Clinical example

Mr. T’s mother often responded to anything her child did that upset her -commonly ordinary activities - with hysterical intensity. She would scold, threaten to abandon the family, or make suicidal gestures. Mr. T’s father was often unavailable or might respond to an upset in the home with an angry outburst. Both parents considered Mr. T to be a bad boy, and Mr. T accepted this attribution. He developed a speech defect based on fear and would place himself at risk in the rough neighborhood in which he lived. He also developed a pattern of defiantly enacting unacceptable mean, exhibitionistic, and sometimes antisocial behaviors that continued into adulthood. Alongside his fear of attack and rejection, his risk taking, and his antisocial acts, he developed adaptive behaviors that, combined with his high intelligence, propelled him into a successful career. In his analysis he often would bring up a current insensitive or antisocial behavior or the memory of one of the many examples from the past. These revelations triggered a momentary experience of shame or guilt that rapidly was lost as a guiding signal. Rather than stay with the shame or guilt, his tone would shift to one of pleasurable defiance followed by exaggerated statements of what an awful person he was. His defiant exaggerations of his badness were dramatizations of a shame state that seemed to both of us a mimicry and mockery of his mother’s histrionics. In this state, his message to me, and to the world, was

OK if you are going to give me a hard time and scold and blame me, I’ll show you what bad really is - I’ll smash this phone or block your path with my car and you can hit me and damage your car.

At these moments he was in a state completely dissociated from his highly skilled cooperative professional persona. By retaining his bad-boy identity he was able to turn shame into the pride and sadistic pleasure he derived from defiance of rules, restraints, and authorities.

Mr. W’s mother had been unprotected and traumatically abused as a young woman, a fact that became known to Mr. W only as an adult. As a child, what Mr. W experienced was his mother’s excessive reaction to his little-boy teasing of his younger sister. Caught in their mother’s distorted projection of her traumatic abuse onto her daughter as victim and her son as destructive abuser, the two children played out their roles in a continuous drama. The little girl would scream “Mother, he’s looking at me! Mother, he’s pointing his finger at me!” The mother would come rushing in to comfort her upset daughter and scold and shame her bad, bad, bad little boy. Seduced by her role of protected victim, the little girl did all she could to provoke his responses. Later, at school age, Mr. W, enacting his bad-boy role, became the class clown. This led to him frequently being sent being to the principal’s office, a happening his sister eagerly announced to her parents. Mr. W’s father remained a passive observer, reluctant to cross his wife and trigger her anger. Mr. W remembers his father on one occasion saying “You’re a cry baby” to his daughter and “You’re a tease” to his son. His father contributed one component to Mr. W’s bad-boy identity by his demand for perfectionism in any task he assigned to his son.

At the same time as Mr. W saw himself as bad, he also recognized he was a person of considerable charm, friendliness, capability, caring, and sensitivity to others. His prevailing sense of self was characterized by a constant feeling that he disappointed others, seeing everywhere he looked an indication of his shameful neglect. In his more fleeting sense of self he recognized his many accomplishments and his great professional success. This confusing dichotomy of identity has its origin in the dichotomy of his mother’s responses to him. In his initial 18 months of life, before the birth of his sister, his mother had been loving and devoted. The difficulty began with the birth of a daughter with whom she had identified as desperately needing protection from a male predator - not her passive, avoidant husband, but the lively vibrant little boy. This whole context was compartmentalized to the triad of protective mother, victim daughter, and predator son. But outside of that context, Mr. W’s mother was attentive, caring, and proud of her achieving son. These two dissociated states continued throughout Mr. W’s adult years, when his mother would suddenly turn on him with shaming scolds when he said something to his sister’s children that would be innocuous to anyone else. This would also provoke his sister into an episode of highly dramatized victimization.

The recurrence and persistence of his “being bad” identity in the minds of mother and sister and his acting it out as class clown led to Mr. W’s skewed view of himself in the world. Fiercely ambitious, he demanded advancement and fairness from others. Simultaneously, he was continually scolding and shaming himself for tasks set aside or not completed. As it impacted his mood, reflecting his underlying affect tone of helplessness to alter his negative identity, he had a very low threshold for seeing failings and experiencing shame, and a high threshold for seeing himself as worthy despite generally receiving high praise from others. He consistently scanned his internal and external world for evidence of what he should have done but did not do. The persistent shame that resulted from his scanning led to his resignation that nothing would or could change for the better. Mr. W’s chronic shame state and his resignation to it led to an abiding underlying affect tinge of sadness. He experienced brief moments of joy from the accolades he received from important people that he impressed, and longer moments of pleasure when he could be by himself, free of obligation. Despite living many aspects of a successful life, admired by many others and offering wise advice and caring to friends and family members, he was endlessly stalked by an embodied sense of shame. Trapped in never knowing whether to believe the accusation originating from his delusional mother’s trauma that he was dangerous made him unable to have good experiences, which had an impact on his underlying affect tone of helpless pessimism.

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