The Psychoanalytic Quarterly, 21, 1952, No. 2: Sylvan Keiser. 'Body Ego During Orgasm.'

A clue to the psychological understanding of the fear of death is afforded by those patients who experience anxiety as sexual excitement approaches the point of orgasm and in whom the orgasm is inhibited by the anxiety. The immediate cause of the anxiety is apprehension of the momentary loss of consciousness which forms part of normal orgasm, and which is comparable to death or sleep since it involves a withdrawal of cathexis from the body-ego. This anxiety is characteristic of oral-dependent types with defective development of the body-ego, resulting from (a) 'distorted reactions to the physiology of the bodily orifices' leading to all erotogenic zones being unconsciously thought of as mouths, and (b) 'inadequate incorporation of introjected objects', leading to a sense of insecurity about the integrity of the body-ego. Patients with this syndrome are superficially very narcissistic, but in fact their preoccupation with their bodies is an attempt to overcome a failure in libidinization of the body and to create a body-image. They are capable of enjoying coitus only up to the point of orgasm, at which time a fear of annihilation and bodily disintegration supervenes. An unconscious wish to suck endlessly is always present, accompanied by the phantasy of an inexhaustible penis (breast) which would enable them to reach satistion without being endangered by their own oral aggression. In reality, coitus is inhibited by the fear that the penis will disappear and leave them non-existent and by the threat of their integrity implicit in the withdrawal of cathexis from the body-ego as libido is increasingly focused on genital sensation. The resulting fear of death 'is a mobilization of anxiety to prevent loss of the primitive ego which threatens a total annihilation of self'. 'The wish to be loved (to be eaten) is equated with destruction of the body ego which engenders anxiety that inhibits the orgasm.'