Shame in Relation to the Body, Sex, and Death: A Clinical Exploration of the Psychotic Levels of Shame

This paper explores the topic of shame in relation to the body, viewing it as the expression of a basic conflict that threatens to obstruct the growth of personality by breaking up the body—mind relationship. The paper presents the psychoanalysis of a psychotic patient whose paranoid shame was associated with the delusion of being noticed. During this analysis, the patient's bodily manifestations and hatred were acknowledged as related to his getting closer to an authentic existence of his own. Particular emphasis is given to the analyst's involvement in the analytic process, in the form of both bodily countertransference and dream activation. The containment and working-through of concrete aspects of hatred and death anxiety, together with the analysand's recognizing the value of sensory perception of his own body, fostered an abatement of symptoms, including his tendency to flee and to attempt to burst the confines of his body. The activation of a connection with the body seems a prerequisite to the development of abstract thinking. The paper describes similar dynamics in two vignettes of less dramatic clinical cases.