is broad. It includes (i) an act
of breaking rules, (ii) the possibility that such act only took place in the
imagination, and (iii) the emotional state of the one who has commit-
ted the transgression. Additionally, by mentioning culpability from a
“sense of inadequacy”, the dictionary definition acknowledges that acts
of omission can also underlie feelings of guilt. This is pure and simple
English.
Now let us turn to five prominent psychoanalytic glossaries. Surpris-
ingly, two of these (Eidelberg, 1968; Laplanche & Pontalis, 1973) do not
have entries on “guilt”. The other three (Akhtar, 2009; Moore & Fine,
1990; Rycroft, 1968) do but end up with definitions of guilt that are of
variable quality. Rycroft (1968) regards it to be “the emotion which fol-
lows infringement of a moral injunction” (p. 59). He adds that guilt dif-
fers from anxiety insofar as
(a) anxiety is experienced in relation a feared future occurrence,

while guilt is experienced in relation to an act already committed,
and (b) the capacity to experience guilt is contingent on the capac-
ity to internalize objects whereas the capacity to experience anxi-
ety is not; animals and infants may feel anxious, but only human
beings with some awareness of time and of others can feel guilty.
(p. 60)
G U I LT 69
Moore and Fine (1990) offer the following passage by way of defining
guilt.
Refers, like shame to a group of affects, including fear of retribution
both from outside and within the self, feelings of remorse, contri-
tion, and penitence. Its core is a form of anxiety with the underly-
ing ideational content: “If I hurt somebody else, I shall be hurt in
turn.” In addition to this outer or inner retaliation for one’s sexual
or aggressive acts or wishes, one may hold the depressive connec-
tion that one has already hurt the other and is being punished for
it; therewith goes the hope that, by atonement through mental or
physical suffering, one can attain forgiveness, that is, regain love
and acceptance. (p. 83)
Though impressive at first glance, these definitions are replete with

problems. Both make inadequate distinction between guilt and remorse.
Rycroft overlooks that guilt is a form of anxiety. Freud (1926d) explic-
itly stated that “The fear of castration at [the father’s] hands becomes
transformed into an undefined social or moral anxiety” (p. 128, italics
added). And, in a footnote to this passage, Strachey translated guilt as
“conscience anxiety”, noting that “[O]ften in Freud, as in the present
passage, stress is laid on the factor of anxiety in the concept” (p. 128).
Rycroft’s insistence on differentiating guilt from anxiety overlooks all
this. Moore and Fine do recognise that guilt is a form of anxiety but
lump too many phenomena (e.g., remorse, atonement, search for for-
giveness) under the rubric of guilt. Moreover, Rycroft leaves no space
for imaginary crimes and Moore and Fine equate guilt with the fear of
punishment (which is a consequence of guilt). The latter also do not
make it explicit that the “sexual or aggressive acts” stirring up guilt are
only those prohibited by the particular society within which they take
place (and its internal representative, the superego) and not of any and
all varieties. Avoiding the excessive zeal of Moore and Fine’s definition,
I opted in my own Comprehensive Dictionary of Psychoanalysis (2009) for
a more modest approach and described guilt as: “a dysphoric experi-
ence felt at breaking rules (familial, religious, national, etc.) or even at
the thought of committing such a transgression” (p. 126). By restricting
the use of the word “guilt” to the gnawing unease felt at a real or imagi-
nary infraction, I prepared the ground for demarcating the boundaries
of guilt from phenomena that are often lumped together with it.
Relationship to shame, remorse, and regret

It is commonplace to come across discussions of guilt—psychoanalytic
or otherwise—that belabour the distinctions between guilt and shame,
but pay little attention to the ways in which guilt differs from remorse
and regret. In the following passages, I will attempt to rectify this omis-
sion and address the overlap of guilt with all three emotions.
Guilt and shame

The literature on the shame-guilt overlap is voluminous (e.g., Abrams,
1990; Grinker, 1955; Kilbourne, 2005; Levin, 1967; Morrison, 1989;
Spero, 1984; Wurmser, 1994) and can hardly be summarised here. It
might suffice to say that the contributors to this literature have vari-
able emphases, separate theoretical perspectives, and different descrip-
tive nuances. However, most contributors seem to agree upon certain
similarities and certain differences between the two phenomena. As
far as the similarities are concerned, both affects are regarded as dys-
phoric. Both are seen to lower self-esteem. And, both work as brakes on
inner temptations and guarantors of “appropriate” behaviour. As far
as differences are concerned, the following are frequently mentioned:
(i) shame is predominantly visual while guilt is predominantly audi-
tory; shame stirs up fears of being seen and found unseemly whereas
guilt makes one hear inner voices of condemnation; (ii) the experience
of shame is often accompanied by physiological markers (e.g., blush-
ing, palpitation) while the experience of guilt is not; (iii) shame results
from the rupture of self-continuity consequent upon psychomotor or
social clumsiness or loss of control (e.g., belching or farting in public,
mispronouncing a word); guilt results from actual or imaginary break-
ing of societal and, internalised rules (e.g., going through a red light,
wanting to steal); (iv) shame, owing to its narcissistic underpinnings,
is often felt for the loved ones’ behaviour as well (e.g., when one’s chil-
dren act inappropriately in public) while guilt is experienced almost
solely regarding one’s own actions or inactions; (v) in structural terms,
shame results from falling behind one’s wished-for self-image and
betraying one’s ego ideal, while guilt results from violating or want-
ing to violate the dictates of one’s superego; (vi) shame pushes for hid-
ing, guilt pushes for confession; (vii) shame is diminished by “quiet”
acceptance by others and guilt is reduced by “loud” forgiveness by
G U I LT 71
others; (viii) shame is developmentally earlier than guilt; the latter,

in its true meaning only evolves after the post-Oedipal consolidation
of the superego,1 and (ix) defences against shame include narcissistic
self-inflation, withdrawal, or turning passive into active by shaming
others; defences against guilt include blaming others, fearing external
punishment, and masochistic self-laceration.
Guilt and remorse

Guilt is a nagging unpleasant feeling of being morally questionable. It
arises from harbouring conscious or unconscious impulses to commit
acts that are prohibited by one’s religion, family traditions, local law,
and, in the internalised form of all these, by the superego. In the end,
guilt is about breaking rules, regardless of whether such transgressions
actually take place or remain confined to the imagination. Remorse is
an unpleasant and burdensome affect as well. It, too, makes one feel
“bad”. However, there are important differences between guilt and
remorse. Guilt is about breaking rules and remorse about hurting oth-
ers. Guilt is diminished by confession, remorse by making reparation.
Guilt can be about past, present, or future; one can feel reprehensible
for having broken rules, in the midst of breaking rules, and at want-
ing to break rules. Remorse is always about the past. It is a dysphoria
that arises after one realises (and truly acknowledges) that one has hurt
someone innocent, or worse, a loved one. Guilt is the sister of anxiety,
remorse a cousin of regret.
The psychoanalyst whose work is of greatest significance to the
experience of remorse is Melanie Klein. While using the terms “guilt”
and “remorse” interchangeably, Klein (1937) described the childhood
origins of the latter emotion in eloquent detail.
When a baby feels frustrated at the breast, in his phantasies, he

attacks this breast; but if he is being gratified by the breast, he
loves it and has phantasies of a pleasant kind in relation to it. In his
aggressive phantasies he wishes to bite up and tear up his mother
and her breasts, and to destroy her also in other ways. A most
important feature of these destructive phantasies, which are tanta-
mount to death wishes, is that the baby feels that what he desires
in his phantasies has really taken place; that is to say he feels that
he has really destroyed the object of his destructive impulses … in the
baby’s mind the conflicts between love and hate then arise, and the
fears of losing the loved one become active. These feelings of guilt
and distress now enter as a new element into the emotion of love
… Side-by-side with the destructive impulses in the unconscious
both of the child and of the adult, there exists a profound urge to
make sacrifices, in order to help and put right loved people who in
phantasy have been harmed or destroyed. (pp. 308, 311, italics in
the original)
As this passage demonstrates, Klein’s views deftly portray the genesis

of destructive impulses, phantasies of having destroyed the love object,
subsequent feelings of remorse, and the impulses of reparation emanat-
ing from these.
Winnicott (1954) proposed the term ‘the state of concern’ for such
developments and saw their beginnings to be around six months of the
child’s age. In a paper titled “‘Psychoanalysis and the Sense of Guilt”,
Winnicott (1956b) declared that
… this important phase of development is composed of

innumerable repetitions spread over time. There is a benign circle
of (i) instinctual experience, (ii) acceptance of responsibility which
is called guilt, (iii) a working-through, and (iv) a true restitutive
gesture. (p. 24)
Winnicott emphasised that maternal tolerance of the infant’s

“ruthless love” and robust instinctual hunger lays the groundwork
for the capacity for guilt, concern, and reparation in the child. While
immensely valuable, Winnicott’s ideas failed to distinguish between
guilt and remorse; indeed, “remorse” is not even listed in the index
of The Language of Winnicott (Abram, 2007), a painstakingly meticulous
dictionary of his use of words.
Guilt and regret

Guilt due to having broken rules (established by family, religion, law,
and society) is often accompanied by wistfulness. One yearns to undo
the act, desperately wishes that one had not done it. And, it is at this
phenomenological juncture that guilt begins to have similarities with
regret. Guilt about past transgressions and regret are both about events
G U I LT 73
that have already taken place. Seen this way, regret is even closer to
remorse since the latter is always about something in the (remote or
near) past. Commenting upon this, I have elsewhere noted that both
regret and remorse
… are about the past. Both are about one’s own actions. Both
can involve acts of commission or omission. Both lead to a wist-
ful rumination to somehow erase or undo the events of the past.
Both can, therefore, underlie the “if only … fantasy” (Akhtar, 1996).
This fantasy assumes that, in the absence of this or that “calam-
ity”, everything would have turned out all right. Both “regret”
and “remorse” can impoverish the ego and contribute to anhe-
donia, depression, and suicidal tendencies. Finally, both “regret”
and “remorse” can serve screen functions and both can be put
to secondary (e.g., sadomasochistic) uses. However, there is one
very important difference between the two emotions: “remorse”
involves feelings about how one’s actions have affected others,
while “regret” involves feelings about how one’s actions affected
oneself. In other words, “remorse” is more object related, “regret”
more narcissistic. (Akhtar, 2009, p. 244)
Two caveats must be attached to the foregoing portrayal of guilt:

(i) the description focuses upon the conscious manifestations of guilt.
The fact is that clinically significant guilt generally exists on an uncon-
scious level. It is discerned through various derivative phenomena
including self-denigration, self-destructive behaviour, inhibitions of
assertiveness and sexuality, inability to accept compliments, provoca-
tive actions to incite punishment, and the phenomenon of “success
neurosis” (Freud, 1916d; Holmes, 2006); and (ii) in real life, distinctions
between shame, guilt, remorse, and regret often get blurred (see
Table 2). This is because the four can coexist. Guilt might cause inhibi-
tions of ego functions and the consequent failure to act appropriately
in a given situation might lead to shame. Vulnerability to shame might
preclude helping someone in distress and, in this way, result in feelings
of guilt. Breaking a rule ordinarily gives rise to guilt but if it leads to a
loved one getting hurt, remorse may also follow. Remorse over hurt-
ing others might be associated with regret over one’s characterological
proclivities. And, so on.
Table 2. Shame, guilt, remorse, and regret.

Variables Shame Guilt Remorse Regret
Trigger Social or Wish to Having hurt Having

physical break someone complicated
clumsiness rules, by an act of one’s own
or failure to do commission or life by an
prohibited omission act of
acts commission
or omission
Source Ego ideal Superego Object Narcissism
relations
Modality Visual Auditory Auditory Unclear
Physiological Marked Some Absent Absent
concomitants
Reflexive Hiding Confessing Rationalising Denying
response
Relief Acceptance Restraint Forgiveness Compensation
provided by
Origins of guilt
The search for the font origio of guilt leads us to two registers of expe-
rience and fantasy. One is made up of ubiquitous events and experi-
ences of childhood. The other is constituted by occurrences that might
be common enough but by no means are ubiquitous. The first category
leads to (i) annihilation guilt, (ii) epistemic guilt, and (iii) Oedipal guilt.
The second category leads to (i) separation guilt, (ii) induced guilt,
(iii) borrowed guilt, (iv) deposited guilt, and (v) survivor guilt. Need-
less to add that the latter four types of guilt, while originating from
idiosyncratic and serendipitous occurrences, can readily exploit the
ubiquitous roots of moral unease; in other words, the two broad catego-
ries of guilt (i.e., ubiquitous and serendipitous) can get condensed with
each other. Waelder’s (1936) “principle of multiple function” applies to
guilt as much as it does to any other psychic phenomenon.
Annihilation guilt
During childhood, our desires are simple, direct, and intolerant of
delay in their gratification. We want what we want; we despise realities
G U I LT 75
and people who come in the way of the fulfilment of our wishes. We
wish such “enemies” gone, vanished, even dead. We wish to annihilate
them. Given the limited circumference of our childhood interper-
sonal world, it is our parents and siblings who usually constitute such
“enemies”.2 They are the ones who seem to come in the way of the
immediate gratification of our wishes. No wonder we hate them from
time to time and, in the typical childhood mode of absolutism, wish
them dead. And, it is the persistence of these death wishes towards
others that becomes the bedrock of the human experience of guilt.
Unlike “annihilation anxiety” (for a formidable survey of literature on
this topic, see Hurvich, 2003), which is the distress felt due to the antici-
pated disintegration of the self, “annihilation guilt” is the distress felt at
the self-caused destruction of one’s love objects.
A particularly nuanced manifestation of such guilt is seen in those
brought up by parents who wish them dead, on a chronic basis, but
did not have the physical and moral courage to actually do the deed.
The child thus raised is unconsciously aware of the parental death
wishes (Ferenczi, 1929) and, if he or she is fortunate enough to achieve
a coherent sense of selfhood and agency, feels guilt at harbouring hate-
ful feelings towards the parents.
Epistemic guilt
An additional source of guilt is formed by our childhood curiosities
and their uninhibited expression. As children, we ask questions that
seem natural to us (e.g., “Why does grandpa smell of pee all the time?”,
“Wouldn’t Aunt Jenny die if she smokes?”) but make adults around
us uncomfortable. At other times, even mundane questions of ours
(e.g., “Dad, what time are we going out?”) are responded to by our
parents (especially if they are tired, hung over, sick, worried, etc.) with
annoyance and disapproval. In either case, we are silenced. But the
questions—and the wish to ask them aloud—remain alive within us.
And since we have internalised the adult injunctions, it makes us feel
bad. This is “epistemic guilt”.3
Curiously, development of such guilt is more marked in bright chil-
dren. Delineating the multifaceted contribution of superior intelligence
to neurosogenesis, Keiser (1969) wrote the following:
Repeatedly it was observed that the child felt guilty for being more
highly endowed than his parents or siblings. Areas of conflict
are often created because the avenues of expression that a child
of superior intelligence may have to seek are completely foreign

to the values of his family. His ambitions for an intellectual life
must frequently be kept secret until late adolescence or even
into adulthood. During the analysis, it became manifest that the
wish for an intellectual life was felt as an expression of hostility
toward the parents. Not only did these patients have the feeling
that they were rejecting their parents because they chose a profes-
sional life commensurate with their ability, but they felt rejected by
their parents because of this choice. This was felt with particular
force if they were the only member of the family with intellectual
ambitions. (p. 458)
Another special form of epistemic guilt pertains to our sexual curiosi-

ties and all sorts of “naughty” prying into our parents’ privacy caused
by them. Remember how, as children, we fearfully but fervently tried
to figure out the mysteries of sexuality? How do babies come into a
mother’s “tummy”? What are the penis and vagina actually meant to
do? What is this thing called “sex”? Is it pleasurable or painful? Do our
parents really “do it”? Such questions and the accompanying sense—
caused by the parental reaction of disapproval—that there is something
wrong about entertaining them, preoccupied us. This, too, forms an
important layer to the bedrock of guilt in all of us.
Immigration is another context that can intensify the ordinary epis-
temic guilt of childhood. Children of parents who have migrated from
repressive and collective cultures to expressive and individualistic
cultures are especially vulnerable to this. They openly ask questions
(regarding authority, rules, career trajectories, their rights, or even about
factual matters such as the history of “their” country) which their par-
ents are ill-equipped to answer. The parents, if already compromised in
their psychosocial functioning, can then retaliate by making the child
feel bad for their enquiries.
Oedipal guilt
When the “annihilation guilt” and “epistemic guilt” occur in the con-
text of early triadic relations within the family, the resulting phenome-
non is called “Oedipal guilt”. Here, the importance of Freud’s (1912–13,
1916d, 1917e, 1924b) observations is paramount. He emphasised that
“[P]arricide and incest with the mother are the two great human crimes”
G U I LT 77
(1916d, p. 333) and that the sense of guilt derived from the Oedipus
complex was a reaction to “the criminal intentions of killing the father
and having sexual relations with the mother” (ibid., p. 333). The gender
bias implicit in these pronouncements (i.e., matricide and incest with
the father being overlooked) was more or less corrected in some of his
other writings. For instance, Freud (1916–17) stated that:
As you see, I have only described the relation of a boy to his father
and mother. Things happen in just the same way with little girls,
with the necessary changes: an affectionate attachment to her
father, a need to get rid of her mother as superfluous and to take
her place, a coquetry which already employs the methods of later
womanhood—these offer a charming picture, especially in small
girls, which makes us forget the possible grave consequences
lying behind this infantile situation. We must not omit to add that
the parents themselves often exercise a determining influence on
the awakening of a child’s Oedipus attitude by themselves obey-
ing the pull of sexual attraction, and that where there are several
children, the father will give the plainest evidence of his greater
affection for his little daughter and the mother for her son. (“The
Introductory Lectures”, Vol. 16, p. 333, italics in the original)
Freud’s main point, however, remained that the erotically driven wishes
to woo the opposite sex parent and eliminate the same sex parent form
the essence of the Oedipus complex,4 and the persistence of such wishes
in the unconscious (despite their overt renunciation due to parental dis-
approval and, later, superego threat) forms a source of lifelong vulner-
ability to guilt. The greater the strength of such unconscious wishes, the
greater the amount of guilt. Success in life’s pursuits then gets equated
with Oedipal victory and mobilises guilt. Indeed, some individuals are
“wrecked by success” (Freud, 1916d, p. 316) and often engineer their
own failures. A few others become “criminal from a sense of guilt”
(ibid., p. 332), that is, they arrange to be punished by conscious mis-
deeds as an expiation for transgressive impulses in the unconscious.
Freud’s earlier (1912–13) proposal of an actual, even if “pre-historic”,
murder of the primal father having saddled man with ancestral “bad-
ness” had a similar Oedipal ring to it.
Regardless of its specific colouration and context, Oedipal guilt
invariably results in a compromised love life. Rescue fantasies towards
the “suffering mother” (in the primal scene) lead men to repeatedly
seek needy women as their love objects (Freud, 1910h), a scenario that
often ends up in frustration once the “rescue” operation is over. In
women, Oedipal guilt frequently leads to frigidity, inability to achieve
orgasm or bursting into tears at the moment of orgasm, and a com-
pulsion to get involved with abusive and betraying partners. Prostitu-
tion fantasies often colour sexuality (in both men and women) when
Oedipal guilt plays a prominent role in psychic life.
Separation guilt
The feelings of “wrongdoing” that narcissistic and needy parents incul-
cate in their children when the latter begin to take steps towards psychic
autonomy and independence is termed “separation guilt” by Modell
(1965). Here the child’s ego advances are age-specific and maturationally
appropriate but are rendered doubt-ridden and “bad” by the parental
response to them. Pine’s (1997) useful distinction between “separation
anxiety” and “separateness anxiety”5 is, however, important to keep
in mind; the former refers to the mobilisation of anxiety due to actual
separation from love objects, the latter refers to the anxiety that results
from experiencing oneself as an autonomous source of agency, thought,
feeling, morality, and action. In light of this, it is better to call the bad
feeling aroused by parental rejection of the growing child’s autonomy
as “separateness guilt”. Regardless of which label one uses, this sort of
guilt is seen more often in children raised by self-centred, sickly, lonely,
and otherwise needy parents.
One situation which can contribute to such guilt with particular
ferocity is that of immigration. Children of immigrant parents often
experience an “acculturation gap” (Prathikanti, 1997) between their
parents and themselves. This has the potential of causing role reversal
between them. As a result, children can be placed in a position where
they have to “translate” (literally or metaphorically) the ways of the
culture-at-large for their parents. This may range from innocuous
advice on how to operate a VCR or a computer to the more serious
interventions of advocacy in medical and legal settings that are beyond
the full comprehension of immigrant parents; clearly, this is more likely
to occur if the older generation is less educated, non-optimally accul-
turated, and not proficient in English. Lan Cao (1997), a Vietnamese
American writer, described such role reversal in poignant terms:
G U I LT 79
The dreadful truth was simply: we were going through life in

reverse, and I was the one who would help my mother through
the hard scrutiny of ordinary suburban life. I would have to forego
the luxury of adolescent experiment and temper tantrums, so that I
could scoop my mother out of harm’s way and give her sanctuary.
Now, when we stepped into the exterior world, I was the one who
told my mother what was acceptable and inacceptable behavior.
And even though I hesitated to take on the responsibility, I had no
choice. (p. 35)
The consequences of such role reversal are that the child comes to
know the family’s financial, medical, and legal secrets somewhat
prematurely. This can burden his ego. More importantly, the parental
dependence makes the child’s developmentally appropriate movement
toward separation and autonomy guilt-ridden.
Induced guilt
A related phenomenon is “induced guilt”. This refers to the feeling of
“badness” that arises in a child when the parents vociferously announce
the suffering they have undergone in raising him. For instance, mothers
who repeatedly tell their child about the difficulties in her pregnancy
and labour (“You know, when you were born, I bled so much that I
nearly died”) end up burdening him with profound guilt (Asch, 1976).
Similarly, immigrant parents who parade their culturally dislocated
lives as a sacrifice for their offspring (“We came to this country so that
you can have a better life”) cause the latter to suffer enormous amounts
of guilt (Akhtar, 2011a). Espiritu (2009) notes that “We did it for the
children” is a common refrain among Filipino immigrants. However,
this might also apply to many other groups, including those from India,
Pakistan, Mexico, and African and Central American countries. The
refrain has a more nefarious twin: “We stayed in this country because
of you guys.” This conveys to the child that the parents are suffering
on a daily basis and are tolerating it only for the sake of their children.
Such declarations on the parents’ part can saddle their offspring with
much guilt.
Children of Holocaust survivors are also vulnerable to induc-
tion of guilt by their parents. Having undergone extreme suffering,
the latter often fail to recognise their children’s age-specific doubts
and apprehensions (Brenner, 2004; Kestenberg, 1980). To a child

complaining about his or her day-to-day angst, such parents tend to
respond by saying: “You do not know what being in trouble means!” Or,
“You call this a problem? You have no idea what I have gone through,”
and so on. The child exposed to such retorts feels badly about voicing
his problems and becomes guilt-ridden.
More frequent than such dramatic inductions of guilt are instances
where parents discourage a child’s authentic strivings and make him
feel guilty for being unique and different from them. Highlighting such
dynamics, Frattaroli (2013) states that:
… highly narcissistic parents who induce this kind of soul-crushing

guilt cannot tolerate, let alone appreciate, their child’s unique indi-
viduality. They systematically violate the sacred play space between
parent and child, invalidating or punishing any spontaneous ges-
ture of the child’s True Self, making them feel guilty and ashamed
about what is most alive in them, as if any genuine self-expression
is an offense punishable by death or shunning. (p. 90)
Borrowed guilt
A counterpart to parentally induced guilt is what, for the lack of a bet-
ter term, might be called “borrowed guilt”. This consists of a growing
child taking the blame for parental mistreatment upon himself and
exonerating them altogether. Such development, designated “moral
defence” by Fairbairn (1940) has two origins: (i) the child’s ego-centric
perception which precludes an awareness of independent motivation
on the parents’ part, and (ii) the child’s attempt to preserve some hope
of things getting better. In other words, if the child allows himself to feel
that his parents are “bad”, then the situation becomes unbearable since
he has no other place to go and no one to seek love from. But, if he feels
that it is he who is “bad”, then, by behaving better, he can hope that his
parents might treat him kindly and stop abusing him.
Deposited guilt
This type of guilt results from the child’s succumbing to the “projec-
tive identification” (Kernberg, 1975; Klein, 1935) of their parents’ guilt.
In other words, parents feel guilty about something and cannot bear
G U I LT 81
it. They split their guilt-ridden self-representations off and deposit

them in their child. Then they subtly manipulate him to live these
attributes out. An illustration is formed by a father who feels guilty
about harbouring hostility towards his own father; he can ward off
this intrapsychic burden by harshly criticising his son for every little
transgression of family rules. Repeated over a long period of time,
especially during the formative years of childhood, such “depositing”
(Volkan, 1987) results in a son who is chronically guilt-ridden due to
no fault of his own.
Once again, children of Holocaust survivors are vulnerable to
such guilt. Parents who might hold themselves responsible (rightly
or wrongly) for the death of relatives in concentration camps, might
project their guilt and “deposit” it in their offspring. The latter then feel
strangely guilty and remorseful, without knowing what is the crime
they are supposed to have committed. Immigration also constitutes a
particularly fertile ground for such developments. Elsewhere, I have
elucidated this phenomenon in some detail.
Children of immigrants can become the “containers” (Bion, 1967[a])

of the parental guilt that is deposited into them. Though idiosyn-
cratic and highly personal variables can lie at its roots, such paren-
tal guilt is usually the result of their having left family members
and friends behind in the country of origin, becoming more afflu-
ent than them, and living in a new country with less than complete
loyalty to it. Such guilt is greater if the move has been from less
affluent and politically unstable countries. And, if the grief over
leaving one’s country and the associated guilt are not adequately
“mentalized” (Fonagy & Target, 1997) and mitigated by the means
of reparative measures, it can be passed on to the next generation,
neatly gift-wrapped in cultural rationalizations. (Akhtar, 2011a,
p. 173)
While true, this statement does not mean that “deposited guilt” is
restricted to the children of immigrants. Parents who are carrying a
heavy load of guilt due to any reason (e.g., corruption at work, cheat-
ing in their marriage) can shift the burden of their remorse and make
their children feel guilty. The latter then develop a proclivity for
masochism in a phenomenon that is best termed “self-punishment
by proxy”.
Survivor guilt
This type of guilt is seen among individuals who suffer from lifelong
anguish over their escaping the fatal blow that fell upon their friends
and family members. Niederland (1968), who originally described such
guilt in the context of Holocaust survivors, states:
In order to understand more fully the pathogenesis of the survivor

syndrome, I repeatedly stressed the need for a sharper focus on
the all-pervasive guilt of the victim as well as the need for a sort of
hyperacusis to guilt on the part of the analyst who has to be aware of
the difficulties because of repression, elaborate defenses, and deni-
als that tend to obscure the guilt. The patients’ guilt-ridden fear of
emotional closeness, their frequent attempts to assuage guilt, their
repetitive guilt-ridden fantasies and dreams about death, violence,
destruction, and their lost love objects, not only demonstrate the
marked ambivalence toward the latter but also resort from the
sadistic and incorporative fantasies leading directly to guilt in
orally-regressed personalities and situations. (p. 314)
It is also seen in those who have outlived comrades killed in combat

and loved ones in accidents. Individuals whose parents died during
their childhood and individuals raised with a grossly impaired sibling
are vulnerable to “survivor guilt” as well. The death of a child almost
invariably leaves a residue of such guilt in his or her parents. One vari-
able that might determine the intensity of guilt in such situations is
whether the escape from ill fortune is the result of an active decision
made by the survivor or due to mere happenstance (Mark Moore, per-
sonal communication, 3 April, 2008). A teenager who defies a parental
curfew and upon his return home finds a parent killed due to a house
fire feels more guilty than one who is unscathed in a car accident which
kills the driver-parent.
Extending Niederland’s ideas further, Modell (1965) proposed that
a sense of guilt can be precipitated by “… the awareness that one has
something more than someone else. This sense of guilt is invariably
accompanied by a thought, which may remain unconscious, that what
one has obtained is at the expense of taking something away from
somebody else” (p. 328). This sort of guilt might get condensed with
other sources of pre-Oedipal or Oedipal guilt but remains a dynamic
G U I LT 83
entity unto itself. The guilt Western tourists experience while visiting
the poor nations of Africa and Asia is the type that Modell has deline-
ated. It is based upon the awareness of being more fortunate than oth-
ers; to be sure, unconscious childhood wishes of robbing one’s siblings
(of mother’s love) and feelings of contempt towards the less fortunate
also play a role in the genesis of such guilt.
Having elucidated the various origins of guilt, we can move on to the
consequences of guilt. The question, “What causes guilt?” has a coun-
terpoint in “What does guilt cause?”
Adverse consequences of guilt

Feelings of guilt—and remorse—can exert considerable influence
upon the course of an individual’s life. The impact is greater if the
guilt is excessive, the ego is weak, and access to receiving forgiveness
(for guilt) and making reparation (for remorse) is blocked. Moreover,
bearable amounts of guilt and remorse, especially when existing on a
conscious level, are more amenable to productive outcomes. Uncon-
scious guilt, in contrast, is vulnerable to defensive distortions that, in
turn, lead to maladaptive behaviour patterns. In clinical practice such
outcomes appear to result from (i) projection of blame, (ii) externalisa-
tion of persecutor, and (iii) libidinisation of suffering, leading to maso-
chism and self-punishment.
Projection of blame
Guilt is often warded off by attributing blame to others. By irritable nit-
picking, the guilty individual shifts the burden of contrition to someone
else. Finding faults in others relieves him of self-criticism. Paranoia thus
becomes a useful defence against depressive anxieties. In his elucida-
tion of the relationship between guilt and hate, Jones (1929) made the
following astute observation.
Hatred for someone implies that the other person, through his cru-
elty or unkindness, is the cause of one’s sufferings, that the latter
are not self-imposed or in any way one’s own fault. All the respon-
sibility for the misery produced by unconscious guilt is thus dis-
placed on to the other, supposedly cruel person, who is therefore
heartily hated. The mechanism is, of course, very familiar in the
transference situation. We know that behind it there always lies

guilt, but further analysis still shows, in my opinion always, that
the guilt itself is dependent on a still deeper and quite unconscious
layer of hate, one that differs strikingly from the top layer in not
being ego-syntonic. (p. 384)
Clinically, this is evident in patients who chronically complain about

others’ behaviour while overlooking their own role in provoking such
mistreatment. Many “injustice collectors” (Bergler, 1961) carry a heavy
burden of guilt over their own aggression underneath their persistent
portrayals of others as wrong and blameworthy. Societally, this mecha-
nism is responsible for political leaders blaming “outsiders” for prob-
lems of their people while ignoring the ways in which they themselves
have contributed to these problems. The Osama bin Laden–George
Bush diatribe is a case in point. Osama bin Laden held Western, par-
ticularly North American, cultural imperialism and political hegemony
responsible for the turmoil in the Islamic world, taking little notice of
how the corrupt and autocratic leaders of Muslim nations were equally,
if not more responsible for the crises there. George Bush, a pro at exter-
nalisation himself, put the blame of America’s problems on Muslims
“out there” who simply did not like “our way of life” and were out to
destroy it;6 he closed his eyes to how the policies of the US government
themselves were corroding the fabric of education, health care, and
employment opportunities in the nation. Bin Laden blamed the West,
Bush blamed the Middle East. Neither were willing (or able) to look at
their own dismal records.
Externalisation of the persecutor

Another pathological consequence of unconscious guilt is that it under-
goes externalisation and gives rise to undue fears of adverse occur-
rences (Jones, 1929). The dread might remain diffuse and create all sorts
of doom and gloom scenarios in the mind. Or, it might be focused upon
authority figures. Employers, policemen, and other individuals in posi-
tions of power then begin to appear too intimidating. One lives a life
of fear and avoidance, though unconscious hostility towards authority
figures (the original cause of guilt) often breaks through and serves as
an agent provocateur of punishment. Locating this dynamic within the
Oedipal context, Jones (ibid.) observed that:
G U I LT 85
If the self-punishing tendencies are at all highly developed, we

may expect to find that the patient will provoke the outer world,
i.e. father-substitutes, to inflict punishments on him, and it is easy
to see that this is done in order to diminish the sense of guilt; by
provoking external punishment the patient saves himself from
some of the severity of internal (self-) punishment. We get three
layers very alike to the other sets of three mentioned above: first
dread of external punishment (e.g., by the father); then guilt and
self-punishment to protect the personality from the outer one, the
method of religious penance; and finally, the evoking of external
punishment, a disguised form of the original one, so as to protect
the personality from the severity of the self-punishing tendencies.
(p. 386)
That externalisation of the source of persecution wards off repressive

anxieties is evident at the large-group level as well. The ubiquitous
human “need for enemies” (Volkan, 1988)—evident at both individual
and group levels—is often determined by this very pathway. By con-
structing others at threatening, an individual forecloses enquiry into the
unacceptable parts of his own mind. By designating the other partner
as selfish, unempathic, and even sociopathic, warring spouses avoid
looking into how they themselves might have contributed to the mari-
tal unhappiness. By locating the source of its problems outside its geo-
graphical boundaries, a nation precludes the scrutiny of how its own
domestic policies contribute to the distress of its people.
Libidinisation of suffering
This is perhaps the most common manifestation of guilt in clinical prac-
tice. Guilt gives rise to a need for punishment and to masochism which
satisfies this need. Since this is a realm of great clinical importance, it
might not be bad to look into the “need for punishment” and “maso-
chism” concepts a bit more carefully.
Sigmund Freud’s ideas about what he called the “need for punish-
ment” evolved in four steps: (i) In “Notes upon a Case of Obsessional
Neurosis” (1909d), he noted that the self-reproaches of the obsessional
neurotic were forms of self-punishment; (ii) In “Some Character Types
Met with in Psycho-Analytic Work” (1916d), he described a character
type called “criminal from a sense of guilt”; this constellation involved
committing outrageous and socially unacceptable, even criminal, acts
in order to elicit punishment and relieve unconscious guilt; (iii) In The

Ego and the Id (1923b), he described the phenomenon of “negative
therapeutic reaction” whereby the analysand responds adversely to a
correct interpretation, thus betraying his difficulty with improvement;
this, too, is an evidence of unconscious guilt; and (iv) In “Neurosis and
Psychosis” (1924b), he talked about how the “need for punishment” can
become sexualised. What was an attempt to seek superego retribution
now turns into an instinctual gratification itself.
Such gratification is subsumed under the concept of “masochism”.
A term coined by von Krafft-Ebing (1892) as a generalisation for the
erotic role of pain and humiliation in the novels of Von Sacher Masoch;
“masochism” consists of being dominated, controlled, hurt, and humil-
iated by a person of the opposite sex for the purpose of erotic gratifica-
tion. This narrow definition led to Freud’s (1905a, 1915c, 1919h, 1920g,
1924c) wide-ranging ideas about masochism. The trajectory of these
speculations dovetails the evolution of his instinct theory in general
and the Oedipal situation in particular. To begin with, Freud (1905a)
regarded sadism and masochism as component instincts of sexuality
and declared that they invariably coexisted; it was thus heuristically
better to speak of sadomasochism than of sadism and masochism
alone. In his first dual instinct theory, Freud (1905a, 1915c) regarded
sadism—a pleasurable infliction of pain upon others—as primary
and masochism as secondary (being a deflection of sadism upon the
self). In his second dual instinct theory, Freud (1920g) proposed that
masochism was a manifestation of the death instinct; it was primary,
and sadism, its outward deflection, was secondary. In these and other
papers (e.g., 1919h, 1924c), Freud related masochism to the fantasy of
being beaten by the father and saw it as providing both sexual satisfac-
tion and punishment for one’s forbidden wishes. He thus introduced
the intricate relationship masochism has with guilt and divided maso-
chism into three types: (i) primary, which was the somatic substrate of
the death instinct bound with the libido of the life instinct; the pleasure
in pain came from the latter source; (ii) erotic or feminine, which was the
attitude underlying sexually exciting fantasies in men of being bound,
beaten, and humiliated,7 and (iii) moral, which emanated from an
unconscious sense of guilt and led to chronic self-depreciation and self-
punishment. Analytic investigators following Freud (e.g., Bergler, 1961;
Berliner, 1958; Brenner, 1959) elaborated, elucidated, and expanded
the meanings of the term “masochism”. This led, on the one hand, to
increasing sophistication of understanding, and on the other hand, to
G U I LT 87
the term “masochism” acquiring “a confusing array of meanings and

connotations drawn from varied levels of abstraction … [which] may
falsely suggest underlying similarity between fundamentally different
phenomena” (Maleson, 1984, p. 325).
A natural corollary of the evolving psychoanalytic ideas on maso-
chism was the concept of “masochistic character”. While a large number
of analysts have contributed to its understanding, the views of the fol-
lowing seem most prominent. Reich (1933) proposed that “masochistic
character” arose out of severe childhood frustrations; much aggression
was mobilised, but, instead of being discharged on frustrating others,
was defensively directed at oneself; individuals with a “masochistic
character” were passive–aggressive, guilt-inducing, and coercive in
their demand for love. Berliner (1958) sidelined the instinctual basis of
masochism and emphasised its object-relational value. Masochism, for
him, was a child’s way to cope with his sadistic parents. The maso-
chist mistreated himself and sought mistreatment by others because his
superego was patterned after his cruel parents; love of suffering was
an adaptive response to an abnormal childhood environment. Brenner
(1959), in contrast, declared that masochism represented the accept-
ance of a painful penalty for forbidden sexual pleasures associated
with Oedipal fantasies. Bergler (1961) saw masochism as “a desper-
ate attempt to maintain infantile megalomania” (p. 18). The masochist
unconsciously provokes and enjoys rejection but consciously reacts
with righteous indignation. This helps him deny his responsibility in
the rejection and his unconscious pleasure in it. After the outburst of
pseudo-aggression, he indulges in self-pity and unconsciously enjoys
the wound-licking. Cooper (1988), who highlighted the coexistence
of narcissism and masochism, proposed the concept of “narcissistic-
masochistic character” (see Chapter Five on betrayal for further details
on this personality constellation). Individuals with such psychopathol-
ogy seek suffering for their instinctual excesses and find justification for
these excesses in their suffering.
Salutary outcomes of guilt and remorse

Guilt and remorse are, in themselves, neither “good” nor “bad”. It is
their underlying causes and, more importantly, their psychic handling
and, after that, their behavioural management which determine whether
matters have turned out to be “good” or “bad”. To be sure, healthier
ways of handling guilt and remorse exist than the mechanisms of
projection, externalisation, and masochistic libidinisation described

above.
Permitting oneself to be aware of unease at wanting to break rules—
“signal guilt” in Fenichel’s (1945, p. 136) terms—can stop one from
giving in to unruly temptations. Recognising that one also harbours
impulses to commit social infractions (e.g., stealing, sexually licentious
behaviour, violence) can curtail the tendency to harshly judge others.
Seeing that just across the abyss of guilt is the terrain of one’s corrupt
and immoral self can result in humility. Confessing one’s real and/
or imaginary “crimes” can serve as a stepping-stone for deeper self-
scrutiny, including seeking psychotherapy or psychoanalysis. Taking
account of all this, it is instructive to note that William Menninger, who
raised many millions of dollars to finance the Menninger Clinic’s edu-
cational and research programmes, often spoke of “the constructive
power of guilt” (quoted in Rosen, 2009, p. 372).
Experiencing remorse, too, can have positive consequences. It cuts
through the “manic defense” (Klein, 1935) of regarding oneself as
blemish-free and diminishes the need for denial and rationalisation.
This, in turn, improves reality-testing. Apologising to the individual one
has hurt, neglected, or betrayed might follow. The possibility of being
forgiven is thus enhanced. Acknowledgment of one’s “bad” behaviour
and expressing contrition raise the self-esteem of the victim and there-
fore go a long way in repairing the damaged relationship between the
victim and the perpetrator.8 Offering reparation as a subsequent step
further diminishes the perpetrator’s remorse and the victim’s sense of
hurt and violation. However, it should be noted that material repara-
tion in the absence of acknowledgement of wrong-doing and apology
can further humiliate the victim and deepen his or her psychic wound.
The application of these ideas to the justice system at large merits
further enquiry. Not unaware of the limitations of restorative justice,
Harding (1999) proposes that it is important that opportunities be pro-
vided to the offender to understand the significance of the victim’s
experience and to make appropriate gestures of remorse and atone-
ment. Chase (2000) reports upon the “victim-offender conferencing pro-
gram” (developed in the United States during the mid-1970s) in which
the court brings offenders and their victims together with a neutral
facilitator. During the meeting, the offender is offered an opportunity
to apologise to his victim, an action that is often met with relief on the
part of both parties.
G U I LT 89
The principle of “doing good” to undo the “bad” undergirds the

rehabilitative dimension of the justice system as well. Guilt and remorse
are washed away by years of good conduct (even if it is done behind
bars) and the damaged internal objects can be more or less restored by
acknowledgement of wrongdoing, apology, reparation, and reformed
behaviour. Often matters do not need to go this far and a guilty indi-
vidual is able to “balance” his inner sense of unworthiness by devotion
to civic service and philanthropy.
Technical implications
Freud’s (1912e) injunction that the psychoanalytic attitude involves “not
directing one’s notice to anything in particular” (p. 111) has been tem-
pered by later technical innovations which speak not only of sharply
focused attention (Brenner, 2000; Gray, 1994) but also of therapeutic
“strategy” (Levy, 1987) that dictates measured and deliberate tracks of
interventions. The comments I am about to make upon working issues
of guilt and remorse in the clinical situation are in this latter spirit.
However, to my mind, the “free-floating responsiveness” (Sandler &
Sandler, 1998) and strategic confrontations and clarifications are not
opposed to each other. Good psychoanalytic work fluctuates between
these two polarities. It is quiet and lambent at one moment and forceful
and direct at another.
Having stated that, I propose that technical handling of guilt and
remorse involves a multi-pronged strategy which takes the following
six factors into account: (i) interpretation of the defences against the
awareness of guilt, (ii) interpretation of the defences against the aware-
ness of the masochistic pleasure drawn from guilt, (iii) interpretation
of the unconscious sadistic aspects of chronic self-blaming, especially
in the context of transference, (iv) reconstruction of the sources of guilt,
(v) interpretation of defensive functions of guilt (e.g., against lack of
omnipotence in those who have lost parents as children), and (vi) help
with bearing some guilt and finding productive ways of dealing with it.
A brief explication of each of these follows.
Interpretation of defences against the awareness of guilt

Overt self-accusation is infrequently encountered in clinical practice.
Derivative forms of guilt and remorse are, however, common, and
present in myriad ways. For instance, the patient cannot tolerate
happiness and success. Or, he cannot acknowledge receiving love. He

chronically blames others and fills up each session by old and new
anecdotes of having been treated unjustly. If the patient is lonely and
has few love objects, he keeps the analyst “safe” from such blame and
restricts the “injustice collecting” (Bergler, 1961) to the extra-clinical
realm. If the patient does have a well-populated interpersonal life, the
analyst is dragged into his paranoid defences faster. In either case, the
forceful projection of the patient’s harsh superego has to be interpreted.
By continually constructing himself as a victim of others, the patient is
warding off the awareness of the fact that, above all, he is a victim of
his own self-hatred and guilt. This needs to be pointed out and made
into a topic for consideration. The anxiety in the path to recognising this
and the consequent squeamishness need to be empathised with and
the unmasking of the unconscious guilt should be done in a piecemeal
manner.
Interpretation of defences against the awareness of masochistic

pleasure drawn from guilt and remorse
Masochism involves drawing pleasure from pain. Guilt and remorse
constitute its powerful catalysts and triggers. As an analyst and psy-
chotherapist, one frequently comes across patients with ferocious
superegos and severe masochistic inclinations. They curse themselves,
call themselves names (e.g., “fatso”, “monster”) and, in one form or
another, indulge in endless self-condemnation. These are their ways of
paying back their conscience without really intending to actually do
anything different. They are mea culpas. Such patients are often una-
ware of the fact that they are drawing a certain kind of pride and joy
from their proclamations. This masochistic pleasure has to be brought
to their attention though there is always the risk that they will regard
such an interpretation as yet another assault. Nonetheless, gently point-
ing out that their pain might have “additional” aspects often constitutes
the first step. This might be followed by bringing to their attention the
zeal and near-excitement with which they report occurrences of shabby
treatment. Still later, a question might be raised if they “like” unpleas-
ant affects aroused in them. If none of this brings resolution, the analyst
might be forced to “refuse to listen” (Akhtar, 2011c) to endless maso-
chistic tales and thus block the instinctual discharge (and pleasure) in
the repeated recounting (see also Sharpe, 1940, in this context).
G U I LT 91
Interpretation of the unconscious sadism in self-blaming

Patients who constantly curse themselves, call themselves names,
declare themselves incurable (while coming with striking loyalty to all
their sessions), seem to manifest what Procci (1987) has called “mock-
ery through caricature”. Using this mechanism, an individual emulates
a harsh parent to the extreme. This allows him or her to maintain an
ongoing tie with the primary object. However, the limit of success in
patterning one’s behaviour after the cruel parent exposes to the world
the unfairness and absurdity of the parent. Pseudo-compliance with
the anti-instinctual attitudes to the extent of caricature ends up mock-
ing the parent and thus covertly discharging the repressed regression
towards him or her.
Within the transference-countertransference realm, such tenacious
self-castigation and “militant hopelessness” (Poland, cited in Mathias,
2008) have a devastating impact upon the analyst’s sense of aliveness,
usefulness, and creativity. That the patient is suffering must never be
overlooked. However, sooner or later in the course of treatment and
with “affirmative interventions” (Killingmo, 1989) firmly in place, the
sadistic dimension of the patient’s masochism has to be brought up for
consideration. If this stirs up further self-condemnation (which reflects
a combination of genuine remorse vis-à-vis the analyst and an intensi-
fication of masochistic sadism), then that has to be handled firmly with
interpretation.
Interpretation of the defensive function of guilt

Alongside the interpretation of the sadomasochistic discharge via guilt
self-recrimination, the defensive functions of guilt need to be uncov-
ered. It should be remembered that guilt and remorse can themselves
acquire manic aims in order to ward off genuine sadness at what has
happened and what one has done. Moreover, constantly feeling guilty
can serve as a shield against competitive and acquisitive desires that,
despite having been caught in conflict, might be developmentally
appropriate. Guilt can also mask the dread of weakness. Remorsefully
holding oneself responsible for the death of a parent during childhood,
for instance, protects one from the horror of realising that it happened
despite one’s goodness and there was utterly no recourse to an alterna-
tive outcome in this scenario. Finally, guilt and remorse can also serve
as defences against one’s goodness and robust capacity for pleasure

especially if these elements have become ego-dystonic due to the dis-
couraging and disparaging treatment by early caregivers (and their
later internalisation).
Reconstruction of the sources of guilt

This is a matter fraught with difficulty. Too early an attempt at recon-
struction runs the risk of oversimplification of the patient’s problems
and fuelling the patient’s tendency to project and externalise. At the
same time, validation of early trauma (especially if it was gross, sus-
tained, and severe) is essential. The analyst therefore has to oscillate
between the broad strokes of such validation and finer brush paint-
ing of moment-to-moment analysis of associations. Space must be left
for surprises to surface and for the patient’s “personal myth” (Kris,
1956)—a rationalised but incomplete autobiographical narrative—to
gradually dissolve. Vectors of the patient’s own agency and even selec-
tivity in establishing internal objects (Corradi-Fiumara, 2009) must
be assimilated into finer reconstructions during the later periods of
treatment.
Help with bearing guilt and finding productive

ways of dealing with it
The analyst has to make sure that the result of his patient’s diminishing
guilt and masochism is not the emergence of narcissism and sadism but
that of humility and concern. The analyst
[…] must convey to the patient not only the direction he wants
the patient to move in, but also confidence that the movement is
inherent in the patient, which means that what the uncured patient
wants is indeed a representation, however distorted, of what the
cured patient will get. (Friedman, 1969, p. 150)
Such movement is facilitated if the analyst retains faith in the patient’s

healthy capacities for growth, a proposition reflecting Loewald’s (1960)
outlining of the childhood need to identify with one’s growth potential
as seen in the eyes of one’s parents.
G U I LT 93
Concluding remarks
In this chapter, I have described the subjective experience of guilt and
distinguished it from the related phenomena of shame, remorse, and
regret. I have traced the origins of guilt to infantile and childhood
aggressive and hostile impulses, both outside and within the Oedipal
context. I have tried to show that Klein’s work is more pertinent to
pre-Oedipal remorse and the consequent drive of reparation while
Freud’s work is more pertinent to Oedipal guilt and the consequent
need for punishment. In addition, I have noted that seeds of lifelong
guilt can be sown by parental proclamations of suffering and sacri-
fice on behalf of their children, by parental depositing of their own
unresolved guilt into the children’s psyche, by parental intolerance of
their children’s developmentally appropriate strivings for autonomy,
and by accidents of nature and random occurrences that leave the
individual in a more fortunate position than his loved ones. Finally,
I have delineated three pathological outcomes (projection, externali-
sation, and libidinisation) and one healthy (apology and reparation)
outcome of guilt.
Despite casting a wide net, I have not been able to address two
important issues, namely, the impact of gender and of culture upon
the experience of guilt. Both variables demand attention but the
burgeoning literature on these topics defies a quick summary here.
Suffice it to say that (i) it is conceivable that some cultures (e.g., Japan)
are more driven by shame (Kitayama, 1997) and others by guilt,
(ii) the earlier report of a high rate of suicide in Germany, Austria,
Japan, and Switzerland and the low rate of suicide in Holland, Italy,
Brazil, and Spain (Weiss, 1974), as well as the more recent assertion
(Nock, Borges & Ono, 2012) that rates are highest in Eastern Europe
and lowest in Latin American countries make one wonder about the
culturally determined vulnerability to guilt and self-punishment,9
and (iii) in a sharp rebuttal to Freud’s (1923b, 1925j) denigration of
women’s morality, recent studies (e.g., Bernstein, 1983; Gilligan, 1982)
have found differences in the nature, not in the strength, of the female
superego when compared to its male counterpart. The relevance of
such culture-based and gender-specific insights to the understanding
of guilt in its clinical and non-clinical dimensions is indeed great and
needs to be pursued further.
Notes
1. This traditional viewpoint is called into question by the concepts
of “deposited” and “induced” guilt; these are discussed later in this
chapter. Moreover, the long-held position that the capacity for genuine
guilt is a post-Oedipal development has been called into question by
the epigenetic scenarios postulated by Klein (1937, 1940) and Winnicott
(1954, 1956b). These theorists place the origin of guilt in the child’s early
dyadic relationship with mother, though their use of the term “guilt”
differs in important ways from that of Freud’s (1912–13, 1916d, 1924a).
This difference is taken up in the later parts of this chapter.
2. Freud (1916–17) notes that while murderous impulses are a regular com-
ponent of the childhood Oedipal experience, such wishes are even more
strongly felt and verbalised in the context of the sibling relationship.
3. The biblical tale of Adam and Eve is an illustration par excellence of such
“epistemic guilt”.
4. Clearly, the opposite is the case in the context of homosexuality; for
literature pertaining to this matter, see Akhtar, Comprehensive Dictionary
of Psychoanalysis (2009, pp. 131–132).
5. Pine emphasises that all anxiety at separation is not “separation anx-
iety”. For instance, a patient who feels anxious upon learning of his
analyst’s vacation may be responding to a drive upsurge consequent
upon the removal of an externalised superego. Or, he may be respond-
ing to an anticipated disorganisation of the self. The former anxiety,
while precipitated by separation, is not true “separation anxiety”, since
the separation in question is from a well-differentiated object. True
“separation anxiety” involves a relationship with an undifferentiated
other and is therefore an “anxiety over the sense of separateness” (1997,
p. 230). This is better termed “separateness anxiety”.
6. Such anti-Islamic xenophobia led to the emergence of the “good
Muslim, bad Muslim” dichotomy in the public mind. Mamdani’s (2004)
penetrating analysis of this issue details the unfortunate consequences
and politico-economic antecedents of this development.
7. The fact that all the cases from which Freud drew the idea of “feminine”
masochism were males betrays a certain rigid preconception of
theorising.
8. Sexual abuse literature pays special attention to this issue, with some
family therapists (e.g., Madanes, 1990) requiring the perpetrator to
actually, even ritualistically, apologise to the victim in front of other
family members.
9. Clearly, more than guilty self-punishment contributes to suicide and
the rates cited here might not be entirely reliable since the reporting
patterns of suicide vary from country to country.
PART II
SUFFERING INFLICTED
CHAPTER FOUR
Deception
W
hile overtly destructive acts derived from rage and hatred
draw sharp clinical and public attention, far more damage is
done to human relations by the quieter evils of lying, cheat-
ing, and deceit. In myriad forms that range from pretentious decorum
at official events to pseudo-cordiality among political adversaries, from
socially convenient bending of truth to outright lying for monetary
gain, and from laborious inflation of the self to deliberate fraud for
seducing others, deception corrodes trust that is the glue of attachment
and interpersonal bonds. Regardless of its form, deception arises from
trauma and causes suffering to self and others. A common denominator
in various types of deception (e.g., mendacity, forgery, betrayal) is the
existence of a lie.
It is this central feature that I will address in this contribution. I will
begin with elucidating the formal characteristics of lies and the motiva-
tions that propel individuals to distort the truth. In the passages that
follow, I will take up the developmental achievements necessary for
the capacity for lying to emerge. Then I will make a brief sociocultural
foray into the worlds of art and entertainment, politics, propaganda,
advertising, forgery, and counterfeit. Following this digression, I will
return to the clinical realm and address the implications of lying for
97
conducting psychotherapy and psychoanalysis. I will conclude with a

few synthesising remarks.
About lying in general

Borrowing a phrase from the former vice-president of the United States
and Nobel Prize winner, Al Gore, I wish to begin this discourse on lying
with some “inconvenient truths”. Here they are:
• Everyone lies.
• Anyone who claims to be forever truthful is telling a lie.
• It is undesirable to be truthful under all circumstances.
• Lying is essential for smooth social dialogue and interpersonal
politeness.
• Different forms and varying extents of lying are integral to many
socially useful lines of work.
• Lying can at times save lives.
• Since all sorts of grey areas exist between what constitutes a lie and
what constitutes a truth, it is not always easy to separate the two.
• The inherent “truth bias” (Feldman, 2009) of human beings makes
them prone to believe what they are told and compromises their
capacity to discern lies.
• Even in forensic settings where distinguishing between truth and lies
is of paramount importance, there is no foolproof method to detect
deception (Watson, 2009).
• Lies come in many shapes and forms even though they share certain
common features.
In order to grasp the various formal characteristics of a lie, it might

not be out of place to begin with a simple dictionary definition. A lie,
according to Webster’s Ninth Collegiate Dictionary (1987) is “an untrue
statement with intent to deceive” (p. 689). Also included in the explana-
tory comments that follow the initial crisp definition are phrases like
“an assertion of something known or believed by the speaker to be
untrue” and the deliberate creation of a “false or misleading impres-
sion” (p. 689). Pooling these titbits with the notion of lying implicit in
the well-known judicial instruction to tell “the truth, the whole truth,
and nothing but the truth” leads one to the idea that a lie can be told in
DECEPTION 99
many ways. Lying is a multifaceted sport with diverse moves available

to the deft player. Some prominent forms of lying are:
• Not telling the truth. Remaining silent while being asked to respond
to a question, the answer to which one actually knows, constitutes
a lie.
• Replacing the facts one knows to be true by false and misleading
information.
• Telling the truth but not the “whole truth” and, by such withholding
of parts of relevant information, altering the inference to be drawn
from one’s report.
• Telling the truth but embellishing it in a way that results in a carica-
ture and thus puts its veracity in question. The mechanism of “denial
by exaggeration” (Fenichel, 1945) belongs in this category.
• Flatly and forcefully questioning and even repudiating an estab-
lished truth. The phenomenon of “gaslighting” (Barton & Whitehead,
1969) where one individual seeks to drive someone crazy by stirring
up doubts about the latter’s perception is an example of this type of
lying. Instances of “soul murder” (Shengold, 1989) where a child’s
perception is ruthlessly erased by a cruel and abusive parent, and
the denial of Holocaust, are other examples from individual and
collective arenas, respectively, of this very type of lie.
• Acknowledging the truth about a certain matter but retrospectively
imputing motives to it that were not in operation earlier. The ego
operation of “sliding of meanings” (Horowitz, 1975) seen in narcis-
sistic personalities is an example par excellence of such a strategy.
What all this demonstrates is that lies come in many forms.1 From bald-
faced assertions of falsehood to subtle distortions or reality, lies elude
simplistic nosological traps. To discern them, one is not only required
to pay close attention to what is being said and why but also to what
is not being said, what is being exaggerated, what is being minimised,
and what is being painted with a revisionist brush. One also has to take
into consideration the intrapsychic and interpersonal context in which
a lie is being constructed and conveyed; lying invariably involves a
self-object scenario, however deeply buried under narcissistic grounds
that might be. And this brings up the consideration of the motivational
dynamics behind lying.
Like all human behaviour, lying is multiply determined (Waelder,

1936). Each lie involves instinctual pressures, narcissistic interests,
superego defects, and ego loopholes. Each lie is a cavern of a wishful
fantasy and an attempt to ward off a dreaded imaginary scenario. Each
lie constitutes a psychic manoeuvre to alter the self-object relations; the
object involved might be a specific human being or a diffuse world of
people and institutions. Each lie has origins and consequences both
within the subject’s psyche and his or her interpersonal surrounds.
Each lie creates something and destroys something. Being opposed to
truth, each lie, to a greater or lesser extent, attacks, or at least bypasses,
the great realities of separateness, finiteness, and the ubiquitous nature
of aggression, genital differences, and the incest barrier.2
The foregoing constitutes a description of the diverse rock-bottom
elements in lying. However, in a particular instance of lying, one or the
other variable might play a more central role. This necessitates the dis-
tinction of motivationally different types of lies though not at the cost of
overlooking their shared psychic ancestry. The following six categories
readily present themselves though clearly they are not tightly exclusive
and overlap each other in many ways.
• Social lies which involve the innocuous excuses and pretences of
daily life.
• Narcissistic lies which include omissions and exaggerations for
avoiding shame.
• Psychopathic lies or deliberate misrepresentations aimed at obtaining
material or sensual gratification.
• Pathological lies which betray a pervasive inability to tell the truth
arising out of an early and fundamental hatred of reality.
• Life-saving lies which have to be spoken in situations of being held
hostage or tortured.
• Occupational lies or deceits are integral to being a spy or undercover
agent.
Within psychoanalysis, Bion (1970) has given most thought to this
topic, looking at the pathological as well as creative aspects of lying.
Bion concluded that truth, being self-evident, does not require a
thinker but a lie, being a manufactured thought, does. Moreover, the
distinction that Bion (1957) made between psychotic and non-psychotic
personalities—or, to put it more accurately, between psychotic and non-
psychotic parts of personality—centres the former’s hatred of reality;
DECEPTION 101
the category of “pathological lies” mentioned above is quite often a

manifestation of such hostile destructiveness towards reality and one’s
perception and knowledge of it.
Lemma (2005) has also made a significant contribution to the psy-
choanalytic understanding of lying. According to her, there are three
psychic and relational configurations associated with lying: (i) sadistic
lying, where the object is duped in an effort to reverse earlier humilia-
tions of the self, (ii) self-preservative lying, where an embellished picture
of the self is offered in order to seduce someone perceived to be disin-
terested, and (iii) a different form of self-preservative lying which could
be called self-protective lying (though Lemma herself does not employ
this expression), and is intended to protect oneself from an intrusive
object.3 Clearly, the dynamic constellations of the self-object representa-
tions in these forms of lying are quite different.
In the first scenario, the self experiences the object as emotionally
unavailable or inscrutable. In the second scenario, the self expe-
riences the object as intrusive and omniscient. Unlike sadistic
lying, the primary anxiety in self-preservative [and self-protective]
lying is not about castration. Rather, in the first scenario, the
anxiety relates primarily to the loss of, or uncertainty about, the
primary object’s love and concern. In the second scenario, claustro-
agoraphobic anxieties are primary in response to an intrusive
object. (p. 744)
Two other issues need mention. The first pertains to the collapse of
motivation and consequence in lying (e.g., shame leading to lying and
this resulting in a deceived other party). Sometimes, this conflation is
obvious. At other times, there occur consequences that were not moti-
vationally sought (e.g., shame leading to lying resulting in an awful
feeling of guilt at having misled someone). In other words, the conse-
quences of lying are both the desired one and the undesired ones and
both types of consequences might involve the self and other. A paral-
lel concern is the psychology of one who is lied to. While unconscious
collusion might exist between him and the liar, the individual who is
fooled brings his own dynamics to the situation. He might be unduly
gullible and believe all that is told to him though not without feeling
deceived and hurt later on. Curiously, some paranoid personalities—
while contemptuous of others’ naivety—are themselves remarkably,
though latently, gullible (Stanton, 1978).
The second issue pertains to the distinction between lying and

“negation” (Freud, 1925h). Negation involves unconscious sequester-
ing of the emotional validity of the psychic truth; even the intellectual
awareness of that truth is limited to its inverted form. Lying, in con-
trast, involves conscious sequestering of what is known and felt to be
true. When an individual using negation says “I never thought of such
and such,” he is speaking the truth; indeed, he has never consciously
thought of such and such. However, when a liar says “I never thought
of such and such,” he is not speaking the truth; he has consciously
thought of it and he knows that he has. Negation involves deceiving
oneself. Lying involves deceiving others.
Developmental origins of the capacity to lie

The capacity to tell lies is not hard-wired.4 It evolves, becomes refined,
and gets consolidated over the course of development. There is evi-
dence that children as young as three can lie and sometimes even two
year olds can do so (Feldman, 2009). The first lies, which are in the
nature of “I did not do it”, gradually evolve into the more advanced
form of “I did not do it; he did it”. Denial of culpability thus finds an
ally in displacement of responsibility. The “countless extravagant lies”
that Freud (1909b, p. 129) said Little Hans spoke in describing the addi-
tion of a younger sibling to his family were even more complex in their
forms and motivations.
Before going into what propels children to lie, however, it is impor-
tant to consider the capacities that are required for the child to become
able to lie in the first place. Fischer (2009) has painstakingly mapped
out this territory. She counts a secure attachment that allows for both
a sense of oneness and separateness and the demarcation between self
and others as two prime benchmarks for the capacity to lie. Also of
great importance in this context is the child’s attainment of reflective
functioning, which implies the renunciation of equating psychic and
physical reality. The consequent “pretend mode” (Fonagy & Target,
1997) permits playing out different schema, trying out different roles,
and experiencing things from an imaginary perspective while retaining
contact with reality. The child in the “pretend mode” (e.g., playing he
is Superman) is not lying; he not only knows that he is not Superman
but recognises that others know that as well. And yet, he enjoys the act
DECEPTION 103
and enjoys others’ indulgent attention towards his play. Fischer (2009)
concludes that achievement of an Oedipal organisation is the
… ultimate requirement for full-fledged lying. It is only then the

child can pull together fantasy, reality, conflict, and compromise,
develop a narrative, know the difference between reality and pre-
tense, feel the pressure of the prohibiting superego, and attempt to
mislead or deceive the other. (pp. 27–28)
Blum (2009) concurs that the development, during the second year of
life, of symbolic, cognitive, and linguistic capacities for pretence and
play and for anticipation of consequences foreshadows the appearance
of intentional lying. According to him, children begin to lie around three
years of age and do so largely to avoid blame. The list of motivations to
lie grows as development proceeds further.
Lies are frequently related to avoiding, restoring, and repairing

narcissistic injury, to raising self-esteem, to avoid punishment, or
to unconsciously seek punishment. The child who invents or exag-
gerates abilities and accomplishments wishes to be the idealized
adults, to become the ideal aggrandized self—the hero or heroine of
a family romance. Wishful thinking, magically undoing disappoint-
ments, narcissistic injuries and traumas, and the greater reliance
of children on defenses of denial, splitting, and role reversal sets
the stage for magical tricks of pretense, deception, guile, and lies.
The child who has experienced parental lying may seek revenge for
having been deceived. (p. 52)
This last part cannot be over-emphasised. The development of “basic

trust” (Erikson, 1950) in children is dependent not only upon repetitive
satisfactory outcomes of the infantile appeal cycle but also upon expe-
riencing parents as honest. Even those children who are fortunate in
this regard can find the situation puzzling at times. For instance, a child
is punished for telling the truth that his grandmother’s cooking stinks
and rewarded for appearing thankful for a gift that he does not like.
In imparting the etiquette of social civility, parents can (and often do)
confuse the child. However, such minor miscarriages of truth do not lead
the child to become a liar. It is chronic betrayal of his trust by parents
and their explicit hypocrisy and dishonesty that lays the groundwork
for lying. At times, however, the parents appear quite moral, even
moralistic, and yet the child turns out to be habitually deceitful. More
often than not, such parents have unconsciously encouraged the child’s
delinquency and have vicariously enjoyed it. This transgenerational
duplicity leads to what Johnson and Szurek (1952) have termed “super-
ego lacunae” in the offspring.
Addititional to these psychoanalytic ideas are empirical studies
of lying children. An important one pertains to the “peeking game”
research (Talwar & Lee, 2002) whereby a child is given a chance to com-
mit a transgression (e.g., by looking at a forbidden object) and then fib
about his action. Three year olds can do so but they lack “semantic leak-
age control”, that is, maintaining consistency of verbal statements and
not letting the fact out that they have peeked. By the age of about six
or seven, some 50 per cent of children can maintain feigned ignorance.
Edelsohn (2009), who has recently reviewed research studies on chil-
dren’s lying from elementary school through adolescence, concludes
that while young children lie to avoid punishment and buttress self-
esteem, adolescents lie for protecting their privacy and enhancing their
autonomy and individuation. Both honesty and lying are learned in the
home and reflect not only the child’s cognitive and moral development
but also the texture of the child’s relationship with his or her parents.
Predominance of love between the two parties strengthens the capacity
for honesty. Predominance of hate tilts the balance towards lying.
Pertinent psychiatric syndromes

While antisocial personality disorder is readily associated with men-
dacity and deception, the fact is that other severe personality disorders
(i.e., narcissistic, paranoid, hypomanic, borderline, schizoid, “as-if”,
and schizotypal) are also prone to lying (Stone, 2009). Such vulner-
ability to distorting facts in external reality is overdetermined.5 The
prevalence of “manic defenses” (Klein, 1935)—the trio of idealisation,
denial, and omnipotence—makes remaining loyal to “facts” difficult.
Narratives get slanted and accounts of what-happened-when get exag-
gerated in this or that direction. The unrelenting search for “all-good”
objects leads to compromises of perception and registration; aspects of
reality that do not fit with the desired experience (at a given moment
or on a sustained basis) are repudiated. Consequently, their recall bears
DECEPTION 105
little resemblance to facts. Yet another factor that propels individuals

with severe character pathology to lie is the intolerance of weaknesses
or blemishes in their own selves. Dreading shame, they give in to the
temptation of narcissistic self-inflation and, in the process, resort to
lying about their accomplishments and their status in life.
The foregoing statements need to be tempered by recognising the
quantitative and qualitative variations of lying between specific types
of character pathology. Individuals with antisocial personality disor-
der, for instance, manifest sustained “deceitfulness, as indicated by
repeated lying, use of aliases, or conning others for personal profit or
pleasure” (DSM-V, 2013, p. 659). Those with narcissistic personality dis-
order also show defects of ethics and morality. Their “readiness to shift
values to gain favor” and “inordinate moral relativism” (Akhtar, 1992a,
p. 69) is often accompanied by outright lying and deception. However,
such behaviour on their part is less pervasive, less coldly manipula-
tive, and less impulsive than that exhibited by antisocial individuals.
Lying is also seen in association with schizoid and paranoid personality
disorders. In the former, lying is deployed largely for social avoidance
(e.g., to not attend a neighbourhood party). In the latter, the picture is
more complex. The aggression-driven corruption of autonomous ego
functions results in a biased, narrow, and rigid cognitive style. The
“need” to overlook aspects of reality that do not accord with one’s pre-
conception is great and contributes to distortions of facts. Moreover,
the moral self-righteousness of the paranoid individual often coexists
with an expedient mendacity (Tobak, 1989) which can catch others by
surprise.
Besides these explicit associations between lying and severe person-
ality disorders, there are the instances of “secret lives”. Here, a seem-
ingly coherent personality organisation exists alongside a dissociated
sector of fantasy, affect, and behaviour. Dissociation, in this context,
does not necessarily imply a personified part of the self that is sepa-
rated from the rest of the personality by an amnesic barrier, though that
can also occur at times. More often the “sector disorders” referred to
here emanate from a rigid and successful operation of splitting mecha-
nisms (Akhtar & Byrne, 1983; Kernberg, 1975). The prominent and hap-
pily married politician who has secret out-of-town rendezvous with
prostitutes, or the wealthy banker who adores his wife and children
while having a hidden second family in another country, illustrate this
type of psychopathology. Freud’s (1924b) early description of perverse
formations is along similar lines. He noted that the ego is pulled, often
to a painful extent, in opposite directions by the demands of the id and
external reality, and at times
… it will be possible for the ego to avoid a rupture in any direc-
tion by deforming itself, by submitting to encroachments on its
own unity and even perhaps by effecting a cleavage or division
of itself. In this way the inconsistencies, eccentricities, and follies
of men would appear in a similar light to their sexual perversions.
(pp. 152–153)
While the discovery of the resulting secret lives is fodder for newspa-
per headlines (especially when it involves celebrities and model citi-
zens), the psychiatric clinics encounter a different type of syndrome
associated with lying. This involves the spectrum of factitious disor-
der and malingering. Also known as Munchausen syndrome (Asher,
1951),6 factitious disorder involves feigning physical or mental illness.
Patients with this disorder simulate, induce, and exaggerate all sorts of
symptoms, often to the extent of ingesting unsafe materials and insert-
ing unsafe objects in their bodies. They might produce fake evidence
of having bled and false documents of suffering this or that malady.
They frequently seek hospitalisation and their goal is to be emotion-
ally taken care of. While deceptive in the literal sense of the word, the
behaviour of these individuals differs from malingering in an important
way. In malingering, distress is feigned for material gain (e.g., monetary
compensation, avoidance of work-related duties) whereas in factitious
disorder, illnesses are faked in order to receive emotional care and
attention (Sadock & Sadock, 2007). The boundaries between factitious
disorder, malingering, and “genuine” hypochondriacal conviction
are, however, not always easy to draw. The heightened susceptibility
to auto-hypnotic suggestion might be so great that the individual suc-
ceeds in suppressing all knowledge of his or her desire to adopt a sick
role (Davis & Weiss, 1974).
Lying and deception in culture at large

In delineating the concept of “false self”, Winnicott (1960) acknowl-
edged that, to a certain extent, reactive and even inauthentic behaviour
is inevitable and might even be necessary for harmonious living with
others. Politeness, good manners, and “white lies” that preclude rup-
tures of interpersonal fabric thus become integral to culture.7 Harmless
DECEPTION 107
deceptions of such sort “grease the wheels of social discourse” (Feldman,

2009, p. 49). We take them for granted.
Then, we encounter the world of advertising. Here the whisper of
deception grows more seductive. Ads in fashion magazines can be
meticulously doctored. The curve of the waist of a beautiful model,
who is wearing this or that lingerie item or supposedly wearing a per-
fume that a designer wants us to buy, is made more acute by the clever
use of scissors. Her cleavage is brushed to appear more alluring. Even
her legs are elongated by inventive photoshopping. Similar embellish-
ment is evident in how expensive properties are portrayed in real estate
brochures. All evidence of “ordinariness” (e.g., newspapers strewn
about, shoes and socks, a wet umbrella, a half-empty bottle of ketchup)
and lived human experience is excised. The interior of the house is pre-
sented as immaculate, undisturbed by those who inhabit it, ideal, and,
in essence, as the domicile of a “purified pleasure ego” (Freud, 1915c).
The lie mesmerises us.8
Lying and deception are also rampant in communication and jour-
nalism. Not restricted to the fakery on “reality” television shows (with
those in dire circumstances staying in luxurious hotels between shoots)
and sensationalism of checkout counter tabloids (e.g., “One-eyed aliens
land in New Mexico”; “Woman gives birth to kittens”), manoeuvres
of deceit find their way into respectable journalism as well. Feldman
(2009), who has researched this matter, reports the following.
The New York Times prides itself on its role as “the paper of record”,
printing corrections to stories sometimes decades after the fact to
maintain its reputation of accuracy. Hence the sensation when it
was revealed that Jayson Blair, a Times reporter, had fabricated
or plagiarised material for dozens of national news stories. He’d
offered reporting from places he had never been, he’d given quotes
from people he’d never interviewed or met, he’d misstated facts,
and he’d made up details. USA Today reported Jack Kelley was
a finalist for the Pulitzer Prize before it revealed, in 2004, that he
had invented material, including portions of the story that had
earned him a Pulitzer nomination. In a front-page article, USA
Today admitted that “Kelley fabricated substantial portions of at
least eight major stories, lifted nearly two dozen quotes or other
material from competing publications, lied in speeches he gave for
the newspaper, and conspired to mislead those investigating his
work.” (pp. 197–198)
The fact that we respond to such revelations with dismay does not
prevent us from marvelling at cold-hearted bluffs in a game of poker
(Moore, 2009) and from enjoying depictions of scammers, impostors,
and con artists on the big screen. Indeed, there has been a long genre
of such movies that includes hits like The Music Man (1962), The Sting
(1973), Dirty Rotten Scoundrels (1988), The Grifters (1990), House of Cards
(1993), Ocean’s Eleven (2001), and Catch Me If You Can (2002). Splitting-
off their avowedly moral selves, the audience vicariously identifies with
the slick protagonist’s finesse while, at a still deeper level, partaking of
the masochistic pleasure of the one who is duped.9
Stakes are raised when we encounter con artists in the real world.
Running Ponzi schemes (e.g., the notorious Bernie Madoff) or glad-
handing “liar loans” (Zibel, 2008)—home mortgages approved without
checking the borrower’s income or assets—they can lead us to financial
ruin. Or they might sell us art and antiquities that turn out to be fake.
One look at the exorbitant prices successful forgeries in the realm of art
can fetch reveals that monetary benefit is a major motivation of lying
here. The list of those who thrive in this business is indeed long. Two
outstanding art forgers who made enormous money by their decep-
tive craft are Hans van Meegeren (1889–1947), the Dutch art dealer who
painted many fake Vermeers, and Tom Keating (1917–1984), the British
con artist who forged more than 2,000 paintings by more than 100 art-
ists in his lifetime. The fact, however, is that the money made by these
two master forgers constitutes a minuscule proportion of that made by
art forgers all over the world. And art is not the only arena where fake
products offer lucrative financial rewards. Collectors of autographs,
rare manuscripts, old photographs, letters, and even stamps and coins
know very well how widely inauthentic objects circulate in the bazaars
of their passion. They can readily recount all sorts of tales involving
someone being swindled by a forger who got away with a huge sum
of money.
However, monetary profit is not the only motive for creating a for-
gery. Emotional factors also seem to play a role here. Prominent among
these are the following:
• Creating a “successful” forgery affords one the wicked pleasure of

fooling others. Compared to oneself, others now appear silly and
stupid. Triumph over their innocence results in gleeful mocking
on a secret basis. In talking of con artists, Blum (2009) emphasises
DECEPTION 109
the “sadism behind their narcissistic charm and charisma” (p. 61).
Deceiving others promises to undo the chronic feelings of inferiority
and impotence the forger often carries within himself.
• Trading in fake products invariably involves a rebellion against
ordinary morality. It involves breaking the law as well. Making and
selling counterfeit objects can thus give vent to emotional conflicts
with authority figures. The irreverence and bravado of an impostor
is a slap in the face of the established order. The ever-present risk of
being caught adds to the thrill of defiance.
• Fakery also fulfils strivings for magical powers. To produce a dol-
lar bill in one’s basement, for instance, gratifies our childish wishes
for becoming “rich” pronto. To paint a Cezanne or a Picasso over a
few days in downtown Cleveland is to reverse time, change location,
and acquire creative genius at will. Just like that, with a snap of the
fingers.
Such considerations of the forger’s sentiments bring us to the other side

of the equation, namely the emotional responses of the witness of a for-
gery. As victims of forgery, we feel an admixture of outrage and shame.
We are hurt by the betrayal and embarrassed by our gullibility. Interest-
ingly, even when we are mere witnesses or onlookers of a forgery, not
its victim, our responses are not simple.
We are all familiar with the scorn we feel upon seeing poorly made
Barbie dolls from the Persian Gulf, French perfumes concocted in the
Philippines, faux-pearl necklaces offered on QVC, fake Rolex watches
sold on a street corner, Coach handbags made in Guatemala, and
designer-label clothing made in Bangladeshi sweatshops. We deride
them. The scorn reflects our rejection of fraud in general. It helps us
repudiate aspects of inauthenticity in our own personality make-up. It
is as if by belittling fake products we are saying that we ourselves are
entirely genuine in our day-to-day behaviour. Our dislike of counterfeit
goods thus turns out to be rather self-serving. This is a sort of fakery
itself.
More embarrassing is the possibility that forgeries and counterfeit
products provide vicarious gratification of our hidden, less-than-noble
impulses. The childhood intolerance for the labour of effort and for the
helplessness of waiting to become adept at something finds a secret
ally in the producer of artifice who fuels our suppressed longings for
quick and swift results that are achieved without effort and practice. He
tells us that the omnipotence we have reluctantly renounced can find

gratification after all. He offers us a path that does not traverse through
law-abiding territories of learning, practice, and hard work. And we
gladly give in to his seductions. To put it bluntly, the clandestine pact
between us and the forger goes like this: “If this guy in Texas can paint
a Van Gogh, maybe we too can accomplish great and even impossible
feats. If he can break rules and fool others, maybe we can also do that
which is prohibited to us.” No wonder we feel a mixture of barely sup-
pressed thrill and a delicious wave of guilty fear upon encountering a
fake product. Hold a counterfeit hundred dollar bill in your hands and
you will immediately know what I am talking about.
Something even deeper about human nature is revealed by the
observation that we admire a better fake more than a sloppy fake. The
more devilishly fooled we are, the more delight we take in the impos-
tor’s product. Why is that? Is the pleasure offered us by a good fake
merely aesthetic? In other words, do we like a better replica of Rodin’s
The Thinker or of the Leaning Tower of Pisa because they look good, that
is, closer to the original thing? Or is it because the better executed fake
shows more thoughtfulness and effort and, by implication, a greater
amount of respect for the creator of the original? The answer to both of
these questions is a resounding “Yes”! Overtly, our reasons for react-
ing more favourably to a good fake are aesthetic. A replica that closely
approximates the original stimulates the admiration we feel towards
the latter. We like the sensation. Covertly, witnessing a good fake pro-
vides us with a well-balanced compromise between our longings for
magic on the one hand and the recognition of value of effort on the
other. It also provides a simultaneous gratification of our childhood
wishes to outsmart our parents as well as keep them on a higher level
than us, and since all of us have the remnants of such childhood wishes
in the basement of our minds, it is not surprising that we simply “love”
a well-executed fake.
Far more sinister consequences are associated with the political
spinmeister’s rhetoric. Mario Cumo’s (former governor of New York
State) quip that campaigning is done in poetry and governing in prose
pales in the face of the exhortative oratory by paranoid and narcissis-
tic leaders. No tricks are left unused in them. Distortions, exaggera-
tions, embellishments, and outright lies prevail. Hardly a reflection of
contemporary moral relativism, deception has played an important,
often devastating, role in politics since time immemorial. The infamous
DECEPTION 111
peace offering of the Trojan horse by ancient Greeks, the Dreyfus affair
of late nineteenth-century France, the massive anti-Semitic propa-
ganda by Nazis during the 1930s, the ideological witch-hunts of the
1950s McCarthy era in the United States are but a few examples of how
wicked shenanigans pervade domestic and international politics. Nota-
ble in this context is Alterman’s (2004) thorough account of lies told by
the US presidents to Congress, the media, and the public at large. It is
a painful saga of how moral values and the honourable covenant to
uphold the truth at the highest level of a democratic government can be
sacrificed at the altar of political convenience. While Bill Clinton’s bald-
faced denial (“I did not have sex with that woman, Miss Lewinsky”)
has its titillating impact, far more serious consequences have followed
Lyndon Johnson’s deceptive assurances regarding the second Tonkin
Gulf incident, Richard Nixon’s Watergate cover-up, Ronald Reagan’s
lies regarding the Iran-Contra deal, George Bush Senior’s false prom-
ises (“Read my lips: no more taxes”), and the younger Bush’s fabricated
reasons to attack Iraq. Indeed hundreds of thousands of people have
been killed due to the last mentioned deceit, to say nothing of its dev-
astating impact upon the American economy and the nation’s prestige
in the eyes of the world.

Encounters with deceitful patients, especially those with prominent
antisocial features, make one painfully aware of the limits of the
applicability of psychoanalysis and even psychoanalytic psychother-
apy (Stone, 2007). Freud’s (1905b) declaration that in order to tolerate
the rigours of psychoanalytic treatment, one must possess “a fairly reli-
able character” (p. 263) readily comes to mind in this context. With-
out honest self revelation, or at least the intent for it, the therapeutic
alliance remains a sham. Gross psychopaths are therefore not suitable
subjects for psychoanalytically derived therapies. Those with milder
antisocial tendencies can, at times, benefit from such treatment espe-
cially when confrontational and cognitive-behavioural interventions
are used in conjunction with it (Cloninger, 2005; Kernberg, 1984, 1992;
Stone, 2007).
Such work might have to start from the very first session of the
patient’s evaluation. The discovery of an overt disregard for the
basic conditions of treatment (e.g., refusing to tell one’s real name or
to give proper contact information) and outright lying needs to be

immediately confronted. The prospect for future therapy is better if such
confrontation leads to plausible explanations (e.g., the patient’s need to
conceal his identity because he is in a government witness protection
programme) or anxiety and shame leading to a quick rectification of the
earlier mis-statement. If, however, the patient responds to the confron-
tation by more lies, improbable rationaliszations, argumentativeness,
and rage, the prognosis is guarded (Akhtar, 1992a). Under such circum-
stances it might not even be possible to begin a treatment. “Therapists
who believe that with enough effort, they can make every patient stay
the course are engaging in omnipotence” (Yeomans, Selzer & Clarkin,
1992, p. 9). Stone (2009), who has extensive experience in working with
criminals and psychopaths, explicitly states that if the lying patient
refuses to abide by the parameters of treatment, he or she needs to be
discharged.
The discovery of deceitfulness might be made much later in the
encounter with less psychopathic individuals. Lies, distortions of truth,
and deliberate withholding of information might enter the treatment as
a form of narcissistic resistance and a ploy to keep one’s shame-laden
aspects hidden from the therapist. Such self-protective motivations
might extend to warding off castration anxiety by repudiating assertive
authenticity (Gediman, 1985) and keeping in abeyance fears that one
would not be liked for what one is in reality. On the other hand, lying
may have greater discharge functions related to early object relations.
Falsehood then itself becomes a form of transference relatedness. Ana-
lytic space, under such circumstances, becomes “a scripted, constrained
space within which the therapist experiences the full impact of the
enactment of an internalized relationship to an object with whom hon-
est and direct communication is felt to be an impossibility” (Lemma,
2005, p. 752).
Here Kernberg’s (1992) concept of psychopathic transference is perti-
nent. According to him, a patient in the throes of such transference con-
sistently lies to the therapist, suppresses useful information, and, as a
result of projecting his own corrupt tendencies, believes that the thera-
pist is dishonest and untrustworthy. At times, the patient tries “uncon-
sciously to provoke the therapist to deceptive or dishonest behaviour,
or at least to inconsistencies in his behaviour that the patient may then
interpret as dishonesty” (p. 223). Kernberg proposes that the proper
approach under such circumstances is to confront the patient tactfully
DECEPTION 113
but directly and to explore the inherent transference relationship in

detail and to resolve it interpretively before proceeding with other
issues. Typically, the “psychopathic transference” gets transformed into
“paranoid transference” before giving way to depressive reparative
feelings and genuine self concern.
In extending Kernberg’s work, Lafarge (1995) described three
transferences characteristic of patients in whom deception and inau-
thenticity are organising themes: (1) imposturous transference in which
the patient actively enjoys deceiving the analyst by his fabrications;
(2) psychopathic-paranoid transference in which the patient is intensely
involved with the analyst who he feels is lying to him and will betray
him; and (3) the psychopathic-unreal transference in which the patient
feels disconnected from the analyst and automaton-like in his own
experience. Lafarge goes on to suggest that two kinds of splitting are
evident in these patients. The first is a compartmentalisation of self-
and object-representations along the libidinal and aggressive lines.
The second is a schism in the experience of reality, with some self-and
object-representations felt to be exaggeratedly and painfully real and
others felt to be lifeless and devoid of meaning. Lafarge indicates that
the two psychopathic configurations are dissociated halves of a single
bad self- and object relations. Each half of this unit is used defensively
against the full experience of complex but frustrated object relations.
Moreover, each dissociated system incorporates a central fantasy of the
parent–child relationship which comes to acquire determinants and
functions from successive developmental levels.
The imposturous transference is at a somewhat higher level. It is
derived from an identification, especially in male patients (who show
it more often), with a grandiose representation of the father in order to
patch over a defective body representation that is poorly differentiated
from that of the mother. The imposturous transference can serve as a
psychostructural umbrella for the psychopathic transferences and the
latter can emerge as regressive defences when Oedipal guilt and castra-
tion anxiety render the imposturous tendency too risky.
Mention must also be made of O’Shaughnessy’s (1990) elegant
and thoughtful paper titled “Can a liar be psychoanalyzed?” Under-
scoring the fundamental antagonism between a liar and a psychoa-
nalysis, O’Shaughnessy described two cases in detail which are quite
similar to those included in the paper by Lafarge (1995) mentioned
above. Both were males. Both lied with excitement initially and then
turned paranoid. Both had “basic suspicions” (p. 190) instead of basic
trust and both felt “cut off from their depths” (p. 191). Like Lafarge,
O’Shaughnessy observed the impostor’s tendency towards idealisa-
tion: “This lie about lying is at the center of the deterioration of his
character” (p. 193). O’Shaughnessy delineated a characteristic “triad of
a deficient primal object, a strong destructive instinct in the patient, and
a general perverse overlay” (p. 193) and concluded that
If the fundamental level of the lie can be understood, that a liar
lies in identification with the lying object, and, at the same time,
if the patient’s hostile lying, his different perspective in regard to
truth and also his perverse excitement at using the lie to communi-
cate with his analyst can be analysed in all their concreteness, I am
sure at least of this: a genuine analytic process can be set in train.
(p. 194)
O’Shaughnessy’s conclusion paralleled Kernberg’s (1992) and Lafarge’s

(1995) proposals. Another commonality in their material is that their
cases reflect the prevalence of males in instances of lying reported
in psychoanalytic literature. This could be in part due to the greater
prevalence of antisocial traits among men (Cloninger, Reich & Guze,
1975; DSM-IV, 1990). What is more curious, however, is that a dispro-
portionate number of papers on lying are written by female analysts
(Chasseguet-Smirgel, 1984; Deutsch, 1922; Greenacre, 1958; Lafarge,
1995; Lemma, 2005; Olden, 1941).10 The reasons for this too are unclear.
Could it be that female analysts are better at detecting lies told by
analysands? Or, is it that deceitful men deliberately seek women
analysts? The latter hypothesis finds support in Chasseguet-Smirgel’s
(1984) observation that male fraudulence grows out of maternal seduc-
tion and the resulting inability to fully experience the Oedipal situation.
Perhaps imposturous men seek female analysts to avoid passive homo-
sexual urges and unconscious guilt vis-à-vis the father whom they have
bypassed and intrapsychically killed.
A special challenge is posed by patients who keep secrets. A secret
is “an intrapsychic cul-de-sac which not only disrupts life’s experien-
tial continuity but also sets into motion defensive processes to guard
its own existence” (Akhtar, 1985, p. 82). While psychoanalysts regu-
larly hear material that their patients wish to keep secret from others
and gradually discern the secrets of the child within these patients
(Gross, 1951; Sulzberger, 1953), encountering patients who tenaciously
DECEPTION 115
withhold pockets of information is disconcerting to them. The risk

of countertransference outrage and intrusiveness is great under such
circumstances. While no hard and fast rule can be set, keeping the
following guidelines might be helpful. When secrets betray split-off
sectors of personality and secret keeping has instinctual discharge
functions (e.g., teasing, exclusion, and sadism), then a confrontational-
interpretive approach seems better. When secrets are kept predomi-
nantly as a defence (e.g., against shame) and the act of secret keeping
has symbolic significance, the traditional, slow, step-by-step approach
centring upon defence interpretation is more useful. Kernberg’s (1984,
1992; Kernberg, Selzer, Koenigsberg, Carr & Applebaum, 1989) and
Margolis’s (1966, 1974) contributions are especially instructive in the
former and latter regards, respectively.
Focusing specifically upon patients with severe character pathol-
ogy, the approach of Kernberg, Selzer, Koenigsberg, Carr & Applebaum
(1989) is direct, confrontational, and consistently centred upon inter-
pretation. They emphasise that while it may take a long time to accom-
plish, deep exploration of the transference implications of the patient’s
lying takes precedence over all other material, except life-threatening
acting out. The following passage illustrates the kind of clinical work
recommended by the author.
• Lying as an expression of hostility towards the self: “You continually

change your story about what happened. This makes it impossible
for me to help you and thus ends up defeating you.”
• Lying as an attack on the therapist: “You continue to tell me the same
thing even after we have agreed that this is a made-up tale. You treat
me, therefore, as if I’m not worthy of your respect.”
• Lying as an expression of fear of retaliation: “You seem to fear tell-
ing me the truth about having taken my magazine from the waiting
room because you think that if you told me, I would become angry
and stop seeing you.”
• Lying as an expression of disillusionment: “You act as if the only way
you can save your skin is to create a fiction about what’s happening.
That means to me that you have no belief that were I really to know
you, anything good could come of it.” (p. 167)
Margolis (1966, 1974), dealing with somewhat healthier patients,

states that the formation of neurosis during childhood involves
keeping certain thoughts and feelings secret from parents. Later, the
ego begins to keep the same (and similar psychic phenomena) hidden
from the superego and even from portions of the ego itself. The pro-
vision of strict confidentiality and the adherence to non-participation
in the patient’s life outside analysis prepare the ground for growing
trust in the clinical situation. With moment-to-moment interpretation
of transference-based fears of criticism, some softening of superego
occurs and the possibility of revealing secrets appears on the hori-
zon. The process of defence analysis, in the hands of an abstinent and
technically neutral analyst, encourages the patient to reveal the con-
scious secrets to the analyst and, later on, the unconscious secrets to
his own ego and superego. In effect, in the psychoanalytic treatment
of neuroses, the exact reversal of what happened during childhood
occurs.
Regardless of its being incisive or painstakingly slow, the emphasis
upon the interpretive approach must not overshadow the importance
of the analysts “holding” (Winnicott, 1960) functions and of his capac-
ity to discern unconscious hope (that the environment will tolerate the
burden of deceit and yet continue to provide care) in the patient’s cheat-
ing and outrageousness (Winnicott, 1956a).11 Only with such a judicious
and tactful admixture of holding and interpretive approaches and that
too on a sustained and long-term basis can a liar be truly helped.
Concluding remarks
In this wide-ranging survey, I have delineated the formal characteristics
of lies, phenomenological subtypes of lies, and psychodynamic motiva-
tions to distort the known truth. Utilising the scene of art forgery as a
didactic scaffold, I have elucidated the dialectical configurations that
intricately bind the liar and his victim. Such a “two-person” explana-
tory approach has, however, not stood in my way to recognise the truly
“one-person” contributions to the phenomenon of lying. My emphasis
has overall been on the multiply determined, multi-functional, object-
related, and ubiquitous nature of lying. At the same time, I have empha-
sised that a concerted effort to be honest and seek psychic truth—to the
extent any such striving can be fully successful—is a fundamental aspect
of mental health and of intensive psychotherapy and psychoanalysis.12
With this in mind, I have made brief comments on patients who misin-
form their therapists during the initial evaluation, the development of
DECEPTION 117
psychopathic transferences, and the special case of secret keeping that

invariably complicates the progress of treatment.
In the emphasis on the fascinating, amusing, and even entertaining
as well as sadomasochistic, harmful, and profoundly destructive effects
of lying, it must not be overlooked that distortion of truth can, at times,
be a loving act intended to protect others. Parens (2009), who makes this
very important point, offers the following poignant vignette to illus-
trate his contention.
May 1940, a Jewish mother and her eleven-year-old son, escaping

the invading German army on a train from Belgium to southern
France are traversing the region of Dunkirk. They hear explosions
that are alarmingly near. Driven by the impulse to protect her son,
eleven, but to her still “her child”, the mother spontaneously says,
“Don’t be frightened, it’s only thunder.” Appreciating her motherly
protectiveness, the son smiles at her. Ten minutes later, the train
stops and they are told to immediately disembark; within moments
of having done so and taken shelter behind dunes, fighter planes
strafe the train, causing little damage. They re-embark when told
to do so. In an unspoken entente, not a word was said about the
mother’s motherly effort to protect her son against too much fear.
(p. 151)
Lying can therefore be a manifestation of kindness just as honesty can,

at times, be an ally of sadism. Having entered this caveat, I would like
to conclude this discourse on lying and deception with a parable drawn
from Panchatantra, the ancient Indian book of folk tales (circa 1031 BCE).
The tale goes like this. Once a woodsman was going through a jun-
gle where he came across a lion trapped inside an iron cage. The lion
is understandably upset and upon seeing the woodsman urges him to
open the gate of the cage and release him. The woodsman does not
appear keen on this since he feels afraid of the beast; indeed he fears
that the lion will eat him up upon being released. However, when he
voices his concern, the lion emphatically assures him that he would do
no such thing. The lion says that he would be utterly grateful and could
not conceive of attacking someone who saved his life. Finding the lion
to be earnest, the woodsman opens the cage and the lion comes out.
Moments later, the lion tells the woodsman that he wants to eat him up.
The woodsman is dismayed and reminds the lion of his promise not to
do so. The lion says that he was telling the truth when he promised but
the procrastination on the woodsman’s part to release him caused delay
and this, in turn, made him hungry. He says that now he cannot help
himself and has to eat the woodsman. Just as this discussion is going
on, a jackal happens to pass by. He stops and asks the arguing duo as to
what is going on. Upon being told the story, first by the woodsman and
then by the lion, with their obvious mismatch, the jackal turns pensive.
He thinks for a while and then says that he does not believe either of
them. In fact, he calls both the woodsman and the lion liars. He says
that he cannot believe that such a large and majestic animal like the
lion could ever fit in that small iron cage. He mocks the woodsman and
the lion for fabricating such an incredulous tale. Annoyed at this, the
lion promptly decides to prove the jackal wrong and re-enters the cage.
With lightning speed, the jackal locks the cage door and thus saves the
woodsman’s life.
As one encounters a fable of such richness, many questions present
themselves.
• Was the lion telling the truth when he said to the woodsman that he
would not attack him?
• Was the lion lying when he said that his hunger had grown because
of the woodman’s procrastination?
• Was the woodsman pathologically gullible (due perhaps to some
unconscious masochism) in trusting the lion to begin with?
• Was the jackal truthful when he accused the lion and the woodsman
of being liars?
• Was the lion pathologically gullible (due to his unconscious guilt at
cheating the woodsman) to believe the jackal and re-enter the cage?
• Was the woodsman aware of the jackal’s lying and in remaining silent
about it, was he not lying himself?
Such questions—and I am certain that many more like these can be

raised—underscore the grey areas between truth and lie, the impor-
tance of the perspective from which a particular statement is assessed,
the moral dilemmas inherent in making judgments in this realm, and
ultimately, the object relational and intersubjective context of lies and
lying. These questions are therefore important. However, the richness
of texture they provide should not be exploited in the service of moral
scepticism. The existence of complexity in this realm does not mean that
DECEPTION 119
there is no such thing as objective truth. Indeed, there is. The fact that
you are reading these words (regardless of your agreeing or disagreeing
with them) is one such truth and to deny it would be a lie.
Notes
1. Any discussion of lies contains within itself implicit assumptions about
truth. If it were not so and truth did not exist (or, was not known), how
could anything be considered a lie? In other words, to know a lie is to
know the truth behind its veil. This theorem might not fit well with the
contemporary hermeneutic turn to psychoanalysis which lays empha-
sis upon co-constructed data, intersubjectivity, and “narrative truth”
(Spence, 1982). Sass and Woolfolk (1988) have provided a thorough
assessment of this tension and Hanly (1990, 1992) has elucidated the
criteria (e.g., coherence, correspondence) for establishing “truth” in
psychoanalysis.
2. Chasseguet-Smirgel’s (1984) concept of regressive anal homogenisation
in the perverse character and Grunberger’s (1989) metapsychological
discourse on the false notion of “purity” are especially pertinent in this
context.
3. In the preoccupation with delineating different types of lies, it should
not be overlooked that an inability to lie, when circumstances demand
such a posture, might also reflect psychopathology. Such “compulsive
honesty” (Rajnish Mago, personal communication, August 19, 2008) is
often accompanied by self-glorification, moralistic exaltation of truth
for its own sake, and a sadomasochistic bent to interpersonal relation-
ships. In more severe cases, such driven desire to be “honest” is cou-
pled with a split-off sector of personality that may be quite corrupt and
perverse.
4. There is some evidence, however, that higher primates can “lie” to
avoid blame and gain advantage over others (Byrne & Whiten, 1992;
Fouts, 1997; Maynard-Smith & Szathmáry, 1999). Stone (2009) has
recently provided a review of the evolutionary literature on the subject
of lying.
5. Freud (1895) used the term “overdetermination” to denote the fact
that psychic phenomena are caused by multiple factors operating in
unison. Thus, forces of constitution and trauma, scenarios of past and
present, and pressures by different psychic agencies converge into the
final common pathway leading to a given phenomenon. Freud’s later
study of dreams (1900a) and parapraxes (1916–17) gave strong support
to this idea. Still later, his delineation of a tripartite psychic structure
(1923b) led to the conclusion that neurotic symptoms were not simply
breakthroughs of instinctual impulses but a compromise between the

demands of id, ego, and superego. Eidelberg (1954) and Hartmann
(1958) later added the aetiological vector of external reality, stating that
not only neurotic symptoms but all psychic phenomena reflect a com-
promise between the demands of the id, ego, superego, and external
reality.
6. The name of the syndrome is derived from the book of fanciful and
absurd adventures and travels attributed to Baron Hieronymus
Carl Friedrich Münchausen. Davis and Weiss (1974) provide a fasci-
nating commentary on how this actually evolved: “The real Baron
Munchausen (1720–1791) of Hanover, Germany, enjoyed an established
reputation as a teller of exaggerated tales related to his experiences as
a cavalry officer in the German-Turkish campaigns of 1737 to 1739. In
1785, Rudolph Eric Raspe published a book entitled Singular Travels,
Campaigns, and Adventures of Baron Munchausen. The book, however,
was a hoax derived from Raspe’s imagination. He had met the Baron
only briefly and did considerable elaboration upon his stories which
rapidly established the Baron as a preposterous liar. It was because of
the fanciful stories, which were both dramatic and untrue, that Asher
decided to choose the name ‘Munchausen’ for the patients who traveled
from hospital to hospital as described, although the original character
never submitted to any surgical operation” (p. 280).
7. While true, this statement does not accommodate cross-cultural varia-
tion in the extent of social pretence and compliant avoidance of truth.
Freeman (2009) provides a comparison of North American-Japanese
cultures in this regard.
8. The idealised “someday … fantasy” evoked by such advertising has a
counterpart in the “if only … fantasy” of nostalgic art and poetry; the
former idealises the future and the latter glorifies the past, whitewash-
ing the blemishes of lost places and times bygone (Akhtar, 1996).
9. See, in this context, my elucidation of gullibility and the unconscious
need to be betrayed in Chapter Five of this book.
10. A few contributions by male analysts (Abraham, 1925; Blum, 1983;
Kernberg, 1992) paradoxically support the female authorial dominance
in this realm.
11. Abraham’s (1925) psychoanalytically informed account of a chronic swin-
dler’s life with its unexpectedly good outcome underscores the poten-
tially redeeming role of forbearance vis-à-vis such psychopathology.
12. The psychoanalytic emphasis upon truth, truthfulness, and
truth-seeking should, however, not lead to idealising psychoanalysts.
Knowledgeable though they might be about the matters of mind,
psychoanalysts are nonetheless ordinary human beings. Like others,
DECEPTION 121
they have character flaws and vulnerabilities. They are hardly immune
to the temptations of lying. Sigmund Freud’s signing “Dr Sigm Freud
u Frau” (German for Dr Sigmund Freud and wife) when he checked
into a hotel in Maloja, Switzerland on August 13, 1898, accompanied
by his sister-in-law Minna Bernays (Blumenthal, 2006) is a recently
unearthed piece of psychoanalytic history that supports this asser-
tion. Other prominent examples are Wilhelm Stekel’s fabricating
clinical material for presentations at early gatherings at Freud’s house
(Bos & Groenendijk, 2006), Masud Khan’s merrily declaring himself to
be a “prince” (Akhtar, 2007b; Hopkins, 2006), and Heinz Kohut’s (1979)
report on the “two analyses of Mr Z” which in fact was an “appalling
deception” (Giovacchini, 2000, p. 78) since Mr Z was most likely Kohut
himself and there had been no second analysis (see also Strozier, 2004).
CHAPTER FIVE
Betrayal
T
he English word “betrayal” is derived from the old French traïr
and the Latin tradere, both referring to “traitor”. Indeed, the
Webster’s dictionary meaning of “betrayal” includes “to deliver
to an enemy by treachery” (Mish, 1998, p. 109). Among other explica-
tions are “to lead astray, to fail or desert especially in time of need, to
reveal unintentionally, [and] to disclose in violation of confidence”
(ibid, p. 109). These phrases indicate that: (a) betrayal involves breaking
someone’s trust in one’s reliability and availability, and (b) betrayal can
be deliberate or unintentional. A third feature, though not explicit, can
also be discerned. This involves the fact that (c) betrayal causes hurt.
The Hindi word for betrayal, vishwas-ghaat (literally, wounded trust)
captures the essence of this phenomenon.
Moving from the confines of the dictionary, I propose two other
facets of betrayal: (d) the phenomenon comes in active and passive
forms (i.e., betraying others and feeling betrayed), and (e) the affects
connected with these forms are conscious or unconscious sadistic glee
and sharp “mental pain” (Akhtar, 2000; Freud, 1926d; Weiss, 1934),
respectively.1 Yet another facet is that (f) betraying and being betrayed
are not as aetiologically, dynamically, and phenomenologically apart
as they initially appear. The drive to betray others and the need to be
123
betrayed invariably coexist. The former is more evident in narcissistic

characters and the latter in masochistic characters. However, the oppo-
site wish is also present in each of them. Narcissistic individuals betray
others while also arranging unconscious betrayals of themselves and
masochistic individuals engineer being betrayed while betraying others
themselves. Cooper’s (1988) proposal of the “narcissistic-masochistic
character”, while addressing a somewhat different terrain of psychopa-
thology is, in part, my heuristic ally in making this assertion.
This Janus-faced syndrome of betrayal, which has remained
inadequately addressed in psychoanalytic literature,2 forms the focus
of my contribution. With the help of two detailed case reports, I will
elucidate the unrelenting need to betray others and the comparably-
driven, albeit unconscious, need to be betrayed. I will follow these case
reports with comments on treating patients in whose lives themes of
betrayal figure prominently and whose transferences are accordingly
shaped and coloured. I will conclude by pulling this material together
and pointing out areas that warrant further attention.
The compulsion to betray

In clinical practice and in life-at-large one often encounters people who
are utterly unreliable. They promise to be somewhere, arrive at a certain
time, bring something, and do some task but habitually fail to meet
such expectations. Their behaviour hurts others who gradually begin
to mistrust them and become wary of them. Behaviourally homog-
enous, such unreliability is actually of three different psychodynamic
varieties:
a. Diffuse ego-impairment: These are hapless individuals who agree to

others’ demands because they lack the courage to say “no”; subse-
quently feeling burdened by what they might genuinely be unable
to carry out, they end up disappointing those who are banking on
them.
b. Identification with over-promising parents: These are adults who, as
children, were repeatedly misled by their parents; the latter made
all sorts of boastful declarations that never came true. Such dashing
of hopes on a repeated basis deeply traumatised the children who,
in an “identification with the aggressor” (A. Freud, 1946), unleash
similar torment upon unsuspecting others once they grow up. Their
B E T R AYA L 125
actions are often subtle and out of their conscious awareness. Their
betrayals of others occur despite their good wishes and, at times, are
a source of surprise and disappointment to themselves.
c. Sadistic triumph over envied others: Individuals who betray
others with conscious sadistic glee usually display “malignant
narcissism” (Kernberg, 1984), that is, a combination of pathological
self-absorption, cruelty, and antisocial behaviour. They have
experienced severe betrayal trauma during childhood and often
view themselves as the most unfairly treated among the family’s
children. They envy other siblings and harbour intense envy and
hatred over their privileged status. Their betrayals are enactments of
their destructive impulses towards their siblings, though, at its base,
their hostility is directed at their parents. Superego functioning is
often compromised and an element of viciousness lurks underneath
their overt seductiveness. The following case illustrates this sort of
compulsion to betray others.
Tall, big-boned, and bold in his gestures, sixty-year-old Paul Ruby
sought psychotherapy reluctantly and pursued it in staccato
fashion. He did accept my recommendation of twice-weekly ses-
sions but took frequent and long leaves during the course of work
which lasted nearly seven years. Paul had been forced to seek help
by his daughter after his divorce when he had begun drinking
excessively and missing work-related appointments. A prosecut-
ing attorney of considerable repute, Paul had been a consummate
womaniser and his divorce was precipitated by an affair which fiz-
zled out once he was on his own. He could not tolerate his girl-
friend’s demands for deeper relatedness.
Over the course of time, I learned about two other affairs and
a long series of one-night stands. Paul seemed embarrassed about
some of these, while reporting others with a sense of triumph.
Betrayal figured in all of them and curiously, the more conscious it
was, the more it seemed to energise him. And, mind you, I am not
referring to the betrayal of his wife—that was taken for granted.
The betrayals in question were those of the various women he
seduced. While the theme appeared again and again in the account
of his life, two episodes struck him—and me—as paradigmatic of
his driven need to betray, though from different vantage points and
with different psychic consequences.
The first of these was “the story of Ellen McGuire” (he named
his various escapades like chapters of a novel),3 a stunningly
beautiful woman whom Paul had known since their childhood.
She came from a more sophisticated and elite family than Paul’s,
though they had grown up in the same affluent suburb of Pitts-
burgh as children. As a child and later as a teenager, Paul had been
intimidated by her snobbish manner, her fine looks, and her elegant
clothes. Then, decades later when he had become quite success-
ful as a lawyer and had made a lot of money, Paul unexpectedly
ran into Ellen who, in his words, “had not amounted to much”.
She was still beautiful, though. Paul “worked on her” for over a
year, befriending her, showering her with gifts, and helping her
obtain a decent-enough job. Soon, they became lovers. Paul had
no shortage of money by this time. He rented a fine apartment and
handed her the keys. A site of their amorous interludes, soon it
became Ellen’s place. Then after he had “fucked her and fucked her
real hard and real good” many, many times, one day Paul arrived
at the apartment and announced that he had terminated the lease
and she had to vacate the place within a week. To a horrified Ellen,
he now recanted with glee how this had been his plan all along and
how this was his only way to overcome how intimidating he had
found her during their childhood and adolescent years. What is
more chilling here is that Paul was hardly regretful in telling me all
this. On the contrary, he regarded his victory over Ellen as a sign of
courage, determination, and manliness. Her pain at his profound
betrayal was peripheral in his version of the story.
In contrast, Paul felt much shame and even a twinge of remorse
in recounting “the story of the Yemeni woman”. I could see that
his betrayal of her had a less calculating and more “accidental”
(i.e., more unconsciously driven) quality about it. Paul had much
difficulty recounting what happened between them. Haltingly, he
gave the following account. He had gone to London presumably
for a business trip but actually to meet a woman whom he had
been courting off and on for a while. With characteristic flair, he
rented a high-end apartment for a week with tip-top amenities—
concierge, chauffeur, cleaning service, and so on. The very first
B E T R AYA L 127
afternoon before his British lover-to-be could arrive at this fancy

place, a poor Arab woman rang the doorbell. She was there to clean
the apartment but, within twenty to twenty-five minutes, Paul had
worked his magic and she was in his arms. They were interrupted
by a call from the concierge, announcing the arrival of a “guest”.
The woman from Yemen went back to dusting and cleaning. Paul’s
British girlfriend entered the apartment and almost immediately he
opened a bottle of champagne. As he went to the kitchen to fetch
two glasses, he caught the hurt and accusing eyes of the cleaning
woman. Paul claimed, and I believed him, that he never forgot that
glance and he gets filled with remorse and shame each time he
recalls it.
Though Paul’s behaviour in the two scenarios differed—the
first, deliberate and near sociopathic, the second, unmentalised and
compulsive, the core sequence of seduction followed by betrayal
was evident in both. (And, there were more “stories” like these in
Paul’s repertoire; only one was different since it pertained to his
being betrayed by a young paramour.) But why was Paul acting
this way and what connection did such behaviour have with his
frequent dropping out from treatment (more marked in the earlier
part of our work) and with his childhood background?
As we explored this, it became clear that Paul had himself suf-
fered significant betrayals in his life. A first-born child and an
“undisputed darling” (Freud, 1917b, p. 156) of his parents, Paul
had been abruptly sent away to live with his out of town aunt
when he was just two years old. He grew up with his aunt until
he finished high school, visiting his parents only once or twice a
year; the presumed reason for his exile was the birth of his younger
sister who was a sickly baby and demanded a lot of attention from
their parents.
In my estimation, Paul had been badly traumatised by this early
betrayal. Then, the discovery that his father was having an affair
when Paul was ten years old and of his uncle and aunt’s enrolling
their son into a private school while Paul attended a public school
also were experienced as serious betrayals. He grew up determined
to make loads of money, never depend upon anyone, and get even.
His promiscuity was based upon his attempts to reverse the narcis-
sistic injuries of his childhood, and his frequent withdrawals from
me—just when I began to be optimistic about our work—embodied

the all-too-familiar seduction-betrayal pattern.
An important aspect of Paul’s transference was his sense that
I was enjoying his dependence upon me. He suspected that I
was gloating over my importance to him. This would anger him
greatly: “Why should I be reliably present for you? Come here on
fixed times, like a dog? What have you done to deserve such loy-
alty and obedience from me?” Painstakingly and in a piecemeal
fashion, we sorted all this out to indicate that Paul wanted to be a
reliable parent to me (in a reversal of his own anaclitic longings)
but then would feel envious of my being the recipient of his reli-
ability. I began appearing to him like his younger (and in his eyes,
more fortunate) sister and he would have to rupture the treatment;
the envy was simply intolerable. Then, after a few missed sessions,
Paul would reappear with promises to be regular in attendance.
As these cycles were repeated, we reconstructed the pain he felt
at having to separate again and again from his parents when he
visited them during childhood. Turning passive into active, Paul
had become “addicted” to betraying (instead of being betrayed).
Working through the hurt, pain, and profound rage that were inter-
mingled in this relational scenario gradually led to the emergence
of genuine sadness about how his life had become messed up and
remorse over how he had hurt so many women in his life. Paul’s
relationship with his sister improved. Though not entirely able to
“forgive” her for having displaced him, he did become capable of
seeing that is was hardly her fault. The rage at her was a displace-
ment of the fury he felt towards his parents for having sent him
away. We were also able to link the seduction-betrayal drama he
had played out with Ellen to the amalgam of his feelings towards
his sister and his mother. As the treatment approached its end, Paul
was able to sustain a loving relationship with a woman. He was not
free of impulses to cheat and to betray her but was able to handle
them by suppression, by masturbating to fantasised sex with other
women and, at times, by making fun of his greed and potential
cruelty. Analysis had not “cured” him but had indeed made his life
less driven, less sadomasochistic, and less complicated. For me,
this exemplified what Freud (1933a) had meant by his statement
that as a result of psychoanalysis, “Where id was there ego shall
be”. (p. 80)
B E T R AYA L 129
This case poignantly illustrates the deleterious effects of pathological

narcissism upon the capacity for object relations. Viewed within a long-
term perspective of time,
The grandiose self always has been, and remains, alone and in a
strangely atemporal world of repeating cycles of wants, tempo-
rary idealizations, greedy incorporation, and disappearing of sup-
plies by spoiling, disappointing, and devaluation. (Kernberg, 1980,
p. 138)
Also pertinent here is Rosenfeld’s (1964, 1971) observation that narcis-

sistic object relations are characterised by omnipotence and defences
against any recognition of separateness between self and the object. The
narcissist’s omnipotence is manifest in his ruthless use of others (see
also Coen, 1992, in this regard) with concomitant denial of any depend-
ence on them, since its recognition implies vulnerability to love, pain
of separation, and envy of what others have to offer. A more malig-
nant situation prevails when angry and destructive aspects of the self
become idealised. Then the individual attempts to destroy whatever
love is offered to him in order to maintain his superiority over others.
In becoming totally identified with the omnipotent destructive aspects
of himself, he kills off his sane, loving, and dependent self. At times, he
remains wistfully aware of his inner imprisonment and feels that there
is nothing anybody can do to change the situation. Avoiding the risk of
being betrayed by anyone ever again, the narcissist isolates himself and
thus ends up betraying his own needy self. Such was the case with Paul
Ruby before he came to see me.
The need to be betrayed

In sharp contrast to him are persons who find themselves betrayed over
and over again. Their employer fails to recognise their valuable contri-
butions. Their friends do not reciprocate their parties. Their spouses
rarely acknowledge their love and their offspring never celebrate their
sacrifices. In Bergler’s (1949) terminology, such individuals are “injus-
tice collectors”. Psychically bruised and embittered, they recount their
woes with pained disbelief; it is as if they had hoped for better treat-
ment from others but were jilted and rebuffed.
That the central problem in such individuals is that of masochism is
clear.4 Less evident is the reason how and why being betrayed (as against
being beaten, being sexually abused, and so on) becomes the central
feature of some masochistic individuals. The answer to how it happens
is the following: the masochist possesses a remarkable, though latent,
gullibility. He believes everything he is told and overlooks facts that
contradict his rosy expectations. Isaacs, Alexander, and Haggard (1963)
have eloquently described the genesis of such naiveté.
When a parent misuses the faith and the developing trust of a
child, a disillusionment occurs which is a great blow to the psyche.
If the child has a strong enough ego, he will integrate the fact as a
determinant of limitations and restrictions on the trustworthiness
of parents and others. If he has a somewhat weaker ego, the disap-
pointment may connote a loss of the illusion of ideal parents and
thereby mean a resulting bereavement, loneliness, and depression.
In such circumstances—anger over the loss of the illusion, and guilt
over the anger—the distrust may be repressed and leave the child
unprepared to discriminate between trustworthy and untrust-
worthy persons. He has thereby become gullible, for he can only
indiscriminately trust. Gullibility has to do with a persistent need
to be deceived. The fact of being repeatedly deceived may serve
additionally as a reassurance that the parents are actually no less
trustworthy than anyone else. (p. 464)
By such mechanisms, the masochist sets himself up for failure, injury,

and feeling betrayed. In this aspect, he is like some paranoid person-
alities who, while contemptuous of other’s naivety, themselves display
a peculiar vulnerability to believing in what they hear from gossip-
mongers (Stanton, 1978). The next question—why being betrayed
becomes the phenotypal expression of “moral masochism” (Freud,
1924c)—leads not only to diverse sources of unconscious guilt (Akhtar,
2013c; Asch, 1976; Modell, 1965; Niederland, 1968) but also to psychi-
cally felt betrayals in the form of actual losses during childhood. In the
course of later development, these experiences tend to become libidi-
nised and imbued with masochistic pleasure.
A diminutive and bespectacled middle-aged internist with a boy’s
face, Joel Lobner arrived at my office because he was considering
divorce and wanted to be “really sure” about the correctness of
B E T R AYA L 131
his decision. In the first session, he recounted in great detail how

unappreciated he felt by his second wife, Nancy. He said that he
had been of help to her in numerous ways, including bailing her
out of serious financial mess during their courtship. With pained
disbelief in his voice, Joel repeatedly talked about how hurt he
felt at her ingratitude towards him. He had decided to divorce her
but was afraid of becoming alone, not finding anyone to love and
marry, and regretting his decision. That is why he had come to see
me: to sort out his ambivalence over the decision he was about to
make.
The subsequent sessions were filled with his providing more
“proofs” of Nancy’s thankless attitude towards him, her imperious
stance, and her jealous rages. Joel repeatedly forgave her for such
insults, began trusting her, but was betrayed over and over again.
Just when he would relax and be spontaneous, she would throw
a jealous temper tantrum, destroying his mental peace. Joel had
shared some of these details with two of his friends and both had
called him a “masochist” for staying in such a painful marriage.
They urged him to get a divorce.
Further details gradually emerged. It turned out that even before
their marriage, Joel had ample evidence of Nancy’s narcissistic
character structure and great sense of entitlement. He recalled that
when they were dating and took their first vacation together, not
only did he pay for all their travel expenses but the bills for all the
ten to fifteen meals they ate together in the lovely West Coast town.
Nancy never offered to share any costs of the trip and, in fact, never
uttered “Thank you” upon his paying all the bills. Joel recalled that
he had noted this with mild unease but rationalised it, thinking
that she was just wanting to be pampered, was letting him run the
show, helping him be a big man, and so on. But now, he considered
her behaviour as entitled and, in retrospect, as a betrayal of his trust
in her as a mutual and reciprocal adult.
Nancy was Joel’s second wife. Joel had been married before and
had felt severely betrayed by his first wife, Rosie, as well. She had
misrepresented her social status, lied about her educational back-
ground, and misled Joel about her prior romantic and sexual his-
tory. In fact, Rosie was pregnant by someone else and only told
this to Joel four days before their wedding. Joel was deeply hurt
and, in a single exception to his all accepting and meek relational
style, became physically violent towards Rosie. However, when,

two days later, she offered to get an abortion, he readily forgave her
and they got married. The details of lies about her social circum-
stances emerged later and each time Joel experienced the piercing
and sharp pain of betrayal, but each time he forgave her and they
carried on with their humdrum domestic life over the subsequent
years. During this time, Joel had two extramarital affairs (i.e., he
betrayed her); the second blew up in his face and resulted in the
break-up of his marriage.
Joel remained single for nearly six years, during which he had
many short-lasting relationships and one that felt deep and sustain-
able to him. According to him, he was able to truly love and have
great sex as well. He was ecstatic. What he was ignoring was how
narcissistic this woman, Angie, was. Sheepishly, he acknowledged
that the first time he visited her apartment, he noted that the living
room walls were adorned with her own photographs (twenty-one,
to be precise). Madly in love, Joel “ignored” this. He also over-
looked her intense ethnocentrism and her prejudice against ethnic
and racial minorities. Joel “forgave” her self-willed nature which
frequently caused him hurt. Soon after they would agree to a plan,
Angie would come up with something else to do or would do some-
thing behind his back which derailed the course of action they had
agreed upon. Joel felt betrayed and hurt but smitten by her beauty
and, intoxicated by their glorious sex life, overlooked all this. Then
one day, he felt greatly betrayed by her and, in a fit of rage, abruptly
broke off with her. He was getting some kitchen remodelling done
and had got her involved in it but she began interfering so much
(often talking to the contractor behind his back) that he told her to
stay away from the project. Angie promised to do so but then went
ahead anyway, calling the contractor to do something this or that
way. She did this without telling Joel, who was informed by the
contractor. Livid with rage, Joel called the relationship off.
All three women in Joel’s life (his ex-wife, his girlfriend between
his two marriages, and his current wife) seemed to betray him in
one way or the other. All three appeared to be phallic-narcissistic
characters: proud, strong-willed, and self-centred. What became
evident during the course of our work, though, was that not only
had Joel too betrayed them (e.g., by occasional one-night stands, by
two affairs, by inordinate absorption in his work), he had repeatedly
B E T R AYA L 133
overlooked the unsuitability of these women for him. Or, to put it

correctly, he had overlooked their narcissism and their potential for
entitlement, lying, and walking all over him. Joel was a masochist.
Joel’s childhood background was characterised by many losses
and many changes of residence. By the time he was five, he had
lived in three different states. By the time he was eleven, he had
lost four significant attachment figures to death (his beloved
maternal aunt died when he was four, his mother died when he
was six, his maternal uncle died when he was nine, and his mater-
nal grandmother—who had been raising him after his mother’s
passing away—died when he was eleven). His mother’s death had
resulted from a protracted illness which required repeated hospi-
talisation, beginning at the time when Joel was merely two years
old. Different babysitters took care of him each time. The impact of
these ruptures was made worse by all the deaths he had to face as
a little child.
Matters were made worse by the fact that Joel’s father moved
away to a distant city and kept promising to take Joel there but
this never materialised. Joel’s hopes were repeatedly dashed. His
only sibling, an older brother to whom he was deeply attached,
repeatedly stole from him, mocked him, beat him, and betrayed his
trust by telling everyone things Joel had begged him to keep secret.
As if this were not enough, Joel was sexually abused by a trusted
and admired older cousin; in a household chronically burdened by
grief, there was no one to protect this motherless child. Even Joel’s
grandfather (from whom Joel did receive support and guidance)
sexually exposed himself to Joel repeatedly before passing away
when Joel was eighteen years old.
All in all, Joel had grown up with betrayal as his constant
companion. And, in a major disidentification with his unreliable
caregivers, Joel had become a fiercely loyal and reliable friend to
many individuals. He took great pride in the fact that some of these
friendships went back as much as nearly fifty years. These friends
were all men, however; with women, the scenario was entirely dif-
ferent. Like Limentani’s (1989) “vagina man”,5 Joel had a tendency
to find phallic-narcissistic women; they brought excitement and
thrill to his otherwise depressive lifestyle and his latently effemi-
nate character. Rosie buttressed his narcissism since he could easily
project his inferiority-laden self-representations into her. Nancy and
Angie enhanced his self esteem by their professional prominence.

Parallel to such a narcissistic agenda of his own, Joel had a maso-
chistic aim as well. He would cling to these self-absorbed women
under the cloak of forgiveness and generosity while feeling repeat-
edly stabbed by their betrayals.
In his treatment with me, Joel looked on the one hand for vali-
dation from me that he indeed was being betrayed, and that his
current wife was (and previous women had been) treacherous and
ungrateful to him. On the other hand, he repeatedly defended her,
forgave her, and felt that if he left her, she would suffer greatly. He
desperately sought my empathy but felt squeamish about receiv-
ing it. He seemed accustomed to his masochistic stance and could
neither bear a challenge to it nor tolerate my attempts to unmask
how he used his suffering as a justification for ignoring his wife’s
needs (betraying her, in a way). He seemed totally oblivious to the
fact that he was betraying her on a daily basis by his “24/7” work
addiction; they had not taken a vacation over the five-year course
of their marriage. Fixed in this sadomasochistic equilibrium, Joel
decided abruptly to terminate treatment, thanking me profusely,
and saying that he would let the passage of time decide whether
he should get divorced or not. He seemed to be ignoring the pos-
sibility that a few years down the road, he might regret his indeci-
sion (actually a “decision” to stay masochistic) and blame time as
having betrayed him. Fascinatingly, one of his favourite novels was
Louis Begley’s The Man Who Was Late (1992), a wry account of a
man unable to bear being loved and ending up committing suicide
in late middle life. Joel left me sad, worried, and feeling betrayed.
This case—and the failure of treatment in this case—impels us to

consider the pleasure and power of masochism. While an exhaus-
tive review of such matters is beyond the scope of this chapter, some
attention certainly needs to be paid to them here. In Brenner’s (1959)
perspective, masochism reflects the acceptance of a painful reality for
guilt-ridden, Oedipal sexual impulses. This is often true. More perti-
nent to the case presented here, however, are the views of Bergler (1949)
and Cooper (1988). Bergler posited that the preservation of infantile
omnipotence is of prime importance to the reduction of anxiety and
as a source of ego satisfaction. When the child faces excessive frustra-
tion, this omnipotence is threatened. The child feels humiliated and, as
B E T R AYA L 135
a result, furious. Being helpless to “get even” with his adult offenders,
the child discharges the aggression upon himself. But, in order to main-
tain a semblance of omnipotence, he libidinises it and learns to extract
pleasure from displeasure. Some inborn tendency made the occurrence
of a pleasure-in-displeasure pattern possible.6 These events later evolve
into adult patterns of psychic masochism. Bergler delineated a three-
step process as being paradigmatic in this context: (a) the masochist
unconsciously incites disappointment and humiliation by his behav-
iour and equally unconsciously derives pleasure from it, (b) he replaces
the knowledge of his own provocation and reacts to the insult with
righteous indignation, and (c) after such “pseudo-aggression” creates
further defeats, he indulges in conscious self-pity. Unconsciously, he
enjoys the masochistic pleasure.
In elaborating upon Bergler’s ideas, Cooper (ibid.) noted that the
capacity to defensively alter the meaning of painful experiences of
childhood is largely for maintaining an illusory self-control. He states
that:
Where the experience of early narcissistic humiliation is exces-
sive for external or internal reasons, these mechanisms of repair
miscarry. The object is perceived as excessively cruel and refusing;
the self is perceived as incapable of genuine self-assertion in the
pursuit of gratification; the gratification obtained from disappoint-
ment takes precedence over genuine but unavailable and unfa-
miliar libidinal, assertive, or ego-functional satisfactions. Being
disappointed or refused becomes the preferred mode of narcissistic
assertion to the extent that narcissistic and masochistic distortions
dominate the character. (p. 128, italics in the original)
Cooper emphasised that the pleasure sought in such cases is not genital-
sexual; it is pre-Oedipal and pertains to self-esteem and self-coherence.
The coexistence of narcissism and masochism is central to Cooper’s
conceptualising. He declared that
In any particular instance, the presenting clinical picture may seem

more narcissistic or more masochistic … However, only a short
period of analysis will reveal that both types share the sense of
deadened capacity to feel, muted pleasure, a hypersensitive self-
esteem alternating between grandiosity and humiliation, an inabil-
ity to sustain or derive satisfaction from their relationships or their
work, a constant sense of envy, an unshakable conviction of being

wronged and deprived by those who are supposed to care for them,
and an infinite capacity for provocation. (p. 129)
Cooper’s eloquence is humbling. It also serves as an exquisitely appro-

priate starting point for considering the problems in treating such
patients.
Treatment considerations
Before elucidating the nuances and strategies of technique, two cave-
ats must be entered. First, the suggestions I am making regarding the
treatment of the betraying and betrayed patients are not to replace the
customary work of empathic affirmation, transference interpretation,
reconstruction, and countertransference vigilance,7 Nor are these sug-
gestions meant to interfere with the “trio of guideposts” (Pine, 1997,
p. 13) of abstinence, neutrality, and anonymity that are a cornerstone
of our approach. What follows are not rules to be respected in work-
ing with all such patients. Indeed, the more psychologically sophisti-
cated and “analysable” the patient, the less attention needs to be paid
to these guidelines. Second, even though I make separate suggestions
for treating narcissistic-betraying patients and for treating masochistic-
betrayed patients, the fact remains that hybrid forms of such psy-
chopathology are common and shifting attention to narcissistic and
masochistic aspects of the patient’s functioning might be essential; this
would call for the use of both types of technical interventions in one
and the same patient.
Having entered these two caveats, we can move on to a considera-
tion of treating narcissistic-betraying patients. The following sequence
of interventions, though appearing overly schematic when put in writ-
ing, applies here. After ample psychic space has been provided for the
analysand to present his version of events and a therapeutic alliance has
evolved, the analyst needs to confront the patient with (a) the driven
quality of his seducing and betraying others, (b) the contradiction
between his seeking love and security while not providing those very
experiences to people he is involved with, (c) the denial of his hostile and
destructive aims towards others who are puppets in an inner theatre of
vindictiveness, and (d) the active jettisoning of moments when empa-
thy towards a victim is experienced and of similar affective-cognitive
B E T R AYA L 137
movements in the transference experience. The analyst also needs

to help the patient (e) become aware of the pleasure he derives from
betraying others, thus seeking to render that pleasure ego-dystonic;
(f) mourn the lost opportunities for love, and (g) bear the newly emer-
gent remorse over his cruelties towards others.
Throughout such work, the twin dangers of a moralising counter-
transference and of causing injury to the patient’s self-esteem should
be avoided. This would necessitate a coupling of interpretive unmask-
ing with empathic-reconstructive remarks (consistently indicating
the traumatic origin of the patient’s behaviour). The defensive func-
tions of betraying others (e.g., turning passive into active, warding off
dependent longings) and the felt need for such defences must also be
underscored.
Just as the treatment of narcissistic patients who betray others is
difficult, so is working with masochistic patients who keep bringing
the same tale of being betrayed in various guises again and again.
Such work requires enormous patience. The analyst must not rush the
process even though the material might appear eminently “interpret-
able”. Although made in a different context, the following comment by
Amati-Mehler and Argentieri (1989) is pertinent here.
The patient ought to experience for a sufficient length of time and

at different levels of the soundness of the therapeutic rapport, the
security of being understood, the benefit of a careful and thorough
working-through of the transference, and a relational structure that
enables him or her to contain the comprehension and the elabora-
tion of the disruption of the transference play. (p. 303)
Such disruption of the patient’s masochistic proclivity, though long in

coming, is ultimately essential. The analyst must (a) understand that
there is a sort of “success” in all the failures reported by the patient;
(b) recognise that “… wreckage may represent more than painful defeat
or punishment. For example, it may also represent the triumph of
archaic moral aims over infantile libidinal aims” (Schafer, 1988, p. 83),
or it may be a way to avoid separateness and aloneness by clinging to
a hurtful “inconstant object” (Blum, 1981); (c) “point out to the ana-
lysand how, when, and why he or she tries to bring about failure or
to experience failure, or dwells on failure in the analytic situation”
(Schafer, 1988, p. 89), especially when good things are about to happen
and happiness seems to be just around the corner;8 (d) help the patient
see how and how often he dismisses or minimises the presence of reli-
able people in his life, that is, people (including the analyst) who do not
betray him; (e) unmask and interpret the patient’s envy of the analyst’s
reliability (Kernberg, 1992) and, in a paradoxical turn of perspective, of
their own reliability in keeping the analytic appointments; and (f) man-
age, control, and learn from the countertransference feelings of exasper-
ation and hostility as well as defences against these burdensome affects
(Asch, 1988; Maltsberger & Buie, 1974).
A note of caution is needed here.9 In focusing upon the betrayer’s
sadism and the betrayed’s masochism, one ought not to overlook that
the former is continually depriving himself of genuine love and affec-
tion (i.e., he is being masochistic) and that the latter in harping about
his suffering is displaying his moral superiority and a condescending
attitude towards others (i.e., he is being sadistic). Remembering Freud’s
(1905a) declaration that sadism and masochism invariably coexist helps
the analyst retain a complex and multifaceted perspective on patients’
associations and transferences.
Concluding remarks
In this contribution, I have delineated some phenomenological and
metapsychological aspects of betrayal. Utilising two case reports, I have
attempted to show the lived and transference experience of betraying
others and of feeling betrayed by others.10 I have emphasised that these
narcissistic and masochistic scenarios often coexist even if one is more
overt and the other covert in a given case. Following the discussion of
these cases, I have outlined some guidelines for the treatment of betray-
ing narcissistic and betrayed masochistic patients, while reminding the
reader that the suggestions I have made are neither essential nor appli-
cable in all cases. Moreover, they are not intended to replace our usual
ways of conducting analytic treatment.
While I have cast a wide net, a few questions remain unanswered.
First, since both the betraying and the betrayed types seem to have
suffered severe betrayal trauma in their childhood, what accounts for
their phenotypical difference? In other words, why do some victims of
childhood betrayal become narcissistic betrayers and others masochis-
tic seekers of betrayal? Such “choice of neurosis” (Freud, 1913c) is most
likely dependent upon some difference in constitutional endowment
with the more inherently aggressive child “opting” for the narcissistic
B E T R AYA L 139
route and the inherently less aggressive (or less outwardly aggressive)
child succumbing to masochism. Perhaps the age and the degree of ego
maturity when the childhood betrayal occurred and the qualitative dif-
ference in helplessness it produced (e.g., by broken promises vs. actual
death of a parent) also play a role here. Putting all these possibilities
together gives rise to the following speculations. Betrayed children
who were constitutionally less aggressive, traumatised earlier, repeat-
edly, and had no recourse but to cling to their betrayers while grow-
ing up, most likely turn out to be masochists. Betrayed children who
were constitutionally more aggressive, traumatised somewhat later,
less frequently, and had recourse to caregivers other than their betray-
ers most likely turn out to be narcissists. However, more data and more
thought are needed about these issues for one to be certain about these
hypotheses.
Another area that needs further exploration is why some narcis-
sistic and some masochistic patients improve with analytic treatment
whereas others do not. While patient-based variables (e.g., honesty,
psychological mindedness, absence of substance abuse, work-related
sources of efficacy and pleasure) contribute much to the prognosis,
quality of the “fit” between the patient and analyst might also matter;
this less than optimally explored realm merits more investigation. And
so does the potential impact of gender and culture upon which pole
of the betrayer-betrayed scenario will predominate in the final psycho-
pathological picture in those exposed to the trauma of severe betrayal
during childhood.
While answers to such questions are awaited, one thing remains
clear. Betrayal is both a specific form of trauma and a constituent of
all psychic trauma. Sexual abuse, physical maltreatment, profound
neglect, mockery, and bullying all include an element of betrayal. All
involve breaking someone’s trust and putting someone’s faith and hope
in question. As a result, the dynamic and technical observations con-
tained in this chapter might apply—in small or large measure—to all
traumatised individuals while maintaining their specificity for those
who have been betrayed and hurt by their caregivers.
Notes
1. Having unintentionally betrayed others, however, leads to remorse,
and realising that one has been unintentionally betrayed diminishes
mental pain.
2. The word “betrayal” appears only eighteen times in the entire corpus of
Freud’s writings (Guttman, Jones & Parrish, 1980, pp. 272–273). Five of
these usages are colloquial and carry little scientific significance. Nine
pertain to “psychic self-betrayal” via slips of the tongue (Freud, 1901b),
clumsy testimony during a court trial (Freud, 1906c), or bodily fidgeti-
ness in a failed attempt to suppress a secret (Freud, 1905e). The remain-
ing four usages are in the context of compulsive rituals (e.g., keeping
scraps of paper) to control a fear of betrayal (Freud, 1896b), the mass
paranoia of a nation defeated in war defensively evolving a collective
“delusion of betrayal” (Freud, 1950a), and the masochistic tendency of
certain individuals who find themselves repeatedly betrayed by friends
(Freud, 1920g).
3. Besides his calling these relationships “stories”, Paul always referred to
various women by both their first and last names. I have encountered
this phenomenon in another narcissistic patient and believe that it is an
unwitting fetishistic ploy to turn women into caricatures.
4. While the term “masochism” has been used in many ways (see Maleson,
1984, for a comprehensive review), Brenner’s (1959) definition remains
authoritative. Masochism, for him, is “the seeking of unpleasure, by
which is meant physical or mental pain, discomfort or wretchedness,
for the sake of sexual pleasure, with the qualification that either the
seeking or the pleasure or both may often be unconscious rather than
conscious” (p. 197).
5. Limentani coined this term for an individual who harbours a powerful
wish to be a woman and has deep envy of everything female. He also
has a secret fantasy of possessing a vagina. Intelligent, charming, and
friendly, the “vagina man” reads voraciously, looks at things intently,
and insatiably seeks the company of others, especially women. He is
feminine but his femininity is hidden behind his attentiveness towards
women. Owing to this attentiveness, his sexual performance is better
than average. According to Limentani, such a person has been raised by
a mother who was somewhat masculine, while also treating her child as
her phallus. The “vagina man” constellation results from an identifica-
tion with such a mother. It serves as a defence against homosexuality.
Moreover, the fantasy of belonging to the other sex helps avoid the fear
of castration.
6. The binding of the death instinct by the libido lays down the ground
for such “primary masochism” (Freud, 1924c). While many psychoana-
lysts have reservations about such a formulation, poets have subscribed
to this view wholeheartedly. A recent illustration is evident in the line
Ghum ke sehnay mein bhi qudrat ne mazaa rakhha hai (literally, “Nature has
B E T R AYA L 141
created the potential of deriving pleasure from pain”) by the Urdu poet,
Nasir Kazmi (1972).
7. Our clinical work is a peculiar amalgam of a warm relationship which
we approach with “evenly suspended attention” (Freud, 1912e, p. 111)
and “without memory or desire” (Bion, 1967b, p. 272), and a theory-
driven deliberateness, hierarchy of interpretation (Loewenstein, 1951),
and “strategy” (Levy, 1987) of technique. We respond to the analysand’s
material with an admixture of “free-floating responsiveness” (Sandler &
Sandler, 1998) and selectively paying “attention now to defence, now
to what is defended against, depending upon which is apparent in a
patient’s communications” (Brenner, 2000, p. 548). My proposal of
certain guidelines for treating betrayed and betraying patients reflects
the spirit of focused attention and strategic interpretation in psycho-
analytic technique.
8. This, of course, is the essence of what Freud (1923b) termed “negative
therapeutic reaction”. He held that unconscious guilt over the wished-
for childhood Oedipal transgressions of incest and murder were
responsible for such a reaction. Subsequent analysts have, however,
added additional dynamics including anxiety over separation from
mother (Asch, 1976; Grunert, 1979), envy of the therapist’s ability to
soothe and help (Kernberg, 1984), and identification with a masochistic
parent (Akhtar, 2009).
9. This discussion of betraying and being betrayed has remained patient-
focused. It has not addressed betrayals of the patient by the analyst.
While their gross forms (e.g., sexual boundary violations) are well-
known and written about (Casement, 2006; Celenza, 2006; Gabbard &
Lester, 1995), more subtle betrayals by the analyst often go unrecog-
nised or are subsumed—by the analyst—under the rubric of “technical
errors” (see Charles, 1997, for a meaningful discussion of this matter).
10. Although the two cases described here involve men betraying women
or feeling betrayed by women, this does not mean that women cannot
do and feel the same. Moreover, betrayal can also occur in the “non-
erotic” realms of money, academic collaboration, national security, etc.
CHAPTER SIX
Revenge
T
he history of human civilisation is replete with examples of
man’s destructiveness towards man. Some of these outbursts
are impulsive, passionate, and transient. Others are calculated,
deliberate, and long-standing. Some involve individuals. Others
involve masses. Some occur only in fantasy and, under fortunate cir-
cumstances, are turned into defiant poetry, biting fiction, and provoc-
ative theatre. Others slit throats, ruin families, and cause bloodshed.
Regardless of their extent, all destructive actions somehow or other
become justified in the mind of the perpetrator. One’s violence is given
a patina of reasonableness through all sorts of rationales and rationali-
sations regardless of whether it involves the plebian tit-for-tat of chil-
dren or the awesome “messianic sadism” (Akhtar, 2007c) of paranoid
fundamentalists. Matters of the former variety fall under the purview of
parents, elementary school teachers, and benevolent clergy. Matters of
the latter variety belong to interdisciplinary think tanks that can inform
sociopolitical praxis.
These two extremes are not encountered in the clinical situation.
What one does witness there are “mid-level” destructive aims and
fantasies directed at old and new objects as well as their recreations
in the transference. Any therapist who has worked with narcissistic,
143
paranoid, and sociopathic individuals would vouch for the veracity of

this observation. Given this, it is surprising that the theme of revenge
has attracted very little attention from psychoanalysts. The PEP web,
which contains over 88,000 entries, comes up with only thirty papers
with “revenge” in their titles over the 113-year history of psychoanalysis.
Clearly, something is remiss here.
This overview is intended to summarise the scattered writings—
psychoanalytic or otherwise—on the topic of revenge and to create
some phenomenological and psychodynamic order out of this chaos. In
addition, the contribution will make a brief foray into the literary realm
and close with elucidating the clinical implications of the observations
made during the effort to unfold the nuances of the issues involved
here.
Phenomenological aspects
The English word “revenge” is derived from the Old French vengier,
meaning “to avenge”. Its dictionary definition includes phrases such
as (i) to avenge by retaliating in kind or degree; (ii) to inflict injury in
return for an insult, and (iii) an opportunity for getting satisfaction
(Webster’s, 1987, p. 1009). An unmistakable implication is that revenge
has ideational, emotional, and behavioural aspects. In the ideational
sphere, revenge is accompanied by a fantasy (conscious or uncon-
scious) of having been grievously harmed by someone and of finding
relief from inflicting damage upon the perpetrator. In the emotional
sphere, revenge is accompanied by feelings of “mental pain” (Akhtar,
2000; Freud, 1926d; Ramzy & Wallerstein, 1958; Weiss, 1934), bitterness,
rage, and defensive exaltation; the vengeful person is often euphoric.
In the behavioural sphere, common manifestations of revenge include
verbal and physical assaults of varying degrees, ranging from sarcasm,
denigration, and hurling obscenities to slapping, hitting, punching,
throwing things at someone, knifing, maiming, shooting, and killing.
However, gross actions of such a sort do not exhaust the behavioural
manifestations of revenge. The phenomena associated with it are com-
plex in many ways.
First: Acts of revenge are not always directed at the individual or
organisation that is viewed as having caused harm. Often the rage ema-
nating from feeling hurt is aimed at objects that symbolically stand for
the injuring party or are weak and vulnerable, hence suitable for being
attacked. Nearly 100 years ago, Rank (1913) pointed out that neurotic
REVENGE 145
acts of revenge are often directed against the “wrong” people. Revenge
fantasies in terrorist acts especially depict how victims of the destructive
impulse are not truly the targets of it (Akhtar, 2003); innocent civilians
are killed and maimed not for rage directed at them but because they are
dispensable pawns in a violent game of chess with their governments.
Second: Redirection of vengeful affects and behaviours can
involve the self. Thus the chronic self-effacement, self-deprivation,
self-denigration, self-mutilation, and self-destructiveness of severely
masochistic patients contain a powerful, though unconscious, element
of revenge. Freud (1917e, 1921c) had long ago discerned this element in
the symptomatology of depression. He stated that
A leading characteristic of these cases is a cruel self-depreciation

of the ego combined with relentless self-criticism and bitter self-
reproaches. Analyses have shown that this disparagement and
these reproaches apply at bottom to the object and represent the
ego’s revenge upon it. (1921c, p. 109)
It is as if the patient, in his misery, has become a walking billboard of

the parental misconduct during his childhood. His ongoing pain and
suffering shouts at the parents with the whole world as their mutual
audience, “Look how much you have damaged me! I am a total failure
compared to everyone else. I am retarded. I cannot grow and it is all
your fault!” (Kramer, 1987, p. 217). Procci’s (1987) concept of “mock-
ery through compliance”, whereby the individual acts out his or her
parents’ destructive intent towards himself in an exaggerated way, also
applies here. And, so does Ferenczi’s (1929) sombre delineation of how
the unwanted child turns pessimistic and devoid of life energy. Even
more dark is the description of “spite suicides” (Zilboorg, 1936) refer-
ring to taking one’s life due more to sadism and sarcasm than depres-
sive hopelessness. Maltsberger and Buie (1980) offer a more recent and
lucid description of this phenomenon.
Would-be suicides often daydream of the guilt and sorrow of oth-

ers gathered about the coffin, an imaginary spectacle which pro-
vides much satisfaction. While the contemplation of such a scene is
a pleasure in itself, the patient may also consciously entertain the
illusion that after the act of suicide he will be present as an unseen
observer to enjoy the anguish of those who view his dead body.
Such an illusion may be held with such intensity that it supersedes
reality in emotional value and forms the basis for action. (p. 61)
Third: Even direct acts of revenge take many forms. Some of them
are active (e.g., sarcasm, physical violence), while others are passive
(e.g., gaze aversion, refusal to eat). Some involve aggression while
others deploy sexuality as a medium. Behaviours that have been
linked with an underlying theme of revenge are as varied as frigid-
ity, euphemistically referred as “revenge on the man” (Fenichel, 1945,
p. 174), incestuous acting-out (Gordon, 1955), pathological stealing
(Castelnuevo-Tedesco, 1974), primal scene reversals (Arlow, 1980),
shop-lifting (Ornstein, Gropper & Bogner, 1983), serial killing (Stone,
1989), and sexual betrayal (Akhtar, 2013a). At times, an individual’s
sexual object choice can also express his or her rebellion and revenge
against the cultural strictures of the family (Freud, 1920g). Neurotic
fears of being bitten by animals too can contain elements of revenge
being taken against oneself for one’s original hostility towards parents
(Freud, 1926d).
Finally, there exists a relationship between the level of character
organisation and the nature of revenge fantasy. At the “higher level
of character organization” (Kernberg, 1970), where identity is well-
consolidated and defences centre upon repression, revenge fantasies—if
they even exist—involve Oedipal issues. Childhood exposure to
parental sexuality fuels such fantasies and their subtle and disguised
seepage into actual behaviour. At the “intermediate” and “lower” levels
of character organisation (ibid.), characterised by identity diffusion and
the preponderance of splitting mechanisms, matters appear more stark.
Revenge, in this context, is usually overt, cold-blooded, and accompa-
nied by conscious sadistic pleasure. Rosenfeld’s (1971) description of
narcissistic personalities who idealise their destructive capacity and
Kernberg’s (1984) delineation of the syndrome of malignant narcissism
which combines grandiosity, paranoid traits, and antisocial tendencies
are highly pertinent here. Fantasies and actions of violent revenge are
common among such individuals and are founded upon severe child-
hood frustrations and actual trauma; their vindictiveness constitutes
the reversal of betrayal and abuse by their parents.
Psychodynamics
Freud’s first comment upon revenge was in the context of trauma
which, he believed, became more pathogenic when suffered in silence.
Taking revenge holds the possibility of getting over the injury, though
REVENGE 147
speaking about what has happened also helps. Here are Freud’s own
words on this matter.
An injury that has been repaid, even if only in words, is recol-

lected quite differently from one that has to be accepted. Lan-
guage recognizes this distinction, too, in its mental and physical
consequences; it very characteristically describes an injury that
has been suffered in silence as “a mortification” (Krankung, liter-
ally “making ill”). The injured person’s reaction to the trauma
only exercises a completely “cathartic” effect if it is an adequate
reaction—as, for instance, revenge. But language serves as a sub-
stitute for action; by its help, an affect can be “abreacted” almost as
effectively. (1950a, p. 8, italics in the original)
Freud later evoked the idea of revenge in his elucidation of the dynam-
ics of Little Hans (1909b) and the Wolf Man (1918b). He regarded
their fears of being bitten and devoured by animals (in reality and in
dreams, respectively) as a boomerang effect of their own hostile fanta-
sies towards their parents, especially in the context of the latter’s sexual
lives. In Inhibitions, Symptoms and Anxiety, written nearly two decades
later, Freud reiterated this idea.
The case of the “Wolf Man” and the somewhat less complicated one
of “Little Hans” raise a number of further considerations … There
can be no doubt that the instinctual impulse which was repressed
in both phobias was a hostile one against the father. One might say
that that impulse had been repressed by the process of being trans-
formed into its opposite. Instead of aggressiveness on the part of
the subject towards his father, there appeared aggressiveness (in
the shape of revenge) on the part of his father towards the subject.
Since this aggressiveness is in any case rooted in the sadistic phase
of the libido, only a certain amount of degradation is needed to
reduce it to the oral stage. This stage, while only hinted at in “Little
Hans’s” fear of being bitten, was blatantly exhibited in the “Wolf
Man’s” terror of being devoured. (1926d, p. 106)
The linkage between a child’s sense of betrayal at the discovery of

parental sexuality and the resulting desire to take revenge is nowhere
more clear in Freud’s writings than in his 1910 paper titled “A Special
Type of Choice of Object Made by Men”. Explicating the Oedipal

situation of the boy, Freud stated:
He does not forgive his mother for having granted the favour of
sexual intercourse not to himself but to his father, and he regards
it as an act of unfaithfulness. If these impulses do not quickly pass,
there is no outlet for them other than to run their course in phan-
tasies which have as their subject his mother’s sexual activities
under the most diverse circumstances; and the consequent tension
leads particularly readily to his finding relief in masturbation. As a
result of the constant combined operation of the two driving forces,
[sexual] drive and thirst for revenge, phantasies of his mother’s
unfaithfulness are by far the most preferred. (1910h, p. 171)
Freud’s papers on family romances (1909c) and on a case of female

homosexuality (1920a) repeated that revenge originated in the child’s
feeling humiliation and injury vis-à-vis parental sexuality. A new
perspective on revenge was, however, evident in “Mourning and
Melancholia” (1917e), where the self-reproaches of both the obsessional
and the melancholic were seen as acts of revenge upon the subject’s
own ego.
The self-tormenting in melancholia, which is without doubt enjoy-

able, signifies, just like the corresponding phenomenon in obses-
sional neurosis, a satisfaction of trends of sadism and hate which
relate to an object, and which have been turned around upon the
subject’s own self. In both disorders, the patients usually still suc-
ceed, by the circuitous path of self-punishment, in taking revenge
on the original object and in tormenting their loved ones by their
illness, having resorted to it in order to express their hostility to him
openly. (p. 251)
Freud repeated these ideas in Group Psychology and the Analysis of the
Ego (1921c, p. 109), though conceding, in Civilization and Its Discontents
(1930a, p. 130), that the severity of self-reproaches and the underly-
ing revenge motif is only partly due to experiential factors (either via
narcissistic injury in the Oedipal phase or via loss of an ambivalently-
held but needed object); inborn constitutional factors also contribute to
the ferocity of the superego and to the overall propensity for rage and
revenge in one’s character.
REVENGE 149
Following Freud, many psychoanalysts enriched the understanding

of revenge-related phenomena. Abraham (1920) described a “revenge-
type of female castration complex” which, reflecting the phallocentric
theorisation of the era, was alleged to cause attacks on the “luckier” male
by castrating him. To deprive him of the satisfaction that he has given
her sexual pleasure, the woman might become incapable of orgasm.
Or, a certain kind of aggressive hypersexuality might develop in her;
this is often accompanied by the exploitative fantasies of being a prosti-
tute. Fenichel (1945) later added that since the infantile oral pregnancy
themes often include the idea that the woman eats the man’s penis, the
revenge-type of female castration complex might also result in eating
inhibitions. Similarly loyal to the drive theory of psychoanalysis, Klein
(1933, 1940) spoke of externalisation of the death instinct and the subse-
quent creation of “bad objects”; these can then be feared and therefore
justifiably attacked. Though the word “revenge” does not constitute an
element of her vocabulary (see Hinshelwood, 1991), Klein’s description
of the “paranoid position” centres upon infantile persecutory anxieties
and phantasies of retaliation against “bad objects”.
Moving away from this drive-based model, Winnicott (1956a) traced
stealing and outrageousness towards others to actual deprivation in
childhood. He did not use the word “revenge” (Abram, 2007), but his
ideas on what he called “antisocial tendency” are certainly applicable
to revenge as well. In his inimitable fashion, Winnicott suggested that
insofar as it compels the environment to respond, “antisocial tendency”
is an expression of hope. The delinquent’s outrageousness is a cry for
help. Winnicott (1956a) noted that there are always two trends in anti-
social tendency.
One trend is represented typically in stealing and the other in

destructiveness. By one trend, the child is looking for something,
somewhere, and failing to find it seeks elsewhere, when hopeful.
By the other the child is seeking the amount of environmental sta-
bility which will stand the strain resulting from impulsive behavior.
This is a search for environmental provision that has been lost,
a human attitude, which, because it can be relied on, gives freedom
to the individual to move, to act, and to get excited. (p. 310)
The tension between a drive-based and a deprivation-based aetiologi-

cal model of revenge tilted over time (just as psychoanalytic theory at
large did) towards the latter view. Even those contributors (e.g., Arlow,
1980; Socarides, 1966) who employed the vocabulary of drives did
so in the context of childhood trauma. Most others (e.g., Boris, 1986;
Castelnuovo-Tedesco, 1974; Daniels, 1969; Horney, 1948; Kohut, 1972;
Steiner, 1996) emphatically favoured the deprivation and/or humilia-
tion hypothesis of the origin of vindictiveness.
In a remarkable paper titled “The Value of Vindictiveness”, Horney
(1948) noted that while rational outrage at a frustrating event settles
soon after it is vented, vindictiveness, in neurotic characters, can become
a way of life. Its aims then are to humiliate, to exploit, and to frustrate
others. Its means can be varied and include the induction of guilt and
inferiority in others, ingratitude, indifference, and active assaults upon
others’ valued traits and capacities. Horney described three forms of
vindictiveness, namely, (i) openly aggressive vindictiveness that is
associated with a certain kind of pride in what is construed as one’s
honesty and straightforwardness; (ii) self-effacing vindictiveness which
operates covertly and exploits others’ inclinations towards fairness and
justice; vindictiveness of this sort evokes the puzzling impression of
being done at the person’s expense; and (iii) detached vindictiveness
that expresses hostility towards others “by not listening, by disregard-
ing their needs, by forgetting their wishes, by making them feel as
disturbing intruders, by withholding praise or affection, and by with-
drawing psychically or socially” (p. 4). Horney emphasised that vindic-
tiveness, while destructive in intent, serves some positive functions as
well. These include its protective power against real and/or imagined
hostility from others, its defensive aim against self-destructiveness, and
its promise to restore injured pride. The need for vindictive triumph,
in Horney’s formulation, arose from many sources, the prime variable
being a pressure to reverse the thoughtlessness or openly cruel humili-
ations experienced at the hands of others. The feeling of vitality and
even thrill provided by acts of revenge also counters the inner sense of
inferiority and shame.
Searles (1956) also underscored the defensive functions of revenge.
He noted that vindictiveness can serve as a defence against repressed
emotions, especially those of loss, separation, and mourning. Accord-
ing to him, the vindictive person is unable to let go of his attachment to
the object that is indifferent to his desire; seeking revenge against that
object maintains the hope of affecting a change in its attitude.
Socarides (1966) noted that the conscious aim of vengeance is ret-
ribution and punishment while the unconscious aim is to cover up
REVENGE 151
disastrous damage to the ego that occurred in early childhood and

revived in adulthood. Vengeance can also serve as a defence against
guilt whereby the self-directed aggression is turned towards the exter-
nal world. Socarides observed that the vindictive person is “grudging,
unforgiving, remorseless, ruthless, heartless, implacable, inflexible
[and] lives for revenge with a single-mindedness of purpose” (p. 405).
There is a certain kind of “pseudo-courageous” attitude here too since
the vengeful individual will go to any extreme to hurt his enemies. Such
unrelenting aggression is a product of early, mainly oral, frustration.
“Damaged fundamentally in the capacity to love, the vengeful person
is unable to withstand future states of deprivation and attacks individu-
als in the environment as if they were representatives of the depriving
breast, frustrating mother, absent father, lost penis” (ibid., p. 410). Envy
plays a big role here and the projection of such envy upon superego
figures leads to hatred of powerful and secretly idealised others.
Daniels (1969) emphasised that triumph over hated objects is so
important for such an individual that he readily cuts ethical corners
and uses any weapon in his “war”. He strikes first and his pre-emptions
betray his paranoia and intense need for control. And, when his victims
complain, he accuses them of being hypersensitive and weak. Daniels
noted that the vindictive person’s hostility goes beyond his explicit
“tormentors” since envy plays a great role in his life as well.
Aside from those who actually “cross him”, the vindictive

character also perceives as definitely threatening anyone possess-
ing more than he does—materially, intellectually, or psychologi-
cally. Bitter envy assails him. Such people must be diminished,
reduced to his level; otherwise, his pride suffers and he begins
to slide into the depression upon the brink of which he is already
standing. Even worse, he begins to be cognizant of the misery of his
lot and of his anguished aloneness. He must enter into relation with
the envied person and make him miserable too; then he will be less
lonely. (pp. 187–188)
Kohut (1972) described the phenomenon of narcissistic rage with great

eloquence. He stated that:
Narcissistic rage occurs in many forms; they all share, however,

a specific psychological flavor which gives them a distinct position
within the wide realm of human aggressions. The need for revenge,
for righting a wrong, for undoing a hurt of whatever means, and

a deeply-anchored, unrelenting compulsion in the pursuit of all
these aims which gives no rest to those who have suffered a narcis-
sistic injury—these are features which are characteristic of narcis-
sistic rage in all its forms and which set it apart from other kinds of
aggression. (p. 379)
Kohut went on to note that such rage is only mobilised if there is an

archaic grandiose self seeking its preservation and regulating the per-
ception of reality. The “enemy” who incites narcissistic rage is not per-
ceived as a separate individual and an autonomous source of initiative
but as a flaw in a narcissistically perceived reality that must be erased
and blotted out.
Castelnuovo-Tedesco (1974) termed the triad of entitlement, steal-
ing, and well-rationalised sadomasochism the Monte Cristo complex.
Describing the protagonist from Alexandre Dumas’s (1802–1870) epon-
ymous novel and adding two clinical cases with similar psychopathol-
ogy, Castlenuovo-Tedesco proposed that:
The act of stealing, on close examination, proves to have a variety
of discernible meanings and functions, all of which are, broadly
speaking, restitutive. It serves, first of all, to undo a loss which is
subjectively perceived as a theft where the patient has been the vic-
tim. Second, it is seen as an opportunity for revenge, for settling a
score and giving back measure for measure. It is my impression, in
sum, that the impulse to steal and the urge for revenge are really
very close to one another. It is also a way of “turning the tables”, of
taking the initiative and, in secret, converting a passive experience
into an active one. It is further a way of controlling a frightening
and dangerous object and rendering it harmless by reinstating a
long lost but cherished sense of omnipotence. Finally, it is a channel
for discharge of substantial aggressiveness and greed. (p. 175)
The connection between greed and revenge found further exposition

in a paper by Boris (1986). Greed, in his conceptualisation, is appetite
turned angry and no longer reliant on the actual object. Greed aspires
for an idealised object, hence is inconsolable. The next step in the proc-
ess is the development of spite or the envious nullification of the other’s
impact and thus, in turn, is followed by seeking revenge. The aim, at
this point, is to stimulate greed and envy in the other.
REVENGE 153
Steiner (1996) elucidated the reverse of this dynamic. He noted that

when taking revenge is felt to be too dangerous, grievance is kept under
check and becomes a nidus for sadomasochistic retreat. Steiner also
noted that the wish for revenge initially represents the pursuit of a just
cause but soon gets caught up in destructive motives of diverse, often
unrelated origins. Moreover, revenge-seeking serves to protect the split-
off good object which can be kept idealised till the time a bad object is
found and destroyed.
In contrast to most of the contributors cited above, Arlow (1980)
returned to the Oedipal origins of revenge-seeking. He noted that expo-
sure to the primal scene, especially if vivid and frequent, leads to narcis-
sistic mortification and a conviction that one is unloved and unlovable.
This trauma gives birth to the wish to wreak vengeance on one or both
of the “betraying” parents. A common manifestation of such a wish is
the tendency to criticise and demean parents and parental surrogates.
More striking are the scenarios where the taking of revenge occurs in
sophisticated enactments or reversals of the primal scene.
In some instances, the individual brings about a repetition of the

primal scene in which he casts himself in the role of witness, often
enough interrupting and causing distress to a couple making love.
Relatively underemphasized, however, are those vengeful repeti-
tions of the primal scene in which the individual causes others to
be witness to his sexual activities. The unconscious import of this
behavior is to make the betraying parents experience the sense of
humiliation, exclusion, and betrayal that the child experienced at
the time of the original trauma, except that in this repetition the role
of the parent may be assigned to somebody else—spouse, child,
lover, etc. (Arlow, 1980, p. 523)
Having covered the multifaceted descriptive and psychoanalytic litera-

ture on revenge, I am now in a position to offer a composite profile of
phenomena that exist in this realm.
An attempt at synthesis
What becomes clear from this review is that many diverse phenomena
are subsumed under the term “revenge”. It appears in the vastly dif-
ferent contexts of repressed, disguised, and symbolically represented
unconscious fantasies as well as of overtly destructive and violent acts

towards others. Confusion also rises from the term “revenge” being
employed for a single act of retaliation triggered by hurtful or violat-
ing action by someone in external reality and also for the character trait
of vindictiveness. Well-justified, rational, and limited acts of retribu-
tion also get lumped together here. The fact is that such “good enough
revenge” is very different from vindictiveness. “Good enough revenge”
meets the following criteria: (i) it is a one-time occurrence, (ii) more of
it is in fantasy and less in action, (iii) it avoids self-destructiveness and
masochism, and (iv) it takes socially productive forms (e.g., writing a
significant book to prove the “enemy” wrong) or carries the potential of
initiating (or resuming) a meaningful dialogue between the victim and
the perpetrator.1 In contrast, vindictiveness is chronic, boundless, con-
suming, and, often, self-destructive besides being grievously harmful
to the real or imagined enemy. People who are given to vindictiveness
continue to harbour resentment towards their offenders for months,
years, and often for their entire life. They are prone to sustained hatred
and can disregard all limits in their pursuit of real or imagined offend-
ers. Western literature contains many such characters. The Merchant
of Venice’s Shylock (Shakespeare, 1596) with his literal-minded insist-
ence upon extracting “a pound of flesh” in lieu of his unpaid debt
and Wuthering Heights’s Heathcliff (Brontë, 1847) with his bitter rants
against the woman by whom he feels betrayed are two outstanding
examples. Towering above these is the character of Captain Ahab in
Melville’s Moby Dick (1851). His hunger for revenge against the whale
that bit off his leg drives him to such “demonic” revenge-seeking that
he ultimately destroys his own self.
The two forms of retaliation (i.e., “good enough revenge” and vin-
dictiveness) stand on opposite poles of the wide spectrum of socioclini-
cal phenomena involved here (see Table 3).
Psychodynamically too, the spectrum of revenge is wide. The phe-
nomena related to revenge seem—like all other psychic phenomena—
multiply determined. Although a background of severe childhood
frustration does play a major role in it, the dynamics of revenge and
vindictiveness exceed it. It comprises variables emanating from all
three sources: defect, discharge, and defence. Moreover, the role of
these variables and the degree of their contribution to the overt behav-
iour differs from case to case. From the perspective of defect, the truly
vengeful individual gives evidence of lacking empathy with his victim.
Desperately wishing to inflict pain upon the “enemy”, he nonetheless
REVENGE 155
Table 3. The spectrum of revenge.

Variables Good enough revenge Vindictiveness
Object External Internal

Emotion Rage Hate
Frequency Once Chronic
Scope Limited Unlimited
Cognition Contextual Narrowed
Ethics Intact Compromised
Narcissism Regained Regained
Pleasure Yes Yes
Masochism No Yes
Sublimation Maybe No
Consequence Constructive Destructive
Time Heals Makes no change
cannot empathise with the latter’s suffering. The “narrow-mindedness”

(Brenman, 1985) that frequently accompanies vengeful actions is also in
part due to defects of “mentalization” (Fonagy & Target, 1997) although
defensive curtailment of cognitive functions also contributes to it. From
the perspective of discharge, revenge gives vent, in a more or less aim-
inhibited manner, to primitive sadism. Drive components from oral and
anal phases are frequently evident in the form of biting sarcasm and
defilement of the enemy’s life. Hostility felt as a result of humiliating
exposure to the primal scene and due to other, more severe trauma also
finds discharge in acts of revenge. While sexual acts (e.g., rape, incest)
can be used as methods of revenge, it is the satisfaction of destructive
aims that is primarily sought and enjoyed. From the perspective of defence,
revenge constitutes the ego’s attempt to reverse humiliating passivity
into triumphant activity, to restore traumatically depleted narcissism,
and to extrude a malevolent “interject” (Bollas, 1999), that is, an object
that has been violently inserted into the self. Revenge, insofar as it car-
ries the hope—mostly unrealistic—permanently erasing the trauma
one has suffered, also acts as a preserver of the good internal object and
a defence against sadness and mourning.
Technical implications
The theme of revenge appears frequently in the course of intensive
treatments. Individuals who seek psychoanalysis or long-term psy-
choanalytic psychotherapy often have significant childhood trauma
in their background and this makes many of them prone to seek

revenge against those who have hurt them (usually, though not invari-
ably, the parents), their substitutes, or the world at large. Needless
to add, such scenarios are sooner or later created in the transference-
countertransference axis as well. Clinical work can thus become quite
bloody. The following guidelines might help negotiate the way through
such hard-to-tread ground.
First, the patient must be allowed to bring out his grievances and, for
quite some time, repeat them as if each rendition is their first exposure
to daylight. Balint (1968) emphasises that in the treatment of deeply
traumatised individuals the analytic process “must not be hurried by
interpretations, however correct, since they may be felt as undue inter-
ference, as an attempt at devaluing the justification of their complaint
and thus, instead of speeding up, they will slow down the therapeutic
processes” (p. 182). To point out discrepancies and contradictions in the
patient’s story, to bring up the defensive nature of his idealisations and
devaluations, and to analyse the potentially masochistic aspects of his
outrage, are tasks that must be left for much later.
Second, during this early phase, the analyst’s activity should remain
restricted to empathic remarks, gentle exploratory comments, and what
Killingmo (1989) has termed “affirmative interventions”. The psycho-
logical essence of such interventions is constituted by four elements:
(i) the element of existence, (ii) the element of relating, (iii) the element
of worth, and (iv) the element of validity. As a result, affirmative inter-
ventions are empathic comments that render plausibility, context-based
validity, and historical meaningfulness to the patient’s experience. Such
remarks are not aimed at revealing meanings; they are directed at estab-
lishing the existence of meaning. On a pragmatic level, they consist of
objectifying (e.g., you have felt very hurt by this person and are, there-
fore, very angry with him), justifying (e.g., no wonder you are upset
since what this person has done to you felt so unfair and unjust), and
contextualising (e.g., you experienced his behaviour as especially dis-
criminating since you have indeed been treated with prejudice before)
elements.
Third, if the revenge fantasies of the patient and their associated
hostile affects are close to consciousness, the work can move on, after
a while, from affirmative to unmasking and interpretive interven-
tions. The analyst must now explore, in a straightforward manner,
the scope of revenge fantasies, the dramatis personae in the theatre
REVENGE 157
of vengefulness, the presence or absence of guilt, and the actual and

imagined reasons why the revenge the patient so desperately seeks has
not been taken and/or how it has, at least partly, been acted out. Clearly
such work has to occur in a piecemeal fashion and with continued
attention to the analysis of defences and resistances that crop up in
this investigative path. Establishing hermeneutic linkages along the
axes outlined above gradually would lead to the patient’s entertaining
healthy forms of “getting even” and also to responsibility, remorse, and
even some forgiveness.
Fourth, if the revenge fantasies have been turned upon the self and
the clinical picture is mostly masochistic, the analyst must help the
patient see, via a moment-to-moment microanalysis of his associations,
how the centrifugal pull of masochism operates. Of course, the ana-
lyst’s comments themselves might be utilised by the patient for self-
castigating purposes (“So it is all my fault?”). This has to be watched
for and pointed out. Closely associated is such a patient’s tendency
to develop “negative therapeutic reaction” (Freud, 1923b; see Akhtar,
2009, for a fuller definition), that is, symptomatic worsening instead of
improvement as a consequence of a correct interpretation of his malady.
In dealing with such occurrences, the analyst must weigh which vari-
able (e.g., unconscious guilt, envious attack on the analyst’s goodness,
clinging to masochistic pleasure) is the most active, most palatable,
and, hence, most interpretable at a given moment. The need for “tact”
(Loewenstein, 1951; Poland, 1975) on the analyst’s part cannot be over-
emphasised in this context.
Fifth, in both types of patients (i.e., overtly sadistic and secretly
masochistic and overtly masochistic and secretly sadistic), a modicum
of limit-setting might become unavoidable. Apt in this context is
Hoffer’s (1985) reminder that departures from analytic neutrality
are permissible when the analyst, the patient, or someone weak and
vulnerable in the latter’s life is at risk of being harmed. However, the
concept of harm must not be restricted to physical harm; violent pro-
jections, tenacious false accusations, screaming, and even consistently
deploying metaphors of life and death (e.g., “I am drowning and you
are just standing on the shore”) aimed at rendering the analyst humili-
ated and helpless have to be “prohibited” sooner or later. The ana-
lyst must remind himself that there is a long-held tradition, ranging
from Freud’s (cited in Alexander & French, 1946) injunction to pho-
bics that they face their feared object, through Ferenczi’s (1921) “active
technique” and Kolansky and Eisner’s (1974) “spoiling” of pre-Oedipal

gratifications, to Amati-Mehler and Argentieri’s (1989) rupturing of
pathologic hope and Akhtar’s (2013b) “refusal to listen to certain kinds
of material”. The analyst must realise that analytic patience, waiting,
and tolerance are not there to be idealised by him or to be abused by
the patient. Limit-setting is often a necessary step in forcing the enacted
material into thought and thus making it subject to exploration and
interpretation.
Sixth, in conjunction with attempting interpretive resolution, the
analyst—especially when working with tenaciously sadomasochistic
patients—must assist the patient’s ego in creating choices. Such choices
might involve the degree and form of revenge that can be taken safely,
the people with whom it should and should not be taken, but most
importantly, whether it is essential to take revenge after all. The last-
mentioned can lead to the analysis of depressive anxieties underlying
the “optimism of revenge” which, in turn, might require some auxil-
iary ego support and gentle reminders of the love and support that
is available to the patient and is underutilised by him. This can make
mourning bearable.
Seventh, while the foregoing paves the way to forgiveness and it is
“good” if that does occur, yet the analyst must not uphold manic ideals
for himself and the patient. He must be able to accept that some injuries
might not be forgivable, especially if there is no admission of wrong-
doing and apology from the perpetrator. In such cases, analytic work
should focus upon why the patient cannot forgive himself for being
unforgiving and to help the patient find more productive ways of deal-
ing with the unmetabolised residues of his childhood trauma.
Finally, the management of countertransference forms an extremely
important dimension in the treatment of severely sadomasochistic
patients. This is especially so because the patients’ desire for revenge
(regardless of whether these are overtly sadistic or masochistic) sooner
or later become activated in the transference relationship. The analyst
is then mocked, devalued, ignored, and actively or passively thwarted.
The patient might act out in his or her actual life in order to hurt the
analyst or directly assault the analyst’s mind, personality, or tech-
nique (Kernberg, 1984, 1992). All this puts a great burden on the ana-
lyst and creates many countertransference risks. The first such risk is
that of masochistic surrender on the analyst’s part. This evolves from
the analyst’s desperate attempt to show that he is different from the
REVENGE 159
patient’s bad internal objects, that he is unerringly tolerant, and that

he never retaliates. Such forced “disidentification with the aggressor”
(Gabbard, 1997), rationalised by the analyst as a necessary accommoda-
tion to the patient’s psychopathology, is actually anti-therapeutic since
it delays or bypasses the analysis of negative transference. It also carries
the risk of conveying to the patient that he or she can get away with
unfettered hostility and destructiveness; this, in turn, fuels the patient’s
deep desire for omnipotence.
A second countertransference pitfall is constituted by the analyst’s
inability to contain the aggression mobilised by violent projections of
bad objects into him. When this happens, the analyst finds himself losing
control, raising his voice, becoming sarcastic, unduly rigid in sticking to
“rules”, and getting into heated arguments about trivial matters. This is
hardly helpful since the patient perceives and utilises such behaviours
as proof that the world is bad, that no one understands him, and that
therapeutic interventions are not invitations to think about oneself but
sadistic assaults upon his views of internal and external reality.
A third risk is for the analyst to turn didactic, even moralising. He
might find himself appealing to the patient’s sense of rationality and
reason. Here Kohut’s (1972) reminder must be heeded: “The transfor-
mation of narcissistic rage is not achieved directly—e.g. via appeals to
the patient’s ego, to increase its control over the angry impulses—but
is brought about indirectly, secondary to gradual transformation of the
matrix of narcissism from which the rage arose” (p. 388).
All these risks emanate from the failed containment of the patient’s
projected hostility. Under ideal circumstances such pitfalls can be
avoided. However, in day-to-day clinical work with vengeful patients,
enactments of either type often become unavoidable. The analyst’s task
then involves a post-hoc analysis (and, self-analysis) of such interac-
tions and repair of the disruption caused by them (Akhtar, 2007d; Wolf,
1988).
Concluding remarks
In this chapter, I have provided a wide-ranging survey of the phe-
nomenological, dynamic, literary, and clinical aspects of revenge. My
scope has been broad and our theoretical stance multifaceted. Through-
out my discourse, I have paid attention to all “four psychologies of
psychoanalysis” (Pine, 1988): drive, ego, object relations, and self.
My understanding of the various phenomena related to revenge and

vindictiveness and my technical recommendations to deal with them
have been similarly broad-based. Two areas have, however, eluded my
attention so far. These pertain to the impact of gender and the culture-
at-large upon the revenge motif in the human psychic life.
First, there is the variable of gender. Are there differences in the fre-
quency, form, and extent of revenge fantasies and acts in the two sexes?
The answer seems far from clear. To be sure, literary and movie protag-
onists of revenge are more often male but the meaning of this remains
ambiguous. Does it simply reflect the male preponderance among the
main characters in fiction and movies regardless of their themes? Does
it embody an anxious avoidance of depicting and encountering female
rage and vindictiveness? Shakespeare’s declaration that “hell hath no
fury greater than a woman scorned” comes to mind in this context. So
does Euripides’ Medea who killed her two sons as revenge against her
husband who had left her for another woman. And then there is Miss
Havisham, from Dickens’s (1861) Great Expectations, who, rejected by
a man, seeks revenge on all men by grooming her protégée, Estella, to
become the ultimate heartbreaker. So there does not seem to be a short-
age of enraged and vindictive feelings in women. However, since men
in general are more outwardly aggressive, the prevalence of revenge-
related violent acts might be greater in them. In women, this rage might
be more disguised or turned inward, resulting in a silently resentful
paranoid-masochistic picture. Early literature of descriptive psychiatry
(Bleuler, 1908; Kraepelin, 1905, 1921) lends some support to this idea
but how far the societal changes over the last century, especially those
resulting from the feminist movement, have altered such conceptualisa-
tions remains unclear.
This brings up the issue of culture. It is my impression that it har-
bours very mixed feelings about taking revenge. That revenge is
justifiable, even godly, is clearly spelled out in the much-revered cita-
tion from the New Testament: “Vengeance is mine; I will repay, saith
the Lord” (Romans 12:19) and, before it, the harsh Old Testament’s
(Deuteronomy 19:21; Exodus 21:24) Lex Talionis (the talion principle)
dictating that one should extract a tooth for a tooth and an eye for an
eye. Moral sanctions of such a sort fuel the hard-wired reflex to retaliate
that is our evolutionary legacy.2 The desire for revenge is thus normal-
ised, even exalted. We accord respect and awe to the vindictive hero in
fiction and popular cinema. Captain Ahab from Melville’s Moby Dick
REVENGE 161
(1851), and the Count of Monte Cristo (1844) from Dumas’s eponymous
novel mobilise much sympathy and admiration in readers around the
globe. And the same is true of the avenging movie characters, rang-
ing from Clint Eastwood’s Dirty Harry series of the 1970s to the Angry
Young Man movies of Bollywood cinema (Akhtar & Choksi, 2005). The
audience simply laps it all up. It seems as if these books and celluloid
dramas afford an abreactive conduit for ubiquitous fantasies of get-
ting even and settling the score. Revenge seems to be “hot” and well
accepted in all cultures.
At the same time, children are discouraged from “tit-for-tat” think-
ing. Vindictiveness is frowned upon. Revenge-seeking is deemed
immature and the ideal of forgiveness is upheld by religious and noble
men (see the lives of Gandhi, Martin Luther King, Jr., and Nelson
Mandela). Parallel to the mesmerising tales of revenge, there exist
moving and poignant narratives of forgiveness especially in the tradi-
tions of Christianity.
Putting such diverse perspectives together leads one to conclude that
society holds ambivalent attitudes about revenge. Consciously, it strives
towards responding to injury by forgiving the enemy. Unconsciously, it
seeks to redress the trauma by taking revenge. Vicarious enjoyment of
“well-justified” revenge in the safety of fiction and movies then becomes
a compromise formation for this conflict of our culture. Some tension
between the correctness of forgiving and seeking revenge nonetheless
remains. Moss (1986) declares the two as competing attempts at recon-
ciliation with the traumatising figures of the Oedipus complex. While
the System Conscious might tilt in favour of one or the other strategy,
both persist unaltered in the System Unconscious. There, they are rep-
resented as self-object pairs involved in the two respective scenarios of
revenge and forgiveness. According to Moss, this fiction of symmetry
“lies at the base of the civilization-wide proclivity toward the pursuit of
revenge and forgiveness as strategies to obliterate the effects of trauma”
(p. 209). The implication is clear: the wish to settle a score never entirely
leaves the human heart.3 And this might not be bad. Elsewhere, I have
observed that
Some revenge is actually good for the victim. It puts the victim’s
hitherto passive ego in an active position. This imparts a sense of
mastery and enhances self-esteem. Revenge (in reality or fantasy),
allowing the victim to taste the pleasure of sadism, also changes the
libido-aggression balance in the self-object relationship. The victim

no longer remains innocent and the perpetrator no longer the sole
cruel party. Now, both seem to have been hurt and to have caused
hurt. This shift lays the groundwork for empathy with the enemy
and reduces hatred. (Akhtar, 2002, p. 179)
A good way to conclude this discourse is therefore to remind oneself of

Nietzsche’s remark that “A small revenge is humaner than no revenge
at all” (1905, p. 71) and Heine’s (cited in Freud, 1930a, p. 110) witticism
that “One must, it is true, forgive one’s enemies—but not before they’ve
been hanged.”
Notes
1. Laura Blumenfeld’s (2002) book, Revenge, reports her encounter with
the Palestinian militant who had shot and wounded her father, a New
York rabbi. One of her goals was to see if she could make her father
human in the gunman’s eyes, since terrorism is not so much about
killing people as about dehumanising them to make a political point.
In effect, she sought to “punish” the terrorist by showing his victim’s
humanity. Her unusual form of revenge led to the Palestinian man’s
apologising to her father and her father’s forgiving him.
2. The deterrence function of revenge is what leads evolutionary theorists
(Barash & Lipton, 2011; Pinker, 2011) to regard revenge as a part of our
evolved human nature. “The necessity of revenge and punishment,
from such vantage point, is necessary for the emergence and suste-
nance of cooperation. It prevents the cooperator from being exploited”
(J. Anderson Thomson, Jr., personal communication, June 8, 2013).
3. The idea that the wish for revenge might be ubiquitous does not sit well
with everyone. The rejecting response to the movie, Inglorious Basterds
(2009, directed by Quintin Tarantino), by many Jewish people, is a case
in point. The movie depicted the fictional scenario of Jewish violence
against the Nazis and thus challenged the apparent absence of revenge
fantasies among Jews. In contrast, the movie, Django Unchained (2012),
showing a freed black slave taking revenge against his white tormen-
tors, was received with relative equanimity by the African American
community. The socio-historical reasons that might contribute to this
differential response remain unclear.
REFERENCES
Abraham, K. (1913a). Restrictions and transformations of scoptophilia

in psycho-neurotics; with remarks on analogous phenomena in folk-
psychology. In: Selected Papers on Psychoanalysis (pp. 169–234). New York:
Brunner/Mazel.
Abraham, K. (1913b). A constitutional basis of locomotor anxiety. In: Selected
Papers on Psychoanalysis (pp. 235–249). New York: Brunner/Mazel.
Abraham, K. (1920). Manifestations of the female castration complex. In:
Selected Papers on Psychoanalysis (pp. 338–369). London: Hogarth.
Abraham, K. (1924). The influence of oral eroticism on character forma-
tion. In: Selected Papers of Karl Abraham, M.D. (pp. 393–406). New York:
Brunner/Mazel.
Abraham, K. (1925). The history of an impostor in the light of psycho-
analytical knowledge. In: Clinical Papers and Essays on Psychoanalysis
(pp. 291–305). New York: Brunner/Mazel, 1955.
Abram, J. (2007). The Language of Winnicott: A Dictionary of Winnicott’s Use of
Words (2nd edition). London: Karnac.
Abrams, S. (1990). Psychoanalytic process: the developmental and the inte-
grative. Psychoanalytic Quarterly, 59: 650–677.
Akhtar, S. (1984). The syndrome of identity diffusion. American Journal of
Psychiatry, 141: 1381–1385.
163
164 REFERENCES
Akhtar, S. (1985). The other woman: phenomenological, psychodynamic,

and therapeutic considerations. In: D. Goldberg (Ed.), Contemporary
Marriage (pp. 215–240). Homeswood, IL: Dow Jones-Irwin.
Akhtar, S. (1992a). Broken Structures: Severe Personality Disorders and Their
Treatment. Northvale, NJ: Jason Aronson.
Akhtar, S. (1992b). Tethers, orbits, and invisible fences: clinical,
developmental, sociocultural, and technical aspects of optimal distance.
In: S. Kramer & S. Akhtar (Eds.), When the Body Speaks: Psychological
Meanings in Kinetic Clues (pp. 21–57). Northvale, NJ: Jason Aronson.
Akhtar, S. (1994). Object constancy and adult psychopathology. International
Journal of Psychoanalysis, 75: 441–455.
Akhtar, S. (1996). “Someday …” and “if only …” fantasies: pathological
optimism and inordinate nostalgia as related forms of idealization. Jour-
nal of the American Psychoanalytic Association, 44: 723–753.
Akhtar, S. (1999a). The distinction between needs and wishes: implications
for psychoanalytic theory and technique. Journal of the American Psycho-
analytic Association, 47: 113–151.
Akhtar, S. (1999b). Immigration and Identity: Turmoil, Treatment, and Transfor-
mation. Northvale, NJ: Jason Aronson.
Akhtar, S. (2000). The shy narcissist. In: J. Sandler, R. Michels, &
P. Fonagy (Eds.), Changing Ideas in a Changing World: Essays in Honor of
Arnold Cooper (pp. 111–119). London: Karnac.
Akhtar, S. (2002). Forgiveness: origins, dynamics, psychopathology, and
technical relevance. Psychoanalytic Quarterly, 71: 175–212.
Akhtar, S. (2003). Dehumanization: origins, manifestations, and remedies.
In: S. Varvin & V. D. Volkan (Eds.), Violence or Dialogue? Psychoanalytic
Insights on Terror and Terrorism. London: International Psychoanalytical
Association.
Akhtar, S. (2007a). Regarding Others: Reviews, Responses, and Reflections
(pp. 80–94). Charlottesville, VA: Pitchstone.
Akhtar, S. (2007b). Four roadblocks in approaching Masud Khan. Psycho-
analytic Quarterly, 76: 991–995.
Akhtar, S. (2007c). From unmentalized xenophobia to messianic sadism:
some reflections on the phenomenology of prejudice. In: H. Parens,
A. Mahfouz, S. W. Twemlow, & D. E. Scharff (Eds.), The Future of Prej-
udice: Psychoanalysis and the Prevention of Prejudice (pp. 7–19). Lanham,
MD: Jason Aronson.
Akhtar, S. (2007d). Disruptions in the course of psychotherapy and psy-
choanalysis. In: B. Van Luyn, S. Akhtar, & W. J. Livesley (Eds.), Severe
Personality Disorders: Everyday Issues in Clinical Practice (pp. 93–108).
Cambridge: Cambridge University Press.
Akhtar, S. (2009). Comprehensive Dictionary of Psychoanalysis. London:
Karnac.
REFERENCES 165
Akhtar, S. (2010). Freud’s Todesangst and Ghalib’s Ishrat-e-Qatra: two

perspectives on death. In: S. Akhtar (Ed.), The Wound of Mortality: Fear,
Denial, and Acceptance of Death (pp. 1–20). Lanham, MD: Jason Aronson.
Akhtar, S. (2011a). Immigration and Acculturation: Mourning, Adaptation, and
the Next Generation. Lanham, MD: Jason Aronson.
Akhtar, S. (Ed.) (2011b). Unusual Interventions: Alterations of the Frame,
Method, and Relationship in Psychotherapy and Psychoanalysis. London:
Karnac.
Akhtar, S. (2011c). Refusing to listen to certain kinds of material. In: S. Akhtar
(Ed.), Unusual Interventions: Alterations of the Frame, Method, and Relation-
ship in Psychotherapy and Psychoanalysis (pp. 83–98). London: Karnac.
Akhtar, S. (2012). The Book of Emotions. New Delhi, India: Roli.
Akhtar, S. (2013a). Good Stuff: Courage, Resilience, Gratitude, Generosity, For-
giveness, and Sacrifice. Lanham, MD: Jason Aronson.
Akhtar, S. (2013b). Psychoanalytic Listening: Methods, Limits, and Innovations.
London: Karnac.
Akhtar, S. (2013c). Guilt: an introductory overview. In: S. Akhtar (Ed.),
Guilt: Origins, Manifestations, and Management (pp. 1–14). Lanham, MD:
Jason Aronson.
Akhtar, S., & Brown, J. (2005). Animals in psychiatric symptomatology. In:
S. Akhtar & V. D. Volkan (Eds.), Mental Zoo: Animals in the Human Mind
and Its Pathology (pp. 3–38). Madison, CT: International Universities
Press.
Akhtar, S., & Byrne, J. (1983). The concept of splitting and its clinical rel-
evance. American Journal of Psychiatry, 140: 1016–1018.
Akhtar, S., & Choksi, K. (2005). Bollywood and the Indian unconscious. In:
S. Akhtar (Ed.), Freud Along the Ganges: Psychoanalytic Reflections on the
People and Culture of India (pp. 139–175). New York: Other Press.
Alexander, F., & French, T. (1946). Psychoanalytic Therapy. New York: Ronald
Press.
Alterman, E. (2004). When presidents lie. The Nation, October 5.
Amati-Mehler, J., & Argentieri, S. (1989). Hope and hopelessness: a techni-
cal problem? International Journal of Psychoanalysis, 70: 295–304.
Arlow, J. H. (1980). The revenge motive in the primal scene. Journal of the
American Psychoanalytic Association, 28: 519–541.
Asch, S. (1976). Varieties of negative therapeutic reactions and problems of
technique. Journal of the American Psychoanalytic Association, 24: 383–407.
Asch, S. (1988). The analytic concepts of masochism: a re-evaluation. In:
R. A. Glick & D. I. Meyers (Eds.), Masochism: Current Psychoanalytic
Perspectives (pp. 93–116). Hillsdale, NJ: Analytic Press.
Asher, R. (1951). Munchausen’s syndrome. Lancet, 1: 339–341.
Bach, S. (1977). On narcissistic state of consciousness. International Journal of
Psychoanalysis, 58: 209–233.
166 REFERENCES
Balint, M. (1959). Thrills and Regressions. London: Hogarth.

Balint, M. (1968). The Basic Fault: Therapeutic Aspects of Regression. London:
Tavistock.
Barash, D. P., & Lipton, J. E. (2011). Payback: Why We Retaliate, Redirect
Aggression, and Take Revenge. New York: Oxford University Press.
Barton, R., & Whitehead, J. (1969). The gaslight phenomenon. Lancet, 1:
158–160.
Begley, L. (1992). The Man Who Was Late. New York: Random House.
Bennett-Levy, J., & Marteau, T. (1984). Fear of animals: what is prepared?
British Journal of Psychology, 75: 37–42.
Berglas, S. (1986). The Success Syndrome. New York: Plenum.
Bergler, E. (1945). Psychopathology of ingratitude. In: C. Socarides (Ed.),
The World of Emotions (pp. 135–142). New York: International Universi-
ties Press, 1977.
Bergler, E. (1949). The Basic Neurosis. New York: Harper & Brothers.
Bergler, E. (1961). Curable and Incurable Neurosis: Problems of Neurotic versus
Malignant Masochism. New York: Liveright.
Berliner, B. (1958). The role of object relations in moral masochism. Psycho-
Bernstein, D. (1983). The female superego: a different perspective. Interna-
tional Journal of Psychoanalysis, 64: 187–200.
Bick, E. (1968). The experience of the skin in early object relations. Interna-
Bion, W. R. (1957). Differentiation of the psychotic from the non-psychotic
personalities. International Journal of Psychoanalysis, 38: 266–275.
Bion, W. R. (1962). A theory of thinking. International Journal of Psychoanaly-
sis, 43: 306–310.
Bion, W. R. (1967a). Second Thoughts. London: Heinemann.
Bion, W. R. (1967b). Notes on memory and desire. In: Cogitations. London:
Karnac, 1992.
Bion, W. R. (1970). Lies and the thinker. In: Attention and Interpretation.
London: Tavistock.
Birds, The (1963). Directed by A. Hitchcock, Universal Pictures production.
Biswas-Diener, R. (2012). The Courage Quotient: How Science Can Make You
Braver. San Francisco, CA: Jossey-Bass.
Bleuler, E. (1908). Textbook of Psychiatry. A. A. Brill (Trans.). New York:
MacMillan.
Blum, H. (1981). Object inconstancy and paranoid conspiracy. Journal of the
Blum, H. (1983). The psychoanalytic process and psychoanalytic inference:
a clinical study of a lie and a loss. International Journal of Psychoanalysis,
64: 7–33.
REFERENCES 167
Blum, H. (2009). Where does the truth lie? In: S. Akhtar & S. Parens (Eds.),
Lying, Cheating, and Carrying On: Developmental, Clinical, and Sociocul-
tural Aspects of Dishonesty and Deceit (pp. 59–67). Lanham, MD: Jason
Aronson.
Blumenfeld, L. (2002). Revenge: A Story of Hope. New York: Simon &
Schuster.
Blumenthal, R. (2006). Hotel log hints at illicit desire that Dr Freud did not
repress. New York Times, p. A-1, December 24.
Bollas, C. (1999). The Mystery of Things. London: Routledge.
Bolognini, S. (2011). Secret Passages: The Theory and Technique of Interpsychic
Relations. G. Atkinson (Trans.). London: Karnac.
Boris, H. N. (1986). The “other” breast—greed, envy, spite and revenge.
Contemporary Psychoanalysis, 22: 45–59.
Bos, J., & Groenendijk, L. (2006). The Self-Marginalization of Wilhelm Stekel:
Freudian Circles Inside and Out. New York: Springer.
Brenman, E. (1985). Cruelty and narrow-mindedness. International Journal of
Brenner, C. (1959). The masochistic character: genesis and treatment.
Journal of the American Psychoanalytic Association, 7: 197–226.
Brenner, C. (1976). Psychoanalytic Technique and Psychic Conflict. New York:
International Universities Press.
Brenner, C. (2000). Brief communication: evenly hovering attention. Psycho-
Brenner, I. (2004). Psychic Trauma: Dynamics, Symptoms, and Treatment.
Northvale, NJ: Jason Aronson.
Brontë, E. (1847). Wuthering Heights. New York: Random House, 2009.
Byrne, R. W., & Whiten, A. (1992). Cognitive evolution in primates:
evidence from tactical deception. Man, 27: 609–627.
Campbell, J., & Pile, S. (2011). Space travels of the Wolfman: phobia and its
worlds. Psychoanalysis and History, 13: 69–88.
Cao, L. (1997). Monkey Bridge. New York: Penguin.
Casement, P. (1991). Learning from the Patient. New York: Guilford.
Casement, P. (2006). Sexual Boundary Violations: Therapeutic, Supervisory, and
Academic Contexts. Lanham, MD: Jason Aronson.
Castelnuevo-Tedesco, P. (1974). Stealing, revenge, and the Monte Cristo
complex. International Journal of Psychoanalysis, 55: 169–181.
Catch Me if You Can (2002). Directed by S. Spielberg, Dreamworks
production.
Celenza, A. (2006). Sexual Boundary Violations: Therapeutic, Supervisory, and
Academic Contexts. Lanham, MD: Jason Aronson.
Chadwick, M. (1929). Notes upon the fear of death. International Journal of
168 REFERENCES
Charles, M. (1997). Betrayal. Contemporary Psychoanalysis, 33: 109–122.

Chase, D. (2000). Restorative justice: use of apologies in criminal law.
Virginia Lawyers Weekly, February 21.
Chasseguet-Smirgel, J. (1984). Creativity and Perversion. New York: W. W.
Norton.
Clockwork Orange, A (1974). Directed by S. Kubrick, Warner Brothers
production.
Cloninger, C. R. (2005). Antisocial personality disorder: a review. In: M. Maj,
H. Akiskal, J. Mezzich, & A. Okasha (Eds.), Personality Disorders (WPA
Series in Evidence and Experience in Psychiatry) (pp. 125–169). Chichester,
UK: John Wiley and Sons.
Cloninger, C. R., Reich, T., & Guze, S. B. (1975). The multifactorial model
of disease transmission II: sex differences in the familial transmission
of sociopathy (antisocial personality). British Journal of Psychiatry, 127:
11–22.
Coen, S. J. (1992). The Misuse of Persons: Analyzing Pathological Dependency.
Hillsdale, NJ: Analytic Press.
Coles, R. (1965). On courage. Contemporary Psychoanalysis, 1: 85–98.
Cook, M., & Mineka, S. (1987). Second order conditioning and over-
shadowing in the observational conditioning of fear in monkeys. Behav-
ior Research and Therapy, 25: 349–364.
Cooper, A. M. (1988). The narcissistic-masochistic character. In: R. A.
Glick & D. I. Meyers (Eds.), Masochism: Current Psychoanalytic Perspectives
(pp. 117–138). Hillsdale, NJ: Analytic Press.
Corradi-Fiumara, G. (2009). Spontaneity: A Psychoanalytic Inquiry. London:
Routledge.
Damasio, A. (1999). The Feeling of What Happens. London: Heinemann.
Daniels, M. (1969). Pathological vindictiveness and the vindictive character.
Psychoanalytic Review, 56: 169–196.
Davey, G. (1992). Characteristics of individuals with fear of spiders. Anxiety
Research, 4: 299–314.
Davey, G. C. L., Forster, L., & Mayhew, G. (1993). Familial resemblances in
disgust sensitivity and animal phobias. Behavior Research and Therapy, 31:
41–50.
Davies, M. (2004). Need, greed, and envy in anorexia nervosa and the
challenge they present. Psychoanalytic Psychotherapy, 18: 432–444.
Davis, D., & Weiss, J. M. (1974). Malingering and associated syndromes.
In: S. Arieti & E. B. Brody (Eds.), American Handbook of Psychiatry (2nd
Edition), Vol. III (pp. 270–287). New York: Basic Books.
Delprato, D. (1980). Hereditary determinants of fears and phobias: a critical
review. Behavior Therapy, 11: 79–103.
REFERENCES 169
Deutsch, H. (1922). On the pathological lie. Journal of the American Academy

of Psychoanalysis, 10: 386–396 (reprinted 1982).
Deutsch, H. (1929). The genesis of agoraphobia. International Journal of Psy-
choanalysis, 10: 51–69.
Deutsch, H. (1933). Psychoanalysis of the Neuroses. London: Hogarth.
Diagnostic and Statistical Manual of Mental Disorders—4th Edition, Text
Revision (2000). (pp. 443–450). Washington, DC: American Psychiatric
Association.
Diagnostic and Statistical Manual of Mental Disorders—5th Edition (2013).
Washington, DC: American Psychiatric Association.
Dickens, C. (1861). Great Expectations. New York: W. W. Norton, 1999.
Dirty Rotten Scoundrels (1988). Directed by F. Oz, Orion Pictures
production.
Django Unchained (2012). Directed by Q. Tarantino, Columbia Pictures
production.
Dumas, A. (1844). The Count of Monte Cristo. New York: Bantam Classics,
1984.
Edelsohn, G. (2009). Developmental aspects of lying. In: S. Akhtar and
S. Parens (Eds.), Lying, Cheating, and Carrying On: Developmental, Clinical,
and Sociocultural Aspects of Dishonesty and Deceit (pp. 59–67). Lanham,
MD: Jason Aronson.
Eidelberg, L. (1954). An Outline of the Comparative Pathology of the Neurosis.
New York: International Universities Press.
Eidelberg, L. (Ed.) (1968). Encyclopedia of Psychoanalysis. New York: Free
Press.
Elson, M. (2001). Silence, its use and abuse: a view from self-psychology.
Clinical Social Work, 29: 351–360.
Emanuel, R. (2004). Thalamic fear. Journal of Child Psychotherapy, 30: 71–87.
Emde, R. (1984). The affective self. In: J. D. Call, E. Galenson, & R. L. Tyson
(Eds.), Frontiers of Infant Psychiatry (pp. 38–54). New York: Basic Books.
Epstein, L. (1979). Countertransference with borderline patients. In:
L. Epstein & A. H. Feiner (Eds.), Countertransference (pp. 375–406).
New York: Jason Aronson.
Erikson, E. (1950). Childhood and Society. New York: W. W. Norton.
Escoll, P. (1992). Vicissitudes of optimal distance through the life cycle. In:
S. Kramer & S. Akhtar (Eds.), When the Body Speaks: Psychological Mean-
ings in Kinetic Clues (pp. 59–87). Northvale, NJ: Jason Aronson.
Espiritu, Y. L. (2009). Emotions, sex, and money: the lives of Filipino chil-
dren of immigrants. In: N. Foner (Ed.), Across Generations: Immigrant
Families in America (pp. 47–71). New York: New York University Press.
Euripides (431 BCE). Medea. Las Vegas, NV: On Demand Publishing, 2013.
170 REFERENCES
Exorcist, The (1973). Directed by W. Friedkin, Warner Brothers production.

Eysenck, H. J. (1965). The Causes and Cures of Neurosis. London: Routledge &
Kegan Paul.
Eysenck, H. J. (1976). The conditioning model of neurosis. Behavior Research
and Therapy, 14: 251–267.
Fairbairn, W. R. D. (1940). Schizoid factors in the personality. In: An Object
Relations Theory of Personality (pp. 3–27). New York: Basic Books, 1952.
Feldman, R. (2009). The Liar in Your Life. New York: Hachette.
Fenichel, O. (1938). The drive to amass wealth. Psychoanalytic Quarterly, 7:
69–95.
Fenichel, O. (1945). Psychoanalytic Theory of Neurosis. New York: W. W.
Norton.
Ferenczi, S. (1921). The further development of the active therapy in
psychoanalysis. In: Further Contributions to the Theory and Technique of
Psychoanalysis (pp. 198–217). London: Hogarth, 1955.
Ferenczi, S. (1929). The unwelcome child and his death instinct. Interna-
Fischer, R. (2009). What it takes to tell a lie. In: S. Akhtar & S. Parens (Eds.),
Aronson.
Fliess, R. (1942). The metapsychology of the analyst. Psychoanalytic
Quarterly, 11: 211–227.
Fonagy, P., & Target, M. (1997). Attachment and reflective function: their
role in self-organization. Development and Psychopathology, 9: 679–700.
Fouts, R. (1997). Next of Kin: My Conversations with Chimpanzees. New York:
Avon.
Frattaroli, E. (2013). Reflections on the absence of morality in psychoana-
lytic theory and practice. In: S. Akhtar (Ed.), Guilt: Origins, Manifesta-
tions, and Management (pp. 83–110). Lanham, MD: Jason Aronson.
Freeman, D. (2009). Sociocultural perspectives on dishonesty. In:
S. Akhtar & S. Parens (Eds.), Lying, Cheating, and Carrying On: Devel-
opmental, Clinical, and Sociocultural Aspects of Dishonesty and Deceit
(pp. 111–127). Lanham, MD: Jason Aronson.
Freud, A. (1946). The Ego and the Mechanisms of Defense. New York: Interna-
tional Universities Press.
Freud, S. (1896b). Further remarks on the neuro-psychoses of defence. S. E.,
3: 162–185. London: Hogarth.
Freud, S. (1899a). Screen memories. S. E., 3: 301–323. London: Hogarth.
Freud, S. (1900a). The Interpretation of Dreams. S. E., 4–5. London: Hogarth.
Freud, S. (1901b). The Psychopathology of Everyday Life. S. E., 6: 1–310. London:
Hogarth.
REFERENCES 171
Freud, S. (1905a). On psychotherapy. S. E., 7: 257–268. London: Hogarth.

Freud, S. (1905d). Three Essays on the Theory of Sexuality. S. E., 7: 135–243.
London: Hogarth.
Freud, S. (1905e). Fragment of an analysis of a case of hysteria. S. E., 7:
1–122. London: Hogarth.
Freud, S. (1906c). Psycho-analysis and the establishment of the facts in legal
proceedings. S. E., 9: 103–114. London: Hogarth.
Freud, S. (1909b). Analysis of a phobia in a five-year-old boy. S. E., 10: 5–149.
London: Hogarth.
Freud, S. (1909c). Family romances. S. E., 9. London: Hogarth.
Freud, S. (1909d). Notes upon a case of obsessional neurosis. S. E., 10:
Freud, S. (1910h). A special type of choice of object made by men. S. E., 11.
London: Hogarth.
Freud, S. (1912e). Recommendations to physicians practising psycho-
analysis. S. E., 12: 109–120. London: Hogarth.
Freud, S. (1912–13). Totem and Taboo. S. E., 13: 1–161. London: Hogarth.
Freud, S. (1913c). On beginning the treatment. S. E., 12: 97–108. London:
Hogarth.
Freud, S. (1915c). Instincts and their vicissitudes. S. E., 14: 117–140. London:
Hogarth.
Freud, S. (1915d). Repression. S. E., 14: 141–158. London: Hogarth.
Freud, S. (1915e). The unconscious. S. E., 14: 159–216. London: Hogarth.
Freud, S. (1916d). Some character-types met with in psycho-analytic work.
Criminal from a sense of guilt. S. E., 14: 310–333. London: Hogarth.
Freud, S. (1916–17). Introductory Lectures on Psycho-Analysis. S. E., 15–16.
London: Hogarth.
Freud, S. (1917b). A childhood recollection from Dichtung und Wahrheit.
S. E., 17: 145–157. London: Hogarth.
Freud, S. (1917c). On transformations of instinct as exemplified in anal
erotism. S. E., 17: 127–133. London: Hogarth.
Freud, S. (1917e). Mourning and melancholia. S. E., 14. London: Hogarth.
Freud, S. (1918b). From the history of an infantile neurosis. S. E., 17: 1–122.
London: Hogarth.
Freud, S. (1919h). The “uncanny”. S. E., 17: 217–252. London: Hogarth.
Freud, S. (1920a). The psychogenesis of a case of female homosexuality.
S. E., 18. London: Hogarth.
Freud, S. (1920g). Beyond the Pleasure Principle. S. E., 18: 7–64. London:
Hogarth.
Freud, S. (1921c). Group Psychology and the Analysis of the Ego. S. E., 18.
London: Hogarth.
Freud, S. (1923b). The Ego and the Id. S. E., 19: 235–259. London: Hogarth.
172 REFERENCES
Freud, S. (1924b). Neurosis and psychosis. S. E., 19: 149–153. London:

Hogarth.
Freud, S. (1924c). The economic problem of masochism. S. E., 19: 157–170.
London: Hogarth.
Freud, S. (1924d). The dissolution of the Oedipus complex. S. E., 19: 171–188.
London: Hogarth.
Freud, S. (1925h). Negation. S. E., 19: 235–239. London: Hogarth.
Freud, S. (1925j). Some psychical consequences of the anatomical distinc-
tion between the sexes. S. E., 19: 241–258. London: Hogarth.
Freud, S. (1926d). Inhibitions, Symptoms and Anxiety. S. E., 20. London:
Hogarth.
Freud, S. (1930a). Civilization and Its Discontents. S. E., 21. London:
Hogarth.
Freud, S. (1933a). New Introductory Lectures on Psycho-Analysis. S. E., 22:
Freud, S. (1950a). A project for a scientific psychology. S. E., 1: 295–343.
London: Hogarth.
Friedman, L. (1969). The therapeutic alliance. International Journal of
Gabbard, G. (1997). Challenges in the analysis of adult patients with
histories of childhood sexual abuse. Canadian Journal of Psychoanalysis,
5: 1–25.
Gabbard, G., & Lester, E. (1995). Boundaries and Boundary Violations in Psy-
choanalysis. Washington, DC: American Psychiatric Press.
Gandhi, M. K. (1940). An Autobiography: The Story of My Experiments with
Truth. M. Desai (Trans.). Boston, MA: Beacon, 1957.
Gediman, H. (1985). Impostor, inauthenticity, and feeling fraudulent. Jour-
nal of American Psychoanalytic Association, 39: 911–936.
Gellerman, D., & Suddath, R. (2005). Violent fantasy, dangerousness, and
the duty to warn and protect. Journal of the American Academy of Psychia-
try and Law, 33: 484–495.
Gibson, E. J., & Walk, R. D. (1960). The “visual cliff.” Scientific American,
202: 67–71.
Gilligan, C. (1982). In a Different Voice: Psychological Theory and Women’s
Development. Cambridge, MA: Harvard University Press.
Giovacchini, P. (2000). Impact of Narcissism: The Errant Therapist in a Chaotic
Quest. Northvale, NJ: Jason Aronson.
Goldstein, J. (1998). Why We Watch?: The Attractions of Violent Entertainment.
New York: Oxford University Press.
Gordon, L. (1955). Incest as revenge against the pre-oedipal mother. Psycho-
analytic Review, 42: 284–292.
REFERENCES 173
Grand, S. (2002). The Reproduction of Evil: A Clinical and Cultural Perspective.

Mahwah, NJ: Analytic Press.
Grant, J. E., Chamberlain, S. R., Schreiber, L. R., & Odlaug, B. L. (2012).
Gender-related clinical and neurocognitive differences in individu-
als seeking treatment for pathological gambling. Journal of Psychiatric
Research, 46: 1206–1211.
Gray, P. (1994). The Ego and the Analysis of Defense. Northvale, NJ: Jason
Aronson.
Green, A. (1980). The dead mother. In: Life Narcissism, Death Narcissism.
A. Weller (Trans.). London: Free Association.
Green, A. (1986). Réponses à des questions inconcevables. Topique, 37:
11–30.
Greenacre, P. (1958). Early physical determinants in the development of
the sense of identity. Journal of the American Psychoanalytic Association, 6:
612–627.
Greenson, R. (1968). Disidentifying from the mother. International Journal of
Grifters, The (1990). Directed by S. Frears, Cineplex-Odeon Films
production.
Grinker, R. (1955). Growth inertia and shame: their therapeutic implications
and dangers. International Journal of Psychoanalysis, 36: 242–253.
Gross, A. (1951). The secret. Bulletin of the Menninger Clinic, 15: 37–44.
Grunberger, B. (1989). New Essays on Narcissism. D. Macey (Trans.). London:
Free Association.
Grunert, U. (1979). The negative therapeutic reaction as a reactivation
of a disturbed process of separation in the transference. Bulletin of the
European Psychoanalytic Federation, 65: 5–19.
Guarnaccia, P. J., & Rogler, L. H. (1999). Research on culture-bound
syndromes: new directions. American Journal of Psychiatry, 156:
1322–1327.
Guntrip, H. (1969). Schizoid Phenomena, Object Relations and the Self.
Guttman, S. A., Jones, R. L., & Parrish, S. M. (Eds.) (1980). The Concordance to
the Standard Edition of the Complete Psychological Works of Sigmund Freud.
Boston, MA: G. K. Hall.
Hanly, C. (1990). The concept of truth in psychoanalysis. International Jour-
nal of Psychoanalysis, 71: 375–384.
Hanly, C. (1992). The Problem of Truth in Applied Psychoanalysis. New York:
Guilford Press.
Harding, J. (1999). Remorse and rehabilitation. In: M. Cox (Ed.), Remorse and
Reparation (pp. 107–115). London: Jessica Kingsley.
174 REFERENCES
Hartmann, H. (1958). Comments on the scientific aspects of psychoanalysis.

Psychoanalytic Study of the Child, 13: 127–146.
Hinshelwood, R. D. (1991). A Dictionary of Kleinian Thought (pp. 412–415).
Northvale, NJ: Jason Aronson.
Hoffer, A. (1985). Toward a definition of psychoanalytic neutrality. Journal
of the American Psychoanalytic Association, 33: 771–795.
Hoffman, L., Johnson, E., Foster, M., & Wright, J. (2010). What happens
when you die? Three- to- four year olds chatting about death. In:
S. Akhtar (Ed.), The Wound of Mortality: Fear, Denial, and Acceptance of
Death (pp. 21–36). Lanham, MD: Jason Aronson.
Holmes, D. E. (2006). The wrecking effects of race and social class on self
and success. Psychoanalytic Quarterly, 75: 215–235.
Hopkins, L. (2006). False Self: The Life of Masud Khan. New York: Other
Press.
Horner, M. (1968). Sex differences in the achievement, motivation, and per-
formance in competitive and non-competitive situations. (Unpublished
doctoral dissertation.) Ann Arbor, MI: University of Michigan.
Horney, K. (1948). The value of vindictiveness. American Journal of Psychoa-
nalysis, 8: 3–12.
Horowitz, M. (1975). Sliding meanings: a defense against threat in
narcissistic personalities. International Journal of Psychoanalysis, 4:
167–180.
House of Cards (1993). Directed by M. Lessac, A and M Films production.
Hurvich, M. (2003). The place of annihilation anxieties in psychoanalytic
theory. Journal of the American Psychoanalytic Association, 51: 579–616.
Inglourious Basterds (2009). Directed by Q. Tarantino, Columbia Pictures
production.
Isaacs, K. S., Alexander, J. M., & Haggard, E. A. (1963). Faith, trust, and gul-
libility. International Journal of Psychoanalysis, 44: 461–469.
Issacharoff, A. (1979). Barriers to knowing. In: L. Epstein & A. H. Feiner
(Eds.), Countertransference (pp. 27–44). New York: Jason Aronson.
Jaws (1975). Directed by S. Spielberg, Universal Pictures production.
Johnson, A., & Szurek, M. (1952). The genesis of antisocial acting out in
children and adults. Psychoanalytic Quarterly, 21: 323–343.
Jones, E. (1913). The God complex. In: Essays in Applied Psychoanalysis, Vol-
ume II (pp. 244–265). New York: International Universities Press, 1973.
Jones, E. (1929). Fear, guilt, and hate. International Journal of Psychoanalysis,
10: 383–397.
Jones, E. (1948). Theory of symbolism. In: Papers on Psycho-Analysis, 5th edi-
tion (pp. 116–141). London: Bailliere, Tindall, & Cox, 1959.
Jordan, L. (2002). The analyst’s uncertainty and fear. Journal of the American
Psychoanalytic Association, 50: 989–993.
REFERENCES 175
Joseph, D. I. (1990). Preoedipal factors in “Little Hans”. Journal of the

Kafka, H. (1998). Fear in the countertransference and the mutuality of safety.
International Forum of Psychoanalysis, 7: 97–103.
Kaplan, H. (1991). Greed: a psychoanalytic perspective. Psychoanalytic
Review, 78: 505–523.
Kazmi, N. (1972). Deewan. Karachi, Pakistan: Urdu Ghar.
Keiser, S. (1969). Superior intelligence: its contribution to neurosogenesis.
Kernberg, O. F. (1967). Borderline personality organization. Journal of the
Kernberg, O. F. (1970). A psychoanalytic classification of character
pathology. Journal of the American Psychoanalytic Association, 18: 800–822.
Kernberg, O. F. (1975). Borderline Conditions and Pathological Narcissism.
Kernberg, O. F. (1980). Internal World and External Reality. Northvale, NJ:
Jason Aronson.
Kernberg, O. F. (1984). Severe Personality Disorders: Psychotherapeutic
Strategies. New Haven, CT: Yale University Press.
Kernberg, O. F. (1992). Aggression in Personality Disorders and Perversions.
New Haven, CT: Yale University Press.
Kernberg, O. F. (1995). Love Relations: Normality and Pathology. New Haven,
CT: Yale University Press.
Kernberg, O. F., Selzer, M. A., Koenigsberg, H. W., Carr, A. C., & Appelbaum,
A. H. (1989). Psychodynamic Psychotherapy of Borderline Patients. New York:
Basic Books.
Kestenberg, J. (1980). Psychoanalyses of children of Holocaust survivors.
Khan, M. M. R. (1983). Lying fallow. In: Hidden Selves (pp. 183–188). New
York: International Universities Press.
Kidder, R. M. (2006). Moral Courage. New York: Harper Collins.
Kilbourne, B. (2005). Shame conflicts and tragedy in “The Scarlet Letter”.
Killingmo, B. (1989). Conflict and deficit: implications for technique.
International Journal of Psychoanalysis, 70: 65–79.
Kitayama, O. (1997). Psychoanalysis in shame culture. The Bulletin of the
Menninger Clinic, 85: 47–50.
Klein, M. (1932). The Psychoanalysis of Children. New York: Free Press,
1975.
Klein, M. (1933). The early development of conscience in the child. In: Love,
Guilt and Reparation and Other Works—1921–1945 (pp. 262–289). New
York: Free Press, 1984.
176 REFERENCES
Klein, M. (1935). A contribution to the psychogenesis of manic

depressive states. In: Love, Guilt and Reparation and Other Works—
1921–1945 (pp. 262–289). New York: Free Press, 1975.
Klein, M. (1937). Love, guilt, and reparation. In: Love, Guilt and Reparation
and Other Works—1921–1945 (pp. 306–343). New York: Free Press, 1975.
Klein, M. (1940). Mourning and its relation to manic depressive states. In:
Love, Guilt and Reparation and Other Works—1921–1945 (pp. 344–369).
New York: Free Press, 1975.
Klein, M. (1952). The mutual influences in the development of ego and
the id. In: Envy and Gratitude and Other Works—1946–1963 (pp. 57–60).
New York: Free Press, 1975.
Klein, M. (1957). Envy and gratitude. In: Envy and Gratitude and Other
Works—1946–1963 (pp. 176–235). New York: Free Press, 1975.
Klein, M. (1959). Our adult world and its roots in infancy. In: Envy and Grati-
tude and Other Works—1946–1963 (pp. 247–263). New York: Free Press,
1975.
Kohut, H. (1972). Thoughts on narcissism and narcissistic rage. Psychoana-
lytic Study of the Child, 27: 360–400.
Kohut, H. (1979). The two analyses of Mr Z. International Journal of Psychoa-
nalysis, 60: 3–27.
Kohut, H. (1980). Self Psychology and the Humanities. New York: W. W.
Norton.
Kolansky, H., & Eisner, H. (1974). The psychoanalytic concept of
preoedipal developmental arrest. (Paper presented at the fall meet-
ings of the American Psychoanalytic Association.) Cited in: S. Akhtar
(Ed.), Inner Torment: Living Between Conflict and Fragmentation (p. 231).
Northvale, NJ: Jason Aronson, 1999.
Kraepelin, E. (1905). Einfuehrung in die Psychiatrische Klinik. Leipzig,
Germany: Barth Press.
Kraepelin, E. (1921). Manic Depressive Insanity and Paranoia. Edinburgh, UK:
Livingston Press.
Krafft-Ebing, R. (1892). Psychopathia Sexualis with Special Reference to
Contrary Sexual Instinct: a Medico-legal Study. Philadelphia, PA: F. A.
Davis, 1978.
Kramer, E. (1987). The analyst’s resolution of revenge resulting from the
treatment of his parents. Modern Psychoanalysis, 12: 207–219.
Kris, E. (1956). The recovery of childhood memories in psychoanalysis.
Kulish, N. (1996). A phobia of the couch: a clinical study of psychoanalytic
process. Psychoanalytic Quarterly, 65: 465–494.
Lafarge, L. (1995). Transferences of deception. Journal of the American
REFERENCES 177
Laplanche, J., & Pontalis, J. -B. (1973). The Language of Psychoanalysis.

D. Nicholson-Smith (Trans.). New York: W. W. Norton.
Lemma, A. (2005). The many faces of lying. International Journal of Psycho-
analysis, 86: 737–753.
Levin, S. (1967). Some metapsychological considerations on the differentia-
tion between shame and guilt. International Journal of Psychoanalysis, 48:
267–276.
Levy, S. (1987). Therapeutic strategy and psychoanalytic technique. Journal
of the American Psychoanalytic Association, 35: 447–466.
Lewin, B. D. (1935). Claustrophobia. Psychoanalytic Quarterly, 4: 227–233.
Lewin, B. D. (1952). Phobic symptoms and dream interpretation. Psycho-
Lichtenberg, J. D. (1991). Fear, phobia, and panic. Psychoanalytic Inquiry, 11:
395–415.
Limentani, A. (1989). Between Freud and Klein: The Psychoanalytic Quest for
Knowledge and Truth. London: Free Association.
Loewald, H. (1960). On the therapeutic action of psychoanalysis. Journal of
the American Psychoanalytic Association, 41: 16–33.
Loewenstein, R. (1951). The problem of interpretation. Psychoanalytic Quar-
terly, 20: 1–23.
Mackinnon, R., & Michels, R. (1971). The Psychiatric Interview in Clinical
Practice. Philadelphia, PA: Saunders.
Madanes, C. (1990). Sex, Love, and Violence: Strategies for Transformation. New
York: W. W. Norton.
Mahler, M. S., Pine, F., & Bergman, A. (1975). The Psychological Birth of the
Human Infant: Symbiosis and Individuation. New York: Basic Books.
Maleson, F. (1984). Multiple meanings of masochism in psychoanalytic
discourse. Journal of the American Psychoanalytic Association, 32: 325–356.
Maltsberger, J., & Buie, D. (1974). Countertransference hate in the treatment
of suicidal patients. Archives of General Psychiatry, 30: 625–633.
Maltsberger, J., & Buie, D. (1980). The devices of suicide—revenge,
riddance, and rebirth. International Review of Psycho-Analysis, 7: 61–72.
Mamdani, M. (2004). Good Muslim, Bad Muslim: America, the Cold War, and
the Roots of Terror. New York: Random House.
Margolis, G. (1966). Secrecy and identity. International Review of Psycho-
Analysis, 47: 517–522.
Margolis, G. (1974). The psychology of keeping secrets. International
Marks, I. (1970). The origins of phobic states. American Journal of Psycho-
therapy, 24: 652–676.
Marks, I. (1987). Fears, Phobias, and Rituals. New York: Oxford University
Press.
178 REFERENCES
Masson, J. M. (Ed.) (1985). The Complete Letters of Sigmund Freud to Wilhelm

Fliess, 1897–1904. Cambridge, MA: Harvard University Press.
Mathias, D. (2008). The analyst’s fears. Newsletter of the Psychoanalytic Soci-
ety of New England East, 20: 9–12.
Maynard-Smith, J., & Szathmáry, E. (1999). The Origins of Life: From the Birth
of Life to the Origins of Language. Oxford: Oxford University Press.
McNally, R. J., & Steketee, G. S. (1985). The etiology and maintenance of
severe animal phobias. Behavior Research and Therapy, 23: 431–435.
Meltzer, D. (1973). Sexual States of Mind. London: Karnac, 2008.
Melville, H. (1851). Moby Dick. New York: Putnam, 2002.
Menaker, E. (1979). Masochism and the emergent ego. In: L. Lerner (Ed.),
Selected Papers of Esther Menaker (pp. 72–101). New York: Human Sci-
ences Press.
Meth, J. M. (1974). Exotic psychiatric syndromes. In: S. Arieti & E. B. Brody
(Eds.), American Handbook of Psychiatry, 2nd edition, Vol. III (pp. 723–739).
New York: Basic Books.
Miller, J. R. (1994). Fear of success: psychodynamic implications. Journal of
American Academy of Psychoanalysis, 22: 129–136.
Mineka, S., Davidson, M., Cook, M., & Keir, R. (1984). Observational condi-
tioning of snake fear in rhesus monkeys. Journal of Abnormal Psychology,
93: 355–372.
Mish, F. C. (Ed.) (1998). Merriam Webster’s Collegiate Dictionary (10th edition).
Springfield, MA: Merriam Webster Press.
Mittleman, B. (1957). Motility in the therapy of children and adults. Psycho-
analytic Study of the Child, 12: 284–319.
Modell, A. (1965). On aspects of the superego’s development. International
Moore, B., & Fine, B. (1990). Psychoanalytic Terms and Concepts. New Haven,
Moore, M. (2009). Cultures of dishonesty: from hidden cancers and con-
cealed selves to politics and poker. In: S. Akhtar & S. Parens (Eds.), Lying,
Cheating, and Carrying On: Developmental, Clinical, and Sociocultural Aspects
of Dishonesty and Deceit (pp. 129–140). Lanham, MD: Jason Aronson.
Morrison, A. (1989). Shame, the Underside of Narcissism. Hillsdale, NJ:
Analytic Press.
Moss, D. B. (1986). Revenge and forgiveness. American Imago, 43: 191–210.
Music Man, The (1962). Directed by M. DaCosta, Warner Brothers
production.
Natterson, J., & Knudson, A. (1965). Observations concerning fear of death
in fatally ill children and their mothers. In: R. Fulton (Ed.), Death and
Identity (pp. 235–278). New York: John Wiley.
REFERENCES 179
Niederland, W. (1968). Clinical observations on the “survivor syndrome”.

International Journal of Psychoanalysis, 49: 313–315.
Nietzsche, F. (1905). Thus Spake Zarathustra. New York: Modern Library
Series, 1955.
Nikelly, A. (1992). The pleonexic personality: a new provisional personal-
ity disorder. Individual Psychology: Journal of Adlerian Theory, Research and
Practice, 48: 253–260.
Nikelly, A. (2006). The pathogenesis of greed: causes and consequences.
International Journal of Applied Psychoanalytic Studies, 3: 65–78.
Nock, K., Borges, G., & Ono, Y. (Eds.) (2012). Suicide: Global Perspectives from
the WHO World Mental Health Surveys. New York: Cambridge University
Press.
O’Shaughnessy, E. (1990). Can a liar be psychoanalyzed? International Jour-
nal of Psychoanalysis, 71: 187–196.
Ocean’s Eleven (2001). Directed by S. Soderbergh, Warner Brothers
production.
Olden, C. (1941). About the fascinating effect of the narcissistic personality.
American Imago, 2: 347–355.
Omen, The (1976). Directed by R. Donner, 20th Century Fox production.
Ornstein, A., Gropper, C., & Bogner, J. Z. (1983). Shoplifting: an expression
of revenge and restitution. Annual of Psychoanalysis, 11: 311–331.
Otto, R. (2000). Assessing and managing violence risk in outpatient settings.
Journal of Clinical Psychology, 56: 1239–1262.
Pally, R. (2000). The Mind-Brain Relationship. London: Karnac.
Parens, H. (2009). Distortions of truth: from white lies to mass mur-
der. In: S. Akhtar & S. Parens (Eds.), Lying, Cheating, and Carrying On:
Developmental, Clinical, and Sociocultural Aspects of Dishonesty and Deceit
Pine, F. (1988). The four psychologies of psychoanalysis and their place
in clinical work. Journal of the American Psychoanalytic Association, 36:
571–596.
Pine, F. (1997). Diversity and Direction in Psychoanalytic Technique. New Haven,
Pinker, S. (2011). Better Angels of Our Nature: Why Violence Has Declined.
New York: Penguin.
Poland, W. S. (1975). Tact as a psychoanalytic function. International Journal
of Psychoanalysis, 56: 155–161.
Potenza, M. N., Steinberg, M. A., McLaughlin, S. D., Wu, R., Rounsaville,
B. J., & O’Malley, S. S. (2001). Gender-related differences in the character-
istics of problem gamblers using a gambling helpline. American Journal of
Psychiatry, 158: 1500–1505.
180 REFERENCES
Prathikanti, S. (1997). East-Indian American families. In: E. Lee (Ed.),

Working with Asian Americans: A Guide to Clinicians (pp. 79–100).
New York: Guilford Press.
Procci, W. (1987). Mockery through caricature: a variant of introjec-
tion utilized by a masochistic woman. Journal of American Academy of
Psycho (1960). Directed by A. Hitchcock, Shamley production.
Puppet Masters (1994). Directed by S. Orme, Hollywood Pictures
production.
Ramzy, I., & Wallerstein, R. (1958). Pain, fear, and anxiety: a study of
interrelationships. Psychoanalytic Study of the Child, 13: 147–189.
Rangell, L. (1952). The analysis of a doll phobia. International Journal of
Rank, O. (1913). “Der Familienroman” in der psychologie des attentäters.
International Zeitschrift Psychoanalyze, 1: 565–567.
Reich, W. (1933). Character Analysis. V. R. Carfagno (Trans.). New York:
Farrar, Straus and Giroux, 1972.
Robertson, I. H. (2013). The Winner Effect: Exploring the Neuroscience of Success
and Failure. New York: St. Martin’s Press.
Rohrlich, J. B. (1987). Wall Street’s money junkies. New York Times, May 7,
p. A35.
Rosen, I. (2009). Atonement. In: S. Akhtar (Ed.), Good Feelings: Psychoana-
lytic Reflections on Positive Emotions and Attitudes (pp. 371–390). London:
Karnac.
Rosenfeld, H. (1964). On the psychopathology of narcissism: A clinical
approach. International Journal of Psychoanalysis, 45: 332–337.
Rosenfeld, H. (1971). Theory of life and death instincts: aggressive aspects
of narcissism. International Journal of Psychoanalysis, 45: 332–337.
Roth, P. (2008). Introduction. In: P. Roth & A. Lemma (Eds.), Envy and
Gratitude Revisited (pp. 1–18). London: Karnac.
Rudnytsky, P. (2012). Rescuing Psychoanalysis from Freud. London: Karnac.
Rycroft, C. (1968). A Critical Dictionary of Psychoanalysis. London: Penguin.
Sadock, B. J., & Sadock, V. A. (2007). Factitious disorders. In: Kaplan and
Sadock’s Synopsis of Psychiatry (pp. 658–664). Philadelphia, PA: Lippincott
Williams & Wilkens.
Sandler, A. -M. (1989). Comments on phobic mechanisms in childhood.
Sandler, J., & Sandler, A. -M. (1998). Internal Objects Revisited. London:
Karnac.
Sass, L. A., & Woolfolk, R. L. (1988). Psychoanalysis and the hermeneutic
turn: a critique of “narrative truth and historical truth.” Journal of the
REFERENCES 181
Schafer, R. (1988). Those wrecked by success. In: R. A. Glick and D. Myers

(Eds.), Masochism: Current Psychoanalytic Perspectives (pp. 81–91).
Hillsdale, NJ: Analytic Press.
Searles, H. F. (1956). The psychodynamics of vindictiveness. In: H. F. Searles
(Ed.), Collected Papers on Schizophrenia and Related Subjects. New York:
Seedat, S., Scott, K. M., Angermeyer, M. C., Berglund, P., Bromet,
E. J., Brugha, T. S., Demyttenaere, K., Girolamo, G., Haro, J. M.,
Jin, R., Karam, E. G., Kovess-Masfety, V., Levinson, D., Mora, M. E. M.,
Ono, Y., Ormel, J., Pennell, B. E., Posada-Villa, J., Sampson, N. A., Williams,
D. R., & Kessler, R. C. (2009). Cross-national associations between gen-
der and mental disorders in the World Health Organization World
Mental Surveys. Archives of General Psychiatry, 66: 785–795.
Seelig, B., & Rosof, L. (2001). Normal and pathological altruism. Journal of
Shakespeare, W. (1596). The Merchant of Venice. New York: Simon &
Schuster, 2010.
Shakespeare, W. (1606). King Lear. San Francisco, CA: Ignatius Press, 2008.
Shames, L. (1989). The Hunger for More. New York: Times Books.
Sharpe, E. F. (1940). Psycho-physical problems revealed in language: an
examination of metaphor. International Journal of Psychoanalysis, 21:
201–215.
Shengold, L. (1989). Soul Murder: The Effects of Childhood Abuse and Depriva-
tion. New Haven, CT: Yale University Press.
Shining, The (1980). Directed by S. Kubrick, Warner Brothers production.
Shneidman, E. S. (2008). A Commonsense Book of Death. Lanham, MD:
Rowman & Littlefield.
Sievers, B. (2012). Socio-analytic reflections on capitalist greed. Organiza-
tional and Social Dynamics, 12: 44–69.
Silberer, H. (1909). Report on method of eliciting and observing certain
symbolic hallucination-phenomena. In: D. Rapaport (Ed.), Organization
and Pathology of Thought (pp. 208–233). New York: Columbia University
Press, 1951.
Silverman, M. A. (1980). A fresh look of the case of Little Hans. In:
M. Kanzer & J. Glenn (Eds.), Freud and His Patients (pp. 96–120).
Socarides, C. W. (1966). On vengeance: the desire to “get even”. Journal of
Solyom, L., Beck, P., Solyom, C., & Hugel, R. (1974). Some etiological factors
in phobic neurosis. Canadian Psychiatric Association Journal, 19: 69–78.
Spence, D. P. (1982). Narrative truth and historical truth. Psychoanalytic
Quarterly, 51: 43–61.
182 REFERENCES
Spero, M. H. (1984). Shame: an object relational formulation. Psychoanalytic

Study of the Child, 39: 259–282.
Stanton, A. H. (1978). Personality disorders. In: A. M. Nicoli (Ed.), The Har-
vard Guide to Modern Psychiatry (pp. 283–295). Cambridge, MA: Belknap
Press.
Steiner, J. (1996). Revenge and resentment in the “Oedipus situation”. Inter-
national Journal of Psychoanalysis, 77: 433–443.
Sting, The (1973). Directed by G. R. Hill, Zanuck/Hill production.
Stone, M. (1980). The Borderline Syndrome. New York: McGraw Hill.
Stone, M. (1989). Murder. Psychiatric Clinics of North America, 12: 643–651.
Stone, M. (2007). Treatability in severe personality disorders: how far do the
science and art of psychotherapy carry us? In: B. van Luyn, S. Akhtar,
& W. J. Livesley (Eds.), Severe Personality Disorders: Everyday Issues in
Clinical Practice (pp. 1–29). Cambridge: Cambridge University Press.
Stone, M. (2009). Lying and deceitfulness in personality disorders.
In: S. Akhtar & S. Parens (Eds.), Lying, Cheating, and Carrying On:
Developmental, Clinical, and Sociocultural Aspects of Dishonesty and Deceit
Strozier, C. (2004). Heinz Kohut: The Making of a Psychoanalyst. New York:
Other Press.
Sulzberger, C. (1953). Why it is hard to keep secrets. Psychoanalysis, 2:
37–43.
Sundeen, M. (2012). The Man Who Quit Money. New York: Riverhead
Trade.
Symonds, A. (1985). Separation and loss: significance for women. American
Talwar, V., & Lee, K. (2002). Development of lying to conceal a transgres-
sion: children’s control of expressive behavior during verbal deception.
International Journal of Behavioral Development, 26: 436–444.
Texas Chain Saw Massacre, The (1974). Directed by T. Hooper, Vortex Pictures
production.
Tobak, M. (1989). Lying and the paranoid personality (letter to editor).
American Journal of Psychiatry, 146: 125.
Tyson, R. L. (1978). Notes on the analysis of a prelatency boy with a dog
phobia. Psychoanalytic Study of the Child, 33: 427–458.
Volkan, V. D. (1976). Primitive Internalized Object Relations. New York: Inter-
national Universities Press.
Volkan, V. D. (1987). Psychological concepts useful in the building of politi-
cal foundations between nations (Track II diplomacy). Journal of the
Volkan, V. D. (1988). The Need for Enemies and Allies. Northvale, NJ: Jason
Aronson.
REFERENCES 183
Volkan, V. D. (1997). Bloodlines: From Ethnic Pride to Ethnic Terrorism.

New York: Farrar, Straus and Giroux.
Wachtel, P. L. (2003). Full pockets, empty lives: a psychoanalytic explora-
tion of the contemporary culture of greed. American Journal of Psycho-
analysis, 63: 103–122.
Waelder, R. (1936). The principle of multiple function; observations on
multiple determination. Psychoanalytic Quarterly, 5: 45–62.
Wall Street (1987). Directed by O. Stone, a 20th Century Fox production.
Wangh, M. (1959). Structural determinants of phobia. Journal of the American
War of the Worlds, The (1953). Directed by J. Carpenter, Paramount Pictures
production.
Waska, R. (2002). Craving, longing, denial, and the dangers of change:
clinical manifestations of greed. Psychoanalytic Review, 89: 505–531.
Waska, R. (2003a). Greed, idealization, and the paranoid-schizoid experi-
ence of instability. The Scandinavian Psychoanalytic Review, 26: 41–50.
Waska, R. (2003b). The impossible dream and the endless nightmare.
Canadian Journal of Psychoanalysis, 11: 379–397.
Watson, C. (2009). Lies and their detection. In: S. Akhtar & S. Parens (Eds.),
Aronson.
Webster’s Ninth New Collegiate Dictionary (1987). Springfield, MA: Merriam
Webster Press.
Weiss, E. (1934). Bodily pain and mental pain. International Journal of
Weiss, E. (1964). Agoraphobia in the Light of Ego Psychology. New York:
Grune & Stratton.
Weiss, J. M. A. (1974). Suicide. In: S. Arieti & E. B. Brody (Eds.),
American Handbook of Psychiatry, Second Edition, Volume III (pp. 743–765).
New York: Basic Books.
Winnicott, D. W. (1954). The depressive position in normal emotional
development. In: Collected Papers: Through Paediatrics to Psychoanalysis
(pp. 262–277). London: Tavistock.
Winnicott, D. W. (1956a). The antisocial tendency. In: Collected Papers:
Through Paediatrics to Psychoanalysis (pp. 306–316). New York: Basic
Books, 1958.
Winnicott, D. W. (1956b). Psychoanalysis and the sense of guilt. In: The Mat-
urational Processes and the Facilitating Environment (pp. 15–28). New York:
Winnicott, D. W. (1958). The capacity to be alone. International Journal of
184 REFERENCES
Winnicott, D. W. (1960). The theory of parent–infant relationship. In: The

Maturational Processes and the Facilitating Environment (pp. 37–55).
New York: International Universities Press, 1965.
Winnicott, D. W. (1962). Ego integration in child development. In: The
Maturational Processes and the Facilitating Environment (pp. 45–53).
Winnicott, D. W. (1968). Use of an object and relating through identifica-
tions. In: Playing and Reality (pp. 86–94). London: Tavistock, 1971.
Winnicott, D. W. (1974). Fear of breakdown. International Review of Psycho-
Analysis, 1: 103–107.
Wolpe, J., & Rachman, R. (1960). Psychoanalytic evidence: a critique based
on Freud’s case of Little Hans. Journal of Nervous and Mental Disorders,
131: 135–148.
Wurmser, L. (1994). The Mask of Shame. Northvale, NJ: Jason Aronson.
Yap, P. M. (1969). Classification of the culture-bound reactive syndromes.
Australian and New Zealand Journal of Psychiatry, 3: 172–179.
Yeomans, F., Selzer, M., & Clarkin, J. (1992). Treating the Borderline Patient:
A Contract Based Approach. New York: Basic Books.
Zibel, A. (2008). Truth time: lenders are about to pay the price for handing
out “liar loans.” The Philadelphia Inquirer, p. c-1, August 19.
Zilboorg, G. (1936). Differential diagnostic types of suicide. Archives of
Neurological Psychiatry, 35: 270–291.
Zilboorg, G. (1943). Fear of death. Psychoanalytic Quarterly, 12: 465–475.
INDEX
Abraham, K. 4, 10, 13, 42, 120, 149 Appelbaum, A. H. 115

Abram, J. 72, 149 Argentieri, S. 137, 158
Abrams, S. 70 Arlow, J. H. 146, 150, 153
act of stealing 152 Asch, S. 79, 130, 138, 141
actual experience 46 Asher, R. 106, 120
adverse consequences of guilt 83 automatic anxiety 7, 15
affective-cognitive movements 136
affirmative interventions 91, 156 Bach, S. 40
Akhtar, S. xiii, 4, 6, 8, 13–15, 17, Balint, M. 16, 64, 156
30–32, 34, 37–38, 40, 46, 49, Barash, D. P. 162
58, 63–64, 68, 73, 79, 81, 90, Barton, R. 99
94, 105, 112, 114, 120–121, Beck, P. 11
123, 130, 141, 143–146, Begley, L. 134
157–159, 161–162 Bennett-Levy, J. 11
Alexander, F. 157 Berglas, S. 39
Alexander, J. M. 130 Bergler, E. 38, 84, 86–87, 90, 129,
Alterman, E. 111 134–135
Amati-Mehler, J. 137, 158 Berglund, P. 63
Angermeyer, M. C. 63 Bergman, A. 13, 60, 63
annihilation guilt 74–75 Berliner, B. 86–87
antisocial tendency 45, 149 Bernstein, D. 93
185
186 INDEX
betrayal 123–140 Celenza, A. 141

compulsion to 124–129 Chadwick, M. 6
defined 123 Chamberlain, S. R. 63
Janus-faced syndrome of 124 Charles, M. 141
need to be 129–136 Chase, D. 88
treatment considerations 136–138 Chasseguet-Smirgel, J. 114, 119
Bick, E. 16 Choksi, K. 161
Bion, W. R. 24, 30, 81, 100, 141 Civilization and Its Discontents (Freud)
Birds, The 20 148
Biswas-Diener, R. 34 Clarkin, J. 112
Blair, Jayson 107 clinical vignettes
Bleuler, E. 160 Amira Hashmi (7) 51
Blum, H. 103, 108, 120, 137 Bob Dolinski (2) 23
Blumenfeld, L. 162 Jill Schwartz (12) 57–58
Blumenthal, R. 121 Joel Lobner (17) 130–134
Bogner, J. Z. 146 Judith Conahan (10) 56–57
Bollas, C. 155 Kathleen Roberts (9) 54–56
Bolognini, S. 31 Laura Klafter (15) 61–62
Borges, G. 93 Marcy Schectman (13) 59
Boris, H. N. 45, 150, 152 Marilyn McDonough (14) 59–61
borrowed guilt 74, 80 Melanie Wright (5) 28–29
Bos, J. 121 Pamela Kasinetz (8) 53–54
Brenman, E. 155 Paul Ruby (16) 125–128
Brenner, C. 29, 86–87, 89, 134, Phil Robertson (6) 50–51
140–141 Rebecca Cohen (3) 24–25
Brenner, I. 65, 80 Sarah Green (1 and 4) 22, 26
Bromet, E. J. 63 Stephanie Brooks (11) 57
Brontë, E. 154 Clinton, Bill 111
Brown, J. 4 Clockwork Orange, A. 20
Brugha, T. S. 63 Cloninger, C. R. 111, 114
Buie, D. 26, 138, 145 Coen, S. J. 129
Bush, George W. 18, 84, 111 cognitive-behavioural interventions
Bush Senior, George 111 111
Byrne, J. 105 cognitive development 103–104
Byrne, R. W. 119 cognitive functions 155
Coles, R. 33
Campbell, J. 10 Comprehensive Dictionary of
Cao, L. 78 Psychoanalysis (Akhtar)
Carr, A. C. 115 69, 94
Casement, P. 45, 141 confrontational interventions 111
Castelnuevo-Tedesco, P. 146 conscience anxiety 69
Catch Me If You Can 108 Cook, M. 11
INDEX 187
Cooper, A. M. 87, 124, 134–136 Escoll, P. 13

Corradi-Fiumara, G. 92 Espiritu, Y. L. 79
cowardice 15–16, 34 Exorcist, The 20
culture of fear 18 extent of dysphoria 4
culture-bound psychiatric Eysenck, H. J. 11
syndromes 17
Cumo, Mario 110 Fairbairn, W. R. D. 80
false self 106–107
daemonic force 30 -reliance 44
Damasio, A. 5 fear 3–33
Daniels, M. 150–151 anxiety 6–8
Davey, G. 11 apprehension 4
Davey, G. C. L. 11 cultural digression 17–20
Davidson, M. 11 defined 3
Davies, M. 40 dread 4
Davis, D. 106, 120 panic 4
deception 111–119 patient’s 24
clinical realm 111–116 phobia 8–14
developmental origins 102 terror 4
in culture at large 106–111 transference-based 116
types 97 Feldman, R. 98, 102, 107
Delprato, D. 12 Fenichel, O. 10–11, 13–14, 32, 37, 42,
Demyttenaere, K. 63 88, 99, 146, 149
deposited guilt 80–81, 94 Ferenczi, S. 75, 145, 157
Deutsch, H. 10, 13, 114 fight-or-flight 4
Dickens, C. 160 Fine, B. 68–69
Dirty Rotten Scoundrels 108 Fischer, R. 102–103
Dumas, A. 152, 161 Fliess, R. 24
Fonagy, P. 27, 30, 81, 102, 155
Edelsohn, G. 104 Forster, L. 11
Ego and the Id, The (Freud) 86 Foster, M. 6
Eidelberg, L. 68, 120 Fouts, R. 119
Eisner, H. 158 Frattaroli, E. 80
Elson, M. 58 free-floating responsiveness
Emanuel, R. 5 31, 89, 141
Emde, R. 11 Freeman, D. 120
emergency rule 18 French, T. 157
epistemic guilt 75–76 Freud, A. 124
Epstein, L. 57 Freud, S. xiii, 4, 6–7, 10, 12–13, 15,
Erikson, E. 63, 103 17–21, 30, 34, 40–42, 48, 50,
erotic/feminine masochism 52, 69, 73, 76–78, 85–86, 89,
86 93–94, 102, 105, 107, 111, 119,
188 INDEX
121, 123, 127–128, 130, 138, borrowed 80

140–141, 144–148, 157, 162 defensive function interpretation
Friedman, L. 92 91–92
defined 68
Gabbard, G. 141, 159 deposited 80–81
gallows humour 32 epistemic 75–76
Gandhi, M. K. 64, 161 induced 79–80
Gediman, H. 112 interpretation of defences 89–90
Gellerman, D. 34 oedipal 76–78
Gibson, E. J. 5 origins of 74
Gilligan, C. 93 reconstruction of the sources 92
Giovacchini, P. 121 regret 72–74
Girolamo, G. 63 remorse 71–72
Goldstein, J. 20 salutary outcomes of 87–88
Gordon, L. 146 separation 78–79
Grand, S. 4 shame 70–71
Grant, J. E. 63 survivor 82–83
Gray, P. 89 technical implications 89
greed 35–65 unconscious sadism
defensive distortions 40–41 interpretation of 91
defined 36 Guntrip, H. 41, 45
descriptive aspects 36 Guttman, S. A. 41, 140
developmental origins 41 Guze, S. B. 114
primary manifestations 36–38
secondary manifestations 38–40 Haggard, E. A. 130
sociocultural aspects 46–48 Hanly, C. 119
Green, A. 40, 52, 64 Harding, J. 88
Greenacre, P. 114 hard-wired fears 4–5
Greenson, R. 63 Haro, J. M. 63
Grifters, The 108 Hartmann, H. 120
Grinker, R. 70 Heathcliff 154
Groenendijk, L. 121 Hinshelwood, R. D. 149
Gropper, C. 146 Hoffer, A. 21, 157
Gross, A. 114 Hoffman, L. 6
Group Psychology and the Analysis of Holmes, D. E. 73
the Ego (Freud) 148 Hopkins, L. 121
Grunberger, B. 119 Horner, M. 4
Grunert, U. 141 Horney, K. 150
Guarnaccia, P. J. 17 Horowitz, M. 99
guilt 69, 71 House of Cards 108
adverse consequences of 83 Hugel, R. 11
annihilation 74–75 Hurvich, M. 8, 75
INDEX 189
identity diffusion 15, 146 Kolansky, H. 158

imposturous transference 113 Kovess-Masfety, V. 63
inconvenient truths 98 Kraepelin, E. 160
induced guilt 74, 79–80, 94 Krafft-Ebing, R. 86
Inhibitions, Symptoms and Anxiety Kramer, E. 145
(Freud) 147 Kris, E. 92
intellectual cowardice 15 Kulish, N. 10
interpretive greed 56–57, 59, 61
Isaacs, K. S. 130 Lafarge, L. 113–114
Issacharoff, A. 57 Laplanche, J. 68
Leaning Tower of Pisa
Jaws 20 110
Jin, R. 63 Lee, K. 104
Johnson, A. 104 Lemma, A. 101, 112, 114
Johnson, E. 6 Lester, E. 141
Jones, E. 12, 40, 83–84 Levin, S. 70
Jones, R. L. 41, 140 Levinson, D. 63
Jordan, L. 30, 51 Levy, S. 89, 141
Joseph, D. I. 33 Lewin, B. D. 10, 12, 14
liar loans 108
Kafka, H. 24 Lichtenberg, J. D. 6
Kaplan, H. 37, 49 Limentani, A. 62, 133, 140
Karam, E. G. 63 Lipton, J. E. 162
Kazmi, N. 141 Loewald, H. 92
Keir, R. 11 Loewenstein, R. 141, 157
Keiser, S. 75
Kelley, Jack 107 Mackinnon, R. 14
Kernberg, O. F. 15, 23, 32, 38, 41, 48, Madanes, C. 94
63, 80, 105, 111–115, 120, 125, Mahler, M. S. 13, 60, 63
129, 138, 141, 146, 158 Maleson, F. 87, 140
Kessler, R. C. 63 Maltsberger, J. 26, 138, 145
Kestenberg, J. 80 Mamdani, M. 94
Khan, M. M. R. 61 Man Who Quit Money, The 64
Kidder, R. M. 33 Man Who Was Late, The 134
Kilbourne, B. 70 Margolis, G. 115
Killingmo, B. 52, 91, 156 Marks, I. 9, 11
Kitayama, O. 93 Marteau, T. 11
Klein, M. 8, 42–44, 52, 71–72, 80, 88, masochism 64, 81, 83, 85–87, 90–92,
94, 104, 149 94, 118, 129, 134–135,
Knudson, A. 6 138–140, 154–155, 157
Koenigsberg, H. W. 115 character 87
Kohut, H. 14, 121, 150–152, 159 moral 130
190 INDEX
sado- 51–52, 86, 91, 117, 119, 128, O’Malley, S. S. 63

134, 152–153, 158 O’Shaughnessy, E. 113–114
types 86 Ocean’s Eleven 108
Masson, J. M. 13 ocnophile 16, 64
Mathias, D. 26, 91 Odlaug, B. L. 63
Mayhew, G. 11 oedipal guilt 76–78
Maynard-Smith, J. 119 Olden, C. 114
McLaughlin, S. D. 63 Omen, The 20
McNally, R. J. 11 Ono, Y. 63, 93
Meltzer, D. 16 optimism of revenge 158
Melville, H. 154, 160–161 ordinariness 107
Menaker, E. 15 Ormel, J. 63
Menninger, William 88 Ornstein, A. 146
mental pain 49, 123, 139–140, 144 Otto, R. 34
Merchant of Venice, The 154
messianic sadism 143 Pally, R. 5
Meth, J. M. 17 paranoid transference 113
Michels, R. 14 Parens, H. 117
Miller, J. R. 4 Parrish, S. M. 41, 140
Mineka, S. 11 Pennell, B. E. 63
Mish, F. C. 3, 36, 68, 123 permissive silences 65
Mittleman, B. 14 phenomenon of narcissistic rage 151
Modell, A. 78, 82–83, 130 phobia(s) 8–14, 31, 33, 147
Moore, B. 68–69 agora- 9, 101
Moore, M. 82, 108 animal 9, 17
Mora, M. E. M. 63 counter- 31–33
moral anxiety 6, 69 miscellaneous 10
moral masochism 86 school 34
Morrison, A. 70 social 10
Moss, D. B. 161 xeno- 17, 94
Music Man, The 108 phobic(s) 157–158
mutilation anxieties 16 -anxious personality 15
character 14–15
Natterson, J. 6 counter- 20, 32
need for punishment 85–86, 93 objects 17
“Neurosis and Psychosis” (Freud) 86 Pile, S. 10
New York Times, The 107 Pine, F. 13, 60, 63, 78, 94, 136, 159
Niederland, W. 60, 82, 130 Pinker, S. 162
Nietzsche, F. 162 pleonexic personality 39, 64
Nikelly, A. 39, 64 Poland, W. S. 157
Nock, K. 93 Pontalis, J. -B. 68
non-interpretation 61 Ponzi schemes 108
INDEX 191
Posada-Villa, J. 63 Roth, P. 44
Potenza, M. N. 63 Rounsaville, B. J. 63
Prathikanti, S. 78 Rudnytsky, P. 18
primary greed 45 Rycroft, C. 68–69
primary masochism 86
Procci, W. 91, 145 sadism 52, 86, 92, 109, 117, 138, 145,
process of defence analysis 116 148, 161
projective identification 24–25, 27, messianic 143
40, 80 primitive 155
psychiatric syndromes, pertinent unconscious 91
104–106 sadistic
Psycho 20 assaults 159
psychopathic transference 112–113, fantasies 82
117 glee 123, 125
psychopathic-paranoid transference lying 101
113 narcissistic- 16
psychopathic-unreal transference 113 oral- 42
Puppet Masters 20 phase of the libido 147
pleasure 146
Rachman, R. 11 self-blaming 89
Ramzy, I. 144 triumph 125
Rangell, L. 10 Sadock, B. J. 106
Rank, O. 144 Sadock, V. A. 106
Reich, T. 114 Sampson, N. A. 63
Reich, W. 87 Sandler, A. -M. 10, 31, 89, 141
revenge 143–162 Sandler, J. 31, 89, 141
antisocial tendency 149 Sass, L. A. 119
attempt at synthesis 153–155 Schafer, R. 137
defined 144 Schreiber, L. R. 63
demonic 154 Scott, K. M. 63
history 144 Searles, H. F. 150
phenomenological aspects secondary greed 45
144–146 Seedat, S. 63
psychodynamics 146–153 Seelig, B. 40
spectrum of 155 self-preservative lying 101
technical implications 155–159 Selzer, M. 112
Robertson, I. H. 63 Selzer, M. A. 115
Rogler, L. H. 17 sense of inadequacy 68
Rohrlich, J. B. 39 separation anxiety 74, 78, 94
Rosen, I. 88 separation guilt 78–89
Rosenfeld, H. 16, 129, 146 Shakespeare, W. 38, 154
Rosof, L. 40 Shames, L. 39
192 INDEX
Sharpe, E. F. 90 “Value of Vindictiveness, The”

Shengold, L. 99 (Horney) 150
Sherman, William T. 33 Van Gogh, Vincent 110
Shining, The 20 Volkan, V. D. 18–19, 24, 81, 85
Shneidman, E. S. 63
shy 15 Wachtel, P. L. 47
Shylock 154 Waelder, R. 74, 100
Sievers, B. 47 Walk, R. D. 5
signal guilt 88 Wall Street 65
Silberer, H. 32 Wallerstein, R. 144
Silverman, M. A. 33 Wangh, M. 10
Socarides, C. W. 150 War of the Worlds 20
Solyom, C. 11 Waska, R. 49, 50, 52
Solyom, L. 11 Watson, C. 98
soul murder 99 Webster’s Ninth Collegiate Dictionary
Spence, D. P. 119 98, 144
Spero, M. H. 70 Weiss, E. 14, 123, 144
Stanton, A. H. 101, 130 Weiss, J. M. 106, 120
Steinberg, M. A. 63 Weiss, J. M. A. 93
Steiner, J. 150, 153 Whitehead, J. 99
Steketee, G. S. 11 white lies 106
Sting, The 108 Whiten, A. 119
Stone, M. 15, 104, 111–112, 119, 146 Williams, D. R. 63
Strozier, C. 121 Winnicott, D. W. 8, 44–45, 61, 72, 94,
Suddath, R. 34 106, 116, 149
Sulzberger, C. 114 Wolpe, J. 11
Sundeen, M. 64 Woolfolk, R. L. 119
survivor guilt 60, 82–83 Wright, J. 6
Symonds, A. 4 Wu, R. 63
Szathmáry, E. 119 Wurmser, L. 70
Szurek, M. 104 Wuthering Heights 154
Talwar, V. 104 Yap, P. M. 17

Target, M. 27, 30, 81, 102, 155 Yeomans, F. 112
Texas Chainsaw Massacre 20
thin-skinned 16 Zibel, A. 108
Tobak, M. 105 Zilboorg, G. 6, 145
trio of guideposts 136
Tyson, R. L. 10
universal fears 17
USA Today 107

Salman Akhtar - Sources of Suffering - Fear, Guilt, Greed, Deception, Betrayal, and Revenge-Karnac Books (2014)

Uploaded by

Copyright:

Available Formats

Salman Akhtar - Sources of Suffering - Fear, Guilt, Greed, Deception, Betrayal, and Revenge-Karnac Books (2014)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Salman Akhtar - Sources of Suffering - Fear, Guilt, Greed, Deception, Betrayal, and Revenge-Karnac Books (2014)

Uploaded by

Copyright:

Available Formats

SOURCES OF SUFFERING

Chapter Five has previously appeared in S. Akhtar (Ed.), Betrayal:

First published in 2014 by

Copyright © 2014 by Salman Akhtar

All rights reserved. No part of this publication may be reproduced, stored

British Library Cataloguing in Publication Data

A C.I.P. for this book is available from the British Library

Typeset by V Publishing Solutions Pvt Ltd., Chennai, India

Printed in Great Britain

ABOUT THE AUTHOR xi

PART I: SUFFERING TOLERATED

PART II: SUFFERING INFLICTED

Writing a book only appears to be a solo endeavour. Behind the scenes,

Salman Akhtar, MD, is professor of psychiatry at Jefferson Medical

of Psychoanalysts’ Laughlin Award (2003), Columbia University’s

Suffering is integral to life. Alongside joy and excitement, it

encounter suffering in clinical and social settings. The book identifies

owing to socialisation patterns and internalised cultural biases, fear

… their needs for attachment experiences and even moments of

lead them to follow a ball out into a dangerous street, climb up

Such nuanced interplay of “nature versus nurture” variables in the

If the memory image of the hostile object is in any manner freshly

inclination to discharge corresponding to the experience of pain.

Anxiety is not newly created in repression; it is reproduced as

In the same contribution, Freud also delineated the seminal “danger

“breakdown” (Winnicott, 1974). Variously termed “psychotic anxiety”

… (i) it originates in early infancy; (ii) it can, however, be reacti-

Regardless of whether it is “neurotic” or “psychotic” in nature, the

Table 1. Fear, anxiety, and phobia.

Source External Internal Externalised

fear because it is out of proportion with the situation in reality. Indeed,

• Agoraphobic syndrome: is the commonest variety, constituting about

Of these four types, animal phobias and miscellaneous specific pho-

the face of a reactive increase in the intensity of drives. Many “simple

In certain cases there is not much displacement; anxiety is simply

The psychodynamics of most phobias is, however, far more compli-

A certain amount of regression is also central to all phobias. The

… all phobics behave like children, whose anxieties are soothed

Agoraphobia, the roots of which were traced to a repressed prostitution

… anxiety prevents them from becoming free from themselves and

Some years later, Deutsch (1929) declared the involvement of a partner

underneath the consciously experienced need for libidinal attachment.

an individual is “constantly imaging himself in situations of danger

of helpless dread in the face of a massively traumatic situation. And,

Where dependence on good internal objects is rendered infeasi-

Meltzer’s proposal has implications for the technical handling of indi-

proverbial iceberg here. The relentless need to externalise aggression

Evoking and fuelling large group fears is a favourite strategy of

Writers of terrifying fiction, ranging from Clara Reeves (1729–1807)

characters. They succeed in collapsing the boundary between mind and

Back to the clinical realm

situation.9 That such work involves a great deal of countertransference

Sensing fear, addressing dangerousness, and setting limits

The analyst’s neutrality with respect to conflict may be suspended

happen in the course of an ongoing treatment or, at times, in the very

Such admixture of limit-setting, supportive measures, environmen-

psychoanalytic practices, supportive and interpretive measures carry

Similar to the technical interventions in the preceding vignette, my

Bearing and containing the patient’s fear