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"I cry and I cry, and very bitterly I cry."
A case study has recently been published (reviewed as "brilliant and richly detailed") that describes an analyst's close and empathic work with an adolescent boy, whose reported history of emotional deterioration reached a grievous state when, after becoming severely distraught, he climbed onto the roof of his two-story home and threatened to jump. Not long after that, he began to engage in in self-mutilating behaviors, displayed increasing obsessions and rituals, turned increasingly physically assaultive toward adult caretakers and became extremely destructive to property in the home, resulting in thousands of dollars in damage.
Examples of his self-destructive behaviors included turning on a gas stove and putting his head over the burner (scorching his hair in the process). In desperation, he finally began cutting himself to write notes in blood that he left around the house, which pleaded for someone to help him. After psychiatric hospitalization, he entered long-term therapeutic group care.
In residential treatment, he seemed to indicate a sense that there had been a lack of emotional attunement with important adults in his early life. This fueled an incessant, often nearly unbearable tone of heated, aggravated and rageful complaint from him during much of the early stages of his care. Over time, many staff members exposed to his bitterness reacted with defensive wishes to reject and punish him, a counter-transference difficulty that others have noted in writings about working with similarly difficult young people in group care.
Eventually, the analyst working with him was able to come to understand his ongoing, adamant, rageful complaints as a special kind of protest, reflective of a desperate hope that things could be better for him in the present, that he need not be doomed to constantly reliving the sense of emotional abandonment associated with his past. Stuart Pizer (1992) described similar observations when he noted, "As I see it, protest, like the 'antisocial gesture,' is a sign both of anger and of hope--the hope for a negotiable environment that will heed the protest as a signal of distress. Protest...is the [young person's] act in the present to renegotiate relational failures of the past...." The Forsaken Child: Essays on Group Care and Individual Therapy
(2000, pp. 107-143) also provides a movingly compelling description of the potential associations between enactments of massive feelings of rage and the emergence of a growing sense of hopefulness.
A similar observation was made much earlier by Winnicott (1956/1992), who pointed out, "The antisocial tendency implies hope. Lack of hope is the basic feature of the deprived child who, of course, is not all the time being antisocial. In the period of hope the child manifests an antisocial tendency...the understanding that the antisocial act is an expression of hope is vital in the treatment of children....Over and over again one sees the moment of hope wasted, or withered, because of...intolerance."
Adapted from: "Psychotherapy in Group Care: Making Life Good Enough," (2003, pp-10-11).
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