When the Body Is the Target Self-Harm, Pain,

In this comprehensive and insightful work, Dr. Sharon K. Farber provides an invaluable resource for the mental health professional who is struggling to understand self-harm and its origins. Using attachment theory to explain how addictive connections to pain and suffering develop, she discusses various kinds and functions of self-harm behavior.

Sharon Klayman Farber, Ph.D., is a Board Certified Diplomate in clinical social work practice in Hastings-on-Hudson, New York

Preface

xiii

Acknowledgments

xxi

Introduction

xxiii

Part I The Borderland of Self-Harm

The Mystery of Self-Harm: Concepts and Paradoxes

3

(42)

The Death Instinct Revisited

4

(1)

Purging, Bloodletting, and Exorcising the Demons

5

(1)

The Fear of Madness

6

(1)

The Body

7

(1)

Symptoms and Language

8

(1)

The Problematic Concept of Suicide

9

(1)

Pain and Suffering

10

(1)

Self-Harm and Pain in the Context of Culture

11

(5)

The Language of Pain and Violence Spoken on the Body

16

(1)

The Spectrum of Bodily Self-Harm

17

(13)

Other Self-Harm in the Spectrum

30

(2)

The Self-Harm Concept in the Literature

32

(8)

Self-Regulation, Self-Medication and Selfobject Hypotheses

40

(1)

Self-Regulation and Attachment Theory Illuminate Self-Harm

41

(1)

The Paradox of Self-Harm

42

(3)

How Common Is Self-Harm?

45

(52)

The Ubiquity of Self-Harm

46

(12)

Contagion and Group Factors in Self-Harm

58

(5)

Process Factors in Contagious Self-Harm

63

(2)

Self-Harm Is as Old as Time

65

(3)

Grooming and Attachments Gone Haywire

68

(5)

Self-Harm and Associated Psychopathology

73

(14)

Adaptation and Dimensions of the Self-Harm Spectrum

87

(2)

Navigating the Borderland and Exploring the Margins

89

(8)

Not Wanting to Know about Self-Harm: Trauma, Violence, and Chronic Mental Illness

97

(14)

Deinstitutionalization and the Chronic Mentally Ill

97

(2)

The Resistance to Understanding the Origins of Trauma

99

(3)

Wartime Violence

102

(1)

Holocaust Survivors

102

(1)

Rape, Domestic Violence, and Child Abuse

103

(1)

The Link between Self-Harm and Trauma Is Established

104

(7)

Part II Neglect, Violence, and Traumatic Attachments

Suffering and Self-Harm: Treating Oneself as the Other

111

(8)

Dehumanization of the Other and Violent Suffering

111

(1)

Effects of Violence

111

(8)

How Attachments Go Haywire

119

(40)

Attachment Theory and Research

122

(7)

Self and Mutual Regulation

129

(14)

Attachment Problems Woven into the Development of Critical Ego Functions

143

(16)

The Psyche-Soma and Traumatic Attachments to Pain and Suffering

159

(32)

The Psychosomatic Dyad and Alexithymia

161

(17)

From Passion to Perverse Omnipotence

178

(1)

Transitional Use of the Body as a Fetish

179

(2)

The Psychotic Core: Up Close and Personal

181

(4)

The Passionate Dance with Death, or The Last Tango?

185

(1)

Passionate Attachments and the Child's Survival

186

(2)

Attachment and Darwin's Theory of Natural Selection

188

(3)

Survival and Sacrifice: When the Prey Becomes the Predator

191

(20)

The Repetition Compulsion

193

(1)

The Dialectics of Safety and Danger, Predator and Prey

194

(2)

Becoming a Wild Animal

196

(1)

Fear of the Beast

197

(1)

Eat or Be Eaten, Kill or Be Killed

198

(1)

Ghosts of Predators Past and Primeval

199

(1)

From Defenseless Prey to Ferocious Predator

200

(2)

Primeval Fear of the Predator in a Past-Life Regression

202

(2)

The Adaptational Advantage of Anxiety

204

(3)

We Are the Gods and the Demons, the Lions and the Sacrificial Lambs

207

(4)

Trauma, Duality, and the Transformation from Prey to Predator

211

(52)

Chaos, Catastrophe, and Snapping

212

(2)

Trauma, ``Aloneness Affect,'' and Self-Harm

214

(1)

The Trauma Response

214

(1)

A Warm Body Is Better Than No-Body; Violent Touch Is Better Than No Touch

215

(2)

The Trauma Continuum and Defensive Altered States

217

(4)

``Doublethink'' and the Psychobiology of Trauma

221

(4)

State-Dependent Memory and the Return of the Repressed

225

(1)

Traumatic Attachments and Addiction to Trauma

226

(4)

Self-Harm: Self-Destructiveness or Survival Tool?

230

(1)

Self-Harm for Healing and Redemption

231

(2)

Addictive Traumatic Reenactments

233

(2)

Becoming One's Own Predator

235

(7)

Regression to the Immediacy of Bodily Experience

242

(21)

Part III The Body Speaks

The Body Speaks That Which Cannot Be Spoken

263

(24)

Self-Harm as Attempts at Self-Regulation

264

(2)

Transitional Functions of the Body in Self-Harm

266

(1)

How The Body Speaks

267

(4)

Approaching Symbolic Use of Language

271

(2)

Bodily Reenactments Speak to the Self

273

(3)

Repetitive Themes

276

(11)

Self-Harm, Gender, and Perversion

287

(36)

Gendered Embodiments of Self-Harm

288

(1)

Masochism and Gender

288

(2)

Trauma and Gender

290

(2)

Depression and Gender

292

(1)

Women Take Their Medicine; Real Men Drink You Under the Table

293

(2)

Gender Differences in Self-Harm in Institutions

295

(1)

Gender Differences in Eating Disorders

296

(1)

Body Alienation

297

(1)

Childhood Body Experience

298

(1)

Adolescent Development

299

(12)

Pregnancy and Breast-Feeding

311

(1)

The Aging Process

311

(6)

Sadomasochism and Other Perversions

317

(6)

The Addiction to Wanting:

323

(26)

``Do Not Want What You Cannot Have''

324

(1)

Destructive Narcissism and Hunger Diseases

325

(3)

The Addiction to More

328

(1)

Symptom Substitution

329

(1)

Adjusting the Medication

330

(3)

The Strongest Medicine for the Deepest Pain

333

(1)

Those Who Need the Strongest Medicine

334

(3)

Special Subgroups with Most Severe Hunger Diseases

337

(8)

Attachment and Hunger Disease

345

(4)

Part IV Clinical Implications

The Attachment Paradigm

349

(24)

The Therapeutic Alliance and Sadomasochism

352

(1)

``There Is No One There for Me''

353

(1)

Supportive Attachments

354

(2)

Typical Problems in Treatment

356

(5)

Treatment Objectives

361

(1)

Focus on Interactive Processes

362

(1)

Engaging the Patient

362

(2)

The Treatment Frame

364

(1)

Physical and Emotional Safety

365

(3)

Qualities Needed for Therapists Treating Self-Harming Patients

368

(5)

Diagnosis, Assessment, and Core Features

373

(10)

Assessment of Self-Harm

374

(1)

Criteria Used in Assessing Self-Harm

375

(4)

Diagnosis

379

(4)

Using Attachment Theory in Therapy of Self-Harm Patients

383

(42)

Core Features of the Self-Harming Patient

384

(30)

Attachments: Different Roads Lead to Rome

414

(1)

Power of the Family

414

(1)

Power of the Group

415

(10)

Transference, Countertransference, and Enactments

425

(38)

Projective Identification and Splitting

426

(1)

Therapist as New Object and Container

427

(1)

Therapist as Interpreter

427

(1)

The Patient's Persona and Transference

428

(5)

The Therapist's Persona and Countertransference

433

(2)

Enactments

435

(26)

The Power of Affective Experience

461

(2)

From Self-Harm to Self-Reflection

463

(36)

How The Story Is Told

464

(2)

Playing and the Creative

466

(4)

Playing with Secrets

470

(3)

Playing with Writing, Drawing, Music

473

(2)

Playing with the Dark Side

475

(2)

Playing with Humor

477

(1)

Playing with Dreams

477

(1)

Playing with the Body

478

(2)

Playing with Images of the Body

480

(2)

Resonating with Patients' Language and Metaphors

482

(3)

From the Language of the Body to Symbolization

485

(1)

Reenactments and Healing: A Paradoxical Circular Process

486

(7)

How Therapy Heals

493

(3)

Becoming Real

496

(3)

Appendix: The Study and Transitional Space

499

(22)

The Study

500

(7)

The Concept of Transitional Space

507

(2)

The Transitional Area of Experience as a Safe Space

509

(1)

The Study as a Safe Space

510

(2)

The Researcher as Idealized Reader

512

(1)

Wanting to Find Meaning in Their Suffering

513

(2)

Pain, Attachments, and Teddy Bears

515

(3)

Body Modifications and Transitional Space

518

(3)

References

521

(38)

Credits

559

(2)

Index

561

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When the Body Is the Target Self-Harm, Pain, and Traumatic Attachments

Summary

Author Biography

Table of Contents

Supplemental Materials