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Woodbury, M.A. (1966). Altered Body-Ego Experiences—A Contribution to the Study of Regression, Perception, and Early Development. J. Amer. Psychoanal. Assn., 14:273-303.

(1966). Journal of the American Psychoanalytic Association, 14:273-303

Altered Body-Ego Experiences—A Contribution to the Study of Regression, Perception, and Early Development

Michael A. Woodbury, M.D.

SUMMARY

From the topographical point of view the unconscious roots of and the connections between the altered body-ego experiences, the perversions, his instinctual drives, and his parental relationships became conscious with the recovery of the primal-scene dream memory for which the Arizona trip and the first wet dream had stood as screen memories—after the problem of curiosity had been worked through in the transference-countertransference dimension.

From the structural point of view the patient had a superego lacuna with respect to his pervert activities. Initially guilt and shame were attached to masturbation and his normal sexual activities, and anxiety was not experienced as such. His altered body-ego experiences and perversions were attempts to obtain instinctual gratification through someone else's ego suggesting an ego defect also. The ego and superego defects were traced to a symbiotic relationship with his mother relived and resolved in the transference. Through identification with the analyst the patient repaired his ego by learning to recognize his drives and obtain gratification for them—and his superego by shifting guilt and

shame from his normal sexual activities to his perversions which found an acceptable outlet in foreplay. He developed a somatic anxiety signal for ego-dystonic drives out of a component of the altered body-ego experiences. His relationship with reality improved to the point where he abandoned his pseudologia fantastica and actively sought fulfillment in mature relationships and adult activities as sexuality entered the conflict-free ego sphere.

From the economic point of view the patient's cathexes were labile and could be withdrawn from his object and self representations causing objects or his body to vary in size according to his libidinal interest. This forms the basic mechanism of what I am calling "perceptual defenses" which occur when the ego apparatus of perception enters the conflictful sphere. In my patient the observing ego itself had been cathected with libidinal energy, hence his voyeurism and fetishism; but during his analysis it became invested with neutralized energy and entered the conflict-free sphere, and his libido became attached to whole objects instead of fetishistic part objects and to the whole sexual function instead of the "preliminaries," as he himself called his perversions.

From the dynamic point of view, we have seen that sublimation of voyeuristic and exhibitionistic drives into his research work replaced less satisfactory defenses, and that the altered body-ego experiences, initially a form of regression, became the somatic component of anxiety: a danger signal to the ego.

Let us now examine the relationship between the patient's perversions, his altered body-ego experiences, his instinctual drives, and his development as reconstructed in the analysis. The patient described his mother as jealous, tense, insecure, intrusive, controlling, and disapproving of thumb sucking, masturbation, sex, and dirt. She had always controlled people through food. The patient experienced this as a murderous assault as he bitterly accused her during the analysis of having overfed his father to death and of doing the same thing to him: even after his marriage his mother kept bringing groceries to him, to his great embarrassment and to the considerable irritation of his wife. She maintained a tie with him by buying him clothes and presents and giving him money. He recalled this pattern of "force feeding" to satisfy mother's needs rather than his own, from his earliest childhood: "I was always

an exceptionally pretty and well-fed baby—a Little Lord Fauntleroy—an asset to my mother who always wanted me to perform for her."

His mother's attitude toward toilet training was revealed when she advised his wife: "Give your children enemas and suppositories at regular times like I did with mine so that they won't soil their diapers while they are asleep." For years the patient referred to the enemas as the "enemies." By treating the patient's anus as an inlet, a mouth, the mother "oralized" his anal phase of development, which may provide one explanation for the feelings of filling up and emptying appearing in the altered body-ego experiences.

When the patient started exploring his world he found a controlling and intrusive mother in the way there too: he was not allowed to suck his thumb, touch his genitals, and very many objects in his immediate environment, most of which were tagged "not for children."

The patient learned to deal with his mother by developing a superficial submissiveness and conformity to protect and preserve his real and secret self. Thus, during the altered body-ego experiences he experienced himself in two parts: an outer shell and an inner tiny "I." This defense against intrusion was acted out in the transference as the patient consciously kept secret from his analyst for three years that it was his mother who had aborted his pregnant girl friend. This confession also revealed that the mother, a nurse, had an outer façade of ethicality and an inner core of dishonesty.

As his mother anticipated and fulfilled all his needs before he could perceive them, the patient failed to learn how to identify and satisfy his own drives. Thus he expressed anger, resentment, and yearning passively and inappropriately through the altered body-ego experiences or in sexual terms by peeping and exhibiting. In the transference he expected me to feel for him, to do things for him, in other words, to provide him in a symbiotic fashion with the emotional and motor patterns he had been prevented from developing. Both the altered body-ego experiences and the perversions expressed his passivity: the former during the sessions when he felt himself shrinking to a helpless tiny self, the latter in the

outside world when he exhibited his erected penis with the expectation that female passers-by would perceive his need and gratify it.

As the patient grew up, his father had less time for him as his practice grew and his other child, a young daughter, demanded her share of his attention. Mother, also neglected by father, reacted to her frustrations by imposing her ambitions on the patient who felt robbed of his personality as she forced him to obtain things she had missed. The patient felt used by his mother who symbiotically treated him as an extension of herself, an improved phallic version of herself who could obtain all the success which had eluded her. Thus, as father receded in the distance, so to speak, mother loomed larger and larger: this visual image is, of course, beautifully represented by the change in size of objects which is such a prominent component of the altered body-ego experiences.

We have seen how the mother controlled the patient's physiology at the oral, anal, and genital stages, and interfered with the manipulation, exploration, enjoyment, and control of his own body and environment. Consequently, the patient developed an intense libidinal interest in looking and being looked at which was positively encouraged by his mother who always loved to exhibit him. Furthermore, hours after hours, the patient as a child would hide and look yearningly through a window at his doctor-father working in his office. It was only years later that "looking" became erotized and directed toward the women father was examining, their shoes in the table stirrups, and their private parts. Hence, it is not surprising that the patient's perverse symptomsexhibitionism, voyeurism, and fetishism—all have to do with the visual sphere and that one of the main components of the altered body-ego experiences is a visual one: objects varying in size.

In short, the altered body-ego experiences articulated with the perversions to express the instinctual needs, attitudes, defenses, and patterns of object relations developed by the patient to deal with his family during his growing years.

The Components of the Altered Body-Ego Experiences

The clinical data presented in the first part of the paper indicate that the patient's altered body-ego experiences represent at the level of self and object representations: (i) superficial submissiveness

(the shell) to shield his real self (the tiny I) from mother re-experienced in the transference through "the secret"; (ii) the experience of distance and loss: objects decrease in size and disappear, leaving the patient with the feeling of being an empty cavity; (iii) the experience of intrusion: large objects crowd and smother him; (iv) the experience of ambivalence: the patient can have his cake and eat it, so to speak, when he perceives the analyst, for instance, as receding to nothingness but knows that he is close by; thus the object representation is destroyed although the object itself is known to remain intact and unprovoked in reality; (v) the experience of love interest and attention: the positively cathected loved object looms large, whereas those of little interest disappear.

Descriptively the altered body-ego experiences also represent the defenses of repression and denial: (the object representation is made to shrink to nothing and disappear from awareness); and withdrawal: the patient's self representation shrinks to tiny size and is experienced as isolated but protected from the outer world by a shell. These primitive mechanisms of defense can be understood in terms of the patient's development: a last-ditch defense against an intruder who, like the patient's mother, invaded his orifices and bodily cavities consists in blocking its perception. Thus we can look at the altered body-ego experiences as perceptual defenses or the ego's awareness of his perceptual filter and shield, the Reizschutz postulated by Freud (15).

Silberer (38) called autosymbolic phenomena "hallucinatory experiences which put forth, 'automatically' as it were, an adequate symbol for what is thought (or felt) at a given instant during the process of falling asleep." There is little doubt that the altered body-ego experiences are "autosymbolic" to the extent that they represent the experiences and defense mechanisms described above.

Objects seem to vary in size during altered body-ego experiences, as is the case in early modes of visual perception. During the stage of visual perceptual primacy, objects in the visual field are perceived as growing bigger as they approach the eye and decreasing in size when they recede. This perception is corrected when the child accepts data from the proprioceptive receptors in his hands indicating that the objects he holds and moves in space are not changing in size: the visual illusion is shattered by manipulation. At

this point the child becomes aware of the constancy of object size and gives up visual perceptual primacy.

In my patient's case visual primacy persisted possibly because of the greater importance of that apparatus (i.e., inborn factors), or because his mother discouraged his manipulative exploration of his body and objects around him, or as a result of both factors. Thus, altered body-ego experiences can be conceived of as a "formal" regression, in Freud's sense (13), to earlier modes of perception which persisted to the stage when the patient, having developed fully organized observing and executive ego functions, could record and utilize this mode of perception as a defense.

During the altered body-ego experiences the patient experienced himself vividly as a hollow cavity or cavern. Furthermore, 80 of the patient's 220 dreams contained symbols referring to holes, cavities, tunnels, houses, and other forms of containers. During the analysis the patient frequently referred to himself as hollow and empty and described his object relations in the same terms: "My relationships to people and the rest of the world are hollow." Thus, the altered body-ego experiences, like his dreams and his conscious self representation, seem to represent not only a regression but the very core of his self concept. The patient stated one day: "I woke up with a gaping-hole feeling—lots of people could fill it," revealing not only cannibalistic desires but also object and experience hunger. Thus, his self representation or his basic "mode of being in the world," as Boss (6) would say, is that of a hollow container yearning to be filled, of a hole, the phenomenology of which has been so well described by Sartre (34).

The cycle of a cavity filling up and emptying, "feeling increasingly big or small" as the patient experienced it during the altered body-ego experiences, forms a continuous thread of experience throughout a person's development from intra-uterine life to adulthood: the fetus is compressed at regular intervals due to uterine contractions and maternal placental pulsations, and is finally squeezed out of the mother's womb—the infant breathes, cries, eats, drinks, urinates, defecates, receives enemas, and grows in size; the adult ejaculates, bears children, and experiences weight changes. Vasomotor changes such as blushing, variation in blood pressure and pulse, and redistribution of blood and body

fluids due to fevers, infections, endocrine changes, heart and kidney diseases, and many other causes produce similar changes of the body image. The tongue, the penis, and clitoris through different physiological mechanisms are capable of changing in size and shape, which I shall discuss at greater length later. This peristaltic visceral pulsating self representation is most primitive and goes underground as it is supplanted by a visual and then a visualsomatic "tridimensional" model of perceptual body-ego organization.

Therefore, I conclude that at one level the altered body-ego experiences represent the perceptual defenses of the patient in an autosymbolic way and the ebb and flow of his object and self representations. They depict a regression, an implosion, in the inner world, of drives and feelings which could not explode and be released in reality.

Other Case Material

A patient suffering from anorexia nervosa was hospitalized for two years at Les Rives de Prangins. She was a severe obsessive compulsive, wearing gloves even when she bathed, as her hands must never touch her body. During one session she stated: "I see you like a Gulliver tied down," adding that she lived in the stars in a cold two-dimensional world where she felt like a fragile hard crystal. What she called the "change" occurred in the course of a program of massages and hydrotherapy: she rediscovered her hands and learned to feed herself again, which she did for a while without the benefit of silverware. This caused her to fall into "the tridimensional world where you mix with people" and was accompanied by a notable loosening in her body comportment and facial expression, by a needed gain in weight, and by a resumption in sexual interests.

It is with schizophrenic patients (44), (45) in acute psychotic panics that the significance of some stages of the altered body-ego experiences became most meaningful. Thus, over a ten-year period I saw twenty-three women patients who, at one point of their hospitalization, cut themselves with razor blades or pieces of glass. In my interviews with these patients after their numerous self-lacerations,

I was impressed by the recurrence of statements such as these: "My body felt like a board. I cut until I can feel my body again. I dissolve to nothing—to a little ball inside of me—the pain brings me back," etc. The patients cut themselves for many reasons, but one common denominator in this behavior was to use pain to stimulate skin sensations and to cause the reinvestment of the body-ego boundaries which led to the end of the depersonalization state.

It is interesting to note that in a study done over a seven-year period, the psychotic panic and depersonalization states leading to self-laceration, assault, or destructiveness in 500 instances were terminated within three hours by the application of cold-wet-sheet packs in 87 per cent of the cases without the use of emergency medication. The rationale of the procedure is that the body-ego boundaries are re-established through the sensory stimulation of the pack in the presence of another person from whom the patient is clearly and definitely differentiated (45).

A neurotic patient described an anxiety attack during the course of his analysis as follows: "All of a sudden I felt a bad feeling coming on me—in the pit of my stomach—I could almost taste it. I lowered my eyes because things, and people and their voices too, seemed strange, still and distant—an unfamiliar feeling—my heart started racing and I could not catch my breath. I tried to keep hold on myself. I moved around, sucked a candy, lit a cigarette, to get away from that falling sensation. Like in my nightmares I fall inside myself—disappear to nothing—die."

Another neurotic patient had always remembered the following vivid dream he had had at the age of fourteen while coming out of general anesthesia which is like waking up in slow motion: "I was inside myself in a cavity which I identified somehow as my heart. I was at the heart of me literally. There were two people pressing rhythmically on a pump or something—to make me tick and breathe." It was only years later that he realized that the two people he had experienced within him were really the surgeon and the nurse who were awakening him.

In schizophrenic patients, panic states were often heralded by a sudden feeling that objects and people close by were actually within them. For instance, after assaulting me a patient told me: "All

of a sudden the voices started again and you were inside of me taking that table and chair with you and smothering me. I had to chase you out." Many patients explained in these terms not only their assaultiveness but their destruction of objects and their preference for denuded rooms or open country when they sensed the approach of these experiences.

An involutional melancholic upon admission at Les Rives de Prangins complained of feeling empty as if his viscera had been replaced by ice. He had lost taste for food, tobacco, sex, and all activities. He also complained of currents throughout his body which he felt was burning in the flames of hell. During his treatment his libidinal investment which had been shifted to his body dramatically returned to his digestive tract and for a few days the patient suffered severe gastric pains as his duodenal ulcer flared up. Rather quickly the investment shifted again from the organ back to the function. The patient who had shunned food then had an episode of bulimia during which, to use his expression, he "stuffed" himself. The reinvestment process continued steadily until all ego functions became cathected again. We see clearly in this clinical example the shift of cathexis from the viscera to the body during his illness and the reverse process as treatment progressed.

A seven-year-old neurotic girl had anxiety attacks during which her body became numb, "like rubber." She felt herself falling into space, then smothered or crushed. This was accompanied by the feeling that noises became louder, then suddenly disappeared to nothing. She eventually discovered that she could interrupt the experiences by inhaling air through her mouth with her tongue close to her palate or by sucking her thumb, which her mother said she had never done before.

A borderline schizophrenic girl, after two years of hospitalization at Chestnut Lodge, described the metamorphic experience of feeling her body change in size and seeing objects around her shrinking or becoming big, adding: "It is like being drunk without having taken anything. It happens when I am anticipating sleep or aware of being sleepy—just before going to sleep—everything whirls or I whirl. I feel nauseated. It happens also when I have a

fever or I am overheated and lie down. Something very thick—a globular mass—it comes down, descends, things are out of proportion. It is my tongue in my mouth that feels very thick. I associate it with a déjà vu feeling—that tongue business is very anxiety provoking." The association of fever and temperature changes with altered body-ego experiences is very common and may have something to do with the fact that the temperature of the infant is more labile than later.

During a phase of her psychotherapeutic treatment a young hebephrenic woman complained of various somatic sensations such as currents throughout her body controlled by an external machine, in any situation when she might have felt a strong emotion. She explained her bulimia, excessive smoking, and drinking of carbonated beverages by saying: "I lose my tongue, these things give it back to me."

A frankly schizophrenic girl hospitalized at Chestnut Lodge for several years associated her rather frequent experiences of changes in her body size and other altered body-ego experiences, which she could provoke at will, specifically with sucking her own tongue, a habit she had had for as long as she could remember as her mother prevented her from sucking her thumb.

A severely schizophrenic young boy hospitalized at the Partridge Center for Handicapped Children said spontaneously during his first psychotherapeutic session: "I think with my tongue." Subsequently, he was able to describe numerous altered body-ego experiences which had to do with the size of his body and that of people and things around him which grew or shrank rapidly at times. It became apparent in our work that these experiences were at the origin of much of his psychotic ideation and behavior: he had developed the involved delusion that electronic equipment was focused on him and affected the size and shape of his body and body parts and those of the objects around him. He was able in time to communicate that he kept very still and with his eyes closed at times, in an attempt to minimize the distorting effects of the machine on him. A clucking sucking noise he made during the sessions was found to accompany the frightening altered body-ego experiences and led us to connect them with tongue-in-mouth

experiences; in this way I learned to understand the meaning of his cryptic statement that he thought with his tongue: his tongue experiences affected his thought processes.

Review of the Literature

Freud (15), and later Reich (32), Fenichel (10) and Fliess (12) emphasized the intimate relationship between ego functions and the body ego. Schilder (36) pointed out the crucial importance of the body image as an intermediate structure between the organic and the social world. Federn (9) localized the source of ego feelings at the boundaries of the body, thus articulating affects and body ego.

Metamorphosias (micropsia and macropsia) were reported many years ago but not elucidated in the psychiatric and neurological literature. Isakower (25) was the first psychoanalytic author who described some aspects of the phenomena I have referred to as altered body-ego experiences. He explained them, in the process of going to sleep, as a regression to early ego states with hypercathexis of the mouth, disintegration of the various parts and functions of the ego, and a diminution of ego differentiation. The large object which approaches the patient and causes the oral sensations in these states is the breast. Bartemeier (3), Fenichel (10), Lewy (29), the Sperlings (39), (40), Miller (30), and many others have described these phenomena, a fact which attests to the frequency of their occurrence.

Eisler (8) emphasized the connection between the capacity to sleep and oral organization. Inman (24) related micropsia to prolonged breast feeding and oral activities in the cases he observed. Lewin (27), (28) connected some aspects of what I call altered body-ego experiences to the dream screen and the memory of the breast. Spitz (41) showed in his article on "The Primal Cavity" how hand, labyrinth, and skin-surface experiences are woven into what used to be called, too restrictedly, "the oral phase." Hoffer (22), (23) provides actual infant observations showing the intimate relationship between the hand, the mouth, and the eyes in the development of the body ego. Alvim (1), in a review article, and especially Augusta Bonnard (4), (5) focused on the

tongue as another dimension of the concept of orality, the importance of which has been "grossly neglected" as an early and primitive perceptual instrument.

Savage (35), Gill and Brenman (17), Azima et al. (2) report altered body-ego experiences occurring during LSD-25 intoxication, hypnotic induction, and sensory deprivation; among these are dizziness, changes in body size, in weight and size of the body parts such as swelling of the head, mouth, and arms, and loss of the awareness of the body or of its parts.

Elements of the altered body-ego experiences such as giants, "little people," and supernatural beings who can change their size and shape at will or disappear into thin air are common to many religions, mythologies, and fairy tales. The very title of Ovid's book, The Metamorphoses, indicates the importance of these phenomena in a mythology where the gods often represented obvious projections of human desires and experiences. In One Thousand and One Nights the genie of Aladdin's lamp provides a typical example of this type of phenomenon: rubbing an ancient lamp (container) summons an all-powerful timeless being who grows enormous or shrinks to a very small size. The story of Puss-in-Boots confronts a cat with an ogre who can change himself into an enormous lion or a tiny mouse in which shape he is swallowed and destroyed by the cat. The oral devouring aspects of the body-size changes are obvious in this tale.

In the English literature, Gulliver's Travels by Swift and Alice in Wonderland by Lewis Carroll (16) present the most striking examples of altered body-ego experiences. Ferenczi, in his article "Gulliver Fantasies" (11), emphasized the defensive aspect of perceiving as small an otherwise large and terrifying object. Greenacre, following a path similar to mine, discussed the relationship between fetishism and faulty development of the body image (19) and focused in her book Swift and Carroll(20) on the relationship between the body-size changes described by these two authors in their writings, their personality patterns, and especially their early developments. Neither Swift nor Carroll achieved genital heterosexual maturity; both liked little girls; although neither was perverse in the conventional sense of the word, both described in their writings a good deal of the pathology acted out by less

gifted but similarly traumatized people. Swift is said to have suffered from Ménière's disease and Carroll from migraine headaches. Sufferers from these diseases often complain of dizziness and disturbances of body image. Thus, in these two writers, as in my pervert patient, we see that sexual immaturity, early traumas, and experiences similar to the altered body-ego experiences occurred together.

Kafka (26) in Metamorphosis writes about the experiences of a man who wakes up transformed into an insect in terms suggestive of a schizophrenic altered body-ego experience.

In science fiction, film cartoons, and even comic strips such as Al Capp's "Li'l Abner" (7), heroes often change form, size, and shape. The recent movie, The Shrinking Man, for instance, tells us the story of a modern Alice in Wonderland in the microscopic world.

Many of our metaphors indicate a relationship between emotions and body image and a concept of man as a container in terms which recall altered body-ego experiences: "swell with pride, shrink with shame, to go to pieces, to blow one's top, to feel crushed, to have a knot in the stomach, to have someone under the skin, to be empty-headed, full of misery," etc. The regression one experiences every night is aptly described as "falling asleep." A patient described an altered body-ego experience as feeling "the room is closing in on me," an expression familiar indeed. This suggests that our language utilizes altered body-ego experiences as a prototype for metaphors.

My clinical data and these observations indicate the frequency of the phenomena I call altered body-ego experiences not only in pathological states but as a matter of general experience.

The Sequence of Altered Body-Ego Experiences

Along the base line of normal consciousness the adult body ego is preconscious, tridimensional, and solid, but elastic enough to include appendages such as clothes or even a car within its boundaries. It provides the tridimensional framework through which objects and the self are perceived.

The body-ego, object, and self representations require a constant

stant flow of cathexis to synthesize and fuse the percepts from the different sensory modalities such as somatic, visual, auditory, vestibular, and visceral. Conversely, when cathexis is withdrawn from part of the system (hypocathexis), it floods another part (hypercathexis). Thus, four categories of phenomena follow one another:

1. Somatic phenomena. As cathexis is progressively withdrawn from the tridimensional body ego, it is experienced as the "exterior," the "shell" or the "armor." It is at this transitional stage, when ego feelings oscillate between the tridimensional and visceral body ego, that a sense of a duality of the self representation may occur. The person may experience this as having a double, observing oneself as one would a stranger (autoscopy), or as being controlled by an external force or a machine. In the final stage of deinvestment of the tridimensional body-ego boundaries, feelings of depersonalization and estrangement result.

The tridimensional body ego may itself be flooded with cathexis when, for instance, the visceral body ego is deinvested; then it becomes conscious giving rise to such experiences as the "currents," tingling, burning, shooting sensations (paresthesias), or the feeling that the entire body or a body part is very large, heavy, tense, or warm (hyperesthesias).

2. Visual and auditory phenomena. Object representations lose part of their cathexes as the distance-perception ego apparatuses are deinvested. This fluctuation in cathexis may give rise to perceptual distortion such as the micropsia-macropsia symptoms and their auditory equivalents (sounds seem to vary in intensity), or even hallucinations upon withdrawal of the cathexis which holds fused together the images from the various sensory modalities of representation.

It should be noted that there is a reverse relationship between self and object representations in the metamorphosias as far as cathexis is concerned: when the patient feels large, objects appear small and vice versa.

3. Vestibular phenomena. Sensations of falling and loss of orientation in space, dizziness, nausea, and loss of balance result as the vestibular apparatus loses the representation of the external world and of the tridimensional body ego as frameworks of reference.

4. Cathexes then flood the visceral body ego with such resulting symptoms as palpitations, dyspnea, sucking and swallowing movements, nausea, the well-known bolus hystericus or "knots" in the chest or stomach, and other respiratory, cardiovascular, gastrointestinal, and urogenital sensations. I have shown how these components of altered body-ego experiences became in my pervert patient the ego's danger signal of anxiety and formed in my neurotic patients the typical symptoms of an anxiety attack. Furthermore, psychosomatic ailments (ulcers, asthma, etc.) may occur when this state of affairs becomes chronic.

The visceral body ego itself may be deinvested, giving the patient the feeling that his insides have been replaced by ice. The cathexis may then flood the tridimensional body ego or invest symbolic representations as in sleep or very primitive fantasies, perceived, for instance, by some hebephrenic patients as an everchanging pattern of colors the significance of which I shall examine later in this paper.

I call the final stage of body-ego regression the visceral body ego, for it includes not only oral but respiratory, cardiac, gastrointestinal (including anal) and urogenital sensations. I have shown that the more psychotic patients associated some of their altered body-ego experiences specifically with tongue-in-the-oral-cavity experiences. During an altered body-ego experience my pervert patient experienced himself as "small, crowded by large objects, sliding in a tunnel-shaped cavity, which is somehow part of me also." He himself eventually associated this type of experience with the tongue in contact with objects (breast, fingers, etc.) in the process of being "mouthed," after dreaming during the third year of his analysis about a 20 foot high pyramid in the aperture of a cave or tunnel surrounded by green or yellow ice cream or mucus. His associations also revealed a confusion, or rather a continuum, between tongue-in-mouth, breast-(or finger)in-mouth, hand-on-penis, eye-moving-in-its-socket, and penis-in-vagina.

The Role of the Tongue

I shall now examine the activities of the tongue and its role in self and object representations which make it, at the visceral body-ego level, the Anlage of some functions which differentiate further

during later development into those of the ego and even the superego. A glance at the motor and sensory homunculus reveals the major importance of the tongue rediscovered in psychoanalysis, so to speak, by Bonnard (4), (5). The executive function of the tongue could be said to consist in determining whether an object is good or bad, "synthesizing" in Nunberg's sense (31) a rather large amount of data in the process. Our language reflects our ontogeny: at this level the "good" object literally tastes good and is swallowed and incorporated, whereas the "bad" object being spit out is denied admittance. In this sense, the tongue in conjunction with the lips and the jaws is a filter or a shield, the prototype of perceptual (Reizschutz) and other modes of defense such as introjection, denial, and splitting into "good" and "bad" objects. Its motor functions allow it to act as a tool exploring the intraoral and extraoral environment. This function is later delegated in part to the eye and the hand. Its perceptual function involves not only taste but touch, temperature, pain, and proprioception. Thus, the tongue not only orients itself and the object in space but analyzes the object into its component qualities: taste, size, shape, consistency, dryness, wetness, etc. Thus, the split or dichotomy between liking and disliking, pain and pleasure, yes and no, good and bad, love and hate, approval and disapproval, starts at this level and could be said to form the Anlage not only of affects, but also of judgment, morality, and therefore of some functions of the superego itself.

Being a mobile organ in the middle of traffic, so to speak, the tongue has to coordinate its activities with the lips, and the chewing, breathing, and swallowing muscles, in order to adapt to its environment in Hartmann's sense (21). This puts it at the crux of an internal communication network. Being also a sentinel at the boundary between inner and outer world, it is not surprising that it is destined to become a signal modulator for communication: the organ of speech.

The metamorphic qualities of the tongue which allow it to change in size and shape provide an important model for the feeling of change in body size noted not only in the altered body-ego experiences but in dreams, hypnagogic experiences, hypnotic induction, drug intoxication, sensory deprivation, and the literary

sources mentioned above. The metamorphic organs, the penis and clitoris, are heirs to the tongue in their sensitivity to pleasurable sensations: let us not forget the role of the tongue in sexual foreplay. The hand (thumb sucking, manipulation of sex organs, and masturbation) is the bridge between the tongue and genitals.

As my clinical data indicate, the visceral perceptual model of an expanding and shrinking self representation offered by the tongue finds a parallel in the visual (and auditory) spheres of object representation in altered body-ego experiences: objects which one had learned to perceive as constant appear again changeable in size and shape. What is the mechanism which makes possible the regression from the tridimensional body ego to visual primacy and the visceral body ego?

Experimenters having taken lysergic acid frequently report synesthetic experiences in which, for instance, sounds produce a fabulous "fantasialike" array of colors and forms in the visual field. Schneider (37) tells us that a congenitally blind man can have a dream entirely visual in nature. The "illuminated" French poet Rimbaud (33) devoted his poem "Voyelles" to the description of colors suggested to him by the sounds of vowels. The patient's "tongue dream" mentioned above is recalled in vivid colors. The Soviet psychiatrist Goldberg (18) reports—if we are to believe newspaper accounts—that the senses of touch and sight of his famous epileptic patient Rosa had become practically interchangeable: she could literally see through her fingertips. Numerous reports in the psychiatric and physiological literature indicate the commonness of synesthetic experiences variously called secondary sensations, photisms, phonisms, gustations, etc. (42).

All these data lead me to hypothesize that the brain has a limited number of patterns of representation (shapes, color, images, etc.) available to all stimuli. These "pigments" are at first shared or may be monopolized successively by the more primitive sensory modes such as visceral sensations, taste, smell, proprioception, equilibrium, and hearing. Later, as visual primacy develops, the eyes usurp the paintbrush causing these patterns to be equated with vision exclusively.

During the regression caused by a shift in cathexis a reverse process takes place. Thus, my hypothesis of synesthesia could partly

explain why altered body-ego experiences, perversion, and dream always involve "visual patterns": in a state of ego regression stimuli other than visual may again take over "the" pigments to seek representation, paint the picture which we subsequently misinterpret as having been "visual" in nature, providing the framework which makes regression from the tridimensional to the visceral body ego possible. In a dream, for instance, visceral sensations or proprioceptive stimuli may form an image with color and shape which, if it is remembered after waking, is retrospectively misidentified as having been visual in origin.

Now that I have a hypothesis to explain the "pigments," I wish to return to a study of the canvas: the screen. It is evident that the tridimensional body ego is a perceptual organizer in the sense that every somatic and visceral sensation is localized with regard to the body ego and that the body's tridimensional organization is projected onto the world in the manner of coordinates—inside-outside, vertical-horizontal, right-left, up-below, front-behind—around which all distance perceptions are organized and represented. My clinical data suggest that during altered body-ego experiences patients project self and object representations on an expanding and shrinking screen which I have identified as the visceral body ego with the tongue as its active organ.

The observations of other authors, or the very language they use in describing their material, leads me to the same conclusion. Piaget, quoted by Lewin (27), tells us that a body who was asked where he dreamed answered: "I dream in my mouth." Bonnard (5) gives an excellent clinical example of the importance of the tongue as the framework of ego integration in regressed states. Speaking of the addictive autoerotic device known as tongue swallowing she tells us that "the only sensation left to her [a patient in a severely depersonalized state] which somehow proved her not to be totally lost was that obtained from the two parts of the upper surface of her curled-over tongue being in contiguity with each other." Isakower's patients (25) describe the following sensations during what I would call an altered body-ego experience: "a crumpled feeling in the mouth—the whole thing begins in the palate—a tickling sensation just behind his upper and lower teeth on his palate and the bottom of his mouth." This suggests

quite literally tongue sensations. Lewin (27) states: "The dream screen came to my notice when a young patient reported as follows: "I had my dream ready for you; but I was lying there looking at it, it turned over away from me, rolled up and rolled away from me'—the dream screen with the dream on it bent over backwards away from her and then, like a carpet or a canvas, rolled up and off into the distance with the rotary motion of two machine tumblers." This description nicely fits my concept of the tongue as the screen not only of dream but of all primitive visceral experiences which presumably occur at a certain point in normal development and are reached by regression during hypnagogic states, sleep, hypnosis, sensory deprivation, LSD intoxication, altered body-ego experiences, and other experiences. Thus, my hypothesis does not invalidate Lewin's concept of the breast as the dream screen but expands it to a more general phenomenon.

These observations and my data suggest that at the visceral body-ego stage the tongue-in-mouth complex acts not only as a "screen" but more precisely as a metamorphic framework, referential system, and perceptual organizer articulating with the rhythmic visceral sensory input: the ebb and flow of blood in the vascular system, of air on the respiratory mucosa, the rubbing of pleura against pleura, and the constriction and expansion of the gastrointestinal system in the process of digesting food. At higher levels of ego development the rubbing of two surfaces retain this body-ego feeling generating power: eating, thumb sucking, fingering the transitional object (43), masturbating, scratching, etc. Let us note that dreams have been connected with eye movements which, of course, cause the eyes to rub against the eyelids with consequent entoptic retinal sensations and possibly secondary organization into a dream. Thus, perceptions projected upon and analyzed by this flexible tongue-in-mouth system retain its plasticity and variability in size and shape: not only the self but objects may seem to shrink, expand, and become distorted in shape. As I have shown above, object size and shape constancy are not achieved at the visual primacy stage either but only at the tridimensional body-ego level under the influence of manipulation. My studies during the past twelve years of the stages schizophrenics undergo while recovering through psychoanalytically oriented psychotherapy

reveal that direct stimulation of the body by specially designated massages and hydrotherapy, in particular upon awakening, caused a reorganization and unification of the body ego with parallel effect upon self and object representations and the use of language. Scattered speech in schizophrenics was observed to parallel fragmentation of the body ego, and the normalization of speech followed the reorganization of the body ego. Thus, even the ability to structure a sentence grammatically and meaningfully seems to depend upon the intactness of the tridimensional body ego (46).

I conclude that the structure of the body ego determines that of self and object representations at the various stages of regression. The data obtained from psychopathology, the process of recovery from neurosis and psychosis, experimental and normal regressive phenomena like sleep lead me to consider that representation of the whole self and of whole objects is an emergent synthesis of the contributions from the various sensory modalities organized by an intact body ego and maintained by a continuous flow of binding cathexis. When cathexis is withdrawn from a part of the body ego whole object and self representations break down into their component parts (nuclei) formed by perceptions from individual sensory modalities. When this state of affairs becomes protracted, it leads to a fragmentation of the self manifested by such phenomena as dreams, hallucinations in the various spheres, sensorimotor or language difficulties.

Thus, if we extrapolate from the data presented here to normal development we can hypothesize that, as soon as maturation permits, perceptions crowd the central nervous system, and part self and object representations begin to cluster around body-ego nuclei representing the various sensory modalities. These nuclei form "screens" or perceptual frameworks with specific motor organizers such as the tongue, the eyes, and the hands. Continuity and coordination of the part self and object representations are achieved by an articulation between the various motor organizers: for instance, the child who sucks his thumb, reaches to catch the moon he sees in the sky, or writes with his tongue sticking out of the corner of his mouth shows how the hand activities articulate with those of the tongue and the eyes. Eventually, the part object and self representations are brought

together like so many two-dimensional pictures which, when superposed, give an additional stereoscopic dimension: the representation of the whole self and the whole object.

Types of Object Relation at Different Levels of Body-Ego Organization

At the visceral body-ego level my patients experienced objects as within them (in the mouth) and crowding them (the tongue). Figure-ground representation and differentiation may have their origin and model in this tongue (figure)-in-oral-cavity (ground) relationship which is later projected into the outer world.

At the intermediate stage of body-ego development, the ego boundaries are fluid because they are in the process of expanding from the lining of the oral cavity and viscera to the skin and appendages or vice versa. When they passed through these transitional stages, my patients experienced dizziness and a shrinking fluid feeling which might explain such phenomena as "falling" asleep, "going to pieces" and "falling apart" in panic states, and the "sinking" feeling of anxiety attacks. As visual primacy develops objects are "eyed" more and "mouthed" less. Partial self and object representations from visceral, visual, and somatic sources have not fused at this stage as the body ego is still similarly fragmented. Thus, the origin of inner and outer stimuli, and what is object and what is self representation, is easily confused. This explains the patients' difficulties in deciding whether objects or their bodies were getting smaller, and whether they were within something or had objects within them. Hallucinations, which are experiences with an inner origin, the stimulus for which is projected onto the external world, could be explained on the basis of a regression to this level of body-ego development and object relation, the partial self- and object-representation nuclei having not yet been integrated as belonging to a single self or object.

Finally, whole objects, triangulated by somatic and visual stimuli, are perceived through and in relation to the solid tridimensional body ego, which provides definite boundaries between inside and outside, differentiating self from object representations and outer from inner stimuli. At this stage objects are handled and eyed.

My assumption is that the pervert patient was fixated at the intermediate stage of body-ego development, characterized by visual primacy. His ego apparatus controlling motility (reaching and handling objects and body parts) which would have allowed him to attain and maintain himself at the tridimensional stage became conflictful because of his relationship with his mother. His visual activities—exhibitionistic, voyeuristic, and fetishistic—were a defense against a deeper regression to the visceral level represented by the advanced stage of altered body-ego experiences, and a restitutive attempt at achieving some form of heterosexual nonincestuous object relation. Thus, the ego apparatus of perception entered the conflictful sphere also.

Finally, I hypothesize that the yearnings, the hunger, the frustration leading during the analytic sessions to altered body-ego experiences and outside to perversions, were visceral in origin, prevented from reaching motor expression and according to our hypothesis of synesthesia misinterpreted as purely visual, thus causing the patient to seek gratifications in visual terms (exhibitionism, voyeurism, and fetishism). This could be called a synesthetic theory of perversions.

Summary

In the study of a case of sexual perversion I have shown in detail the dynamic meanings and uses of altered body-ego experiences; from that and other material I concluded that the altered body-ego experiences represented a continuum of regression as cathexis is withdrawn from the tridimensional through the intermediate to the visceral body ego with accompanying somatic, visual-auditory, vestibular, and visceral phenomena. Then I considered the tongue as the motor organizer of the visceral body ego, and its activities as the Anlage of many ego and superego functions. Furthermore, it seemed that the eyes and the hands played the same role for the intermediate and tridimensional body ego. I studied the phenomenon of synesthesia as a possible vehicle for the perceptual regression occurring during altered body-ego experiences and suggested a synesthetic theory of perversion. I concluded that at every stage of regression or development the body-ego structure determines that of self and object representations and hypothesized

that in normal development body-ego nuclei formed perceptual organizers and partial self and object representations, which were eventually brought together by the activity of the three motor organizers—tongue, eyes, hands—to build whole object and whole self representation. Finally, the types of object relation possible at the three different levels of body-ego organization were described.

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