Cultic Studies Review, Vol. 7, No.
3, 2008, pp. 291-296
When the Body is the Target:
Self-Harm, Pain, and Traumatic
Attachments
Sharon Klayman Farber
Jason Aronson Publisher, Inc. (an
imprint of Roman & Littlefield,
Inc.): Lanham, MD. 2002. ISBN-10:
0765703718; ISBN-13: 978-0765703712
(paperback), $55.00 ($49.20,
Amazon.com). 616 pages.
Reviewed by Lorna Goldberg,
M.S.W., L.C.S.W.
Many years ago,
before vacation periods, I would
invariably get into an accident of
some sort. I had acquired an
attitude about myself as someone who
was just clumsy and accident-prone.
After I had begun therapy, I had a
minor car accident before a
long-awaited summer vacation. When I
entered my therapy session, I
offhandedly told my therapist about
the accident, but proudly dismissed
it, declaring, “I’m not going to let
this ruin my vacation.” My therapist
was not so ready to brush this off.
He encouraged me to explore all the
feelings that I had felt before and
after the accident. This continuing
process of looking at the underlying
thoughts and emotions that are
expressed in the self-harming action
of accident-proneness has allowed me
to begin to live a more
accident-free and emotionally free
life.
Dr. Sharon
Farber captures this concept and so
much more in her beautifully written
book, When the Body Is the
Target. From a conceptual point
of view, in revealing the “mystery”
of self-harm, she points out how
self-harm is used to maintain the
outward sign that something is wrong
on the inside. Farber notes that
some of us might self-harm in
relatively minor ways, in behaviors
(such as nail biting) that are
low-key versions of the impulses
that are more strongly expressed by
severe eating disorders or
self-mutilating behaviors. We are
informed that self-harm is about
individuals who cannot live
peacefully in their own skin.
When the Body is the Target
focuses on those who experience
their emotions not in their minds,
but in and through the immediacy of
their bodies. In the authoritarian
world of the cult, self-reflection
and “negative” feelings are
discouraged and demeaned through the
leader’s manipulations and doctrine,
and interfered with through numerous
thought-stopping techniques. The
result of these limitations might be
that the body becomes a central
expressive source for the discharge
and regulation of feeling,
particularly pain and anger the cult
member experiences. According to
Farber, for those individuals who
severely harm themselves, the
predominant mode of self-experience
is sadomasochistic pain and
suffering. That is, physical
violence is the language of those
who lack the ability to use metaphor
or symbols to express emotions or
unspeakable pain; they use their
bodies to speak for them. These
ideas, all clearly presented, are
fundamental to Farber’s
understanding of self-harm and are
useful for those of us who work with
individuals who have learned that
they must submit to the needs of
others rather than allow the direct
expression of their own needs.
The concepts in
this book, while complex and
psychoanalytically based, are
written with clarity and without
psychoanalytic jargon. For example,
Farber emphasizes that self-harming
behavior can be seen as a
psychological symptom that is caused
by more than one factor, serving
multiple and paradoxical functions
in the psyche in the individual’s
attempt to feel better or gain
relief. She shows the reader how
this behavior, which is quite risky
and potentially dangerous, allows
those who are deadened by depression
or dissociation to “come alive,” or,
by contrast, how such behavior
offers relief to those who
experience the anxiety of constant
hypervigilance. In this way, Farber
views self-harm as playing an
adaptive role and self-regulatory
function in the life of the trauma
survivor, by terminating a painful
state of dissociation or
hyperarousal.
In exploring
self-harm’s connection to trauma as
a causative factor, Farber explains
how childhood shock traumas of
physical and sexual abuse, medically
related traumas, or the strain
trauma of neglect are experienced as
direct assaults to the body. If no
one was present to protect and
soothe the child at a time of
overwhelming pain, the child might
begin to repeat this hurtful
experience through self-injurious
body behavior in an attempt to
regulate mood or states of
hyperarousal. This scenario
contrasts with the background of the
protected child who develops the
expectation of comfort from others
and eventually repeats this positive
experience by soothing herself and
taking care of her body.[1]
Although Farber touches on many
psychoanalytic theories, she
emphasizes attachment research and
its connection to trauma. She
particularly cites the work of Peter
Fonagy and his associates to
establish the relationship between a
secure early relationship and the
ability to be self-reflective and to
know the minds of others.
The findings of
Farber’s research study, presented
in this book, suggest that it is the
severity of the trauma suffered in
childhood and adolescence,
particularly the cumulative trauma
of violent sexual and physical abuse
maintained in a climate without
secure attachments, that is a key
factor in the development and
maintenance of dissociation,
self-injurious habits, and
eating-disordered habits in
childhood. The severity of the
trauma also is significant in the
development in childhood of a
general sense of body alienation,
which can contribute to the
development of eating-disordered
behavior, self-mutilating behavior,
and other forms of self-harm later
in adolescence and or adulthood.
However, Farber
indicates that self-harm might not
be solely the result of trauma
experienced early in life. Self-harm
can result from the ordeal of being
under the influence of a powerful,
manipulative, sadomasochistic leader
who co-opts one’s ability to think
critically and have ownership over
one’s own body. Self-harming
behavior in these instances is seen
as the outcome of cult programming
and cult-learned practices and
rituals that create dissociative
behaviors to enhance the leader’s
influence and doctrine in which
dietary restrictions or various
forms of abuse are either encouraged
or seen as acceptable. Those of us
who examine the world of cults have
seen how dietary restrictions or
physical or sexual abuse often is
redefined as necessary to increase
the members’ level of purity. The
acceptance of this destructive
behavior is supplemented by the
contagion and peer pressure of the
group. In my work with former cult
members, I also find that self-harm
may be the result of an attempt to
play out, through the body, a
cult-induced message not consciously
acknowledged by the former cult
member.
Farber explains
that, just as addictive alcoholism
is a progressive disease, the
behavior of chronic bulimics and
self-mutilators follows a
progressive course from
preoccupation to ritual preparation
(which helps to induce a dissociated
mental state) to compulsivity (need
to perform the behavior) to shame
and despair. She considers that this
behavior might reveal a
psychological addiction to trauma, a
compulsion to repeatedly and
unconsciously reenact and express,
through bodily self-harm, severe
trauma suffered in childhood. Having
been the passive victim of traumatic
abuse in childhood, the individual
will be compelled to repeat the
trauma, sadistically inflicting
violence on others or
masochistically inflicting violence
upon the self. Anger that is
physically directed at the self is
central to the life of the
individual who has been abused and
violated, leading to repetitive
reenactments upon the body that have
the potential to become dangerously
out of control. Although Farber
touches on this, I might more
centrally suggest that these early
abusive experiences (particularly,
but not only, by those who suffered
from sexual abuse) also have a
libidinal component, and libido is
interwoven with aggression in these
acts.
I found the
section of the book on clinical
implications to be as illuminating
and extensive as the previous
sections on theory. Not only does
Farber give the reader principles
for working with this population,
she also highlights these principles
with vignettes from her own and
other therapists’ clinical work.
First and foremost, after a
comprehensive understanding of the
inherent power of these symptoms,
Farber assures the reader that
attachment to self-harm can be both
emotionally and biochemically
altered through the development of a
secure attachment. The attachment
relationship can serve as a bridge
to the idea of the possibility of
different relationships in the real
world. These early relationships
were quite destructively exciting
and aggressive, and sexual feelings
become mixed together in potentially
destructive ways. Farber explains
that the aim of therapy can be to
transform harmful bodily enactments
by building in patients a capacity
to reflect upon their experience and
make a symbolic leap from the body
to the mind. Treatment addresses
this pathological split between mind
and body. In promoting this, Farber
again emphasizes the necessity for
the therapist to recognize the
meaning of this behavior and the
understanding that patients do what
they do, no matter how hurtful, to
feel better.
To begin to
change this course of action, the
therapist needs to moderate each
patient’s harsh judgments about the
self. For example, the patient might
feel disgust at feeling turned on by
the self-harming behavior. The
tendency to have harsh attitudes
toward these regressive episodes
will need to be challenged, and it
is an important step for the patient
to develop empathy toward herself.
If the therapist can explore all of
this in a nonjudgmental fashion and
begin to look at the connection to
the past, the patient’s harsh
attitude might be modified. Helping
the patient link present behavior
with repressed or dissociated
feelings can not only aid in
awareness of the full meaning of the
behavior, but also increase
awareness of feelings and the
ability to put emotions into words
rather than express them through
enactments. Furthermore, Farber
points out that the therapist’s
attitude of strength, vitality, and
humor is needed in order to tolerate
the patient’s aggression (and
seductiveness), and to resist either
rescuing the patient (who might
demand to be rescued), or getting
pulled into retaliating during
dramatic enactments that might
occur. If the therapist can
recognize and reflect on what has
occurred, enactments that generate
from the patient’s intense
sadomasochistic relationship style
developed in the past can be a
positive and useful force that
involves a corrective experience for
the patient. In the process of
recognizing and reflecting, the
therapist must be able to contain
powerful affects, listening to her
own inner states and taking
responsibility for her own feelings.
Farber does an excellent job
illustrating, with her own case
material, how the therapist might
handle all of these highly charged
situations. She also suggests the
need for taking on a body “caring”
role in focusing on how the patient
abuses or neglects the body. This
focus can become a corrective
experience for the patient while it
also might lessen body alienation.
Farber returns to concentrating on
the adaptive role of the behavior.
She suggests that the therapist
might question, “What does the
self-harm do for you? How does it
help you?”
Themes of
victimization and narcissistic
entitlement, as well as boundary
violations, might be played out by
the patient with the therapist in
treatment sessions. I particularly
feel that Farber’s discussion on a
patient’s sense of specialness and
entitlement is quite helpful for
therapists. For example, she wisely
suggests that patients might need to
look at how getting others to do
what she wants might not always be
to her advantage.
Farber
encourages the therapist to use
supervision or peer-group support,
as well as to work collaboratively
with other professionals, such as
medical doctors, for the therapist’s
benefit as well as the patient’s. In
addition to a psychodynamic focus,
it is important for the patient to
be armed with a variety of coping
mechanisms—i.e.,
cognitive-behavioral strategies for
tolerating impulses to self-harm and
to better manage the dysphonic
affect associated with the impulse.
Having these skills will lead to a
patient’s feeling more in control of
her impulses.
Farber has
given those of us who work in the
cult field a scholarly and
clinically informative work about
our patients who suffer and affect
us in powerful ways. Many of our
patients who are former cult members
enter treatment and don’t initially
reveal self-harming behaviors,
either because of discomfort and
shame or because these behaviors are
habitual and dissociated. However,
in time, patients often begin to
share their secrets with us.
Farber’s book not only contributes
directly to our understanding of
self-harm, but also indirectly
increases our understanding and
management of potentially harmful
symptoms that patients might defend
against through action and that
might elicit strong emotions in
ourselves.
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