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My story begins in October 1976, when I was doing a hospital placement internship at a state institution. I met Sara quite by accident. She was wandering the hospital halls, and I was wandering the same halls in search of another therapist's office. For some reason, I was not alarmed by her bizarre appearance: her streaked, white make-up worn almost in the manner of a circus clown, her throaty mutterings of unintelligible sounds, and the cries coming from deep within her stomach. To the contrary, I found her to have a childlike beauty and vulnerability. I did, however, feel her fear and rage. It was as if we did not speak the same language, as though I had taken a patient from a foreign land and had her lie on my couch and speak to me in a special kind of communication based on feeling and counter-feeling.
I have selected examples from the notes compiled during five years of sessions with this patient, in order to illustrate the operation of both the narcissistic defense and the narcissistic transference. Representative samples of the patient's apparently meaningless “word salad,” and of her use of self-attack, loss of identity, confusion, and ego fragmentation, have been included. These were received by the analyst as symbolic communications.
When I first encountered Sara, I saw an olive-skinned, darkhaired, small yet sultry, childlike woman. Her body was rigid, and she walked like a robot. I did not sense any danger, but her manner,