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While there are many exchanges that take place during our early development, some have a more profound impact on our developmental trajectory
than others. In the milieu of a disturbed mother-child dyad, what becomes
of self and other object representations? How do the derivatives of trauma,
neglect, and overstimulation become expressed and used during important life transitions? In this paper, convergent themes in the analysis of
an eleven-year-old boy and a forty-year-old man illustrate how the evocative nature of smell was used as a means of holding on to early object ties
and fantasies of a blissful union. I am proposing that by conceptualizing
encopresis and the use of body odors as an expression of the individuals
early trauma and object representations, we can advance our understanding of the tenacity of these symptoms and further develop appropriate and effective technical approaches. A select review of the literature is
used to establish the relationship between earlier developmental phases
and an internalization of early object relations relevant to this paper.
Introduction
during my work with eleven-year-old steven, we came to
understand his symptom of encopresis as a means of holding on to his
relationship with his mother. Stevens comfort with the smell of his feces
and the repulsion it provoked in others led to a counterreaction and
Bernadette Kovach, Ph.D., is an adult analyst and an Advanced Child Analytic Candidate
at the Michigan Psychoanalytic Institute. I am grateful to Nancy Kulish, Marvin Margolis,
Michael Singer, and my fellow candidates at MPI for their contributions to my development.
It is with sincere gratefulness that I would like to acknowledge Dr. Ivan Shericks consultation both during Stevens analysis and throughout the writing of this paper. I would
also like to acknowledge Kerry Kelly Novick and Dr. Channing Lipsons careful editing and
comments throughout the development of this paper.
The Psychoanalytic Study of the Child 66, ed. Robert A. King, Samuel Abrams, A. Scott
Dowling, Paul M. Brinich, and Claudia Lament (Yale University Press, copyright 2012 by
Robert A King, Samuel Abrams, A. Scott Dowling, Paul M. Brinich, and Claudia Lament).
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Bernadette S. Kovach
symptom formation and the intensity of his conict have become apparent (Blum, 2007a, 2007b; Chused, 2007; Ross, 2007). Ross (2007,
pp. 78794) purports that by reconsidering Little Hanss symptom formation as a means of conveying the trauma of the family constellation, as well as Frau Grafs abusive behaviors toward her children, we
are afforded the opportunity to reect on how these early experiences
became woven into later developmental stages and fantasies. Although
the major focus was on Hanss fear of horses and phobic behavior,
there were many other symptoms present, including Hanss rage when
expected to use the chamber pot (Blum, 2007a, p. 757).
According to Anna Freud (1963, p. 253), feces are offered as gifts,
which are surrendered to the mother as a sign of love. The childs
productions and the process surrounding their productions becomes
representative of the movement toward self-mastery and mutual reciprocity. In other words, in each instance of self-mastery, including toilet
mastery, early mother-child interactions are represented in the childs
experience of self and other. Therefore, mother-child dyadic experiences become woven into the separate actions of the child. In the
presence of a good enough mother, separation and mastery become
part of a reciprocal exchange of pleasure in self and other. However,
this was not the case with Little Hans. Even though Hanss mother was
overly solicitous toward him, preferring him over his father and his sister (as reported by Blum, 2007a, p. 755), he did not wish to give gladly
of his bodily productions, as other toddlers are apt to do. His feces
would not be easily surrendered and therefore could not be enjoyed
as a production separating him from his mother. Instead of a mutually
pleasing developmental transition, Hans kept himself painfully tied to
his mother, and she to him. His feces became an expression of his
wish for omnipotent control and the attendant masochistic surrender
that had likely been part of his relationship with his mother from infancy. His difculty relinquishing his feces was complicated and could
easily represent rage at his parents, just as it could represent a partial
internalization of his mothers treatment of him as her widdler (see
Ross, 2007, p. 788). Frau Grafs abuse of baby Hanna, overstimulation
of Hans, and loss of her own productive capacity as a musician set
the stage for Hanss particular expression of reciprocity through bodily
productions. Through an understanding of his identication with his
mother, Hanss reference to his feces as a baby can also be understood
as a reference to the way his mother treated his sister Hanna as the fecal
baby, unwanted and disposable.
There is sufcient agreement in the literature that derivatives from
earlier stages of development inuence later stages. How do the deriva-
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I think you should know that this is a miserable child. He is hostile and
foul. He has been to several doctors and there is no reason for him to
continue to lose control of his bowels. I believe it is his choice. I expect
because of his background, and the way he has behaved with me, he is
lled with rage. The profound neglect and poverty this child has endured is as repulsive as what he does.
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in my ofce. Using the toy buildings and other toy construction materials, Steven promptly formed a circle. He was the hub and I was on the
outside of the womblike structure. Steven repeated this scene each day
for several months, only allowing me to participate from outside of the
circle as a witness and narrator. The toy structure had become a physical boundary allowing Steven to feel held within my ofce yet separated
from me while he told the story of his life. Toy dolls were brought
into the circular city. These toy characters came to be known as the
people and the babies. The babies were usually bad and unwanted.
The people changed rapidly from hostile to neglectful, depending on
the story that needed to be told. Themes of longing, disappointment,
overstimulation, and inhuman living conditions were exemplied in the
actions of the babies and the people. The babies were thrown away, left
in the cold to die, anally pierced with long rods by doctors, fed poisonous elixirs, and left alone to fend for themselves for hours.
Eventually, Steven invited me to play along using the doctor and
grandmother dolls. My dolls could occasionally enter the circle, but I
was to remain outside the circle. During this time, Stevens anger toward
me and other doctors was expressed in displaced violence toward the
doctor and grandma dolls. The doctor doll was thrown off the roof of a
building, run over, hit, beaten, and tortured. As the fervor of his attacks
on the doctor doll increased, I wondered aloud if he was worried that
I would be like the other doctors and try to put him on medication or
make him do homework or worse. Steven responded with surprise and
relief: Yes! They were all stupid. They didnt help me. I know what I
need to do but I cant do it.
Steven continued to express his rage and sadism in displacement
over the next several months. Although Steven continued to help pick
up at the end of a session, messes within the play town were made and
not cleaned. Toy bathtubs were lled with imaginary shit and the doll
people were routinely urinated or defecated on to Stevens delight. The
people walked around with their heads on backward, butts rst, because
That is the most important part of them! Steven exclaimed.
Over the next several months of analysis, a crazy woman appeared.
She was crazy because she hated her baby and so she threw him off the
top of the buildings. She abandoned him in the streets, where he was
thrown in the garbage like trash. If the doctor doll tried to intervene
and help the baby, Steven would stop playing. In those moments, I silently wondered if he felt thwarted in his efforts to express his sadistic
feelings and have them accepted by me. When I did not intervene,
Steven would initially respond with delight, but eventually he became
silent and angry. His reactions led me to believe that when the doctor
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Bernadette S. Kovach
doll did nothing to help the baby, Steven experienced me as just like
others who had abandoned him and done nothing to stop his earlier
traumas. I was frustrated and confused. Eventually Steven announced
his reason for withdrawing from play when the doctor doll tried to
intervene: Doctors are not to be trusted! He sobbed. All they want
to do is take away what is mine. They want to punish me for keeping
what is mine.
Steven began to make demands for more people, more men, and
gifts from me. He wanted me to make people with him. The oedipal
strivings implied in his request were indicative of the progress Steven
was making in the analysis. At the same time, I also considered if his
need to create people was linked with his need to create something
with his stool, and as such, I introduced pungent smelling modeling
clay into our work. At rst, we made colorful adults to help the other
people in the city and to take care of the children. Then we began to
make babies, not just any babies; we made chocolate babies by mixing
the colors together. However, chocolate babies were not the only addition to our sessions. Stevens symptom of encopresis also began to be
expressed in session more frequently. As Stevens in-session encopresis
escalated, his cooperation at home also increased, as did his at-home
interest in self-care and toilet mastery. In order to support our sessions
and Stevens mastery of self-care, his stepmother prepared a backpack
with a change of clothes, cleaning supplies, and a plastic bag for his
soiled underwear. The backpack became known as Stevens clean kit
and was brought to session each day in case he needed to clean himself before the ride home. Over the next several months, we enjoyed
a complete but temporary remission in Stevens encopresis. During his
remission, Steven gave me a gift of words. He brought in the book The
Golden Compass (Pullman, 1995) to help me understand how he felt
about losing what was his.
After Steven returned from a two-week vacation at his mothers house,
his play in session changed. We stopped creating people, and the babies were once again mischievous and hid from the adults. The babies
were repeatedly taken out and put back into their hiding places. Steven
giggled and squealed as the babies moved in and out of hiding. His
expressions of pleasure took on a frantic quality as the babies naughty
behaviors turned to stealing and eventually killing the adult characters. I was again barred from directly playing with the toys or Steven.
I asked Steven if he wanted me to feel excluded the way he had felt
separate and excluded from me and others. Stevens answer came in a
pronouncement that he wasnt clean now or while he was at his moms.
His mother worked long hours and rarely spoke with him while he was
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with her, except to point out how difcult her life was. His symptom of
encopresis had returned along with his rage at being abandoned and
not being able to be held or to hold on to his mother.
Steven continued to reject me during our sessions by inviting me to
play then abruptly stopping me from any interactions with him or the
toy people. During these nonplay times, I reexively began to make
things. I made paper ornaments, rugs out of scraps of cloth, and anything I could think of. I produced something to keep me occupied
while I sat alone outside the toy barrier. Eventually Steven began to
take my productions from me. As I sat, left with nothing, I wondered
silently how I could make something out of the loneliness I was feeling.
I craved stimulation of any kind. Steven withdrew further into himself,
barely acknowledging my presence. As my feeling of isolation increased,
I decided to tell Steven I believed he wanted me to feel lonely and unable to talk about my feelings because he felt unable to talk about his
painful, lonely feelings. Stevens response came in the form of a story
about a toy he had received for Christmas. He said he would take the
toy into his room and talk with it until he fell asleep. Sobbing bitterly,
he added, It was taken from me, like everything else I really want to
keep. His story was reminiscent of the teddy bear that had been taken
from him and later lost by his mother. Both memories were emblematic
of the tenuous connection between Steven and his mother, and her
unavailability to him physically and emotionally.
Several weeks later Steven brought a surprise for me on his return
from a long weekend with his mother. When I opened the door to my
waiting room, Steven was lying on the oor looking through a magazine, excited to see me. He smiled, but the smell in the waiting room
was overpowering, leaving me unable to greet him in kind. Picking up
his clean kit, he eagerly walked down the hall to my ofce, seemingly
oblivious to the odor. Sitting on the oor, Steven opened his clean kit,
revealing its contents. He had stuffed his backpack with soiled underwear and pants. I stood motionless as thoughts raced through my mind
about cleanliness, germs, and illness. I pictured the types of organisms
that grow and multiply in fecal material. I remembered a story I had
read as a child about a little girl that died from diphtheria, a devastating illness, from drinking water contaminated with feces. I thought
about my child and my other patients. What resounded in my mind
was I cannot do this.
Closing the door to my ofce, I asked Steven what he was planning.
He smiled and said, I thought we could play. As he started to reach
into his clean kit, I stopped him abruptly saying, No Steven. I am sorry,
but I cant appreciate this the way you do. I cant do this. I am not able
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to play with your poop the way you do. I know it is exciting for you. I
am too old, and so are you now. We can pretend to play with poop, but
not for real. I was completely repulsed at the sight of the fecal-stained
clothing and stench. As my disgust and fear escalated, I felt propelled
to send Steven home to use our time to clean his clothes and his body.
Stevens smell, his fatal gift,2 and his murderous rage evoked a countertransference enactment of terror and rejection. Together we acted
out the rejection Steven so often experienced in his past and current
relationships with others.
Another aspect of Stevens symptom became clear to us in subsequent
sessions. Steven wanted to play with the toy people again. The babies
took other people prisoner and placed them in a big dumpster. The
captured people could not hear or see, but they could smell everything.
Of utmost importance, the captured people could never leave the babies and never go away or make him go away the way his mother and I
had. It was during these sessions that we were able to begin recognizing
and discussing Stevens enjoyment in the anal stimulation of pooping
and his fantasies of holding on to the people in his life. We were able
to understand how he used his symptom of encopresis as a means of
maintaining a hostile dependent relationship with others as both captor
and captured in fantasy and in reality.
Although Steven spoke more frequently about his anger and frustration with others, particularly his mother, he continued to foul the air
and make messes in his pants. Over the course of about four weeks,
Stevens mother continued to disappoint him by not picking him up for
visits and not calling him. At the same time, my own mothers health was
worsening, eventually resulting in her death. During this period of the
analysis, a pattern developed with Steven letting go of gas or expelling
small amounts of his feces into his pants whenever he felt disappointed
by his mother. Feeling assaulted by the smell of feces and my own recent loss, I began to search for a way to comfort myself. At some point
in my search, I remembered the handkerchiefs my mother had given
me. I began to develop my own pattern and repetition. Each morning
as I dressed, I took out one of my mothers handkerchiefs, sprayed it
with her perfume, and tucked it in my sleeve, just as I had watched my
mother do when I was a child. I would leave a corner of the handkerchief out so that I had easy access to the scent and the comfort of the
memory of my mother. As an anticipated spring break neared, Stevens
excitement grew. When Steven arrived for our last session before vaca2. The term fatal gift is used in reference to Orgel and Shengolds 1968 paper on gift
giving (p. 380).
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months old, and in her preoccupation with her pregnancy and the familys mounting nancial struggles, she admittedly became lax in her care
of him. Michael believed that his mother was not just lax in caring for
him, but had difculty allowing him to separate from her. His mothers
responses to his queries about toilet training were offered as an example
of the difculty she had allowing him to become independent. He was
told that although he was ready to move ahead with bowel and bladder
control, his mother continued to put him in diapers. She rationalized
her actions saying she believed it would be easier to train both children
at the same time. It was around this time that Michael rst began to
withhold his stool, sometimes to the point of abdominal cramping and
eventual soiling. His mother was also reluctant to send him to kindergarten and held him back a year ignoring signs of school readiness,
including his ability to read uently by age four. Michaels symptom of
encopresis came to be understood as an expression of his rage as well
as the unconscious dynamics between Michael and his mother. After
learning of his fathers affair with a woman in another city, it seemed
likely that his mothers actions were in part displaced aggression at
Michaels father for betraying her and the children. It appeared that
both Michael and his mother were invested in keeping him small and
soiled.
Through continued talks with his mother and an increased trust in
his memories, Michael became convinced that his independence was
threatening to his mother and that she appeared to feel betrayed by
him for not staying her baby. His mothers wish to keep him a baby
matched his own wish to be a baby again so that he could be cared for
and loved, as he believed his sister was. Laughing anxiously, Michael
recalled bathing with his sister until elementary school. Hesitantly he
recalled their last bath together: I remember feeling very excited. Mom
was not with us at rst but came in when Jody started yelling. One of
us pooped in the tub. I remember telling my sister it was a ship. My
mother was furious when she pulled my sister out of the tub. She left
me in there. Afterward I began to take showers, although Mom always
criticized, saying I smelled. I guess I learned to separate and gain independence by sitting in my shit and stinking.
After several months of analysis, Michael no longer drank, and he
had resumed writing. In the face of these gains, he continued to have
sex with women who were emotionally unavailable to him. My attempts
to make transference interpretations were met with extreme hostility,
denial, or cancellations. It seemed to me that Michael, like Steven,
needed more people to play with. Michael lled his life with people
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who were unpredictable and hurtful, like the crazy lady in Stevens
town. In session, he lled the room with words. Despite his verbosity, I
felt left out. A circle of words began to form, with Michael as the hub.
Michaels words built a boundary around him, excluding me from direct
discussions of his transference reactions and his emotional life. In what
appeared on the surface to be a masochistic surrender, he complied
with the analytic rule of saying what comes to mind while expressing
his rage through hostile and sadistic detailing of his interactions with
others and his sexual encounters. The transition from anal expression
of emotion to the use of words included Michaels anal expulsion of
words as a means to express his wish to draw me in and repulse me.
The unconscious goal was to stop any growth in the analysis recreating
his relationship with his mother.
In addition to his copious use of words, Michael began to come to
session without bathing. The scent of his sexual activities lled the room
along with his words. He would arrogantly announce that he despised
the ease with which he could seduce the women he met. Michaels
worry that he was interchangeable and unremarkable was mixed with
his fantasy of omnipotence and his contempt for those he could seduce.
Michael became increasingly depressed as each sexual conquest became
proof that he could seduce or be seduced by a woman but never truly
loved. I wondered if Michael was worried that I too might be seduced
into some action, proving that I was as interchangeable and corruptible
as all the other women were. Michael replied, My wish is to nd someone innocent and incorruptible, yet I know I will feel rejected because
someone like that would want nothing to do with me.
In a subsequent session, Michael recalled the following dream: In
the dream I walked to the top of this perfectly round hill, and at the top
of the hill was a woman. She was someone I knew, but Im not sure who
it was exactly. We stood facing each other for a long time. We were both
naked but not touching each other. We were just looking at each other.
We held hands and turned toward the sun. As we turned, we somehow
became one. We united. Its always what I am looking for. I believe that I
will nd someone that will join with me, and the feeling will be perfect.
I will totally and willingly lose myself in a perfect union. Michaels association to the dream was a memory of giving a mirror to a girl he was
smitten with in middle school. He found out that she wanted nothing
to do with him and only took his mirror to see herself and not because
she cared about him or the gift he had given her. Michael feared that
his feelings and memories would not be reected back to him or understood by me and he would again feel rejected and alone.
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Michael continued to bring the scent of the women he was with into
session, along with other body odors. I regarded his actions as some
remnant of his earlier encopresis and his way of expressing something
about his relationship with his mother. However, without Michael verifying his early childhood experiences, I could only speculate that this
was his way of showing me what he found unable to say. The answer
became clear through an enactment in the form of a parapraxis. During the height of Michaels sexual exploits, he came to session with a
strong smell of incense on his clothes. The smell was so strong that I
became irritated. In response to my annoyance, I commented, You
smell strongly of incest today. My slip took us both by surprise. After a
burst of anxious laughter and playful utterances of surprise, Michael responded in a somber tone, Its funny you should say that; I had a dream
last night that really troubled me. I wasnt going to tell you, but now that
youve said that, I will. I dreamt about having sex with my mother. Who
the hell actually dreams of having sex with their mother? Well, I do, I
guess! As Michael continued to speak, his dream became melded with
memories of sleeping in his mothers bed while his father was away. He
slept on the oor of their room until he was almost twelve years old.
In his place on the bedroom oor, he was witness to the sights, sounds,
and smells of his parents nighttime activities. Michael felt invisible, like
an audience in a theater observing a lm. His parents, the actors in this
nighttime lm, behaved as if he were not there. Yet Michael was both
participant and observer. He participated in their experience, just as I
was a participant observer in his sexual activities in the analysis through
his words, the smells, and sounds he brought into the room with him.
After telling me about his special place in his parents room, as he
and his mother called it, Michael was able to explore the relationship
between his longing for a perfect union and his jealous and competitive feelings toward others. Michael was also better able to discuss his
wish to excite and repulse me. He longed to make me feel jealous and
discarded, as he had felt as a child and in the transference.
Another aspect of Michaels use of smell became evident as we continued to explore his reluctance to shower and use deodorant. I wondered
aloud if he was marking his territory or making sure my other patients
knew he was there. Michael laughingly agreed, adding, Thats part of it,
but I also think its because I want you to notice me and not forget me
when I leave. Michael associated his feelings of being forgotten to the
birth of his sister and to being in his parents bedroom. He believed that
he went unnoticed unless he was making a mess or a smell that would
announce both his presence and his annoyance at being forgotten and
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rejected. Michael lled the room with his scent and his words just as
Steven had lled the room with his smell and his soiled clothing in an
effort to be remembered and to remember.
During his associations to his use of smell, Michael recalled scenes
from a movie that he felt summarized his relationship with his mother
and father. In the movie, a baby was born to a husbandless shmonger.
Just after delivering the baby, the shmonger pushed her infant son
onto a mound of garbage, leaving him to die. However, the baby did not
die. He was found and brought to an orphanage, and his mother was
executed for attempted murder. The shmongers infant son looked
and smelled ghastly, as if he had taken in the smell of the garbage
and the disdain his mother had for life. His pallor and stench left him
undesirable to other children and adults. An interesting twist in the
characterization of this child was the notion that he had a keen sense of
smell, yet he could not smell himself. As a young man the shmongers
son learned how to extract the essence from the women whose scent
he found enticing. He longed to make the perfect scent, the scent of
innocence, a scent he had never known and never possessed. Michael
also longed to make the perfect scent.
Michael tearfully described how he felt responsible for not being
wanted or loved. He believed that somehow he had been born evil. In
his fantasies, he murdered each of the women he slept with and took
their souls, just as the shmongers son in the story stole their scent.
Michael believed he had been born without a soul. He, like the man in
the movie, was without the essence of innocence. His scent had been
fouled, and as such, Michael held on to his bodily smells to communicate what he had witnessed and felt. Michaels scent and his words
were used by him to exist outside of me and within me, the way an
infant takes up the spaces of the mothers body and later her thoughts.
In subsequent sessions, Michael expressed his belief that giving up his
scent would leave him without the memories of a time with his mother
when he was held as an innocent.
Discussion
Although there are several differences in the two cases presented, in
part related to developmental differences, there are a number of important similarities. Both Michael and Steven wanted to deny their feelings of being unloved, unwanted by their mothers, and abandoned by
their fathers. Both felt disposable and therefore acted as if their lives
and their relationships were disposable. Although their sadomasochistic
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