1« Manic defense » as it is used in this paper should not be confused with the term « mania » as it appears in descriptive psychiatry. Manic behavior has long been recognized as a central aspect of bipolar illness as it presents in adolescence and adulthood. In recent years a reductionistic characterization of the behaviors of young children has led to the controversial extension of the diagnosis, now described a « disorder of the brain », to that age group, as well. It is not the focus of this paper to enter in to that debate. This is a paper – not about the brain – but about the mind. I endorse a metapsychological point of view that recognizes that all behavior has meaning and acknowledges that a myriad of conscious and unconscious factors – both cognitive and affective – interact with inside and outside influences in an epigenetic developmental framework to create that meaning. Symptoms and defenses, including the manic defenses I will describe, are compromise attempts to deal with the conflicts that inevitably arise between contradictory wishes and with the demands of reality.
2Such challenges are monumental in adolescence. The uniqueness and complexity of this phase and its developmental tasks have long been acknowledged. In his seminal Three Essays on the Theory of Sexuality (1905) Freud characterized the « detachment from parental authority » as « one of the most painful, psychical achievements of the pubertal period ». He heralded the task as, « important for the progress of civilization ». In 1937, at the culmination of her training with the Vienna Psychoanalytic Society, Anny Katan presented to Freud and her colleagues a paper about a type of displacement active in normal adolescence. She summarized her analysis of an early adolescent girl who had begun a relationship with a boy. She reported having enjoyable fantasies about him but, not wishing to reveal these to her analyst, she decided to leave her analysis. Katan recognized that her patient’s behavior constituted a « flight » from treatment, but reflected on what she viewed as a developmentally appropriate aspect of the girl’s behavior. Noting that puberty ushers in a recurrence of oedipal conflict, she reviewed how in normal development an adolescent must ultimately fail in the struggle against the drives so that « … instinctual desires are displaced from the incestuous object on to the other, new objects ». She reflected that the course for this is protracted and vacillating and observed that, « the adolescent does not always succeed completely and immediately in this process of removal ». Since Katan recognized that she was proposing a form of displacement different from what is typically observed as a defense, where incestuous features are retained, she chose the term « removal ». She noted that in normal, healthy development, the process, once accomplished, is irreversible.
3While we can recognize that instinctual urges toward primary objects will always remain in the unconscious, I take from Katan’s use of the word « removal » that she was thinking of something more definitive than Freud’s idea of « detachment from parental authority ». In an unpublished paper Denia Barrett (2005) observed, « This permanent, irreversible process may be similar to the establishment of reaction formations during the anal phase – another time when the ego turns against the drive and secures a far reaching achievement of dominance over it that affects the personality in critical ways. This appears to involve something more complicated than usual for a defense mechanism, which may only be necessary at certain times or in certain circumstances ». In the 70-plus years since Katan first offered these ideas others have expressed similar thoughts regarding the transformational developmental processes at work during adolescence. Aarons (1970) elaborated Katan’s defensive concept of « removal » and considered the changes in psychic energy and object choice in adolescence.
4Others authors found the concept of object removal helpful but viewed it as part of a broader process with their thinking extending from Mahler’s (1963) ideas about separation-individuation. For example, while Adatto (1966) recognized « removal » from infantile objects in the adolescent’s attempt to establish defenses against preadolescent object ties, he also felt that the process of separation-individuation that began in infancy and toddlerhood was the « genetic forerunner of late adolescence, since more definitive separation and individuation occur at the end of adolescence » when « the infantile love objects are relegated to a more unconscious position and become more a part of the psychic apparatus ».
5Peter Blos devoted much of his career to the study of adolescents and found Katan’s concept of « object removal » a valuable one in explaining adolescent object relations (1958, 1965). However, Blos (1967, 1979) went on to write at length about separation-individuation in adolescence and proposed that adolescence be viewed as the « second individuation process ». Referencing Mahler (1963) he stated, « What is in infancy a “hatching from the symbiotic membrane to become an individuated toddler” becomes in adolescence a shedding of family dependencies, the loosening of infantile object ties in order to become a member of society at large … ». Like Katan, Blos (1979) felt that with the healthy culmination of adolescence, self and object representations acquire firm and stable boundaries that are resistant to cathectic shifts. He further noted that « without a successful disengagement from infantile internalized objects, the finding of new, extrafamilial love objects in the outside world is either precluded, hindered, or remains restricted to simple replication or substitution ». Blos noted various similarities between separation-individuation in infancy and adolescence. He observed that in each phase there occurs a « heightened vulnerability of the personality organization », the « urgency for changes in psychic structure in consonance with the maturational forward surge » and, in instances of failed individuation, resulting deviations in development. Blos also acknowledged an important difference between the phases when he observed that « the object disengagement through individuation at the adolescent level does not proceed in relation to external objects as it did in early childhood ». Rather, it « proceeds in relation to the internalized objects ».
6Blos recognized the developmental reality of adolescent regression and saw a causal connection between the disengagement from reanimated infantile libidinal dependencies in adolescence and the corresponding developmentally predictable emergence of both drive and ego regression. He asserted, « … progressive development is precluded if regression does not take its proper course at the proper time within the sequential pattern of the adolescent process … ». Blos clarified his view that it is the « disengagement » from internalized objects that contributes to a shift to a heightened libidinal self-investment with this leading to « the proverbial and transient self-centeredness and self-aggrandizement of adolescence ». He further observed that these attitudes typically coexist with opposite feelings including « the sense of nothingness (the state of helplessness) and despair (the state of object loss) ». He stated that in teens these, « affective states are akin to mania, depression, and mourning ».
7Responding to Blos, others have expressed caution against drawing too close a parallel between separation-individuation in infancy and the corresponding transformations that occur in adolescence. Roy Schafer (1973) elaborated on the difference between infancy and adolescent phases that Blos acknowledged and expressed the view that in adolescence the giving up of relations to infantile objects does not constitute « individuation », per se, since the fact that objects already exist is an indication that individuation has long since occurred.
8Erna Furman (1973) stressed that Mahler’s findings have contributed greatly to our understanding of infants and toddlers but noted that adolescents, unlike toddlers, have progressed through an oedipal phase and respond to emerging genital impulses with oedipal fantasies that are linked to object representations of their parents. Furman stated, « The adolescent task of diverting the genital impulses to love objects outside the family consists both of shifts in cathexis and of new identifications … partial and selective identifications with the parents are developmentally much more advanced than the identifications of the young toddler ». Noting her agreement with Katan, Furman stated that the aim of adolescent parental identifications « is to assist the decathexis of the incestuous aspect of the parental object representations and enable the adolescent to become a sexual adult like his parent ».
9Brandt and Silverman (1985) bring a different factor into focus when they emphasize the quality of maternal investment as influencing the outcome of the separation-individuation process. They note Mahler’s (1968) observation that « the most extreme separation reactions occur in children who were involved in a situation in which the symbiotic relationship was too exclusive or in which the mother could not accept the child’s individuation and separation ». They add, « It is our impression that this is as true during adolescence as it is during early childhood ». They recall Jacobson’s (1964) observation that « the deeper and more powerful the imprint of the mother’s attitudes, the more they will arrest and interfere with the child’s autonomous development ». I agree with Brandt and Silverman (and for that matter with Mahler and Jacobson) that the quality of maternal – and I would add paternal – investment in a child impacts in no small way an adolescent’s progression toward adulthood. I also find much of value in Blos’ writings : his observations of the similarities between the separation-individuation phase of infancy and adolescence ; the importance he places on the role of regression in adolescence ; and the corresponding emergence of affective states that are « akin to mania, depression, and mourning ». But I also agree with Schafer that the difference Blos points to between the phases is an essential one. The infant and toddler libidinally cathects internal representations of primary objects as an aid to individuation and differentiation. By contrast, to use Katan’s term, adolescents struggle to « remove » themselves from their incestuous libidinal ties to allow for progression toward mature, adult sexual independence.
10Denia Barrett (2005) addressed the importance of oedipal phase contributions to this process and noted that Katan was referring to « the triangular relationship older adolescents must work over internally and master in order to be free to pursue and enjoy their own adult sexuality. The internal sense of oneself as a partner in a twosome … must shift from being a version of the original representations of oedipal objects and triangular relationships to a revised version based on new realities and understandings of choices that are based on mutuality rather than rivalry or possession, genitality rather than pregenitality ». Clinicians who work with adolescents recognize that this is not easily achieved. The process of finding a new object is often fraught with difficulty, conflict, and ambivalence, especially when revised oedipal conflicts are tinged with sado-masochism or the sequellae of early experiences of decathexis or loss, on the one hand, and seduction or overstimulation, on the other. These are the teens who find « removal » difficult as their conflicts and compulsion to repeat keep them tied, even in perverse ways to their primary objects and compromise their ability to turn toward new objects in a mature and healthy fashion. These often are the adolescents we encounter in our work and these are the histories they bring. As I have worked with such young persons I have found it essential to think of their symptoms and defensive behaviors in the context of this struggle to resolve their conflict-laden incestuous object cathexes.
11Robert Furman (1988) also found Katan’s concept of object removal an invaluable one that led him to a deeper appreciation of adolescent loneliness. He described how analyzing provocative behavior or regressions often pointed toward an effort to ward off loneliness. He recalled work with a boy of 14 who was both underachieving in school and abusing alcohol on weekends – maneuvers that came to be understood as efforts to escape feeling lonely. Furman asked what would be « so wrong with being a bit lonely ? » and paraphrased the young man’s response. « It’s ok for you to say that. When you’re lonely, it’s for people. For me it’s different. When I am lonely I am so lonely inside. I feel so empty. It’s unbearable. I don’t even know what I’m lonely for. If I did, it would be easier. I could manage it better. » Furman added, « This loneliness … is particular and poignant, rather special to adolescence and results from the beginning removal of instinctual investment from the internal representatives of the parents ». In my work with adolescent patients I have often recalled Furman’s portrayal of loneliness and have come to recognize the role that feeling lonely plays in the experience of virtually every young person faced with the task of object removal. While I recognize that some adolescents struggle with deep depression during the phase, I have come to believe that what is often diagnosed as clinical depression is actually the normal and healthy (albeit painful) experience of loneliness. Furthermore, I have come to appreciate how helpful and even essential it is for young persons to be able face and feel such lonely feelings to discover their ability to tolerate them. Indeed, to do so might be thought of as an achievement in a way that is comparable to and an extension of what Winnicott (1954) described regarding the attainment of the depressive position. When this can be done the resulting sense of mastery and increase in self esteem greatly facilitate an adolescent’s ability to progress with object removal and the attainment of adult genitality.
12A review of the psychoanalytic literature reveals that the concept of loneliness is one that has received only minimal consideration. This is as true today as it was almost 50 years ago when Fromm-Reichmann (1959) noted that « … loneliness is one of the least satisfactorily conceptualized psychological phenomena, not even mentioned in most psychiatric textbooks ». She added, « Very little is known about its genetics and psychodynamics, and various different experiences which are descriptively and dynamically as different from one another as culturally determined loneliness, self-imposed aloneness, compulsory solitude, isolation, and real loneliness are all thrown into one terminological basket of “loneliness” ». Satran (1978) observed that « Loneliness and defenses against loneliness in adolescence may account, in part, for why adolescence is often forgotten and why, as Anna Freud noted, it is often bypassed in the treatment of adults ».
13Pearson (1968) writing on behalf of a Philadelphia based study group focusing on child analytic technique described latency children behaving in « silly » ways as a defense against « a fear of lonesomeness – actually of being left alone because of not being loved ». Thus, in latency the affect and the defense against it appear to operate at a superego level. By contrast, when silliness or excited acting out emerges in the work with a teenager, it appears predominantly as a manic defense against a form of loneliness that results from a different point of origin. Rather than stemming from a fear that love will be withdrawn by the object, the lonely feelings come in the burgeoning awareness that it is the adolescent, who is feeling the need to modify the instinctual quality of the relationship with his or her parents.
14Based on comparative survey data from more than three thousand adolescents, Ostrov and Offer (1978) concur. They note that adolescents are highly vulnerable to feelings of loneliness because of the push toward independence essential to their developmental stage. They distinguish adolescent loneliness as qualitatively and developmentally different from loneliness during other stages, noting the painful inner craving for intimacy and closeness that, unlike the quality of depression experienced in adulthood reveals an underlying element of hope.
15I find myself in essential agreement with this definition, particularly with its focus on the aspect of « hope, » a concept that has been addressed by Laufer (1997) and his colleagues from the Brent Adolescent Centre in London. I have noted in my work with more severely depressed adolescents that they tend not to offer much in the way of early childhood memories or experiences. In fact, when asked directly they tend to deny having particular memories. By contrast, among less depressed teens or among those who have progressed in treatment, I have often encountered a greater degree of spontaneous reporting of childhood memories, including sad or conflicted ones as well as happy ones. I have recognized this ability to recall and talk of memories as a sign of hope for the future and base this on the premise that one cannot look forward with a sense of optimism unless one can first recall and cathect a past when one felt happy and could master or at least « bear up » in the face of conflicts, sadness, and even trauma.
16Perhaps this hope and longing is what compels so many relatively typical teens to turn so excessively and compellingly to one another in search of an antidote to loneliness. Consider the immense popularity among teens of such Internet sites as « FaceBook », « MySpace », and « YouTube » where they can use (and abuse) the opportunity to compose, create and share information with one another, oftentimes spending several hours a day in such activities. When young persons seem constantly to be involved with friends and peers, it is easy to misinterpret this as a sign that they are not lonely, rather than recognizing the driven way in which they pursue such involvement as a defensive attempt to ward off loneliness. A 2006 study of teenage behavior, reported by Olsen, claims that, « the average teen chats via IM (Internet messaging) with 35 people for a total of three hours a week ». The study further notes that when not reaching out directly to peers, teens turn to the sense of connection and fulfillment they find in the music with which they identify. They report that « 75% of teens spend two or three hours a day downloading or listening to music online ».
17Much has been written about the myriad hormonal, biological, and neurobiological changes that occur in adolescence, including non-object and non-instinctual factors that contribute to adolescent loneliness even as they pave the way for maturation. These include the expanding capabilities for abstract and cognitive thinking and the recognition of diverse and extra-familial systems of beliefs and values. Rather than discounting the influence of these factors, I would assert that it is this very confluence of change that creates in the adolescent a feeling of loneliness, the depth of which is unlike any previously experienced. This makes it all the more essential that it be recognized for what it is – rather than being « pathologized » for what it might become. In my work with young teenagers I have often encountered situations where feelings of disconnection, usually with roots in early childhood, led to feelings of loneliness and emptiness inside and the use of what I have come to view as manic defenses to ward off those feelings.
Jane was a high school freshman who was referred to me by a psychiatrist who had twice admitted her to an adolescent inpatient unit after scratches on her wrists made with a comb were termed « suicidal gestures ». The psychiatrist recognized that rather than truly depressed or suicidal, Jane was angry at her divorced parents and had used her self-hurtful gestures as a way to get their attention. He saw in her impulsive acting out a defense against how frightened she felt by the lack of supervision and oversight that her still quarreling parents extended to her. Jane’s methods of acting out were varied, driven, and manic in quality. Though known to be of high intelligence, her school work suffered as, rather than doing homework, she spent time in her room each evening, downloading music from the Internet and « texting » or talking on her cell phone with peers. Often she cut school and violated her curfew and when she did she sometimes wandered the streets of her neighborhood, associating with older peers, many of whom had histories of delinquency, drug and alcohol abuse. While she did use these substances herself, her excessive eating had caused her weight to grow to over 200 pounds.
An only child, Jane had been adopted as an infant by parents who had been unable to conceive. While it appeared that both parents had doted on her and provided her with an excess of toys, clothes, and gifts from toddlerhood on, this apparent indulgence had masked their times of being unavailable to their daughter. Jane’s mother had long struggled with depression and a variety of physical ailments and her high-power father had often been preoccupied with his business activities. They had finally divorced during her middle school years and each had become involved with other potential partners as Jane had entered high school.
Treatment with Jane began in an unorthodox way. Her father had called me to say that she needed to be in treatment in order to be released from the hospital. When I met them in my waiting room I asked Jane if she wanted to meet with me alone or with her father. She opted to meet privately. Rather than seeming at all depressed, or even distressed, she flooded me with non-stop, buoyant commentary about her favorite music, her taste in fashion, the pleasure she took in drawing and dancing, and the other teens she had met on the inpatient unit. She spoke with excitement about the other patients, what they had been sharing with her about their lives, and what she had been doing in an effort to help them feel better. When I asked about those actions of hers that had gotten her admitted, she avoided answering by asking me if I would require her to make a contract that she would not do anything more to hurt herself. I told her that I did not believe in those kinds of contracts and explained my belief that if she really wanted to keep hurting herself there was nothing that I, or anyone else, for that matter, could do to stop her. I added that, having listened to her, it was not my thought that she wanted to end her life. Rather, I was impressed by how much she seemed to enjoy connecting with and relating to others. She smiled in response to this comment and said, « Maybe I’ll be a psychologist someday ». I answered by saying that in letting me know that she was thinking about the future that way, it seemed that she was agreeing with my assessment. We asked her father to join us and Jane took the lead by explaining what I had said about not making contracts. She further explained that I was an analyst who met with patients four times a week, something she thought she should do. Understandably, her father seemed a bit overwhelmed and asked me if what Jane was saying was so. I confirmed the accuracy of what she had said and added that while I thought it was too soon to recommend an analysis, I thought that Jane and I could meet for a couple of weeks to see if she could use such a treatment. Jane was true to her word about wanting an analysis and remained in treatment for two and a half years. For months she continued to flood me during our sessions, talking almost non-stop from the time she entered the office. What seemed noteworthy, even as it was puzzling, was the way that she would start off on one topic, only to quickly abandon it as she went on, just as excitedly, to talk of something else. It was as if she could not stop filling herself up with one new thought after another, even as she could not let herself finish a thought. Over time, as I was able to get her to notice this and begin to wonder with me about it, she was able to begin to tolerate thinking of the fear of emptiness that she was warding off and the lonely feelings that it implied. Gradually, she was able to tell me about her early childhood years and the many times she was left to feel abandoned and disappointed. She made connections to how her overeating was an effort to fill up the emptiness. Her street wandering and associating with strangers was able to be understood as an economic attempt to escape from loneliness as she responded to a long repressed yearning to find and reunite with her birth parents.
Much of significance was addressed and worked through in Jane’s analysis and there were positive results as she lost weight, began to do well in school and developed stable and lasting relationships with peers, both male and female. She also became more effective and mature in her ability to communicate with both of her parents, including at a feeling level. I have often reflected though that, what made the work possible, especially as we met and engaged in a working alliance, was that Jane could note that I saw in her, not someone who was depressed and fragile but someone whose frenetic behavior was a defense against the loneliness she struggled to ward off as she longed to connect and relate in a meaningful way – with herself as well as with others.
In work with an eighth grader who had been in analysis since fourth grade, I encountered an extreme, manic-like preoccupation with downloading music in work. In addition to sharing feelings of loneliness, Michael, like Furman’s patient, described a profoundly empty feeling, inside. He had been adopted as an infant and his toddler years had been tragically disrupted when his adoptive father died. After her husband’s death, Michael’s mother, overtaken by grief, focused on her work and Michael was often left in the care of nannies. Throughout his early childhood he had grown obese and, though test results showed him to be very bright, he was at best an average to mediocre student. When he entered middle school, his passive and ineffectual behavior became even more pronounced. As we noted how he frequently lost his school books or « forgot » to turn in homework or study for tests, I began to take up with him how hard it seemed for him to hold on to what we came to call his « loving feelings » for himself. It was in this context that he began to admit to feelings of loneliness and « emptiness ». As he became more able to share these self-observations, he described how, even when not hungry, he felt compelled to eat, sometimes to the point of consuming an entire large pizza. As such observations helped him gain better control over his eating, evidence of an alternative attempt to fill the emptiness inside came into his analysis. Michael confessed that most evenings, while supposedly studying in his room, he was driven to download « pirated » music files from the Internet. He knew that what he was doing was illegal and was aware of efforts to catch and prosecute persons behaving in this way. But he could not stop himself. He admitted having stolen thousands of tunes, so many that his computer had become overloaded and virtually unusable. He admitted he could never enjoy listening to the music because all he could think of was « getting more ».
While I was mindful of the displaced masturbatory aspect of Michael’s behavior, I was also struck by its manic quality. What proved most useful to the analysis was talking with him about the « emptiness » and the loneliness it implied. We did this by thinking of it as a sign of strength, rather than weakness. At times Michael had complained that he thought he should « just die ». He saw no point in living. I disagreed and said that his behavior actually seemed an indication to the contrary. His wish to be « filled up » was a sign of how much he yearned to connect and have meaningful relationships with others. While there was much of significance in the analysis that followed, this work on « empty », lonely feelings proved a turning point. As Michael became better able to feel hope for his future, a sense of self pride emerged and he became more social and academically successful. He began to participate avidly in sports, something he had always avoided, and he took pride in losing weight and being physically fit and active.
19Perhaps because of their relatively young ages, Jane and Michael’s symptoms did not include the use of alcohol, cigarettes, or drugs. However, as many high school and college patients have shared their comparable feelings of emptiness and loneliness, they have simultaneously described their often excessive use of such substances. Their comments have caused me to wonder about the dynamics contributing to these defensive behaviors. Many would agree that drinking in adolescence is both quantitatively and qualitatively different from adult drinking. It’s a far cry from a cocktail after work, a glass of wine at dinner or cooling off with a beer after a round of golf or mowing the lawn. Patient after patient has described – often with defensive grandiosity – his weekend, and sometimes daily, drinking excesses. It has become the norm on college campuses that the « weekend » begins on Thursday evening. For many students this means that drinking begins on Thursday afternoon. They have explained that it is essential to arrive at a party or to head out for an evening of « bar hopping » already « blitzed ». Then, as the evening progresses, often extending through much of the night, there typically follows more, almost constant drinking, even to the point of passing out.
20This drinking often occurs in the context of any number of drinking games. A web search of such games reveals a subculture and a booming industry. Hundreds of sites pander to high school and college students offering rules for dozens of games ranging from ones using sporting equipment, cups, cards, dice, or coins ; and ones based on watching television shows, movies, and even the State of the Union Address. For this last category drinking is required when certain anticipated words, phrases or actions occur. Other websites are devoted to the sale of equipment, t-shirts, posters and drinking paraphernalia and still others advertise the locations of up-coming drinking game tournaments. The most popular of the drinking games, surpassing even « Quarters, » is reported to be « Beer Pong ». As described in Wikipedia, « Beer Pong … involves propelling a ping pong ball across a table with the aim of making the ball land in one of several cups of beer. The game generally involves two teams, [each] with … 10 cups [or] more … with each team composed of two people. When a point is scored, the loser consumes the contents of the cup where the ball landed. When a team has scored in all of their opponents’ cups, the game is won ».
21As I puzzled over this burgeoning evidence and reports from patients about their drinking activities, I found myself yearning for a way to understand what I was hearing. I was impressed by the driven, even obsessional degree to which some pursued these activities. I became convinced that there was something about their compulsive use of alcohol that I was failing to appreciate; something about the excessive drinking and the state of being « blitzed » that played an essential role in their defense against their conflicts. As with loneliness, my effort to gain a clearer metapsychological understanding of adolescent alcohol abuse in the psychoanalytic literature was less than fruitful. While any number of case studies report alcohol or drug use by adolescent patients, there is little attempt to understand the underlying reasons for this particular defensive choice beyond unsatisfying and vague references to « peer pressure » or a wish to « escape ». Various studies (reported by Wieder & Kaplan, 1969) refer to unresolved conflicts with early omnipotent narcissism; histories of mother-infant conflicts resulting in disruptive and unsatisfying early feeding experiences ; the co-occurrence of alcohol use and abuse among parents, siblings and extended family members ; or the use of alcohol among adolescent survivors of sexual abuse where alcohol use represents a defense against the recurrence of post-traumatic anxiety and depression generated by re-exposure to sexual contact (Prior, 1996). Referring to both alcohol and drug use among adolescents, Hartman (1969) identifies an attempt on the part of substance using adolescents to change « depression into elation ». It was through a confluence of further reading, listening to patients and thinking that this idea of defensively attempting to change « depression into elation » grew in significance for me. Recalling Blos’ (1979) thoughts on manic affective states in adolescence, I turned to the literature on the metapsychology of mania and manic defensive behaviors.
22Winnicott (1935) wrote about manic defenses employed against the « depressive position » in normal emotional development and encountered in work with patients ranging in age from latency to adulthood. He observed that such defenses are used « to cover a person’s capacity to deny the depressive anxiety that is inherent in emotional development ». « Clinically », he noted, « we see not so much the denial as the elation that is related to the denial ». In Bertram Lewin’s papers on mania (1949, 1954) he noted how manic attacks attempt to recapture anxiety-free states. He felt that in addition to being a defense against object loss, manic behavior could also be used to defend against anxiety experienced in the context of anticipated object loss. Reminiscent of the adolescent’s task in object removal, Lewin (1949) noted in the manic behavior of his adult patients that they relied on excessive action to distract them from any repetition or reoccurrence of incestuous thoughts. He observed that his manic patients turned either to « escaping into an alcoholic stupor » or resorting to manic behavior as their only viable options.
23In my search I also discovered among the writings of Maurits Katan a paper titled, « Mania and the Pleasure Principle » (1951). In conceptualizing the metapsychological processes involved in melancholia and in mania, M. Katan noted that, in depression, the ego feels a sense of deprivation in relation to a lost or threatening object and responds with defensive attempts to recapture the object through « introjection ». This idea is consistent with thinking put forward by Freud in such papers as « Instincts and their Vicissitudes » (1915) and « Mourning and Melancholia (1917) and later expanded by Abraham (1924) in a monograph that focused on manic-depressive states. Katan observed that to ward off or escape from depression, elation is sought through a return to the pleasure principle. This state is brought about by a regressive process in the ego that transforms biting impulses into earlier, drinking or sucking urges. Reflecting upon the relationship between oral and urethral processes in mania, Katan considered a defensive process that involves a recurring impulse to introject the lost object through sucking or drinking. Once the object is obtained in this way however, that is to say taken inside, the unconscious fear arises that the introjected object will be destroyed and thus lost again. This leads to the urge to return the object to the outside world. At the unconscious level Katan felt that this gets accomplished through a urethral process, a « urinating out » that occurs in both literal and figurative ways (e.g., « flight of ideas »). Once done, though, the object is again felt to be lost and the process must recycle. It is the rapid cycling of this « taking in and urinating out » that results in the « cyclothymic » pattern of the disorder.
24Katan acknowledged that many manic episodes are not preceded by a depression, as such, but are employed defensively to fend off depression. In such instances, from the very beginning, an outer conflict is maintained by the ego, albeit in the « sucking in/urinating out » process described. Katan considered that in such instances, the attempt at restitution aims to create pleasure in order to neutralize a narcissistic wound. For my own purposes, Katan’s thinking about manic defensive processes was particularly useful as it relates to the adolescent’s alcohol (and drug) seeking behavior. Alcohol, drugs, and smoking all appear to function as defenses against an intolerable internal state triggered by the object loss inherent in the object removal task.
25It perhaps goes without saying that the behaviors and attitudes of parents can either facilitate or interfere with a young person’s efforts to achieve object removal. This was noted by Furman (1988) who recalled the sage advice he’d received from a pediatric colleague who advocated that parents of children going off to college be advised to forego any plans to divorce or sell the family home (and to this I would add, or redecorate or find a new use for the child’s bedroom), as it is not the time to challenge the child’s external sense of home when he is so concerned with what he must amend internally.
26In considering the manic defenses used to ward off the « empty » feelings associated with loneliness in adolescence I have so far noted efforts to restore the lost object through such methods as overeating, compulsively downloading music from the Internet, and the unique form of adolescent drinking, and drunkenness. While I have not had extensive experience analyzing drug abusing adolescents, my suspicion is that manic defensive are employed in those cases, as well. This was noted by Wurmser (1974) who saw drug use as a « defense against overwhelming affects ». He observed in particular that amphetamine use served to eliminate boredom and emptiness in pursuit of « an artificial normalizing or even manic defense against underlying depression ».
27In a related way I have often wondered, in this context, about the deeper meaning behind teenage smoking. We are familiar with the lectures latency age children receive each year in school about the dangers of smoking, drinking, drug usage, and sexual promiscuity. Following these talks children may criticize their parents for driving home from a restaurant after having a glass of wine with dinner. They express their disgust over the uncle who smokes and they assert that they will never give in to older peers who might tempt them with drugs or challenge them to become sexually active. Yet, these are the same youngsters who as adolescents only a few years later turn to these very behaviors. While this raises questions about the effectiveness of such conscious-level cautionary programs, we try to explain this transformation by pointing to the tendency of young persons to engage in adult-like behaviors that are otherwise forbidden to them. In this way we might also consider that drinking, smoking, and drug usage all fall into the category of displacements of adult sexual activity. But here, too, might there be more to understand ? Might Winnicott, Lewin, and Katan’s ideas shed further light on why these particular behaviors are the ones chosen ? Specifically, with regard to smoking, might the sucking in and blowing out of the smoke represent a parallel to the sucking in and urinating out process described by Katan and considered earlier in the context of adolescent drinking ?
Jared was a youngster with whom I had the opportunity to work over the course of several years, ranging from a twice-weekly psychotherapy from third through seventh grades, followed by weekly sessions during high school, and ultimately a four-times-weekly analysis after he was unhappy at college and returned home to attend a local school from which he eventually was able to graduate. Jared struggled with narcissistic wounds that ran deep and connected with unresolved feelings about the breakup of his parents’ marriage when he was a toddler. He’d been left with various sitters while his mother worked for a time before re-marrying when Jared was in first grade. His mother had struggled with depression ; between her marriage and relationship with the step-father she had turned to Jared for companionship and comfort, sleeping with him and doting on him, only to turn away from him in a way that left Jared feeling hurt and abandoned, feelings against which he had long struggled to defend. As might have been expected, achieving object removal was a protracted and difficult process for Jared. From middle school on he diluted his interest in real life activities and relationships by defensively and grandiosely thinking of himself as a future movie maker. He imagined himself « the next Quentin Tarantino ». Though he repeatedly tried to write movie scripts, he could never get beyond the first few pages. Gradually he came to recognize the defensive pleasure he found in fantasizing, a pleasure that was lost when he was confronted by the challenge of converting a fantasy into something real. We observed how this compromised his relationships, especially with girls, and we talked of how his need to be in complete control (something he had not had as a toddler or preschooler) kept him out of any real relationships.
Jared’s loneliness was palpable during his senior year of high school. As he began to face and talk about his loneliness, he described how he would drive about in his car, sometimes for hours, listening to music and associating to the meaning the songs held for him. Though he was able to leave home for college, once gone he warded off his loneliness by speaking to his mother on the phone on a daily basis, sometimes several times a day. It is perhaps noteworthy that within weeks of his departure for his freshman year, his mother had undertaken a massive remodeling of the family home. At college Jared’s relationships with girls were short-lived. His pattern was to obsess about a girl he might see walking on campus or meet at a party, debating, sometimes for weeks on end, whether he should call her. Though he could see that this pattern allowed him to maintain fantasy control, economically letting him have and not have a relationship at the same time, it was a long time before he was able to risk a lasting relationship. Beginning in his first term he pledged a fraternity, a process that resulted in many drinking binges, sometimes extending over several days. Ultimately, as he continued to find his loneliness unbearable, after a year and a half he transferred to a college near his home.
Even as Jared took note of his drinking binges throughout high school and college, he was more observant of and curious about, his use of cigarettes. As a latency child Jared had always found smoking disgusting and had insisted he would never smoke. When he took up cigarette smoking in high school he observed that he would only smoke when he was out drinking, something he did with peers on weekends. However, he would never buy cigarettes and he came to recognize that part of the significance of the smoking process for him was to be able to « bum » a cigarette from a friend. Getting a cigarette in this way gave him a sense of connectedness and he found comfort in the thought that the ensuing indebtedness would guarantee further contact. Jared spoke at length of his awareness of how he would hold and smoke a cigarette. He identified feeling « feminine » as he watched the movements of his wrist and the way he could make the smoke undulate as it ascended. He also focused on the « taking in » and « letting out » as he reported his efforts to learn how to « French inhale » and blow smoke rings.
As we discussed these observations Jared was able to consider his struggles with internal conflicts : ambivalence, activity vs. passivity, and bisexual conflicts were all noted. As well, Jared came to see that through preoccupying himself with cigarettes in this way, he remained self-absorbed and oblivious to all that was going on around him. He could achieve the economical position of appearing to be interested and involved with peers while he was in fact keeping himself set apart, maintaining his loyalty to his mother.
29In my work with each of the patients I have described I remained cognizant throughout of how, as adolescents, they were all developmentally challenged by the task of object removal. I have always thought it unfortunate that Anny Katan’s patient left her analysis so precipitously. Even though it helped Katan to recognize in her patient a developmentally typical process, it took from her the opportunity to analyze the progression of the process with its incumbent conflicts. I also think that it has led some who have read her paper over the years to think that adolescents should not be in analysis. My experiences cause me to argue the opposite position. I think that of all the developmental phases, it is during adolescence when one is most able to utilize and benefit from analysis. Their seeming defensiveness to the contrary, if given sufficient respect, time, and permission to do so, the fact that they are inundated with bodily changes and developmental challenges make adolescents most able to take up the task of self-observation. I have never encountered a teen that was not, at base, pleased to have someone with whom to talk, think, and share feelings. Oftentimes it is just such a relationship that allows even the relatively depressed and frightened adolescent to begin to find hope and courage for the future.
30In her paper on object removal Katan specifically cautioned against directly interpreting the displacement, since to do so might promote regression in the adolescent patient. For this reason, in lieu of focusing on incestuous aspects of relationships with parents, with each of the patients reported above, we instead considered how their drinking, smoking, or striving to acquire things to fill up the emptiness inside were defensive behaviors to ward off feeling lonely. What proved essential in each case was to consider how their efforts at facing and bearing the loneliness were in fact signs of strength and an indication of a core feeling of hope. To the extent that each could view their loneliness as an important developmental achievement, that indicated a yearning for new relationships, it meant that they really did want to grow up to become independent adults. Rather than viewing themselves as depressed, they came to identify a sense of capacity and optimism. It was in the context of this realization and the sense of pleasure that it provided that each could begin to turn away from a dependence on manic defenses.
31I have suggested that, while many teens may appear clinically depressed, what is often diagnosed as depression, and subsequently medicated as such, is better understood as a unique form of loneliness. It is beyond the scope of this paper to elucidate the criteria for a differential diagnosis, but from the above it should be apparent that, even in cases of serious depression, when medications are employed, it remains an important clinical task to support a young person’s efforts to contain or bear his or her depressed or lonely feelings as a positive sign of strength and hope. We have noted that in the depressed teen, in an attempt to preserve the object, aggression is turned against the self. To counter this trend it is important that the healthy part of an adolescent’s ego be addressed and supported to view the taking of medication as a personal act of kindness – something the patient is doing for him or herself, on a temporary basis, as the ability to cope with painful feelings is strengthened. This stands in contrast to an adolescent passively complying with the « requirement » of doctor and parents to take medication out of « need », in a way that can feel like a confirmation that one is « mentally ill », impaired or deficient. To be placed in this position only serves to deepen one’s depressed and lonely feelings and accelerates a spiraling sense of despair and hopelessness. One might even consider that there is an element of strength present in the so-called « non-compliant » adolescent psychiatry patient.
32In a recent article, Altman (2005) characterizes our culture as a « manic society ». This manic quality makes it difficult for us to care about others and works against developing a sense of social responsibility. He observes how people take pride in their ability to « multitask » and considers the frenetic efforts of parents and teens to get into prestigious colleges as though to do so is the definition of success, even though he notes that studies have found that these are often the very students who eventually fail to succeed. He notes that for some parents this driven pattern begins with competing to get their children in to what they perceive to be prestigious nursery schools. On a cultural level this seems an extension of the individual difficulty to make choices in relationships that are based on « mutuality rather than rivalry or possession, genitality rather than pregenitality » (Barrett, 2005). With these narcissistic preoccupations proliferating as they do, is it any wonder that adolescents in our culture find themselves in such conflict, and so unable to successfully emancipate and become mature ?
Thomas F. Barrett, Ph.D., Hanna Perkins Center for Child Development. A version of this paper was first presented as the Marianne Kris Lecture at the Annual Meeting of the Association for Child Psychoanalysis, Washington, D.C., May 6, 2007.